Avoiding diagnostic errors in admitting patients to a nursing home.

Sometimes the members of the medical profession have been castigated for unpreparedness and shortcomings in the management of nursing home populations because their pre-admission diagnoses often have not agreed with the post-admission evaluations. In contrast, the authors' survey of a local situation revealed a high degree of diagnostic accuracy in admissions to a nursing home. Discussed are appropriate steps that nursing-home admission evaluators can take to ensure the avoidance of errors in the entrance diagnosis.

Renal cell carcinoma: relevance of angiogenetic factors.

Angiogenesis is essential for tumour growth. Mostly hypervasculariced renal cell carcinoma (RCC) usually express angiogenic factors, e.g. basic fibroblast factor (bFGF), vascular endothelial growth factor, and angiogenin (ag). This study was designed to evaluate the improvement of serological angiogenesis-factors, their prognostic relevance and correlation to tumour-grade, -stage and -volume. Measurement of bFGF, vEGF and ag was done with ELISA (Quantikine), R and D-Systems Europe Abbington, United Kingdom. The control group comprised 39 healthy blood donors, RCC-group were 35 patients with different RCC. Survival dates were presented with Kaplan-Meyer-curves, significance was tested with students-t-test. For all angiogenic factors a highly significant difference between the healthy and RCC-group was found. A strong correlation between angiogenic factors and tumor grade, -stage and -volume, was not found, but a trend for each of the angiogenic factors to correlate with grade was seen. No survival benefit was seen between patients with normal angiogenic factor over those with elevated angiogenic levels.

Triamterene calculus.

Triamterene therapy is an unusual cause of nephrolithiasis and, when this agent is found in a stone, generally it is deposited in minor amounts. We report a renal calculus consisting mostly of triamterene and its 2 major metabolites in a patient taking a triamterene-containing drug, and discuss some implications.

Effects of phenobarbital, phorone and carbon tetrachloride pretreatment on the biliary excretion of acetaminophen in rats.

Rats with cannulated bile ducts excreted 24.6% of an i.v. dose of 100 mg/kg acetaminophen (AA) into bile within 8 hr, 0.9% as unchanged drug, 5.5% as sulfate, 15.1% as glucuronide and 3.1% as the glutathione conjugate. Pretreatment with phenobarbital (0.1% solution for 7 days instead of drinking water) significantly decreased the amount of total AA recovered in bile, to 12.8% mainly as a consequence of reduced glucuronide excretion (3.5%), whereas the GSH-conjugate was augmented to 6.3%. Pretreatment with the GSH-depletor phorone (250 mg/kg i.p. 1 hr prior to AA) slightly reduced the total recovery of AA to 19.2%, due to a diminished excretion of the glucuronide (10.3%). Liver damage due to carbon tetrachloride administration (0.5 ml/kg p.o. 24 hr prior to AA) markedly decreased the total recovery of AA to 8.9% as a consequence of the reduction of the glucuronic acid (5.0%) and the GSH-conjugates (0.2%). These observations are discussed with respect to the effects of phenobarbital, phorone and CCl4 on microsomal and cytosolic GSH-dependent enzymes involved in the metabolism of AA.

Biliary and renal excretion of paracetamol in man.

In 6 postsurgery patients with T tubes inserted in their common bile ducts, biliary excretion of paracetamol amounted to 2.6% of an oral dose (1 g), consisting of unchanged paracetamol (0.57%) and conjugates of sulfate (0.36%), glucuronic acid (0.36%) and cysteine (1.63%). Renal recovery in the same patients was 35.3%, consisting of 2.6% unchanged paracetamol, 12.7% paracetamol sulfate, 9.0% glucuronide, 3.9% cysteine conjugate and 4.0% mercapturate.

Biliary excretion of acetaminophen in diabetic and hyperthyroid rats.

In streptozotocin-induced diabetic rats the biliary excretion of total acetaminophen (AA) was reduced to 14.1% of the dose (100 mg/kg i.v.) as compared to 24.6% in controls. This was due to a significant decrease in the amounts of AA-sulfate and AA-glucuronide, whereas the AA-GSH excretion was not altered. These effects were paralleled by a marked decrease in the bile flow in diabetic rats. In hyperthyroid rats (pretreated with 0.1 mg/kg T3 for 4 days) no significant alterations in the total AA or AA-conjugate excretion into bile were observed; moreover bile flow in hyperthyroid rats was in the same range as for controls. In all, known changes in hepatic microsomal or cytosolic enzyme and cosubstrate concentrations during the diabetic or hyperthyroid state do not at all correlate with their influence on the biliary excretion of AA and its conjugates.