Urea recycling in sheep: effects of intake.

The effect of intake on urea production, entry into the digestive tract and return of N to the ornithine cycle was studied in four sheep. Each sheep received 0.6, 1.2 and 1.8 x estimated maintenance energy intake quantities of grass pellets for 9 d. After 4 d of adjustment, N balance measurements were conducted between days 5 and 8. From day 7 to day 9 animals were continuously infused, via the jugular vein, with [15N15N]urea and three urine samples were collected at approximately 2 h intervals 48-54 h after the start of infusion. Total urea and enrichments of [15N15N]- and [14N15N]urea in the urine samples were determined. Urea production was calculated from the isotopic dilution of [15N15N]urea and entry into the gastrointestinal tract (GIT) obtained from the difference between this and urinary urea elimination. Urea which enters the GIT undergoes hydrolysis to liberate NH3 which may be reabsorbed and enter the ornithine cycle in which case the product is [14N15N]urea, based on the probabilities of labelled and unlabelled N providing ureagenic precursors. The quantity of urea-N which returns to the ornithine cycle from the GIT can thus be calculated. Existing models based on this approach yield overestimates of the fate of individual urea molecules due to a failure to allow for multiple recycling of [14N15N]urea species through the GIT. Refinements introduced to cover this resulted in a 33-48% reduction in calculated return of label for the current study. The present model also predicted that 95% of the label movements across the GIT could be accommodated by three or fewer entries and returns of urea-N and 99% by recycling for a maximum of six occasions. Urea-N production increased with intake (P < 0.001) and exceeded digestible N values at all intakes. Urea which entered the digestive tract, both in absolute terms (P < 0.001) and as a proportion of production (0.62, 0.69, 0.73; P = 0.027), increased with intake. The proportion of entry into the digestive tract which was returned to the ornithine cycle remained reasonably constant (0.37-0.41) across all intakes but the absolute amount increased (5.6, 9.2 and 15.0 g N/d; P < 0.001) with intake. If allowance is included for losses of 15N in faeces then the approach offers a relatively simple means of estimating anabolic reuse of urea by digestive tract micro-organisms and can complement data obtained from the technically more demanding arterio-venous and multiple-isotope techniques used hitherto.

Trisomy Xq in a male: the isochromosome X Klinefelter syndrome.

We report on a male with trisomy Xq resulting from an isochromosome Xq which is preferentially inactivated: 47,XY,+i(Xq). Six previous cases have been reported. These patients are similar to patients with classical Klinefelter syndrome (47,XXY) in that they have infertility, decreased masculinization, gynecomastia, and elevated luteinizing hormone (LH) and follide stimulating hormone (FSH) levels. They may differ in having average intelligence and normal to short stature. These findings indicate that extra copies of the long arm of X have phenotypic expression, even though activated only in early development.

Dynamic preoperative assessment of cardiac reserve in elective aortic surgery.

Myocardial infarction accounts for over 50 per cent of mortality following elective abdominal aortic surgery. Previous history of ischaemic heart disease and abnormal ECGs, common in vascular patients, are unreliable parameters for predicting myocardial response to stress. Exercise ECGs are often valueless, as claudication may mask myocardial insufficiency. Myocardial performance was studied preoperatively in 29 consecutive patients undergoing elective aortic bifurcation grafting, using a Swann-Ganz catheter to measure the rise in pulmonary artery wedge pressure (PAWP) produced by rapid intravenous infusion of plasma (200-400 ml). A Frank-Starling Curve was obtained by plotting LVSWI against PAWP. Two important values were obtained: (a) 'Upslope' or gradient of the ascending portion of the curve. Low values identify patients most at risk from cardiac complications. Six patients who suffered from postoperative cardiac complications had a mean 'upslope' value of 1.568 +/- 0.681 (1 s.e.m.), whereas the 23 who did not, had a mean value of 7.094 +/- 0.745 (1 s.e.m.), a significant difference (P less than 0.001); (b) 'PAWPmax', the ventricular filling pressure above which work output dropped. Infusion beyond this may precipitate pulmonary oedema. PAWP was observed at levels greater than PAWPmax in all 6 patients who developed either pulmonary oedema or myocardial infarction. The myocardial performance curve can reliably identify high risk patients and permit control of intravenous therapy within individual safety limits, thereby preventing pulmonary oedema.

The lysis of artificial thrombi.

The susceptibility to lysis of artificial thrombi formed from native rabbit blood in the presence or absence of dextran was determined using the Chandler loop technique. Thrombi of identical weight were formed in the presence of saline or dextran and when spontaneous thrombolysis was allowed to take place, thrombi formed in the presence of dextran 70 were lysed to a greater extent than those formed under control conditions. The possible factors influencing this observation were studied. Increasing concentrations of streptokinase increased the extent of thrombolysis in both control and dextran treated thrombi. Maximal streptokinase induced thrombolysis occured in the presence of a 2 per cent final concentration of dextran Mw 40,000 and 500,000 and dextran 70 at a final concentration of 1.2 per cent. Increased thrombolysis was not observed when albumin was substituted for dextran. Finally, similar observations were recorded for streptokinase induced thrombolysis using human blood.