The influence of initial resting posture on range of motion of the lumbar spine.

The aim of this study was to investigate the influence of initial resting posture on range of motion of the lumbar spine in 18 normal subjects. Subjects resting posture and active range of motion was measured using the CA-6000 Spinal Motion Analyser (OSI, USA) in five test positions, namely in flat standing and with a variety of heel raises. Analysis showed that there was no significant correlation between subject's normal resting posture and active range of motion. However, when subjects resting posture was artificially altered with heel raises, significant effects on the active range of motion were demonstrated. Increasing heel height significantly influenced resting posture in the sagittal plane only. As heel height increased, the lumbar lordosis decreased and a significant reduction in the range of lumbar spine flexion (P<0.001) was observed. Simulating pelvic asymmetry influenced resting posture in the frontal plane and significant effects on the range of lateral flexion (P<0.05) were observed. These results have important clinical implications in terms of using range of motion of the lumbar spine as an examination tool and suggest that studies using range of motion as an outcome measure should consider initial resting posture.

Small bowel permeability--a variable effect of NSAIDS.

The baseline permeability of small bowel in 57 healthy volunteers was assessed by measuring the mannitol and chromium-EDTA recovery in a 5-hour urine collection after ingestion of a drink containing a mixture of 1 g of mannitol and 3.7 MBq of 51Cr-EDTA. Subjects were treated with medication for 1 week followed by permeability studies as described above. The regimens used were diclofenac sodium (Voltaren) 50 mg po tid (21 subjects), Voltaren SR 75 mg bid for 1 week (34 subjects), indomethacin 50 mg tid (10 subjects), and tenoxicam (Mobiflex) 20 mg daily (13 subjects). There was no significant difference between the mannitol recoveries at baseline or after any of the drugs. The permeability was clearly increased by indomethacin and by Voltaren SR. Conventional-release Voltaren increased permeability, but the results were not significantly above baseline. Mobiflex had no influence on the measured permeability. Our results suggest that the SR preparation of diclofenac has a more pronounced effect than regular diclofenac sodium; thus different NSAIDs and different preparations of the same NSAID may have different effects on small bowel permeability.

A comparison of cyclosporine assays using sequential samples from selected transplant patients.

The monitoring of cyclosporine (CsA) whole blood concentrations is an integral part of immunosuppressive treatment with this drug. Although such monitoring has been facilitated by the introduction of monoclonal immunoassay techniques, there is a paucity of published data comparing the assays longitudinally in selected patients. The purpose of our study was to co-evaluate two monoclonal immunoassays (Cyclosporine FPIA whole blood assay, Abbott Laboratories; Cyclo-Trac SP-whole blood RIA, Incstar Inc.) and a high-performance liquid chromatography (HPLC) technique for quantitating CsA in sequentially collected trough whole blood samples from 14 patients up to 75 days after renal (n = 6), heart (n = 3), and liver (n = 5) transplantation. HPLC CsA metabolite analyses (AM1, AM9, AM4N) were performed. Although CsA concentrations within most patients were significantly higher (p < 0.05, paired t test) when measured by both immunoassay techniques compared to HPLC, levels determined in three patients, (one liver, two renal) for the FPIA/HPLC comparison and one patient (liver) for the RIA/HPLC comparison were not significantly different (p > 0.05). CsA levels within nine patients were not significantly different (p > 0.05) when FPIA and RIA were compared, but results within three patients, (one liver, two renal) were significantly higher (p < 0.05) by RIA compared to FPIA, but results within one patient (heart) were significantly higher (p < 0.05) by FPIA. Our results demonstrate first that depending on the patient, HPLC-derived CsA results are not consistently lower than results generated by immunoassay techniques and second that CsA levels obtained by FPIA are statistically equivalent or in some patients, statistically less than RIA-derived levels.

Radioimmunoassay of salivary cyclosporine with use of 125I-labeled cyclosporine.

We prepared 125I-labeled cyclosporine (125I-CS) by modifying the procedure of Mahoney and Orf (Clin Chem 1985;31:459) and characterized it with regards to maximal immunoreactivity (greater than 90%), trichloroacetic acid precipitability (greater than 90%), and stability (90% immunoreactive after five half-lives of 125I). For a particular preparation of 125I-CS, we estimated its immunoreaction concentration (50 pmol/L) and the equilibrium constant for its reaction with Sandoz polyclonal antiserum (K = 3.9 X 10(9) L/mol). By substituting 125I-CS as tracer in the Sandoz radioimmunoassay and by modifying other aspects of the assay, we developed a procedure that is sufficiently sensitive (0.34 micrograms/L) to allow measurement of "trough" (lowest inter-dose) cyclosporine concentrations in parotid saliva. Of 38 kidney-transplant patients, 35 had measurable concentrations in saliva (mean 8.3, SD 5.2 micrograms/L), and these correlated moderately with paired serum concentrations (r = 0.68, P less than 0.001). We believe that measurement of salivary cyclosporine may offer a simple way of estimating the free fraction of the drug in serum or plasma.

Plasma volume changes induced by hypertonic hemodiafiltration and standard hemodialysis.

We have previously reported that treatment of uremia by hypertonic hemodiafiltration (H-HDF) results in a more stable hemodynamic response as compared to standard hemodialysis (HD). The purpose of this study was to determine if plasma volume (PV) preservation was a significant factor in this response. Nine patients were studied during single treatment sessions of H-HDF and HD. Both sessions were 3 h in duration and the ultrafiltration rate and volume were matched. 10 microCi of 125I human serum albumin were injected 40 min before each session for measurement of PV. Changes in PV during the session were determined from the change in plasma albumin concentration and the hematocrit. The decrease in PV was significantly less during H-HDF. This was associated with a significantly higher plasma sodium and osmolality. The calculated effective osmolality during H-HDF was not only higher than in HD, but showed a significant increase at 2 and 3 h when compared to the baseline level (p less than 0.05). The calculated volume of extravascular mobilization was higher during H-HDF and is probably the mechanism of the PV preservation. In conclusion, this study demonstrates that PV is preserved during H-HDF better than during HD as a result of a more adequate plasma refilling; this appears to be mediated by an increased plasma effective osmolality.

Splenic reticuloendothelial function in patients with active rheumatoid arthritis.

Splenic reticuloendothelial function was assessed in 20 patients with active rheumatoid arthritis by measuring the clearance of autologous heat-damaged labeled erythrocytes from the circulation. Eight patients (40%) had delayed clearance but in contrast to previous reports, we found no correlation between disease activity, levels of circulating immune complexes and splenic hypofunction. The absence of IgM rheumatoid factor was noted in 7 of 8 patients with delayed clearance times.

Evaluation of a direct radioimmunoassay for carcinoembryonic antigen.

1. A radioimmunoassay for CEA using commercially available reagents (CEA-Roche), which avoids the perchloric acid and dialysis steps used in the CEA-Roche assay, has been devised. 2. Comparison of results on 746 plasma samples using our assay with those obtained using the CEA-Roche assay revealed a highly significant correlation coefficient (0.72; p less than 0.00001). 3. A further comparison of results on 373 plasma samples using our assay, but including a preincubation step with goat serum, with those obtained using the CEA-Roche assay also revealed a highly significant correlation coefficient (0.89; 0.00001). The goat serum preincubation step eliminated most of the discordant results in which our assay value was higher than CEA-Roche assay, presumably because of anti-goat antibodies in the patient plasma sample.

Reversed ester analogues of pethidine: isomeric 4-acetoxy-1, 2, 6-trimethyl-4-phenylpiperidines.

The preparation and stereochemical characterization of all three isomeric forms of 4-acetoxy-1, 2, 6-trimethyl-4-phenylpiperidine is described. Of these, only the t-2-Me, c-6-Me, r-4-OCOMe isomer was an effective analgesic in mice (2.3 X pethidine) as judged by the hot-plate test. The results, together with reported data, demonstrate the potency raising effects of axial methyl alpha- to nitrogen and the lowering action of equatorial alpha-methyl substituents in reversed esters of pethidine.

Radioiodinated antibody to carcinoembryonic antigen: binding to normal and cancerous human colon in vitro.

Samples of tumor and normal mucosa from 32 patients with adenocarcinoma of the colorectum were examined for their capacity to bind radioiodinated antibody to carcinoembryonic antigen (anti-CEA) lgG. Twenty-three (72%) of the tumors bound significantly more antibody than the respective normal mucosa. The results indicate that radiolabeled anti-CEA may be useful in the in vivo localization of CEA-producing tumors and metastases in man, and may have application in vitro as a diagnostic marker of precancerous change in colorectal biopsies from patients at risk of developing colorectal cancer.