Plasma and red blood cell carnitine and carnitine esters during L-carnitine therapy in hemodialysis patients.

Plasma and red blood cell (RBC) carnitine and acylcarnitines were determined in 20 hemodialysis (HD) patients during three different L-carnitine dosages (1, 5, and 15 mg/kg body wt), each for 3 mo. Before L-carnitine treatment, free carnitine was significantly lowered in plasma but elevated in RBCs compared with healthy subjects. Short-chain acylcarnitines were elevated in plasma and normal in RBCs. HD therapy decreased plasma free and acylcarnitines markedly but did not influence RBC values. Low-dose L-carnitine treatment normalized both plasma- and RBC-free carnitine. Dosages of 5 and 15 mg/kg body wt increased plasma and intracellular carnitine and carnitine esters impressively. Plasma and RBC carnitine fractions remained elevated even after a 6-wk washout period. Low-dose L-carnitine treatment is sufficient to correct disturbed plasma and RBC carnitine and carnitine esters of HD patients. Elevated RBC carnitine esters decreased very slowly, suggesting low RBC carnitine turnover. Carnitine overdosage should be prevented in those patients who benefit from carnitine therapy.

Ketogenic and antiketogenic effects of L-carnitine in hemodialysis patients.

Eighteen hyperlipidemic hemodialysis patients were treated with 1, 5, and 15 mg L-carnitine/kg body weight (each dose was given for three months) given intravenously at the end of the dialysis therapy. Low dose L-carnitine treatment caused an increase in plasma total carnitine (TC), short chain acylcarnitine (SCC), and long chain acylcarnitine (LCC). An increase in plasma free carnitine (FC) occurred only in the 10 responders who showed a significant decrease in serum triglycerides. Serum VLDL triglycerides, VLDL cholesterol and VLDL phospholipids also decreased in the responders compared to nonresponders. There was no difference in HDL- and LDL-lipoproteins in both responders and nonresponders. L-carnitine in doses of 5 or 15 mg/kg body weight caused markedly elevated plasma levels of all carnitine fractions but no further lipid lowering effect. Moreover, enhanced serum triglycerides were observed in some hemodialysis patients. Thirteen out of 15 patients displayed an increase of HDL triglycerides and 5, an increase of VLDL triglycerides. Our data suggest that low doses of L-carnitine are effective in treating hypertriglyceridemia in selected patients. Low dose L-carnitine also avoids unphysiological high plasma levels of carnitine and carnitine esters and prevents antiketogenic effects in hemodialysis patients.

[DSA of the pulmonary vessels during endobronchial laser- and afterloading therapy of malignant bronchial stenoses]. / DSA der Pulmonalgefässe bei endobronchialer Laser- und Afterloadingtherapie maligner Bronchusstenosen.

The findings are reported of the DSA examination of the pulmonary vessels in 16 patients with malignant bronchial stenoses, for whom laser or after-loading therapy was being considered. In these patients an improvement of dyspnoea can be expected only of there is adequate perfusion of the involved lung segment. DSA demonstrated stenoses or occlusions of main pulmonary or lobar arteries in six patients. Ten patients had a normal pulmonary circulation. In most cases the result of the DSA examination was important in determining treatment.

[Detection of narcotic-containing packages in "body-packers" using imaging procedures. Studies in vitro and in vivo]. / Nachweis von Rauschgiftpäckchen beim "body-packer" durch bildgebende Verfahren. Untersuchungen in vitro und in vivo.

The increase in narcotic smuggling through swallowing small packages ("body packing") has created problems in detection and in avoiding acute intoxication. Five such cases are reported. Experiments have been carried out in vitro in order to investigate how such narcotic packages could best be shown by radiological examination, by CT or by MRT.