bluuebunny/crossref_metadata_2025 huggingface dataset:
Augmented Interleukin-18 Production by Peripheral Blood Monocytes in Patients with Minimal-Change Nephrotic Syndrome
Authors: Matsumoto Koichi , Kanmatsuse Katsuo
Published: April 2003

Background/Aim: The etiology of minimal-change nephrotic syndrome (MCNS) is poorly understood. It has been proposed that cell-mediated immunity and T-cell activation are key features of this glomerular disease. Interleukin (IL)-18, a novel interferon-γ-stimulating factor, may act as an important effector molecule involved in various immune responses. To our knowledge, very little is known about the involvement of IL-18 in NCNS. The aim here was to define further the involvement of IL-18 in MCNS. Methods: To understand the role of this cytokine, in vitro IL-18 levels were analyzed by a sensitive enzyme-linked immunosorbent assay (ELISA) method in 16 patients with MCNS who were either in a stable or active condition. The disease controls included 16 patients with IgA nephropathy (IgAN). The IL-18 levels were compared with values in healthy controls. Results: Significantly increased spontaneous and lipopolysaccharide (LPS)-stimulated production of IL-18 was detected in peripheral blood monocyte (PBM) cultures of MCNS patients with the nephrotic syndrome (NS) as compared with those of normal controls. Moreover, when individual MCNS patients were followed through their clinical illness, IL-18 levels were increased during the active phase and normalized as the patients went into remission. The amounts of IL-18 are significantly correlated with the levels of vascular permeability factor (VPF) in MCNS patients. Conclusions: Thus, in MCNS patients, the level of IL-18 was increased and this increase was related to the activity of this disease. The data provide circumstantial evidence for a role of IL-18 in MCNS.
Clinical Significance of Natriuretic Peptides and Cyclic GMP in Hemodialysis Patients with Coronary Artery Disease
Authors: Osajima Akihiko , Okazaki Masahiro , Kato Hiroaki , Anai Hirofumi , Tsuda Yuki , Segawa Kayoko , Tanaka Hiroshi , Tamura Masahito , Takasugi Masayuki , Nakashima Yasuhide
Published: April 2003

Background: Plasma concentrations of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and cyclic guanosine monophosphate (cGMP) are suitable markers of ’dry body weight’ (DW) in hemodialysis (HD) patients. However, it is still unknown whether these markers can be applied to patients with renal failure and coronary artery disease (CAD). We examined the reliability of these peptides as volume markers in HD patients with CAD. We also assessed the relationship between natriuretic peptides and indices of left ventricular (LV) function. Methods: Plasma concentrations of ANP, BNP and cGMP were determined before and after HD in patients with CAD (group 1, n = 19, mean age 63 ± 12 years) and were compared with those of patients without cardiac disease (group 2, n = 20, age 61 ± 15 years). Using data obtained by cardiac catheterization, we examined the relationship between natriuretic peptides and indices of LV function in HD patients with CAD. Results: Baseline ANP (244 ± 205 pg/ml), BNP (713 ± 928 pg/ml) and cGMP (29.6 ± 21.6 pmol/ml) were significantly higher in group 1 than in 11 healthy volunteers (18.6 ± 9.9 pg/ml, 7.7 ± 7.6 pg/ml, cGMP 8.9 ± 4.9 pmol/ml, respectively). HD significantly reduced plasma ANP (87 ± 75 pg/ml) and BNP (477 ± 702 pg/ml) although they were still above normal control. HD reduced plasma cGMP (7.2 ± 4.5 pmol/ml) to normal values, suggesting the elimination of cGMP across the dialyzers. Baseline levels of ANP, BNP and cGMP in group 2 were less than those of group 1 but higher than the control. HD reduced natriuretic peptides in group 2 to levels lower than those in post-HD group 1. After HD, there was no significant correlation between reductions in body weight and changes in ANP or BNP. Baseline ANP and BNP levels closely correlated with pulmonary artery pressure, pulmonary artery wedge pressure, left ventricular end-diastolic pressure and left ventricular ejection fraction. A significant correlation was observed between BNP levels and the severity of CAD. Conclusion: ANP, BNP and cGMP seem to be a useful markers for fluid overload but not for DW in HD patients with CAD. Plasma ANP and BNP might be useful markers for left ventricular function.
Central Diabetes insipidus following Carbon Monoxide Poisoning
Authors: Chang Ming-Yang , Lin Ja-Liang
Published: April 2003

Diabetes insipidus is a rare complication after carbon monoxide poisoning. We report on a woman and her daughter who were noted to have polyuria and hypernatremia after exposure to carbon monoxide. Both patients were responsive to desmopressin therapy, and the diagnosis of central diabetes insipidus was made. The development and correction of hypernatremia further complicated the neurological damages caused by carbon monoxide poisoning. These cases illustrate the possibility of central diabetes insipidus and hypernatremia after carbon monoxide poisoning and the importance of immediate antidiuretic hormone treatment and careful fluid therapy.
Severe Hypomagnesemia and Hypoparathyroidism in Kearns-Sayre Syndrome
Authors: Katsanos K.H. , Elisaf M. , Bairaktari E. , Tsianos E.V.
Published: April 2003

Kearns-Sayre syndrome (KSS) is a multisystem mitochondrial disorder characterized by the invariant triad: onset before 20, progressive external ophthalmoplegia and pigmentary retinal degeneration, plus at least one of the following: complete heart block, cerebellar dysfunction and CSF protein >100 mg/dl. Autopsies from patients with KSS revealed widespread tissue distribution of mitochondrial (mt) DNA deletions. These deletions result in significantly lower activities of the enzymes of the respiratory chain. KSS has been associated with a variety of endocrine and metabolic disorders in <10% of patients, while renal tubular involvement is extremely rare. We present an 18-year-old girl with KSS who developed hypoparathyroidism and renal tubular dysfunction with inappropriate mangesiuria and kaliuria. We further discuss the renal tubular damage in KSS emphasizing its pathophysiology and clinical phenotype, and review the possible mechanisms of hypoparathyroidism in KSS.
Embryonic Renal Collecting Duct Cell Differentiation Is Influenced in a Concentration-Dependent Manner by the Electrolyte Environment
Authors: Schumacher Karl , Klotz-Vangerow Sibyl , Tauc Michel , Minuth Will W.
Published: April 2003

Background: During kidney development, the embryonic collecting duct (CD) epithelium develops into a heterogeneously composed epithelium consisting of principal and intercalated cells. It is unknown by which molecular mechanism the different cell types arise. We have experimental evidence that the electrolyte environment is involved in the process of terminal cell differentiation. Methods: Embryonic CD epithelia from neonatal rabbit kidneys were microsurgically isolated and maintained in gradient perfusion culture for 13 days under serum-free conditions. Controls were maintained in the same medium (Iscove’s modified Dulbecco’s medium; IMDM) on basal and luminal sides. Experimental series were performed with IMDM only on the basal side, while on the luminal side IMDM with increasing concentrations of NaCl was used. Finally, the development of principal and intercalated cell features was registered by immunohistochemical labeling with markers specific for adult CD cells. Results: Immunohistochemical markers show that the differentiation pattern is quite different when the embryonic CD epithelia are cultured in IMDM only as compared with specimens kept in IMDM supplemented with 3–24 mmol/l NaCl on the luminal cell side. First signs of changes in development were seen when low doses of 3–6 mmol/l NaCl were added. Conclusions: We conclude that facultative protein expression in embryonic CD epithelium is influenced by the electrolyte environment and starts to be upregulated after administration of unexpectedly low doses of 3–6 mmol/l NaCl added to the luminal perfusion culture medium and increases in a concentration-dependent manner.
Evaluation of the Severity of Traumatic Rhabdomyolysis Using Technetium-99m Pyrophosphate Scintigraphy
Authors: Chang Horng-Rong , Kao Chia-Hung , Lian Jong-Da , Shu Kuo-Hsiung , Cheng Chi-Hung , Wu Ming-Ju , Chen Cheng-Hsu
Published: April 2003

A quantitative scoring method was designed to assess the extent of muscle damage. Technetium-99m pyrophosphate (99mTc-PYP) scintigraphy was performed for 9 patients experiencing crush injury in the Chichi (Taiwan) earthquake. The magnitude of muscle uptake of 99mTc-PYP was graded as follows: grade 0, less than bone radioactivity (BRA); grade 1, equal to BRA; grade 2, higher than BRA; or grade 3, greatly higher than BRA. The area of muscle injury was estimated according to the rule of nines. The sum of the muscle injury size multiplied by its corresponding grading was defined as the anterior or posterior score according to the anterior or posterior images. Each image was interpreted by two physicians and average anterior and posterior scores were calculated. The muscle score was defined as the geometric mean of the average anterior and posterior scores. Significant correlations were obtained between the muscle score and duration of time trapped (r = 0.868, p < 0.01), peak serum creatine kinase level (r = 0.866, p < 0.01), peak serum phosphorus level (r = 0.877, p < 0.01) and number of hospital days (r = 0.875, p < 0.01). A negative correlation between the muscle score and blood pH (r = –0.706, p < 0.01) was also observed. We concluded that this scoring method may be used as an adjunct for evaluating the locations of trauma and the severity of crush syndrome, and for predicting the duration of hospital stay.
Successful Treatment of Massive Lower Gastrointestinal Bleeding Caused by Mixed Infection of Cytomegalovirus and Mucormycosis in a Renal Transplant Recipient
Authors: Ju Ji Hyeon , Park Ho Sung , Shin Mi Jung , Yang Chul Woo , Kim Yong Soo , Choi Young Jin , Song Ho Jin , Kim Sang Woo , Chung In Sik , Bang Byung Kee
Published: April 2003

We describe a case of lower gastrointestinal bleeding due to mixed infection of cytomegalovirus (CMV) and mucormycosis in a renal transplant recipient. A 33-year-old male received renal transplantation and his clinical course was uneventful. On the 18th postoperative day, acute rejection was developed and this was treated with high-dose methylprednisolone and OKT3. During antirejection treatment, sudden onset massive hematochezia was developed. Emergency colonofibroscopy revealed multiple colonic ulcers and pathologic findings were consistent with mucormycosis and CMV infection. The patient was successfully treated with amphotericin B (1.0–1.5 mg/kg) and ganciclovir (62.5–125 mg/day) for 5 weeks. To our knowledge, this is the first report showing coexistence of mucormycosis and CMV in the colon ulcer base. This finding suggests that CMV infection may trigger fungal infection in the pathogenesis of colonic ulcer.
The Effect of Estrogen on Renal Phosphorus Handling in the Rat
Authors: Dick Ian M. , Prince Richard L.
Published: April 2003

Background/Aims: Phosphorus reabsorption in the kidney is regulated by parathyroid action on the sodium phosphorus cotransporter (Na-Pi cotransporter). There is some evidence that estrogen may also regulate renal phosphorus handling but it is not known if this is an effect of estrogen on filtered phosphorus load. Methods: This study examined the effect of estrogen on renal phosphorus handling during infusion with calcium or EDTA. Six month old Sprague Dawley rats were bilaterally oophorectomized (OOX) or underwent a sham operation under ether anaesthesia 6 weeks before undergoing infusion with calcium chloride or EDTA. A second study examined renal phosphorus handling after estrogen replacement in the OOX rat injected with 20 µg estradiol valerate, or vehicle alone, prior to calcium infusion. Results: A comparison of filtered phosphorus load with renal phosphorus excretion indicated that the estrogen replete rat had a higher renal excretion of phosphorus when infused with both calcium (p = 0.004) and EDTA (p = 0.037) at all filtered phosphorus loads. A similar analysis in calcium infused, estrogen replaced, OOX rats indicated an effect of estrogen to increase renal phosphorus excretion (p = 0.007) at all filtered phosphorus loads. OOX resulted in a mild metabolic alkalosis, an effect not reversed by estrogen administration, that was not related to renal phosphorus excretion. OOX decreased renal sodium excretion and uncoupled the relation between renal phosphorus and sodium excretion, an effect reversed by estrogen replacement. Conclusion: Ovarian hormone deficiency in the rat results in a decrease in renal phosphorus excretion. This finding is comparable to effects of the menopause and hormone replacement therapy in postmenopausal women.
Low-Protein Diet Suppresses Serum Insulin-Like Growth Factor-1 and Decelerates the Progression of Growth Hormone-Induced Glomerulosclerosis
Authors: Doi Sonia Q. , Rasaiah Suvi , Tack Ivan , Mysore Jagannatha , Kopchick John J. , Moore Jack , Hirszel Przemyslaw , Striker Liliane J. , Striker Gary E.
Published: April 2003

A low-protein (LP) diet has been associated with amelioration of renal function in glomerulosclerosis (GS). However, the mechanisms involved are still unclear. We have used a mouse transgenic for bovine growth hormone (GH), which develops progressive GS and exhibits consistently elevated levels of circulating GH and insulin-like growth factor (IGF)-1, to study the effect of dietary protein restriction. LP (6% protein) and normal-protein (NP, 20% protein) diets were maintained for 30 weeks in mice with established GS of mild/moderate degree. The degree of GS was markedly attenuated in LP compared to NP mice. Quantitative analysis revealed a significantly lower GS index (1.4 ± 0.9 in LP vs. 2.8 ± 0.8 in NP) and glomerular volume (0.8 × 106 ± 0.1 × 106 µm3 in LP vs. 1.2 × 106 ± 0.1 × 106 µm3 in NP) in mice with restricted protein intake. These morphologic changes were accompanied by a significant reduction in renal expression of α1 type-IV collagen (2.4-fold) and tenascin (1.4-fold) in LP mice. Serum IGF-1 decreased by 40% and showed a significant correlation with α1 type-IV collagen expression with the LP diet. The present finding supports the use of the LP diet to decelerate the progression of GS and furthermore suggests that one of the mechanisms involved in this process is the GH/IGF-1 regulation by protein intake.
An Occult Cause of Arteriovenous Access Failure: Central Vein Stenosis from Permanent Pacemaker Wire
Authors: Chuang Chiao-Lin , Tarng Der-Cherng , Yang Wu-Chang , Huang Tung-Po
Published: April 2003

Central vein stenosis is an indolent and underestimated complication of permanent pacemaker placement. It leads to serious problems in hemodialysis patients when arteriovenous (AV) fistulae/grafts were created at the ipsilateral arm. We, herein, reported 3 cases of AV access failure resulting from permanent pacemaker-related central vein stenosis. The pathogenesis, clinical manifestations, radiological findings, and therapeutic solution on this issue are discussed. It is mandatory to place the AV fistula/graft and permanent pacemaker wire on the opposite side for prevention of the high risk of AV access failure.
Psoas Abscess with Osteomyelitis in a Patient Undergoing Long-Term Hemodialysis
Authors: Kato Akihiko , Takahashi Toshiaki , Watanabe Tetsuya , Furuhashi Mitsuyoshi , Maruyama Yukitaka , Hishida Akira
Published: April 2003

We describe a 69-year-old male patient on maintenance hemodialysis for 24 years who developed a fatal left psoas abscess with osteomyelitis at the hip joint following acute enterocolitis. He had systemic β2-microglobulin amyloid deposition in colon epithelium and psoas muscle. Cultures from abscess fluid and femoral bone marrow yielded Bacteroides fragilis. To our knowledge, this is the first case on hemodialysis having a psoas abscess following acute gastrointestinal infection. This rare case suggested that a secondary psoas abscess could be one of the occult infections in patients undergoing long-term maintenance hemodialysis.
Marked Atherosclerosis in a Patient with Familiar Lecithin: Cholesterol Acyltransferase Deficiency Associated with End-Stage Renal Disease and Diabetes Mellitus
Authors: Homma Sumiko , Murayama Naoki , Yoshida Izumi , Kusano Eiji , Kuriki Ken , Saito Ken , Asano Yasushi
Published: April 2003

Familial lecithin:cholesterol acyltransferase (LCAT) deficiency is a rare genetic disorder of the lipid metabolism caused by the absence of LCAT activity in plasma. It is not generally accompanied by atherosclerosis in spite of low high-density lipoprotein cholesterol levels nor by diabetes mellitus. However, reports of long-term follow-up or autopsy findings are rare, and the true incidence of atherosclerosis in LCAT deficiency is not clear. We report on the long-term observation of a patient with familial LCAT deficiency who developed renal failure, diabetes mellitus, and marked atherosclerosis. The patient died of sepsis from foot ulcers 7 years after starting hemodialysis and 13 years after the diagnosis. Marked atherosclerosis characterized by medial calcification in small arteries was observed at autopsy. The genesis of the atherosclerosis seemed to be on the basis of a combination of factors.
Treatment of Renal Stones by Extracorporeal Shock Wave Lithotripsy
Authors: Renner Ch. , Rassweiler J.
Published: April 2003

Based on an extensive review of the literature and our own clinical experience, this article attempts to present clear guidelines for the management of various kidney stones that will be acceptable to clinical urologists and their patients. Regarding our own patients, we compared different studies and discussed the results concerning the anatomical kidney situation, stone size, stone localization and observation time. Stone-free rates of patients with calyceal diverticula calculi range from 4 to 58%, with an increase after longer follow-up periods. According to the importance of residual fragments following extracorporeal shock wave lithotripsy (ESWL), we have to distinguish between clinical insignificant residual fragments and clinical significant residual fragments. 24 months following ESWL, stone passage occurs as a continuous process, and if there are no clinical symptoms, any endoscopic procedure should be considered as over-treatment. Newer ESWL technology has increased the percentage of clinically insignificant residual fragments. We consider percutaneous nephrolithotripsy in most of the patients with renal calculi smaller than 30 mm in diameter only as second-line therapy.
Solvent Effect in vitro of Anticolana Valley Water on Renal Stones: Analytical-Instrumental Study
Authors: De Angelis Curtis S. , Curini R. , Fraioli A. , Petronio B.M. , Ricciuti G. , D’Ascenzo G.
Published: April 2003

The presence of humic and fulvic acids in the Anticolana Valley (Fiuggi) water has been established. On the basis of this evidence we investigated the capacity of Anticolana Valley (Fiuggi) water to dissolve renal calculi in vitro. Crystals of calcium oxalate monohydrate to simulate a kidney stone were prepared. Human renal stones of calcium oxalate monohydrate were obtained by courtesy of the Division of Urology of ‘La Sapienza’ University (Rome), the Division of Urology of the University of Havana (Cuba) and the ASTIF of Fiuggi. The study was performed using the Anticolana Valley (Fiuggi) water, distilled water and tap water (ACEA, Rome), in a specially designed Perspex apparatus. Each calculus was subjected to a water flow of 2 liters/24 h. The capacity of the Anticolana Valley (Fiuggi) water to dissolve human and synthetic calculi was found to be much higher than that of distilled water which in turn was significantly more effective than tap (ACEA) water.
Decreased Concentrations of Serum Phospholipid Plasmalogens Indicate Oxidative Burden of Uraemic Patients Undergoing Haemodialysis
Authors: Brosche Thorolf , Platt Dieter , Knopf Burkhard
Published: April 2003

Experimental evidence indicates that uraemic patients undergoing haemodialysis are subject to increased oxidative stress. Plasmalogens are a phospholipid subclass found in cell membranes and plasma lipoproteins, which may work as an endogenous antioxidant. Using gas chromatography, we measured reduced portions of fatty aldehyde dimethyl acetals (16:0 DMA and 18:0 DMA, representing derivatives of plasmalogens) in fatty acid patterns of fasting serum phospholipids from 30 patients with chronic renal failure (CRF) receiving repeated ambulatory haemodialysis, as compared to 99 normal control subjects (CS). The highly significant difference of mean 16:0 DMA and 18:0 DMA values between CRF patients and CS (0.53 ± 0.15 vs. 0.67 ± 0.13, p < 0.001 and 0.33 ± 0.11 vs. 0.40 ± 0.11, p < 0.01, respectively) was lost when the patients were compared to subjects older than 85 (16:0 DMA) or 75 years (18:0 DMA). Weak, but significant inverse correlations with age or triglycerides were observed in blood serum of CS for 16:0 DMA and 18:0 DMA, respectively, but not of the patients. Partial correlation analysis indicated a mutually independent association of age and triglyceride values with serum plasmalogens in CS, but not in CRF patients. In conclusion, the reduced content of serum plasmalogen phospholipids of uraemic patients undergoing haemodialysis suggests an increased oxidative stress.
Diabetic Glomerulosclerosis without Overt Diabetes mellitus
Authors: Grcevska L. , Polenakovic M. , Petrusevska G.
Published: April 2003

The duration of diabetes mellitus and the presence of hyperglycaemia were thought to be important in the development of nodular glomerulosclerosis. We report on 3 patients without overt diabetes, but with glucose intolerance, all male, aged 43–66 years, with histological features of diabetic glomerulosclerosis. The nodular form was present in 2 patients and the diffuse form in 1. These cases suggest that factor(s) other than hyperglycaemia are responsible for diabetic renal damage.
Hemoglobin Level Is an Important Determinant of Acid-Base Status in Hemodialysis Patients
Authors: Borawski Jacek , Myśliwiec Michał
Published: April 2003

Background/Aims: We studied the relationship between hemoglobin (Hb), which is a major buffer of blood, and arterial blood total carbon dioxide (tCO2) levels in maintenance hemodialysis (HD) patients. We also evaluated the difference between the tCO2 measured with a standard Hb value of 15 g/dl, and that assayed with an actual Hb level entered into an analyzer. Methods/Results: In 105 patients the predialysis tCO2 level of 21.4 ± 2.84 mEq/l inversely correlated with the Hb level of 9.5 ± 1.78 g/dl (r = –0.358, p = 0.0002). This indicated that the rise in Hb from 6 to 14 g/dl could result in a decrease of about 5 mEq/l in the tCO2 level. In 20 patients the tCO2 level measured at the Hb of 15 g/dl was 21.0 ± 2.47 mEq/l, and higher (p = 0.009) than that of 20.8 ± 2.45 mEq/l estimated at the actual Hb. The difference between these two measurements was inversely associated with the Hb level (r = –0.579, p = 0.007). The measurement of tCO2 at the unadjusted Hb slightly underestimated the degree of acidosis when the actual Hb level was < 11.5 g/dl. Conclusion: The degree of anemia and, to some extent, laboratory technique should always be considered when interpreting changes in arterial blood acid-base balance in maintenance HD patients.
Infant Leukemia Suggestive of Natural Killer Cell Precursor Origin Followed an Unusual Clinical Course
Authors: Shinoda Kunihiro , Muraki Takayuki , Yano Mituru , Yamada Tetsuya , Takao Akira
Published: April 2003

We report a patient with infant leukemia showing the rare phenotypes of CD2+, CD4+, CD7+, CD56+, CD3–, CD5– who followed an unusual clinical course. The patient was a 3-month-old girl who was admitted because of unusual purpura looking like a black ring. On admission WBC count was 85.8 × 109/l and bone marrow aspiration revealed a nucleated cell count of 112.0 × 109/l with 70.8% atypical lymphocytes. On the 3rd hospital day, the WBC count decreased by about 1/5 without chemotherapy and partial remission was obtained. But about 3 weeks later, the WBC count increased again and she died. Based on surface marker analysis, genotypic analysis and autopsy, we diagnosed infant leukemia suggestive of natural killer (NK) cell precursor origin.
Bilateral Interstitial Pneumonic Shadows Caused by Perivascular Fibrosis and Extramedullary Megakaryopoiesis of the Lung in a Case of Advanced Agnogenic Myeloid Metaplasia and Myelofibrosis
Authors: Ueno Hirohisa , Yoneda Ryouji , Ogawa Wataru , Yoon Seitetu , Kitazawa Souhei , Kitazawa Riko , Kasuga Masato
Published: April 2003

A 59-year-old man with progressive and advanced agnogenic myeloid metaplasia, also called idiopathic myelofibrosis, had complications showing bilateral interstitial pneumonic shadows. Pathological assessment of transbronchial biopsy revealed pulmonary perivascular fibrosis and infiltration of megakaryocytes. Autopsy 3 months later showed extramedullary megakaryopoiesis and fibrosis in lung, pleura, kidney, liver and spleen. Histopathological analysis for platelet-derived growth factor (PDGF) and PDGF-receptor revealed an abnormally high expression of the PDGF-receptor-β gene in pulmonary fibroblasts. This is the first description of an association between pulmonary fibrosis and PDGF in idiopathic myelofibrosis.
Expansion of CD14+CD16+ Blood Monocytes in Patients with Chronic Renal Failure Undergoing Dialysis: Possible Involvement of Macrophage Colony-Stimulating Factor
Authors: Saionji Katsu , Ohsaka Akimichi
Published: April 2003

A novel subpopulation of blood monocytes coexpressing CD16 antigen and low levels of CD14 antigen (CD14+CD16+ monocytes) has recently been identified, and expansion of these CD14+CD16+ monocytes has been reported under some pathological conditions. In this study, we examined the immunophenotype of blood monocytes in patients with chronic renal failure (CRF) who were undergoing hemodialysis (HD, n = 52) or continuous ambulatory peritoneal dialysis (CAPD, n = 36) using two-color immunofluorescence flow cytometry. The percentage and absolute number of CD14+CD16+ monocytes were significantly higher (p < 0.001) in both HD and CAPD patients compared with those in healthy control subjects. We also determined the plasma concentrations of hematopoietic growth factors and cytokines using an enzyme-linked immunosorbent immunoassay. The plasma levels of macrophage colony-stimulating factor (M-CSF) were markedly increased in both HD and CAPD patients relative to the normal controls. The plasma M-CSF levels correlated significantly with the number of CD14+CD16+ monocytes in the whole group of subjects. These findings suggest that elevated endogenous M-CSF levels may participate in the expansion of CD14+CD16+ monocytes in CRF patients undergoing dialysis.
Activity of a Nitroxylated Analog of Daunorubicin, Ruboxyl, in B-Lymphoproliferative Disorders
Authors: Seminara Patrizia , Franchi Fabrizio , Konovalova Nina , Pioli Claudio , Rossetti Roberto , Tubani Luigi , Doria Gino , Rossi Fanelli Filippo
Published: April 2003

A nitroxylated analog of daunorubicin, ruboxyl (RBX), showed low toxicity but significant lympholytic effect in preclinical evaluations. A series of studies in vitro and in animals demonstrate that RBX is a putative agent in the treatment of many neoplasms. We report the results of a study in mice in which RBX showed selective B-lymphocyte immunosuppression. On the basis of this experience, RBX was administered to 3 patients with multiple myeloma and two patients with Waldenström’s disease. The results of this pilot clinical study show that this compound has good activity and low myelotoxicity and cardiotoxicity, but seems to be characterized by a threatening immunosuppressive effect.
Adult T-Cell Leukemia with Anti-HTLV-I Antibody but No HTLV-I DNA in Tumor Cells
Authors: Fujiwara Hiroshi , Arima Naomichi , Matsumoto Tadashi , Ohtsubo Hideo , Matsushita Kakushi , Kukita Toshimasa , Tei Chuwa
Published: April 2003

Adult T-cell leukemia (ATL) is usually defined as a malignant disease of T cells infected by human T-lymphotropic virus type I (HTLV-I). In the present study, we describe a 49-year-old woman with an acute type ATL, whose leukemic cells do not contain the HTLV-I genome. Laboratory tests revealed an increase in abnormal lymphocytes with convoluted nuclei, elevated serum lactate dehydrogenase levels, increased thymidine kinase activity and soluble interleukin-2 receptor-α levels. Serum examination demonstrated positive anti-HTLV-I antibody, but Southern blot analysis using the whole HTLV-I genome as a probe did not detect any integration of the viral genome. In contrast, PCR detected the HTLV-I pX region in the same DNA samples as used for Southern blot analysis. These findings suggest two possibilities. One possibility is that ATL in this patient is generated by other pathogens than HTLV-I virus. She is also an HTLV-I carrier. The other possibility is that her leukemic T cell clone derived its malignant phenotype from HTLV-I infection, and once this malignant phenotype was obtained, partial deletions of viral genome repeated until the whole viral genome was deleted. Although there is no direct evidence, the former possibility is more likely in the present case.
Expression of Granzyme B and Perforin in Multiple Myeloma
Authors: Xagoraris Iordanis , Paterakis George , Zolota Bassiliki , Zikos Panagiotis , Maniatis Alice , Mouzaki Athanasia
Published: April 2003

Multiple myeloma (MM) remains an incurable disease by conventional therapy. MM tumor cells evade the immune system and can induce immunosuppression by producing immunomodifying agents such as TGF-β, FasL, vascular endothelial growth factor and Muc-1. In the present study, we show that bone marrow cells from a patient suffering from MM IgG/k type, stage IIIA, when cultured, expressed granzyme B and perforin, normally expressed exlusively by cytotoxic T cells (CTLs) and natural killer (NK) cells. In addition, phenotypic analysis revealed that the cultured cells were activated antigen-presenting cells with NK targeting capacity. We propose that expression of these cytolytic enzymes may constitute an additional adoptive mechanism by the tumor cells to actively destroy the host immune effector cells.
Activated T-Cell and Bispecific Antibody Immunotherapy for High-Risk Breast Cancer
Authors: Lum Lawrence G. , Sen Manjula
Published: April 2003

Nontoxic approaches are needed to improve overall survival (OS) and progression-free survival (PFS) for high-risk breast cancer. Combination immunotherapy (IT) consisting of activated T cells (ATC), interleukin-2 (IL-2), and CTL (GM-CSF) was given after peripheral blood stem cell transplant (PBSCT). There were no major toxicities and there appear to be improvements in OS and PFS over historical controls. In order to develop specific cytotoxic T lymphocytes (CTL), we combined ATC with the use of bispecific antibody (BiAb). By arming ATC with anti-CD3 × anti-HER2/neu BiAb (HER2BiAb), the approach converts nonspecific ATC into HER2/neu (HER2) specific CTL. ATC remain armed, kill tumor targets for days, and produce cytokines after binding to tumor. Arming ATC with BiAbs may prove to be effective for targeting a variety of tumors with and without high-dose chemotherapy.
Retinal Abnormalities in Newly Diagnosed Adult Acute Myeloid Leukemia
Authors: Specchia Giorgina , Albano Francesco , Guerriero Silvana , Buquicchio Caterina , Pomes Linda , Pastore Domenico , Carluccio Paola , Delle Noci Nicola , Liso Vincenzo
Published: April 2003

Retinal abnormalities (RA) are very frequently observed in adult patients with acute myeloid leukemia (AML), but the clinical significance of these findings has not been fully investigated. We examined the fundus oculi in a cohort of 122 adult patients with AML at presentation and analyzed some clinical and biological features to assess whether there was any association with RA. For this purpose, we subdivided the patients into two groups according to the presence or absence of RA (groups 1 and 2, respectively). We considered current laboratory parameters such as white blood cell (WBC) count, hemoglobin (Hb), platelets and serum lactate dehydrogenase (LDH). Moreover, we subdivided the patients into two groups according to age <60 (group A) or ≧60 years (group B) to evaluate a possible association between RA and response to treatment and/or overall survival (OS). In our series, a higher median age and a lower Hb value were associated with group 1 (p = 0.001 and p = 0.04, respectively); the median LDH value was 812 U/l (range 224–5,551) and 607 (range 181–5,244) for groups 1 and 2, respectively (p = 0.02). There was no association between RA and karyotypic alterations. In terms of outcome, in group A (<60 years), 80% patients who achieved complete remission (CR) were in group 2 vs. 13% nonresponders (NR) (p < 0.0001). Median OS of group 2 patients was 49.7 months compared with 7.2 months for those in group 1 (p = 0.002). In group B, 58% patients who achieved CR were in group 1 vs. 15% NR (p < 0.006). Median OS of patients in group 2 was 14.6 months compared with 2.9 months in group 1 (p = 0.02). Our data show that RA are significantly associated with some biological features and with shorter OS in AML patients and this parameter seems to be an effective clinical sign of poor prognosis in terms of CR.
Venous Thromboembolism as First Manifestation of Cancer
Authors: Piccioli Andrea , Prandoni Paolo
Published: April 2003

Since Trousseau’s time numerous studies have addressed the relationship between cancer and venous thromboembolism (VTE) providing firm evidence of the increased risk of subsequent clinically overt malignancy during the follow-up of patients with idiopathic VTE. These malignancies are not limited to certain subtypes, but involve virtually all body systems. This knowledge has led to a long-standing debate on the need to screen for occult malignancies patients with idiopathic VTE with no clinical evidence of cancer at the time of the index thrombotic event. In fact the high incidence of newly discovered cancers does not automatically imply that screening is indicated in these patients since it is unknown whether a substantial proportion of cancers can be diagnosed, whether the diagnosed cancers are treatable and what the impact on cancer-related mortality is. Proper clinical trials are being conducted to find an answer to these questions.
Hepatic Veno-Occlusive Disease following Hematopoietic Stem Cell Transplantation
Authors: Richardson Paul , Guinan Eva
Published: April 2003

The clinical syndrome of hepatic veno-occlusive disease (VOD) is one of the most common and serious complications following hematopoietic stem cell transplantation (SCT). High-dose chemotherapy or chemoradiation therapy in the context of autologous and allogeneic SCT can profoundly injure sinusoidal endothelium and hepatocytes within zone 3 of the liver acinus, producing the clinical syndrome of hepatomegaly and/or right upper quadrant pain with jaundice and fluid retention, typically manifest as weight gain. The incidence is variable and ranges from 10 to 60%. Mild to moderate disease is characterized by eventual complete resolution. In contrast, severe disease frequently results in multiorgan failure and death. The purpose of this review is to discuss the pathophysiology and clinical features of VOD, and the current status and future directions of research for both prevention and treatment.
Treatment of Venous Thrombosis in the Cancer Patient
Authors: Levine Mark N. , Lee Agnes Y.Y.
Published: April 2003

Venous thromboembolism is a common complication in patients with cancer. The management of deep vein thrombosis and pulmonary embolism can be a considerable challenge in patients with cancer. The cancer itself and associated treatments contribute to an ongoing thrombogenic stimulus, while cancer patients are thought to be at increased risk for anticoagulant-induced bleeding. Initial treatment of acute thromboembolism is with intravenous unfractionated heparin or subcutaneous low molecular weight heparin. Treatment at home with low molecular weight heparin is an attractive option in patients with malignant disease. Long-term treatment of acute venous thromboembolism has traditionally been with oral anticoagulants. However, the inconvenience and narrow therapeutic window of oral anticoagulants make such therapy unattractive and problematic in cancer patients. Low molecular weight heparins are being evaluated as an alternative for long-term therapy because their anticoagulant effects are more predictable and laboratory monitoring is unnecessary. Although many clinical issues remain unresolved in the treatment of cancer patients with venous thromboembolism, the future holds much promise as new antithrombotic agents, including factor Xa antagonists and oral thrombin inhibitors, are being tested in clinical trials.
Monocytoid B Cell Lymphoma Associated with Antibodies to Myelin-Associated Glycoprotein and Sulphated Glucuronyl Paragloboside
Authors: Donfrid M. , Apostolski S. , Suvajdžić N. , Janković G. , Čemerikić-Martinović V. , Atkinson H.D.E. , Čolovic M.
Published: April 2003

Monocytoid B cell lymphoma (MBCL) is an immunologically and morphologically well-defined low-grade lymphoma with a predilection for lymph nodes of the parotid region. We describe an association of MBCL with anti-myelin-associated glycoprotein (MAG) polyneuropathy in a 53-year-old male. The diagnosis of stage IV MBCL with nodular bone marrow infiltration, Sjögren’s syndrome and sensorimotor polyneuropathy was made in October 1996. Serum immunoelectrophoresis demonstrated IgMĸ paraprotein. This was then cross-reacted with epitopes of MAG and sulphated glucuronyl paragloboside (SGPG) on myelin sheaths, and detected by thin layer chromatography and Western blot. Direct immunofluorescence of a sural nerve biopsy showed loss of myelin fibres, segmental demyelinization and IgM deposits on the myelin sheaths. The cerebrospinal fluid was normal. After six cycles of chemotherapy (ChlVPP protocol), all the patient’s haematological parameters normalized accompanied by an improvement in neurological signs. The improvement of the polyneuropathy after chemotherapy indicates that the autoimmune anti-MAG and anti-SGPG antibodies resulted from the neoplastic lymphoid proliferation.
Mesenteric Panniculitis Presenting with Autoimmune Haemolytic Anaemia
Authors: Viðarsson Brynjar , Matthíasson Páll , Agnarsson Bjarni A. , Önundarson Páll T.
Published: April 2003

Mesenteric panniculitis is a rare idiopathic inflammatory disorder that can lead to sclerosis. We describe a patient with mesenteric panniculitis presenting with abdominal symptoms and autoimmune haemolytic anaemia. The symptoms remitted after splenectomy and gradual steroid taper. This may suggest an autoimmune component in the aetiology of mesenteric panniculitis.
22-Oxacalcitriol Upregulates p21WAF1/Cip1 in Human Parathyroid Glands
Authors: Shiraishi Koji , Tsuchida Masahiro , Wada Takashi , Yoshihiro Satoru , Takai Kimio , Suga Akinobu , Kaneda Yoshitaka , Naito Katsusuke
Published: April 2003

In the era of 22-oxacalcitriol (OCT), newly synthesized 1α,25-dihydroxyvitamin D3 analogue, against secondary hyperparathyroidism, the indications of parathyroidectomy (PTx) has been restricted. Recent investigations on animal models have revealed the inhibitory effects on PTH secretion after OCT treatment, whereas there has been no evidence about human parathyroid glands. A 38-year-old man with a 19-year history of hemodialysis was performed PTx after the failure of OCT treatment. Expressions of proliferative nuclear cell antigen (PCNA), calcium-sensing receptor (CaSR), vitamin D receptor (VDR), p53 and p21WAF1/Cip1 were analyzed by Western blotting and immunohistochemistry on resected parathroid glands. We confirmed up-regulations of CaSR and VDR, which contribute the reduction of serum PTH, by OCT treatment. Concomitant up-regulation of p21WAF1/Cip1 but not p53, especially in nodular hyperplasia, can be considered to induce cell cycle arrest of the parathyroid cells, but not cytocidal effect of OCT.
Efficacious Response with Low-Dose Indapamide Therapy in the Treatment of Type II Diabetic Patients with Normal Renal Function or Moderate Renal Insufficiency and Moderate Hypertension
Authors: Madkour Hosameldin , Ali Kareim , Nosrati Saeid , Massry Shaul G.
Published: April 2003

We examined the efficacy of low daily dose (1.25 mg/day) of indapamide in the treatment of high blood pressure in patients with diabetes mellitus with normal renal function and those with moderate renal insufficiency (serum creatinine <1.5 mg/dl). The study was an open label one of four months duration. Twenty-eight patients were enrolled in the study and only 15 completed it. Within 2 weeks of therapy, systolic blood pressure fell from 173 ± 4.5 to 144 ± 2.0 mm Hg and diastolic blood pressure from 96 ± 2.1 to 80 ± 1.8 mm Hg (p < 0.01) and blood pressure remained at these levels throughout the study. The results show that low dose indapamide is effective in the treatment of moderate hypertension in patients with diabetes mellitus who have normal renal function or moderate renal insufficiency. Therefore, this dose of 1.25 mg/day is recommended for the treatment of such patients.
Correlates of Sleep Behavior among Hemodialysis Patients
Authors: Williams Sharon Wallace , Tell Grethe S. , Zheng Beiyao , Shumaker Sally , Rocco Michael V. , Sevick Mary Ann
Published: April 2003

Background: Given the importance of sleep to overall physical and mental well-being, we sought to identify the correlates of seven sleep disturbances in a cross-sectional study of a biracial population of male and female patients treated with hemodialysis. Methods: Univariate and multivariate analyses of a cohort study of adult patients with end-stage renal disease. Demographic, psychosocial, clinical, and health and physical functioning variables were included. Results: Waking up during the night (57%) and waking up too early (55%) were the most commonly reported sleep problems. Multivariate analyses consistently indicated that levels of pain, depressive symptoms, and physical functioning were consistently associated with the seven sleep disturbances. Conclusion: Sleep disturbances are common in patients with end-stage renal disease. Physical and mental well-being were consistently related to the seven sleep disturbances.
Continuous Intravenous Sodium Ferric Gluconate Improves Efficacy in the Maintenance Phase of EPOrHu Administration in Hemodialysis Patients
Authors: Bolaños Luis , Castro Pedro , Falcón Teresa G. , Mouzo Ricardo , Varela José Manuel
Published: April 2003

Although intravenous iron has proved to optimize the efficacy of EPOrHu in hemodialysis patients, hitherto no consensus exists with respect to the best regimen of intravenous iron administration. We started a prospective randomized study in 26 patients undergoing chronic hemodialysis who had adequate iron metabolism indices (serum ferritin >100 µg/l; %TSAT >20%; %HypoE <10% and CHr >26 pg) and were in the maintenance phase of EPOrHu administration (target hemoglobin obtained >10 g/dl). All patients were receiving sodium ferric gluconate (Ferrlecit®) intermittently prior to the study and after a 1-month wash-out period where iron was not administered patients were randomized to receive the same previous dose of intravenous iron either in a continuous (6.25–21.3 mg in every hemodialysis session) or an intermittent regimen (62.5 mg every 1–4 weeks, not modifying the previous schedule of administration). At 16 weeks, the continuous group showed a significant increment in serum Hb (11.83 ± 1.12 g/dl) with respect to baseline (10.96 ± 1.31 g/dl) (p < 0.05), whereas no differences were obtained in intermittent group (baseline: 11.16 ± 1.03 g/dl; 16 weeks: 11.14 ± 0.90 g/dl, NS). In contrast with the intermittent group, serum ferritin increased significantly in the continuous group (16 weeks: 508 ± 157 µg/l; baseline: 368 ± 56 µg/l; p < 0.05), whereas %TSAT and CHr did not modified during the study in both groups. %HypoE increased significantly with respect to baseline values in the continuous group (p < 0.05) and close to significantly different in the intermittent group (p = 0.06). Our study suggests that hemodialysis patients in the maintenance phase of EPOrHu administration would obtain further benefit in terms of serum hemoglobin level with a continuous intravenous serum ferric gluconate regimen, at least in the short term.
Severe Rhabdomyolysis due to Malignant Hyperthermia during Renal Transplantation Procedure Can Cause Delayed Graft Function
Authors: Caglar Kayser , Orhan Mehmet Emin , Gulec Bulent , Yavuz Izzet , Yenicesu Mujdat , Guzeldemir Erdal , Vural Abdulgaffar
Published: April 2003

A case of rhabdomyolysis from malignant hyperthermia occurred during renal transplantation surgery is presented. After the completion of vascular and uretherovesical anostomosis, the patient’s heart rate began to rise, sweatiness was observed and body temperature increased to 41°C. Additionally, metabolic and respiratory acidosis and hyperkalemia were detected. Serum creatine kinase and lactic dehydrogenase levels were increased significantly. After external cooling and the administration of dantrolene sodium, body temperature and heart rate were decreased. During this period; furosemide, mannitol and sodium bicarbonate were given. Three hours after the completion of surgery, urine output was begun and urine myoglobin was found to be positive. Renal function improved gradually and serum creatinine level decreased to 1.6 mg/dl on the 14th postoperative day. Malignant hyperthermia can lead to severe rhabdomyolysis and delayed graft function in renal transplant recipients. Early diagnosis and intervention is crucial for protecting renal function.
»Nach der Katastrophe»: Auschwitz in Jungs Texten
Authors: Erlenmeyer Arvid
Published: April 2003

In diesem Vortrag wird anhand von Jungs Texten gezeigt, welche Bedeutung er dem später als Holocaust bezeichneten zeitgeschichtlichen Ereignis gab. Weiter wird versucht zu verstehen, warum Jung das «ungeheuerlichste Verbrechen aller Zeiten» [1945] im Text von «Antwort auf Hiob» [1952] nicht mehr benennt, wie ich meine, zugunsten einer zu befürchtenden zukünftigen atomaren Apokalypse.
Das Ethische Selbst1
Authors: McFarland Solomon Hester
Published: April 2003

Die Autorin argumentiert, dass die ethische Haltung eine Entwicklungsposition ist, die aber im Unterschied zur Kleinianischen Theorie (von der paranoid-schizoiden zur depressiven Position) die teleologische Implikation der Entwicklung des Selbst betont, in der die angeborene Fähigkeit des Selbst, durch den Prozess der Individuation es selbst zu werden, betont wird. Das Ringen um psychologische Ganzheit und die Integration des projizierten Schattens vollzieht sich unter Schmerz und erfordert Opfer. Es ist aber auch befriedigend für das Selbst, ständig wachsende Zustände der Wahrheit, der moralischen Freiheit, des Sinnes und des Wertes zu erreichen. Um eine Übereinkunft zwischen den sich widersprechenden Bedürfnissen nach Nähe und Unterscheidung zu erreichen, muss das Selbst fortwährend mit sich und dem nahen Anderen kämpfen. Die Gefahren dieses Kampfes sind in den Variationen narzisstischer Objektbeziehungen ausserhalb und innerhalb des Behandlungszimmers sichtbar. Eine ethische Haltung reflektiert die analytische Beziehung selbst, in der beide Partner sich dem jeweils Anderen zur Verfügung stellen und durch die Begegnung mit dem jeweils Anderen verändert werden dürften.