[Effects of short-term application of recombinant human growth hormone on urea production rate in patients in the early postoperative phase]. / Effekte einer kurzzeitigen Applikation von rekombinantem humanem Wachstumshormon auf die Harnstoffproduktionsrate von Patienten in der frühen postoperativen Phase.

OBJECTIVE: To determine the effect of short-term recombinant human growth hormone (rhGH) administration on urea production rate (UPR), N balance and aminograms. DESIGN: Prospective, double-blind placebo-controlled study. SETTING: Intensive care unit of a University Hospital. PATIENTS: 20 adult patients after major abdominal surgery. INTERVENTIONS: Postoperative substitution of rhGH (Saizen, Serono, Aubonne, CH) in a dose of 0.15 IE/kg BW for 3 days. The serum levels of hGH, insulin-like growth factor-1 (IGF-1), ACTH and cortisol were measured as well as the amino acids in plasma. The degree of catabolism was calculated according to Woolfson's formula, which is based on the UPR, and by calculation of the cumulative N balance. RESULTS: With exception of proline, the plasma amino acids between the groups receiving active substance and total parenteral nutrition (TPN) and those receiving placebo and TPN did not differ significantly. Neither was there a significant difference between the groups for any other parameter measured. The UPR and IGF-1 levels showed only a tendency towards higher values as compared with the placebo group (UPR verum group, values in g/day: 1st measurement, 29.8 +/- 16.7; 2nd measurement, 28.3 +/- 17.7; 3rd measurement, 32.1 +/- 19.1; 4th measurement, 33.1 +/- 21.2. UPR placebo, values in g/day; 1st measurement, 32.6 +/- 23.9; 2nd measurement, 30.8 +/- 17.9; 3rd measurement 41.6 +/- 28.7; 4th measurement, 47.3 +/- 29.5. IGF-1 verum group, values in nmol/l; 1st measurement, 25.7 +/- 19.2; 2nd measurement, 44.8 +/- 23; 3rd measurement, 52.4 +/- 30; 4th measurement, 54.3 +/- 20. IGF-1 placebo, values in nmol/l; 1st measurement: 22.9 +/- 11.7; 2nd measurement, 37.0 +/- 19.4; 3rd measurement, 38.4 +/- 21.4; 4th measurement, 40.0 +/- 23.0). The ACTH-cortisol axis was only slightly depressed in the group receiving active substance. CONCLUSIONS: We conclude that short-term rhGH administration over 3 days is not capable of significantly reducing the UPR in postoperative patients, but we cannot exclude a significant difference between rhGH group and placebo after a longer administration period.

[Gliadin IgA antibodies in diagnosis of celiac disease in childhood]. / Gliadin-IgA-Antikörper bei der Zöliakie-Diagnostik im Kindesalter.

An enzyme immunoassay kit for the determination of anti-gliadin-IgA antibodies in serum has been evaluated in the diagnosis of coeliac disease in childhood. 84 patients, 22 of them with coeliac disease according to ESPGAN's criteria were tested between 1978 and 1989 and the results have been correlated with the findings on small intestine biopsy and the clinical features. The sensitivity of the test was 95.5% and the specificity was 87.0% on initial diagnosis. On a gluten-free diet reduced antibody levels were seen in all patients. During gluten challenge 11 of 13 children showed an increase in anti-gliadin-IgA concentration. Of the remaining 2 without antibody elevation IgA deficiency became manifest in one patient, the other had a nearly normal mucosa on small intestine biopsy. Provided that IgA deficiency is ruled out and the gluten intake is sufficient the test seems to be useful for screening and might replace biopsy after gluten challenge in cases of increasing antibody levels.

[The automated determination of the dibucaine number using the Greiner G450 selective analyzer. A routine parameter of significance?]. / Die automatisierte Bestimmung der Dibucainzahl am selektiven Analyzer GREINER G450. Ein Routineparameter von Bedeutung?

UNLABELLED: Patients who are homozygous for an atypical pseudocholinesterase enzyme (PCHE) suffer a prolonged neuromuscular block after succinylcholine application. In order to determine which patients have atypical PCHE preoperatively, an automated method using the Greiner G450 analyzer was developed. PATIENTS AND METHODS: The contribution of blocked and unblocked PCHE by dibucaine hydrochloride (optimal concentration 10(-4) mol/l;) was determined in 113 patients (ASA groups 1-2) and the dibucaine number (DN) was evaluated. RESULTS: According to the DN, the patients were subdivided into three groups: group A (PCHE 5.01 +/- 1.64 kU/l, DN 74.47 +/- 0.87); group B (PCHE 4.28 +/- 3.41 kU/l, DN 64.95 +/- 3.41); group C (PCHE 1.33 +/- 0.54 kU/l, DN 13.08 +/- 2.19;). PCHE and DN of group A corresponded with normal standard values, whereas the patients in groups B and C could be considered to be patients with heterozygous and homozygous atypical PCHE, respectively. CONCLUSIONS: Our data indicate that an automated analysis of blocked and unblocked PCHE with the Greiner G450 can be easily done in a routine laboratory. By interpreting the DN, the possible risks of delayed succinylcholine degradation can probably be prevented.