[Psychophysical stress reactions during a psychoanalytic interview]. / Psychophysische Belastungsreaktionen während eines tiefenpsychologischen Interviews.

In 37 young volunteers analytically oriented interviews were taken and their effects being compared to those of conventional stressors using mental arithmetic. Because of their similarity to day-to-day stressors we expected higher cardiovascular reactions (blood pressure, heart rate and catecholamines) under interview situations than in mental arithmetic. Conforming this hypothesis, we found higher reactions in blood pressure regulation, while heart rates were not higher under interview situations compared to laboratory stressors. Epinephrine showed a qualitative difference: Only in interview situations we found a significant rise of 27%. Plasma cortisol also showed a rise in interview situations, however, smaller. We therefore suggest, that analytically oriented interviews are an adequate method to investigate cardiovascular reagibility in young hypertensive-prone persons.

Effect of renal function on cytokine secretion of monocytes and lymphocytes.

The effect of renal function on cytokine secretion capacity of mononuclear cells was analysed in patients who had not been subjected to any form of renal replacement therapy. The aim of the study was especially to determine whether there is a defect of monocyte function. The patients were divided into three groups of 12 on the basis of renal function: group I, serum creatinine 1.5-3 mg/dl; group II, 3-6 mg/dl; and group III, > 6 mg/dl. Serving as controls were 36 age- and sex-matched healthy volunteers. IL-1 beta, IL-6, TNF-alpha, IL-2 and IF-gamma concentrations were measured in the supernatants of stimulated and unstimulated cells isolated from the blood. Renal function was not found to have any effect on the secretion capacity of IL-2 and IF-gamma. However, the secretion capacity of IL-1 beta of lipopolysaccharide (LPS)-stimulated monocytes was reduced in patients of group III to 214 +/- 290 pg/ml, compared with 501 +/- 327 pg/ml in controls (P = 0.047). The effect was even more accentuated for IL-6 (group III: 5422 +/- 5116 pg/ml; controls: 16,319 +/- 12,474 pg/ml; P = 0.019). Spontaneous secretion levels did not change for any of the cytokines, and LPS-stimulated TNF-alpha secretion was also normal. Highly purified blood monocytes/macrophages were stained for CD14, HLA-DR, CD11c, and CD4. Neither the percentage of positive cells nor the fluorescence intensity, as measured by FACS, was influenced by renal function, and no correlation could be established between function and phenotype.(ABSTRACT TRUNCATED AT 250 WORDS)

[Inferior vena cava compression syndrome in cystic kidney. Duplex ultrasonic diagnosis]. / Vena-cava-inferior-Kompressionssyndrome bei Zystennieren. Duplexsonographische Diagnose.

Four months after renal transplantation for polycystic renal degeneration a 38-year-old man developed breathing-related pain in the left upper lung and a sinus tachycardia (130/min). Lung perfusion scintigraphy demonstrated pulmonary emboli from an acute venous thrombosis of the left lower leg. Polycythaemia and impairment of clot-inhibiting factors were excluded. Ultrasound examination of the abdomen revealed stenosis of the inferior vena cava (IVC) distal to the hepatic veins, dorsal to the liver and ventral of a huge right polycystic kidney which had been left in situ at the time of the renal transplantation. Duplex sonography demonstrated a band-like flow profile in the region of the stenosis. Blood flow was clearly increased (0.62 m/s) and not affected by either heart rate or breathing movements. The findings were confirmed by angiography. The right kidney, weighing 5 kg, was removed at surgery. The IVC stenosis was postoperatively found to be relieved and duplex sonography gave normal findings.

[Indirect azygos-vein-continuation syndrome with aneurysm of the inferior vena cava]. / Indirektes Vena azygos-Kontinuations-Syndrom mit Aneurysma der Vena cava inferior.

Nausea and emesis after exercise were leading symptoms in a 28 year old patient with indirect vena azygos continuation syndrome. This anomaly was verified by sonography, abdominal CT and by venography. The CT examination revealed initially structures of malignant appearance low to the renal position by angiography. This appeared to be distended collaterals. Therapeutic intervention aims primarily to the prevention of complications such as thrombosis of the distal venous flow or venous insufficiency of the lower extremities. Prophylactically we suggest low dose heparin and compression stockings.

Monitoring of renal allografts by duplex ultrasound.

Deterioration of renal transplant function due to rejection is accompanied by changes in renal blood flow that can be measured by duplex ultrasound (DU). In the present study, 60 transplanted patients were followed up. A total of 233 duplex examinations, 68 percutaneous biopsies, 44 renal scintigraphies, and 6 transplant nephrectomies were performed on these patients. Diagnoses were made on the basis of clinical and histological data. Renal perfusion was calculated by means of DU. In addition, the arterial Doppler signals were quantified using a pulsatility index (PI). Mean perfusion of normal renal allografts was 0.47 l/min. A decrease in blood flow could be found in acute vascular and chronic rejection but not in acute cellular rejection. A lack of renal perfusion due to acute vascular rejection was observed in four patients. Mean PI, used as a parameter of DU, rose significantly in all forms of rejection, which could be diagnosed with a sensitivity of 93% and a specificity of 86%. Cyclosporin overdosage did not alter the Doppler flow shape.

[Interaction of cyclosporin and ethambutol-isoniazid]. / Interaktion von Ciclosporin und Ethambutol-Isoniazid.

A 34-year-old patient prophylactically received tuberculostatic treatment with ethambutol and isoniazide after having had an allogenic renal transplant and immunosuppression with methylprednisolone and cyclosporine. The tuberculostatic treatment was discontinued 165 days after the transplantation. The cyclosporine blood level, which was measured daily thereafter, gradually rose from 250 ng/ml to 400 ng/ml. It is possible that enzyme induction due by the tuberculostatic drugs was responsible for the increased breakdown of cyclosporine.

Erythropoietin-hematocrit feedback circuit in the anemia of end-stage renal disease.

Deficient erythropoietin (EP) production is thought to be a key factor in the pathogenesis of the anemia of end-stage renal disease. We describe the interrelationships between radioimmunoassayed plasma EP levels, reticulocyte counts corrected for anemia (CRC) and hematocrit (HCT) under challenge by hemorrhage, transfusions and hemodialysis in 32 chronically-hemodialyzed patients. Spontaneous hemorrhage resulted in a decrease in HCT (P = 0.001) and increases in both EP (P = 0.006) and CRC levels (P = 0.0065). Transfusions of two units of packed red cells into each of 16 patients suppressed EP (P = 0.0004) and CRC (P less than 0.0001) after about 28 and 42 hours, respectively. Repeat transfusions after one to 27 days resulted in similarly significant suppressions of both EP and CRC, except the CRC remained on higher levels for prolonged periods of times. Within a few hours after each transfusion of 2,3-diphosphoglycerate-poor red cells, both EP (P = 0.009) and CRC (P = 0.007) increased temporarily between one to 18 and three to 38 hours, respectively. Hemodialysis resulted in alkalinization (P = 0.008) of blood but not in changes of EP or CRC counts. The data show that, with the EP-HCT feedback loop persisting, increased endogenous hormone levels elicit erythropoietic responses, and that the regulation of EP levels may involve determinants such as oxy-deoxyhemoglobin interactions.

[Recurrences of extracapillary glomerulonephritis in 2 kidney grafts in the same patient]. / Rezidive einer extrakapillären Glomerulonephritis an zwei Nierentransplantaten beim gleichen Patienten.

An IgA-IgM positive, rapidly progressive glomerulonephritis developed in two successive transplants in a 28-year-old patient. Both transplants failed. In the prevention and treatment of rejection corticoids and cortisone, antithymocyte globulin and cyclosporin A were administered but could not prevent the development of this form of glomerulonephritis. It remains to be shown whether it presents a contraindication to transplantation.

Aneuploidy as a marker of minimal residual disease in leukemia.

Aneuploidy as an indication of abnormal cellular DNA content has recently been confirmed to be a reliable marker of malignant cells in human solid tumors and hematologic malignancies. Flow cytometry (FCM), measuring cellular DNA content in thousands of cells within seconds, is able to safely detect the "rare event cell," the rare aneuploid cell in a diploid cell population. This very fast and sensitive technique was combined with a newly developed cell separation technique. Cell separation prior to FCM enabled us to detect malignant cells at concentrations of 0.05% in blood, bone marrow, and lymph node cell suspensions of patients with leukemia. An illustration of this method is presented in conjunction with first clinical applications demonstrating that patients with minimal residual disease in clinically complete remission had significantly shorter survival times than patients in whom no minimal residual disease was detected with this new method.

Separation of diploid from aneuploid cells in acute lymphoblastic leukaemia.

A new method for the separation of diploid and aneuploid cells from blood of patients with leukaemia is described. Density gradient separation using a modified silica particle gradient was combined with analysis of cellular DNA content by flow cytometry. Submicroscopic levels of diploid or aneuploid cells were enriched up to 90% purity. Three patients with acute lymphoblastic leukaemia and no evidence of aneuploid cells after separation are in continuing complete remission after 24.5-47 months. Two patients with aneuploid cells detected after separation expired in relapse 0.5 and 3 months later. Cell separation prior to flow cytometric analysis might be a useful tool to detect submicroscopic levels of aneuploid leukaemic cells in blood and bone marrow, and to predict impending relapse.

Effect of diuretics on the tubuloglomerular feedback response.

To study the influence of diuretics on the tubuloglomerular feedback mechanism, early proximal stop-flow pressure (SFP) was measured during loop exposure to different drug concentrations. SFP was recorded continuously during arrested flow and at a perfusion rate of 50 nL/min. The perfusate consisted of isotonic saline, to which varying amounts of furosemide. bumetanide, piretanide, or hydrochlorothiazide were added to obtain final concentrations between 10(-6) and 10(-4)M. The loop diuretics furosemide, bumetanide, and piretanide showed inhibition: an inverse log-linear relation between the luminal concentration and the respective feedback response. No differences between the dose-response curves of furosemide, bumetanide, or piretanide could be demonstrated. The effective concentration range was between 10(-6) and 10(-4)M, the mean effective dose (ED50) was close to 10(-5)M for each of them. In contrast, hydrochlorothiazide did not alter the feedback response. The effect of loop diuretics was rapidly and repeatedly reversible.