Vitamin E-bonded cellulose membrane, lipoperoxidation, and anemia in hemodialysis patients.

In hemodialysis patients, oxidative stress results from an imbalance between the production of reactive oxygen species and antioxidant defense mechanisms. Recently, a new dialysis multi-layer membrane has been developed, by modifying the inner surface of regenerated cellulose to support a vitamin E coating. The aim of our study was to investigate the effects of hemodialysis treatment with vitamin E-modified membrane on anemia and erythropoietin requirement in a group of chronic uremic patients. Ten uremic, non diabetic, patients on standard bicarbonate dialysis were treated with vitamin E-bonded dialysis membrane for 12 months. Hematological parameters, erythropoietin requirement, serum vitamin E and serum malonyldialdehyde (MDA) were evaluated before starting the study and monthly. No significant changes in hemoglobin level, RBC count, hematocrit and EPO requirement were observed. Basal vitamin E levels were in the normal range (13.0 +/- 2.88 mg/L vs. 14.79 +/- 3.12 mg/L; NS). On the contrary, basal MDA levels were higher than those observed in the control group (1.87 +/- 0.36 vs. 1.13 +/- 0.18 mmol/mL; p < 0.01) and a significant decrease of MDA levels was found after 1 month of Excebrane treatment (1.39 +/- 0.25 nmol/mL; p < 0.02). In conclusion, the role of the "oxidative hemolysis" in the pathogenesis of anemia in CHD patients is still not clearly defined, but it could be of minor clinical relevance. Although the effectiveness of vitamin E-coated membranes as a scavenger of ROS allows a better control of intradialytic oxidative stress, it doesn't seem to contribute to clinical management of anemia in these patients.

Indications for Neisseria gonorrhoeae cultures in children with suspected sexual abuse.

OBJECTIVE: To determine the clinical predictors of Neisseria gonorrhoeae infection in children examined for sexual abuse. DESIGN: Retrospective review of a prospective management plan. SETTING: A 240-bed children's hospital with 36,000 emergency department visits per year. INTERVENTION: In 1988, a Pediatric Emergency Medicine Department protocol was introduced for the examination of children who present with complaints suggestive of sexual abuse. RESULTS: From January 1990 through December 1991, the records of all children less than 12 years of age examined for suspected sexual abuse were reviewed. Vaginal/urethral, oral, and rectal cultures for N gonorrhoeae were performed in 316 children. Seven children (2.2%) had a total of 12 positive cultures: seven vaginal/urethral, four rectal, and one oral. Evidence of vaginal/urethral discharge on physical examination was the best predictor of N gonorrhoeae infection (sensitivity, 100%; specificity, 88%; positive predictive value, 16%; and negative predictive value, 100%). Historical and physical evidence of discharge was significantly associated with N gonorrhoeae infection (P < .0006 and P < .000001, respectively). CONCLUSIONS: Children less than 12 years of age examined for sexual abuse who did not have evidence on physical examination of vaginal or urethral discharge were found to have a 100% probability of having negative vaginal/urethral, oral, and rectal N gonorrhoeae cultures. These findings do not support the practice of obtaining cultures for N gonorrhoeae routinely in all children who present for evaluation of possible sexual abuse.

Treatment of uraemic hyperphosphatemia with calcium acetate: a safe alternative to calcium carbonate.

Clinical usefulness of calcium acetate (CAA) as phosphorus binder was assessed in 19 stable hemodialysis patients with persistent hyperphosphatemia. All were dialysed thrice weekly with a constant dialytic schedule and a dialysate calcium of 3.5 mEq/l. One month prior the study beginning all patients stopped assumption of Ca and vitamin D supplements. In the first period of the study CAA (mean daily doses 2.2 g) was administered for one month followed by 15 days of withdrawal. The mean serum phosphorus decreased from 7.6 +/- 1.4 to 5.8 +/- 0.8 mg% (p < 0.005). After 15 days of withdrawal mean serum phosphorus reached the pretreatment value. Then the patients entered a long term study with personalized doses of CAA (between 1 and 4 g/day) and administration in 8 of them of alpha-calcidol. After a mean follow-up period of 5.4 +/- 1.5 months serum phosphorus was reduced from 7.5 +/- 1.1 to 5.6 +/- 1.1 mg% (p < 0.0005) while calcemia increased from 9.0 +/- 0.7 to 9.6 +/- 0.6 mg% (p < 0.005). Only one patient developed mild hypercalcemia. We concluded that CAA is a safe alternative to calcium carbonate for the control of hyperphosphatemia of uraemic patients for the most efficient phosphorus binding and the lesser absorption of calcium.

Effect of tolazamide on basal ketogenesis, glycogenesis, and gluconeogenesis in liver obtained from normal and diabetic rats.

The effect of tolazamide on in vitro rates of gluconeogenesis, ketogenesis, and glycogenesis was determined in liver tissue from fasted normal and diabetic rats. Hormones were not added to the incubation mixture. Two concentrations of the drug were tested, one of which was therapeutic (40 micrograms/ml) and other immoderately elevated (400 micrograms/ml). Neither drug concentration affected hepatic glycogen synthesis. However, the low dose of tolazamide inhibited ketogenesis in the diabetic liver by 39% and in the control liver by 32%; oxidative CO2 production from palmitate was reduced in parallel with ketogenesis. The drug did not alter ketogenesis in isolated intact mitochondria. Similarly, this same therapeutic dose curtailed hepatic gluconeogenesis only in control liver (74% inhibition); this reaction was unaltered by this drug concentration in the explants derived from the diabetic rats. The logarithmically higher dose inhibited hepatic gluconeogenesis in both control and diabetic liver tissue by 56% and 51%, respectively. Hence, possibly acting at a postreceptor site, therapeutic concentrations of tolazamide can decrease rat hepatic in vitro gluconeogenesis and ketogenesis.