Canine prostate specific esterase (CPSE) as an useful biomarker in preventive screening programme of canine prostate: CPSE threshold value assessment and its correlation with ultrasonographic prostatic abnormalities in asymptomatic dogs.

Due to the increased attention that pet-owners devote to their animals and to the improved veterinary care, investigations regarding methods to early detect prostatic disorders that might affect canine life quality have been performed. Canine prostate specific esterase (CPSE) concentration was reported to be higher in dogs suffering from prostatic diseases. This study aimed to estimate the CPSE threshold as a biomarker to early identify prostatic diseases in asymptomatic dogs. The ultrasonographic examination of the prostate was performed in 19 dogs (6-40 kg; 1-5 years) with no symptoms of prostatic diseases. Dogs were grouped according to the presence (Group A) or absence (Group B) of prostatic disorders at the ultrasound (altered appearance, the presence of cysts or irregular borders). For each dog, a venous blood sample was collected to measure serum CPSE and the ratio between calculated and normal expected prostatic volume was assessed for each dog. The CPSE data were statistically analysed (t test, p < .05), and the CPSE threshold in blood serum between groups was calculated by ROC. In 11 dogs, ultrasonography showed signs of prostatic abnormalities (Group A, 2-5 years), while no signs were detected in eight dogs (Group B, 1-3 years). The calculated/estimated volume ratio resulted greater than 1.5 in Group A dogs. The CPSE was statistically different between groups (p < .0001): higher in Group A (mean = 184.9, SD = 126 ng/ml) than in Group B (38.9 ± 22.1 ng/ml). The cut-off CPSE threshold was 52.3 ng/ml (ROC, AUC = 0.974, SE 95.6%, SP 89.2%). This study suggests that CPSE serum concentration higher than 50 ng/ml in asymptomatic dogs is associated with ultrasonographic alterations and increased the prostatic size (volume by 1.5 times greater than the normal size). As the onset of prostatic disorders often remains asymptomatic, the rapid assessment of CPSE could be suitable for selecting preventively those animals that would require further accurate evaluation.

Prostate vascular flow: The effect of the ejaculation on the power doppler ultrasonographic examination.

Power Doppler sonography (PD) can accurately depict tissue perfusion, recognize slow flows, and is relatively angle independent. The monitoring of local blood flow by Doppler ultrasonography is helpful in differentiating prostatic physio-pathological conditions, but the recognizing of physiological variables that could affect it is crucial to apply this technique in clinical practice. This study aimed to evaluate if ejaculation affects blood flow to the prostate and to state how long this effect lasts. Serial PD examinations of prostate were performed in 18 dogs (1-5 years, 6-40 kg) immediately before (T0) and after (T1) the ejaculation, and repeated 6 (T2), 18 (T3) and 24 (T4) hours later. For each examination, two representative PD images were chosen and ranked by two independent observers according to the following scoring system: 0 = mild subcapsular (S) vascularization without clear evidence of parenchymal (P) vascularization; 1 = moderate P and S vascularization; 2 = severe S and moderate P vascularization; 3 = severe P and moderate S vascularization; 4 = severe P and S vascularization. Interobserver agreement was assessed using Kappa of Cohen. Ranked data, grouped according to time, were compared by ANOVA and Tukey HSD test (p < .05). Variations in the vascular flow pattern at different times were observed for all dogs. The statistical analysis evidenced a significant difference for T0 vs T1 and vs T2 and vs T3 (p < .01), with no significant difference for T0 vs T4 (p > .05). Interobserver agreement was very good (Kappa of Cohen = 0.86). This study demonstrated a definite increase in vascular flow to the prostate after ejaculation. The present results suggest a minimum of 24 hr sexual rest before the PD examination of the gland. This result should be taken into account whenever Doppler sonography is used to evaluate potential hyperaemia in dogs suspected of having prostate abnormalities.

Endogenous ouabain and cardiomyopathy in dialysis patients.

BACKGROUND AND METHODS: Endogenous ouabain (EO) is markedly raised in patients with chronic renal failure. As high EO induces myocardial cell hypertrophy in vitro and it is associated with left ventricular hypertrophy (LVH) in essential hypertensives and in patients with heart failure we investigated the relationship between plasma EO and LV mass and geometry in 156 end-stage renal disease (ESRD) patients. EO was measured by a specific radioimmunoassay and by mass spectrometry. RESULTS: On univariate analysis, plasma EO was directly related to LV mass (r = 0.26, P = 0.001) and LV end diastolic volume (r = 0.25, P = 0.002) and these relationships held true in multiple linear regression models including a series of potential confounders. Patients with eccentric LVH (n = 41, i.e. 26%) had the highest plasma levels of EO when compared to patients with other patterns of LV geometry (P = 0.001). Furthermore, plasma EO had diagnostic value for eccentric LVH because the area under the corresponding ROC curve (68%) was significantly greater (P = 0.002) than the threshold of diagnostic indifference. In this analysis, the sensitivity was 91% and the specificity was 36%. The positive predictive value was 33% but EO had a remarkably high negative predictive value (92%) for the exclusion of eccentric hypertrophy. CONCLUSIONS: In ESRD patients, plasma EO is independently associated with LV mass, LV volume and eccentric LVH. The results of this study are compatible with the hypothesis that EO is involved in alterations of LV mass in ESRD.

Prediction of whelping date in large and giant canine breeds by ultrasonography foetal biometry.

OBJECTIVES: To derive the growth curves of the inner chorionic cavity and the biparietal diameter in large and giant dog breeds by ultrasonographic foetal biometry. To evaluate their accuracy in the prediction of whelping date and the effect of litter size and foetal sex ratio. METHODS: Foetal biometry parameters were obtained using serial ultrasonographic examinations in eight large (26 to 40 kg) and nine giant (>40 kg) pregnant bitches with known breeding dates and concentrations of serum progesterone during oestrus. The relationship between inner chorionic cavity or biparietal diameter growth and days to parturition were analysed by linear regression and the equations derived from the growth curves were applied to predict the whelping day. The accuracy of the prediction (whelping day ±1 day and ±2 days) and the litter size and sex ratio were recorded. RESULTS: The results showed a significant relationship between days before parturition and inner chorionic cavity or biparietal diameter. The overall accuracy at ±2 days was greater, than that at ±1 day. In giant breed bitches, the accuracy of the prediction by biparietal diameter was significantly lower in small, than normal litter size. No effect of foetal sex ratio was observed. CLINICAL SIGNIFICANCE: Foetal biometry parameters obtained by ultrasonography can be used to predict whelping dates in large and giant dog breeds.

Impact of immunosuppression on improvement of results in clinical pancreas transplantation.

Since November 1975, 103 pancreas transplantations have been performed in 97 insulin-dependent diabetic patients. Pancreas and kidney were grafted simultaneously in 84 patients (plus 1 double retransplantation). Eighty-nine pancreas grafts were prepared by duct obstruction with neoprene, and 14 were pancreaticoduodenal grafts with enteric diversion in a Roux-en-Y loop. Five immunosuppressive protocols were subsequently used. With the latest protocols, patient and pancreas survival improved to 93 and 72% at 1 yr, respectively. The improvement in graft survival appeared to be particularly related to the reduction of the number of pancreas grafts lost in rejection. The patients treated with the last protocols, including cyclosporin A (CsA) and only low doses of steroids, showed a better glucose tolerance after provocative tests. Pancreas-graft function did not appear to be influenced by CsA treatment.

Kidney-graft survival in simultaneous kidney-pancreas transplantation.

Patient and kidney survival rates were compared between 69 diabetic patients undergoing simultaneous kidney-pancreas transplantation (group 1) and 723 nondiabetic patients undergoing kidney transplantation (group 2). The patients were treated with different immunosuppressive regimens over the years: steroids plus antilymphocyte globulin (ALG) plus azathioprine (Aza); cyclosporin A (CsA) plus ALG; steroids plus ALG plus Aza, replacing Aza 1 mo posttransplantation; or low doses of steroids plus CsA plus Aza. One-year kidney survival rates with the different regimens were 50, 42, 54, and 76%, respectively, in group 1 and 71, 74, 78, and 84%, respectively, in group 2. Patient survival was 60, 57, 71, and 86%, respectively, in group 1 and 93, 95, 94, and 96%, respectively, in group 2. Differences between the two groups were statistically significant for the first three protocols but not for the one used in this study. In group 1, 38 patients (55%) had a functioning kidney graft, whereas 15 (21%) lost their kidney to rejection. Between these two patient categories, there was no significant difference in age, sex, duration of diabetes, time on dialysis, blood transfusion number, HLA immunization, or HLA matching. Thus, since 1984, kidney-graft survival has not been inferior in diabetic patients. This improvement is mainly due to a decreased mortality related to better patient preparation and improvement in immunosuppression.

Segmental duct-obstructed pancreas grafts versus pancreaticoduodenal grafts with enteric diversion.

Between January 1985 and September 1987, we performed a prospective comparative study between segmental-pancreas transplantation with duct obstruction by neoprene (n = 17) and pancreaticoduodenal transplantation with enteric diversion to a Roux-en-Y intestinal loop (n = 14). All recipients had insulin-dependent diabetes. The immunosuppressive protocol consisted of low doses of the steroids cyclosporin A and azathioprine. Mean follow-up was 16.5 mo for the enteric-diversion group and 13.5 mo for duct-obstructed groups. Two-year patient and pancreas- and kidney-graft actuarial survival rates were 92.9, 75.5, and 74.2%, respectively, in the former group and 92.3, 58.4, and 63.7%, respectively, in the latter group (NS). Five whole-organ grafts were lost (3 vascular thromboses, 1 pancreatitis, 1 rejection), and four segmental grafts were lost (2 vascular thromboses, 1 bleeding, 1 patient's death with functional graft). More surgical complications occurred in the recipients of whole-organ grafts and were often related to the intestinal anastomosis. A satisfactory blood glucose control was observed at 3 mo and 1 yr in both groups. Provocative tests showed higher and prompter insulin secretion in patients with whole-organ grafts. In patients with segmental grafts, the response was lower and delayed with a general tendency to impaired glucose tolerance. A marked hyperinsulinemia after meals was observed in whole-organ graft recipients. Slight nocturnal hyperinsulinemia was observed in both groups. At 1 yr, glycosylated hemoglobin was normal in both groups. The absence of a significant difference between the two groups, in terms of survival and graft function, and the lower surgical complication rate seen with segmental grafts have made us return to neoprene-injected segmental grafts.

Deranged platelet calcium homeostasis in diabetic patients with end-stage renal failure. A possible link to increased cardiovascular mortality?

OBJECTIVE: Platelet hyperfunction is a typical feature of the prothrombotic state that frequently complicates the natural history of diabetes. In uremia, a bleeding diathesis is present, which principally involves the primary phase of hemostasis. Thus, in patients with uremia of diabetic origin, the infrequent coexistence of two opposite alterations of hemostasis takes place. In patients with uremia, an increased incidence of cardiovascular events and related mortality is observed. This phenomenon is greatly amplified in uremia of diabetic origin. Calcium homeostasis is a critical aspect of platelet function, which has recently become available in human diseases. The aim of this study was to evaluate calcium homeostasis in platelets from patients with uremia of diabetic and nondiabetic origin. RESEARCH DESIGN AND METHODS: We evaluated, by means of Fura 2, the intracellular concentration of ionized calcium ([Ca2+]i) in platelets from 18 patients with uremia of diabetic origin, 12 patients with uremia of nondiabetic origin and 16 healthy control subjects [Ca2+]i was evaluated in resting conditions and after stimulation with 0.05, 0.1, 0.5 U/ml thrombin. RESULTS: Platelets from uremic patients with diabetes had higher resting [Ca2+]i than both control subjects (P = 0.01) and uremic patients without diabetes (P = 0.001). Similarly, after stimulation with thrombin, the absolute increase of [Ca2+]i was higher (P < 0.05) in platelets from uremic patients with diabetes compared with both control subjects and uremic patients without diabetes. The relative increase of [Ca2+]i was higher (P < 0.05) than normal in platelets from uremic patients after weak or intermediate strength thrombin. No correlation were present between [Ca2+]i values and other clinical and laboratory variables potentially associated with platelet hyperfunction. CONCLUSIONS: Diabetes and uremia in combination further deteriorate the abnormal platelet calcium homeostasis observed in uremia.

Free-insulin profiles after intraperitoneal, intramuscular, and subcutaneous insulin administration.

The aim of our study was to compare the time course of plasma free-insulin appearance after injection of equal amounts of insulin into the peritoneal cavity above and below the transverse mesocolon, intramuscularly, and subcutaneously. Seven nondiabetic subjects undergoing cholecystectomy received in random sequence 0.2 IU/kg of insulin into the peritoneal cavity above or below the transverse mesocolon. Concentrations of plasma free insulin were compared with those obtained from seven other nondiabetic subjects after repeated injections of equal amounts of insulin intramuscularly and subcutaneously. Intraperitoneal insulin above the transverse mesocolon yielded a faster rise of free insulin, peaking at 15 min, whereas intraperitoneal insulin below the transverse mesocolon produced a somewhat slower rise, peaking at 30 min. The area under the curves between 0 and 15 min was greater after the injection above than below the transverse mesocolon (P less than .05). Intramuscular and subcutaneous insulin injections resulted in a slower rise of plasma free insulin, peaking at 60 and 90 min, respectively. We conclude that the pattern of insulin appearance in the plasma resembles more closely physiologic events after intraperitoneal than after subcutaneous or intramuscular insulin administration.

Endocrinometabolic effects of whole versus segmental pancreas allotransplantation in diabetic patients--a two-year follow-up.

We have investigated the metabolic effects of segmental (neoprene-injected) pancreas transplantation versus whole (enteric-diverted) pancreas transplantation. Seventeen uremic insulin-dependent diabetes mellitus (IDDM) patients received a simultaneous pancreaticorenal transplant: in a prospective, randomized study, 9 patients received a segmental neoprene-injected graft (group A) while 8 patients received a total pancreaticoduodenal graft, with enteric diversion (group B). The immunosuppressive therapy was based on ALG, CsA, azathioprine, and steroids. Three months after surgery, patients were submitted to the following metabolic investigation: i.v. and oral glucose tolerance tests, Hba1, i.v. arginine test, and a 24-hr metabolic profile. The OGTT, HbA1, and metabolic profile were repeated 12 and 24 months after transplantation. At 3 months after transplantation, the OGTT showed delayed insulin secretion and higher blood glucose levels in group A. Serum insulin levels after IVGTT or arginine were higher in group B than in group A. OGTT at 12 and 24 months were unchanged in group B, while in group A a higher incidence of impaired glucose tolerance (IGT) and diabetes mellitus response were observed. HbA1 and blood glucose levels during the 24-hr profile showed good metabolic control in both groups at 3, 12, and 24 months. We can conclude that both the segmental and total pancreas transplantation restore a good metabolic control in IDDM patients, though a higher incidence of IGT and DM responses were observed after OGTT in the patients receiving a segmental graft. These abnormalities do not seem to interfere with metabolic control in everyday life. These results seem to be the consequence of the different B cell masses transplanted with these two techniques.

Bioelectrical impedance in the evaluation of the nutritional status of hemodialyzed diabetic patients.

Bioelectrical impedance is a technique allowing a quick, repeatable and reliable assessment of body composition. This method was applied to detect total body water (TBW), fat (FAT) and fat-free mass (FFM) in 80 normal subjects, 65 diabetic (45 insulin-dependent [IDD], 20 non insulin-dependent [NIDD]) and 34 uremic diabetic patients (20 IDD, 14 NIDD) submitted to hemodialysis three times a week. Uremic patients were tested at the end of the dialytic session. Multivariated analysis adjusted for age, sex and disease showed the following results: body mass index (BMI) increased with age (p < 0.005) and in the presence of NIDD (p < .001); TBW was lower in nephropathic patients (p < 0.05) and in the female sex (p < 0.0001); FFM decreased with age (p < 0.005), female sex (p < 0.0001) and in nonuremic NIDD (p < 0.001). Correspondingly FAT increased with age (p < 0.005), female sex (p < 0.0001) and in nonuremic NIDD (p < 0.001). Sixteen uremic subjects, randomly selected from both IDD and NIDD groups, tested at the beginning and at the end of the same hemodialytic session, showed a significant decrease of TBW which corresponded to the correction of their overhydratation. In our patients uremia does not seem to influence the nutritional status and the bioelectrical analysis could be applied to determine the real dry weight in hemodialyzed diabetic patients.

[Vascular access for chronic hemodialysis in diabetic patients]. / Accessi vascolari per emodialisi cronica in pazienti diabetici.

The aim of this study carried out on 33 uremic diabetic patients submitted to chronic hemodialytic treatment was to assess the kind of complications related to the vascular approach used as well as their short- and long-term incidences. Out of the 46 anastomoses prepared, 39 were arteriovenous fistulae according to Brescia-Cimino and 7 were PTFE grafts. The actuarial survival rate was 88%, 79%, and 63% after one, two and four years, respectively. The most frequent compliance was thrombosis. Our experience demonstrates that the distal arteriovenous fistula may be considered a valid vascular access for hemodialysis also in diabetic patients.

[Induction of general anesthesia with ketamine for short surgical interventions in pediatric patients with chronic hepatic pathologies]. / L'induzione dell'anestesia generale con ketamina per brevi interventi chirurgici in pazienti pediatrici affetti da patologie epatiche croniche.

Serum levels of bilirubin and of other four enzymes known to be elevated in liver diseases were measured preoperatively and controlled on the first and fourth postoperative day in 14 children with chronic liver disease and anesthetised for liver biopsy using Ketamine (7 patients, group A) or other drugs (group B). Serum levels of gamma GT, Ph. Alk, direct and indirect bilirubin show neither significant variations nor differences between the two groups of patients. SGOT and SGPT basal levels were similar in the two groups and were rather two-fold the normal values. At the first postoperative day, in group B only SGOT levels increased significantly. Moreover, their increase over the basal levels monitored at the first day was significantly lower in the group of patients anesthetised with Ketamine than in group B. In group A, SGPT values were constant showing a small, non significant decrease, while in group B, above levels present a significant increase at the postoperative day and a significant difference between the two groups. At the fourth day, SGOT and SGPT differences versus basal values were not significant. Our experience shows that - as known by normal subjects - Ketamine has no hepatic toxicity in pediatrics patients affected by chronic liver disease, too. Finally, our study suggests that Ketamine must be used in hepatopath children whenever they have to be submitted to total anesthesia.