bluuebunny/crossref_metadata_2025 huggingface dataset:
Kidney Disease in Byzantine Medical Texts
Authors: Poulakou-Rebelakou Effie , Marketos Spyros G.
Published: April 2003

The most significant contribution of the great Byzantine physicians to the evolution of medicine is their effort to summarize all the medical knowledge of the Greco-Roman world, which included earlier sources in antiquity, lost forever in our days. The transition from ancient to medieval medicine included the adoption of Christian spiritual values, which took place in the early Byzantine period (4th to 7th century). In the field of nephrology, under the influence of Hippocratic and Galenic doctrines, the most prominent medical personalities, Oribasius of Pergamum, Aetius of Amida, Alexander of Tralles and Paul of Aegina, performed the role of the researcher and healer, as well as that of the encyclopedist. Their works on kidney disease are presented in this paper.
Vitalism and Synthesis of Urea
Authors: Kinne-Saffran E. , Kinne R.K.H.
Published: April 2003

In 1828, Friedrich Wöhler, a German physician and chemist by training, published a paper that describes the formation of urea, known since 1773 to be a major component of mammalian urine, by combining cyanic acid and ammonium in vitro. In these experiments the synthesis of an organic compound from two inorganic molecules was achieved for the first time. These results weakened significantly the vitalistic hypothesis on the functioning of living cells, although Wöhler, at that time, was more interested in the chemical consequences of isomerism than in the philosophical implications of his finding. However, the chemical synthesis observed by Wöhler does not represent the reaction which is employed in the mammalian liver for urea synthesis. The mechanism of this process was elucidated by the German physician Hans A. Krebs and his medical student Kurt Henseleit in 1932 and was shown to include the ornithine cycle. This ‘urea cycle’ is only observed in living cells; this apparently vitalistic phenomenon is caused by the compartmentalization of the various enzymatic reactions in mitochondria and cytosol, respectively.
Contributions of Camillo Golgi toRenal Histology and Embryology
Authors: Dal Canton Ilaria , Calligaro Alessandro L. , Dal Canton Francesca , Frosio-Roncalli Moris , Calligaro Alberto
Published: April 2003

Camillo Golgi was awarded the Nobel prize in 1906 for his studies on the fine anatomy of the central nervous system. His wide present popularity depends on his discovery of the cell apparatus, the tendon mechanoreceptor and the tactile corpuscles of the fingertips that are named after him. However, Golgi also made important contributions to nephrology. In 1882, he published novel observations on the mechanism of renal hypertrophy, which he understood to be due to renal cell proliferation. Two years later, he described tubular cell mitoses in the kidney of a patient with tubulointerstitial nephritis, which he interpreted as an essential part of the repair process. His most important findings, published in 1889, were obtained by studying the microscopic anatomy of the kidney with an original technique that allowed the isolation of whole intact nephrons. He discovered that the ascending limb of Henle’s loop always returned to the glomerulus from which the tubule originated, and he realized that the early distal tubule passed between the glomerular arterioles. In addition, applying the same method to dissect nephrons in progressive phases of development, he identified exactly what tubular segments originated from the various parts of the metanephric early S-shaped structure.
Inference of the Existence of High Blood Pressure as a Cause of Renal Disease in the Mid-19th Century: Observations on Vascular Structures in the Kidney
Authors: Newton Nina M. , Fine Leon G.
Published: April 2003

Histological examination of the kidney was well under way by the mid-19th century. Pathological changes noted to be present in Bright’s disease gave rise to considerable debate in the literature of the time. Toynbee was perhaps the first to note medial hypertrophy and intimal narrowing of blood vessels in the kidney, while Johnson, around the same time, thought that kidney disease was the cause of compressed vessels. Although he later proposed a causal relationship between contraction of vessels and hypertrophy, Johnson never went beyond the insights articulated by Bright himself and failed to make the link between hypertrophy of vessels and persistently raised blood pressure. Traube considered the possibility that cardiac and renal disease could be the consequences of the same unknown disease, but rejected hypertrophy per se as a causal factor. Gull and Sutton disagreed strongly with Johnson and proposed the presence of a general disease which leads to both cardiac hypertrophy and renal disease. But it was Ewald, writing in Germany, who was able to ascribe both cardiac and vascular hypertrophy to increasing tension in the arterial system and he was the first to articulate the effect of hypertension on the kidney.
Experimental Nephritis: One of theEarliest Publications on the Subjectby a Pioneer of Neohippocratism
Authors: Marketos Spyros G. , Koutras Demetrios A.
Published: April 2003

From the beginning of the 20th century, cumulative experimental work has provided considerable evidence for the possible immune mechanisms by which certain diffuse glomerular diseases develop. The first classic well-documented studies are attributed to Masugi and his research team (1933), whose experimental model involved the induction of glomerulonephritis by the administration of antikidney sera. However, 23 years earlier, in 1910, Alexander Cawadias had published a monograph on the same subject, for which he was honored with the Medal of the Paris University School of Medicine. In his study, Cawadias concluded that the mechanism of experimental nephritis was multifactorial and that the progression and the aggravation of uremic disease was caused by the production of nephrotoxins and/or antibodies against renal tissue. Cawadias referred to ‘a new colloid substance’, a kind of autoantibody in the context of anaphylaxis; he can be credited with foreseeing the modern era of the autosensitivity and immunology of renal diseases. Although Cawadias is well-known as a pioneer of Neohippocratism, his contribution to experimental nephritis has not been amply appreciated; he merits better recognition as one of the pathfinders in the field of renal immunopathogenesis.
A New Treatment forInterdialytic Hyperkalemia – The Use of Fosinopril Sodium
Authors: Mousa Dujanah , Rassoul Zalmai , Popovich William , Hassan Abdalla , Margate Veronica , Hawas Fahad , Suleiman Mohammed , Al Khader Abdulla
Published: April 2003

Fosinopril sodium is the first of the phosphinic acid class of angiotensin-converting enzyme inhibitors (ACEI). It is used as an antihypertensive agent, but differs from other ACEI in its dual routes of excretion (liver and kidney), and less incidence of hyperkalemia and cough. We conducted a study in known chronic hemodialysis patients who developed interdialytic hyperkalemia in spite of other treatments to control hyperkalemia. We used fosinopril in this group of patients to assess the effect of fosinopril on serum potassium (K) levels. Twenty-four patients were given fosinopril 10 mg at 18:00 h daily for 8 weeks. K levels were measured before and after each dialysis treatment. Interdialytic weight gains were recorded. The average pretrial potassium level was 6.57 mmol/l (± 0.47), and the posttrial level was 5.34 (± 0.76); p ≤ 0.0001. No statistically significant interdialytic weight gain or reduction occurred. No first dose hypertensive effect or cough were reported. We have found the use of fosinopril to be successful in lowering predialysis serum K levels in hyperkalemic dialysis patients.
Urinary Epidermal Growth Factor Excretion in Children with Chronic Renal Failure
Authors: Tsau Yong-Kwei , Chen Chiung-Hui
Published: April 2003

To investigate the excretion of urinary epidermal growth factor (EGF) in children with chronic renal failure (CRF), we have measured the urinary EGF/creatinine ratio (EGF/Cr) and the 24-hour urine EGF concentration in 19 children with CRF, 11 children with kidney disease and normal creatinine clearance, and 12 healthy children. Children with CRF had a significantly lower daily urine EGF concentration as well as urinary EGF/Cr. In contrast, children with kidney disease and normal renal function had normal daily urine EGF levels and urinary EGF/Cr. Accompanied by no difference in serum EGF between these two groups of patients, these data provide indirect evidence of the kidney as a source of human urinary EGF. There was a positive correlation of urinary EGF/Cr with creatinine clearance in all renal patients (r = 0.608, n = 30, p < 0.001). A much better correlation was found between daily urine EGF and creatinine clearance (r = 0.855, n = 30, p < 0.001). Our results implicate that there is a functional relationship between glomerular filtration and urinary EGF excretion, and that the urinary EGF/Cr may be a reliable indicator of urinary EGF excretion in children with CRF.
Protein Intake Seems to Respond to Increases in Kt/V despite Baseline Kt/V Greater than 1.2
Authors: Marcus Roy G. , Cohl Edith , Uribarri Jaime
Published: April 2003

The nutritional status is a strong predictor of outcome in hemodialysis patients. Adequate delivery of dialysis is necessary for hemodialysis patients to maintain their protein nutrition. In general, a single-pool Kt/V of 1.2 has been considered adequate dialysis. We recently decided to maximize the blood flow during hemodialysis in all of our patients; this enabled us to increase the dose of delivered dialysis in those patients who were not initially utilizing their maximum blood flow. There were 18 patients who already received a Kt/V greater than 1.2. We were able to increase Kt/V even further in 10 of them, resulting in a significant increase in nPCR and a trend to increase serum albumin over the next 6 months of follow-up. The mean normalized protein catabolic rate (nPCR) and serum albumin remained unchanged in the remaining 8 patients whose Kt/V could not be increased. Our data provide evidence that protein intake in hemodialysis patients will increase with an increase in delivered dialysis above the level generally considered to be adequate.
Treatment with a Ca2+ Channel Blocker, Barnidipine, Reduces Platelet-Derived Growth Factor B-Chain mRNA in Glomeruli of Spontaneously Hypertensive Rats
Authors: Hashimoto Masami , Yamauchi Takayoshi , Ogura Toshio , Oishi Tetsuya , Mimura Yukari , Otsuka Fumio , Kashihara Naoki , Makino Hirofumi
Published: April 2003

We investigated the effect of barnidipine hydrochloride, a Ca2+ channel blocker, on the glomerular level of mRNA expression of platelet-derived growth factor (PDGF) B-chain and transforming growth factor (TGF)-β1 in spontaneously hypertensive rats (SHR) with reverse transcription and polymerase chain reaction. Thirteen-week-old SHR were provided with food containing barnidipine (0.6 mg/g of food, average dose during treatment: 53 mg/kg of body mass/day) for 3 weeks. A stable reduction in systolic blood pressure relative to that of age-matched control SHR was recorded after week 1 of therapy. Although no renal histological changes were observed after 3 weeks of treatment with barnidipine, the level of expression of PDGF B-chain mRNA in glomeruli was significantly reduced relative to that in control SHR. The glomerular level of TGF-β1 mRNA expression was not affected by the treatment. Treatment with barnidipine significantly reduced the excretion of urinary protein. Thus, the stable reduction in systemic blood pressure by barnidipine is associated with a reduction in PDGF B-chain mRNA expression in the glomerulus and reduction in urinary protein excretion in SHR.
Use of Cefazolin for Peritonitis Treatment in Peritoneal Dialysis Patients
Authors: Agraharkar Mahendra , Klevjer-Anderson Paula , Rubinstien Eytan , Galen Malcolm
Published: April 2003

For over two decades, intraperitoneal administration of vancomycin and an aminoglycoside has been an accepted regimen for the empiric treatment of peritonitis in the peritoneal dialysis patient, until definite identification of the organism has been made. The recent emergence of vancomycin-resistant organisms has been of great concern in many centers. The current treatment recommendation therefore is to use cefazolin in place of vancomycin. We analyzed peritonitis data from January 1, 1996 to June 30, 1997, prior to switching over to cefazolin. Seventy-five percent (27 episodes) in 1997 as compared to 78% in 1996 were due to gram-positive organisms. Twenty-two percent (8 episodes) were due to gram- negative organisms in 1997, 21% in 1996, and 3% (1 episode) due to yeast in 1997, 3% in 1996. Staphylococcus epidermidis (SE) caused 33% of the gram-positive peritonitis episodes in 1997 as compared to 37% in 1996. Twenty-two percent of the gram-positive episodes were due to Staphylococcus aureus (SA) in 1997 and 46% in 1996. Enterococcal infections were 26% in 1997 and 1% in 1996. All of these were confined to only 1 patient. The antibiogram revealed 100% sensitivity of both SA and SE to vancomycin and 100% sensitivity of SA to cefazolin, but only 11% sensitivity of SE to cefazolin. The same patient population had a 48% sensitivity of SE to cefazolin in 1996, showing a sudden and substantial increase in resistance to SE. Even though SE is thought to be a less virulent organism, treating patients with a high probability of being infected by SE with an antibiotic showing 89% resistance is not warranted.
Membranoproliferative Glomerulonephritis Type I, Mixed Cryoglobulinemia and Lymphoma in the Absence of Hepatitis C Infection
Authors: Rosas Sylvia E. , Tomaszewski John E. , Feldman Harold I. , Foster Mary H.
Published: April 2003

Chronic hepatitis C virus infection has been linked to cryoglobulinemia, membranoproliferative glomerulonephritis, and malignant B-cell lymphoproliferation, suggesting a possible pathogenetic link between these disorders. We report a patient with the latter clinical triad in the absence of hepatitis C infection. We postulate that the persistent and dysregulated immunologic activity associated with chronic antigen stimulation, inflammation and/or B-cell malignancy induces nephritogenic autoantibodies, including cryoglobulins, that produce a similar clinical syndrome in genetically susceptible individuals.
Is the Prevalence of HIV-Associated Nephropathy Decreasing?
Authors: Ahuja Tejinder S. , Borucki Michael , Funtanilla Marjorie , Shahinian Vahakn , Hollander Michael , Rajaraman Srinivasan
Published: April 2003

Initial reports have suggested that approximately 10% of patients with HIV-infection develop HIV-associated nephropathy (HIVAN). It has also been predicted that by the end of the decade, HIVAN is likely to become a third leading cause of end-stage renal disease (ESRD) in African-Americans between the ages of 20–64 years. As the morbidity and mortality from HIV-infection has decreased in the last few years, it is possible that prevalence of HIVAN is also changing. We therefore screened HIV-1-infected patients followed in our hospital for HIVAN. A screening urinalysis was performed in 557 HIV-1-infected adult patients between March and May 1998. Of these, 252 were outpatients and 305 were Texas Department of Criminal Justice inmates (TDCJI). Demographic and laboratory data of these patients was obtained from the HIV patients’ database. Fifty percent of the patients were African-American, 36.6% were Caucasian and 12.7% were Hispanic. The mean age of patients was 37 ± 8 years. Seventy-nine percent of the patients were males and a history of intravenous drug abuse (IVDA) was present in 28%. Twenty-three percent of the patients were concomitantly infected with hepatitis C virus, 4.1% were positive for hepatitis B surface antigen, and rapid plasma reagin test for syphilis was positive in 9.1%. In 38 patients who had more than 100 mg/dl (2+) proteins on screening urinalysis, total urinary proteins were quantitated by collecting 24 h urine specimens. Fifteen of these patients had urinary proteins more than 1.5 g/day (12 patients >3.5 g/24 h and 3 patients >1.5 g/24 h). A renal biopsy was done in 14 of these patients and clinical diagnosis of HIVAN was made in one patient who refused biopsy. Renal biopsies revealed HIVAN [9], diabetic nephropathy [2], membranoproliferative glomerulonephritis [2], Fibrillary glomerulonephritis [1]. All 10 patients (5 TDCJI and 5 outpatients) with HIVAN were African-American. Two of these 10 patients had a history of IVDA and another two were concomitantly infected with hepatitis C virus. The plasma viral load (Pvl) and total CD4 count was not different in patients with or without HIVAN [(Pvl log 10.05 ± 1.39 vs. 9.9 ± 2.18 copies/ml, p = 0.78) (CD4: 187 ± 192 vs. 288 ± 249 cells/μl, p = 1.17) mean ± SD]. We conclude that in our HIV-infected population HIVAN exclusively affected African-Americans and the prevalence in them was 3.5%.
High Density Lipoprotein Catabolism in Primary Cultured Hepatocytes from Daunomycin-Induced Nephrotic Rats
Authors: Gomikawa Shuzou , Suzuki Kazuhiko , Takamitu Yoshihiro
Published: April 2003

We investigated into HDL (high density lipoprotein) catabolism with primary cultured hepatocytes to elucidate the causes of increased HDL apolipoproteins in the plasma of daunomycin-induced nephrotic rats (D rats). The phospholipid, triglyceride, cholesterol, cholesteryl ester and apolipoprotein contents in HDL increased in D rats compared with control rats (C rats). The uptake (binding plus internalization) of 125I-HDL from D rats to two groups of hepatocytes was significantly greater than that of 125I-HDL from C rats. Uptake of 125I-HDL from D rats to D rats’ hepatocytes was significantly greater than that of 125I-HDL from C rats to C rats’ hepatocytes. The degradation of 125I-HDL from D rats was greater than that of 125I-HDL from C rats using two groups of hepatocytes. These results demonstrated that the uptake and degradation of HDL to D rats’ hepatocytes were greater than those of HDL to C rats’ hepatocytes. The increased HDL apolipoprotein content in the plasma of D rats may not be due to decreased uptake and degradation of HDL in hepatocytes compared with C rats.
Delayed Graft Function Complicated by Spontaneous Renal Allograft Rupture without Acute Rejection
Authors: Philipneri Marie , Solomon Harvey , Garvin Paul J. , Bastani Bahar
Published: April 2003

We report a young male patient who developed spontaneous renal allograft rupture 7 days after cadaveric renal transplant, complicated by delayed graft function, without evidence of rejection on allograft biopsy.
Influence of NH4CI on Polarized Release of Endogenous Protein Degradation Products and on Morphology in LLC-PK1 Cells
Authors: Wardelmann Eva , Ling Hong , Heim Inge , Schlebusch Harald , Heidland August , Pfeifer Ulrich
Published: April 2003

Increased renal ammoniagenesis is thought to be a causative factor for renal hypertrophy which occurs in several disorders accompanied by metabolic acidosis. We studied the influence of ammonia on the polarized release of degradation products of endogenous proteins in LLC-PK1 cells. Release of acid-soluble radioactivity to the extracellular space decreased under the influence of NH4Cl with a remarkable transient reduction of basolateral release. Electron microscopically NH4Cl-treated cells showed numerous enlarged lysosomes suggesting an accumulation of incompletely degraded cytoplasmatic material in the lysosomal compartment. We conclude that split products of lysosomal degradation of endogenous proteins are preferentially transported to the extracellular space via the basolateral plasma membrane.
Differing Roles of Body Mass and the Renin-Angiotensin System in Mediating the Hypertension Syndrome
Authors: Weber Michael A. , Smith David H.G. , Neutel Joel M.
Published: April 2003

Background: Hypertension is characterized not only by a metabolic syndrome that includes obesity and insulin resistance, but also by increases in left-ventricular mass (LVM), reduced arterial compliance and altered renal function. This investigation has examined a possible role for the renin-angiotensin system as well as body mass and insulin values in mediating these cardiovascular and renal aspects of the hypertension syndrome. Methods: This was a cross-sectional study of 142 patients identified by community screening. Mean (±SE) age was 46 ± 1 years and patients had stage I–II hypertension (blood pressure: 145 ± 1/98 ± 0.5 mm Hg). For analysis, patients were divided into 2 groups: those with body mass index (BMI) <27 kg/m2 (lean, n = 72) or BMI >27 kg/m2 (overweight, n = 70). Results: By univariate analysis, LVM in lean patients correlated significantly with plasma renin activity (PRA), plasma aldosterone, BMI and systolic BP; but with multivariate regression, only PRA (p < 0.01) and BMI (p < 0.04) remained in the model as independent predictors of LVM. For LVM in overweight patients, only BMI (p < 0.02) remained in the model. For total arterial compliance (stroke volume/pulse pressure) only fasting plasma insulin (in the overweight group) was significantly related (p < 0.01). For urinary protein excretion, the only predictor in lean patients was PRA (p < 0.02), whereas in overweight patients it was BMI (p < 0.03). For creatinine clearance, BMI (p < 0.01 in overweight patients) remained in the model, though by univariate regression PRA had an age-dependent dichotomous relationship to clearance: r = +0.25 (p < 0.01) in patients <55 years, but r = –0.54 (p < 0.01) in patients ≥55 years. Conclusion: These findings suggest that in overweight patients cardiovascular and renal values depend chiefly on body weight and insulin, but that in normal weight hypertensives the renin-angiotensin system may play the major role.
Simvastatin-Induced Rhabdomyolysis in a Patient with Chronic Renal Failure
Authors: Al Shohaib Saad
Published: April 2003

Simvastatin belongs to a class of lipid-lowering drugs which completely inhibit 3-hydroxy-3-methylglutaryl co-enzyme A (HMG CoA) reductase. The commonest adverse effects of therapy with simvastatin HMG CoA reductase inhibitors are gastro-intestinal disturbance, myositis and myopathy. Rhabdomyolysis leading to renal failure has been reported, but it appears to be very rare, except in patients also receiving cyclosporin, nicotinic acid or gemfibrozil. Here we report the case of an elderly lady who was known to have chronic renal failure, but who developed rhabdomyolysis following simvastatin therapy. Her symptoms of muscle pain, fatigue, myoglobulinuria, oliguria and pulmonary oedema appeared 48 h after the first dose of simvastatin. Simvastatin was immediately stopped, and the patient was dialysed for 1 week. Her renal function improved and came back. We suggest that extreme care should be exercised in prescribing this drug, particularly for the elderly with renal impairment.
Developmental Change in Na,K-ATPase α1 and β1 Expression in Normal and Hypothyroid Rat Renal Cortex
Authors: Nakhoul Farid , Thompson Curtis B. , McDonough Alicia A.
Published: April 2003

Renal Na,K-ATPase drives active reabsorption of sodium and cotransported solutes along the nephron. There is a large increase in net Na+ reabsorption in the postnatal rat kidney. It has previously been established that the postnatal increase in expression of sodium pump isoforms in the brain, but not the heart, is blunted in the hypothyroid neonate. The aims of this study were to establish whether the developmental increase in renal sodium transport is associated with coordinate increases in the abundance of the sodium pump α1 catalytic and β1 glycoprotein subunits and Na,K-ATPase activity, and to determine whether thyroid status influences the postnatal increase in renal Na,K-ATPase expression. Pregnant rats were made hypothyroid with low iodine diet, propylthiouracil and perchlorate. Offspring were hypothyroid assessed by triiodothyronine/thyroxine RIA. Renal cortical membranes were prepared from euthyroid and hypothyroid rats from 6 to 24 days of age. There was no change in Na,K-ATPase activity or expression between 6 and 15 days. Between 15 and 24 days, Na,K-ATPase activity increased 1.35-fold while sodium pump α1 and β1 subunit abundance increased coordinately to 1.7- and 2-fold over the previous period, respectively. In hypothyroid neonates, kidney weight was less than in euthyroids, and Na,K-ATPase activity, α1 and β1 subunit pool sizes did not significantly increase as a function of age between 6 and 24 days. We conclude that the postnatal increase in sodium pump activity can be accounted for by coordinate increases in the pool sizes of α1 and β1 subunits and that, like in brain, this increased Na,K-ATPase expression is dependent on normal thyroid status.
Diagnosis and Treatment of Tuberculosis in Hemodialysis and Renal Transplant Patients
Authors: Vachharajani Tushar , Abreo Kenneth , Phadke Ajit , Oza Umesh , Kirpalani Ashok
Published: April 2003

Background: The incidence of Mycobacterium tuberculosis in hemodialysis (HD) and renal transplant (RT) patients in developing countries is high. With the resurgence of tuberculosis in the US, insights gained in the diagnosis and treatment of this infection in HD and RT patients in developing countries should be valuable to physicians in the West. Methods: A retrospective study of 40 cases of tuberculosis, 24 in HD patients (24/177, 13.6%) and 16 in RT patients (16/109, 14.7%) diagnosed over a period of 21 months in one center. Results: The clinical features, diagnostic procedures, and management dilemmas of this group of patients are described in this report. Diabetes mellitus was the most common associated disease in both groups of patients. Fever, the most common presenting sign, was persistent low grade in 66.6% of HD patients and high intermittent in 56.2% of RT patients. Fever of unknown origin was only seen in RT patients. Pulmonary involvement was most common in both groups, presenting either as infiltrates or effusions. Tuberculous peritonitis was seen only in HD patients (33.3%). Eight HD patients were treated for tuberculosis for variable periods prior to transplantation, 4 of whom had less than 6 months of therapy. None had a recurrence of tuberculosis after transplantation. Because of the known cyclosporin-lowering effect of rifampicin resulting in an increased cost of immunosuppressive therapy, 13 patients were treated successfully with rifampicin-sparing therapy. Conclusion: Tuberculosis should be included in the differential diagnosis of fever in HD and RT patients, especially if fever is of unknown origin in the RT patient. M. tuberculosis in the renal transplant patient can present with high intermittent fever. Partial treatment of tuberculosis is sufficient prior to renal transplantation but treatment should be continued to completion after transplantation. If the cost of immunosuppressive therapy is prohibitive because of rifampicin, rifampicin-sparing antituberculosis therapy can be successfully employed in RT patients.
Renal Magnesium Wasting, Hypomagnesemic Hypocalcemia, Hypocalciuria and Osteopenia in a Patient with Glycogenosis Type II
Authors: Oktenli Cagatay
Published: April 2003

We describe a patient with late-onset glycogenosis type II with renal magnesium wasting, hypomagnesemic hypocalcemia, hypocalciuria and osteopenia. He was admitted to our hospital for evaluation of lower limb weakness and mild deterioration of liver function. Serum magnesium and calcium were low with low-to-normal levels of PTH in the patient. Echocardiogram revealed marked concentric hypertrophy of the left ventricle. An X-ray film of his spine showed a thoracic (Th12) vertebral compression fracture. Bone mineral density of the lumbar spine L2-L4 showed a reduced value. Kidney, liver and muscle biopsies were performed. These were found to have histologic features consistent with glycogenosis type II. In addition, accumulation of PAS-positive material in the cytoplasmic vacuoles of the tubular epithelium was present only in the distal tubules. An oral magnesium supplement was useful in helping to correct the hypomagnesemia, despite the presence of renal magnesium wasting in our patient. Magnesium supplement was also sufficient to maintain normal serum calcium concentrations. However, the hypocalciuria persisted in our patient despite correction of hypomagnesemia. In conclusion, the consistent association between the glycogen accumulation in distal tubules, renal magnesium wasting, hypomagnesemic hypocalcemia and hypocalciuria, in the absence of other identifiable reasons, suggests a cause-and-result relationship. Also, the combination of renal magnesium wasting, hypomagnesemia and hypocalciuria is a picture similar to that of Gitelman's syndrome in our patient. The glycogen accumulation in distal tubules may cause renal magnesium wasting and hypocalciuria through tubular injury. Therefore, we may speculate that the present case has glycogenosis type II-associated Gitelman's-like syndrome.
Jungs Selbst-Begriff unter dem Aspekt der Dialektik von Ich-Selbst
Authors: Ruf Inge
Published: April 2003

Leider besteht für diesen Artikel keine Zusammenfassung. Als Einstieg stellen wir den Textanfang zur Verfügung.Vom dialektischen Denken sagen Horkheimer und Adorno [1971, p. 17], dass darin ‘jedes stets nur ist, was es ist, indem es zu dem wird, was es nicht ist’. Im Zentrum dieser Arbeit steht die Dialektik von Ich-Selbst, das dialektische im Widerspruch Zusammengespanntsein von Ich und Selbst als Einheit im Widerspruch. Ich-Selbst in seiner Dialektik verstanden ist Ausdruck des Selbst-Widerspruch-Seins des Menschen im Hier und Jetzt. Und es ist Ausdruck des Selbst-Widerspruchs der Seele als Seele und Geist. Es geht mir darum, die Beziehung zwischen Ich und Selbst nicht als einen linearen Individuationsprozess zu verstehen, der als Prozess der Ganzwerdung linear auf ein Ziel hinstrebt, sondern die Selbst-Ich/Ich-Selbst-Beziehung zu begreifen als dialektische Bewegung; als Bewegung, wo aus der autonomen seelischen Aktivität heraus sowohl Ich als auch Selbst je aktuell sich wandeln in Auseinandersetzung mit der inneren sowie mit der äusseren Welt. Mit Hegel gesprochen ist damit der einzig mögliche Ausweg aus der Gegensatzproblematik gefunden, der schöpferische Ausweg ‘Werden’ [Hegel, 1990, p. 16].
Das Selbst und das Absurde: Chandler, Camus, Kafka und Jungs Selbst-Konzept
Authors: Knoll Dieter
Published: April 2003

Leider besteht für diesen Artikel keine Zusammenfassung. Als Einstieg stellen wir den Textanfang zur Verfügung.Je mehr ich mich mit der Gegenüberstellung von Selbst und Absurdem beschäftigte, desto stärker wurde die Sehnsucht nach einer Kraft, die ich schliesslich als Liebe identifizierte. Das Absurde evozierte den anderen Pol, von dem Hölderlin sagt: ‘Die Liebe weiss nichts vom Tod’ (Zitat aus dem Film ‘Feuerreiter’). Ach hätte ich mich doch lieber mit ihr beschäftigt! Und doch kam ich zu ihr über die Begegnung mit dem Absurden. Ich stelle Entwürfe des Absurden oder des Nichts der Konzeption und Erfahrung des Selbst gegenüber und fokussiere neben Jung auf so unterschiedliche Autoren wie Chandler, Camus (hier besonders ‘Die Pest’ und ‘Der Mythos von Sisyphos’) und Kafka (vor allem ‘Das Schloss’). Mit einem Zitat von Raymond Chandler gehe ich zunächst mitten ins absurde Erleben der Welt. Ich erlaube mir mit Chandler auch einen Ausflug in die Trivialliteratur, die uns – wie auch das populäre Kino – Lehrmeister sein kann, was archetypische Wirkfelder heute ausmacht.
Die Transzendentalität im Begriff des Selbst: Überlegungen zum ‘Interpersonalen Selbst’ in der analytischen Psychologie
Authors: Emrich H.M.
Published: April 2003

Leider besteht für diesen Artikel keine Zusammenfassung. Als Einstieg stellen wir den Textanfang zur Verfügung.Wie weit ist das Ich ein Konstrukt, eine Konstruktion des Selbst, also im Grunde eine Selbstillusion? Dies ist eine Frage, die der gegenwärtige Neuro- Konstruktivismus uns stellt. Wenn das so wäre, dann wüssten wir gerne mehr über die Konstitution des Selbst. Über uns etwas wissen, über unsere Ichlichkeiten, hiesse dann, etwas mehr über unser Selbst zu erfahren. Andererseits geht es um die Frage nach der Möglichkeit der Verdinglichung, der Konkretisierung des Selbst in der Metapsychologie C.G. Jungs: Ist sie möglich? Ist sie legitim? Wir versuchen, uns diesem Thema zu nähern vom Standpunkt der Philosophie, der Metapsychologie und schliesslich der Interpersonal-Theorie.
Überlegungen zur weiblichen Homosexualität
Authors: Springer Anne
Published: April 2003

//8RÜber die Jahre hinweg gab es unter meinen Patientinnen immer wieder in ihrer Partnerwahl homosexuell orientierte Frauen. Die späteren Patientinnen machten von ihrer Homosexualität Mitteilung im Erstinterview, und immer schwang die ängstlich-aggressive Frage mit oder wurde offen gestellt, ob ich eine Analytikerin sei, die sie zur «Heterofrau» umerziehen wolle. Ich glaubte, dies verneinen zu können und bestand auf meinen üblichen Auswahlkriterien: Einschätzung der prospektiven Möglichkeiten bei möglichst weitgehender grundsätzlicher Akzeptanz des vom Patienten gewählten Lebensweges und persönliche Sympathie. Ich ging davon aus, dass zweifellos in mir vorhandene Wertungen in Bezug auf die weibliche Homosexualität durch Selbstreflexion bearbeitbar seien und spürte gegenüber der sexuellen Innen- und Aussenwelt dieser Patientinnen zu Beginn der Analyse ein sympathisierendes Interesse.
Der hilfreiche Dritte im Drachenkampf: ein Versuch über den hinreichend guten Vater
Authors: Huber Roland
Published: April 2003

//8RIch beginne meine Überlegungen mit einer doppelten Anleihe: bei Janine Chasseguet-Smirgel und bei Thomas Mann. Ihrem Sammelband «Zur psychischen Bedeutung der Vater- und Mutterbilder» (Untertitel) stellt die französische Psychoanalytikerin ein Sprachbild von Thomas Mann über einen östlichen Mythos voran. Es handelt sich um das mythische Bild von den zwei Bäumen im Garten [T. Mann: Die Bäume im Garten, 1930; zitiert nach Chasseguet-Smirgel, 1988]:
The Postnatal Growth of Cochlear Nucleus Subdivisions and Neuronal Somata of the Anteroventral Cochlear Nucleus in the Mongolian Gerbil (Meriones unguiculatus)
Authors: Gleich Otto , Kadow Celia , Strutz Jürgen
Published: April 2003

We have analysed the postnatal volume increase of the cochlear nucleus subdivisions from birth to senescence in the Mongolian gerbil. All subdivisions showed the most prominent growth in the 2nd week of life before the onset of hearing on day 12. After the onset of hearing, the dorsal and the postero-ventral portion of the cochlear nucleus showed only a moderate degree of further growth. The antero-ventral cochlear nucleus, however, almost doubled in volume after the onset of hearing, reaching a maximum in 4-month-old animals. In ageing gerbils, we observed a small but systematic reduction of the cochlear nucleus volume. To further assess which elements contribute to the growth of the antero-ventral cochlear nucleus after the onset of hearing, we analysed the somal size of the neurones. Before the onset of hearing, somal and volume growth were highly correlated. However, somata had reached an adult size by the onset of hearing. We conclude that the growth of the antero-ventral cochlear nucleus after the onset of hearing is due to changes in the neuropil.
Subdivisions of AuditoryCortex and Levels of Processing in Primates
Authors: Kaas Jon H. , Hackett Troy A.
Published: April 2003

In a series of experiments on New World and Old World monkeys, architectonic features of auditory cortex were related to tone frequency maps and patterns of connections to generate and evaluate theories of cortical organization. The results suggest that cortical processing of auditory information involves a number of functionally distinct fields that can be broadly grouped into four or more levels of processing. At the first level, there are three primary-like areas, each with a discrete pattern of tonotopic organization, koniocortical histological features, and direct inputs from the ventral division of the medial geniculate complex. These three core areas are interconnected and project to a narrow surrounding belt of perhaps seven areas which receive thalamic input from the major divisions of the medial geniculate complex, the suprageniculate/limitans complex, and the medial pulvinar. The belt areas connect with a lateral parabelt region of two or more fields that are almost devoid of direct connections with the core and the ventral division of the medial geniculate complex. The parabelt fields connect with more distant cortex in the superior temporal gyrus, superior temporal sulcus, and prefrontal cortex. The results indicate that auditory processing involves 15 or more cortical areas, each of which is interconnected with a number of other fields, especially adjoining fields of the same level.
Degeneration of Spiral Ganglion Cells in the Chinchilla afterInner H air Cell Loss Induced by Carboplatin
Authors: Takeno Sachio , Wake Mark , Mount Richard J. , Harrison Robert V.
Published: April 2003

The anticancer drug carboplatin has been used to generate inner hair cell (IHC) lesions in the cochlea of chinchillas. This has provided a valuable model for the study of the relative roles of IHCs and outer hair cells (OHCs). In the present study, we examined the pathological and temporal relationships between the degeneration of the cochlear IHCs and type I spiral ganglion cells (SGCs). A single intravenous dose of 200 mg/m2 carboplatin produced extensive IHC loss with no apparent effect on the OHCs. The auditory brainstem response threshold was significantly elevated by 2 weeks following treatment and remained stable through 12 weeks. Elevated thresholds were well correlated with morphological lesions. On the other hand, the SGC population progressively decreased from 2 to 12 weeks after treatment, to about half of the control density values. A positive correlation existed between the density of SGC and the number of surviving IHCs. These results indicate that selective damage to IHCs causes a distinct loss of SGCs.
Effect of Temperature on the Transient Evoked and Distortion Product Otoacoustic Emissions in Rats
Authors: Khvoles Roza , Freeman Sharon , Sohmer Haim
Published: April 2003

In order to study the energy dependence of the cochlear amplifier, transient evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) were recorded in rats during gradual cooling to 27°C and heating to 40°C. In the range 33–39°C, the TEOAEs and DPOAEs were maximal in amplitude and almost insensitive to temperature. However, they were significantly depressed (reversibly) at higher and lower temperatures. Intensity functions were plotted at 37, 27 and 40°C for both types of oto-acoustic emissions. At 37°C intensity functions were nonlinear, with a notch at mid-intensity regions. At 27°C, the magnitudes were depressed more at the lower intensities and threshold elevations were observed. As a result, the intensity functions were more linear and the notch was no longer seen. This result provides further evidence for a more active, energy-dependent component of the otoacoustic emissions at lower intensities for both TEOAEs and DPOAEs. The cooling probably affects the lower intensity otoacoustic emissions by inducing a depression in the endocochlear potential, by reducing the motility of the outer hair cells and by introducing a small conductive hearing loss.
The Effects of Amplitude Modulation on Acoustic Reflex Decay
Authors: Cook Raymond D. , Ferguson Michael O. , Hall III Joseph W. , Grose John H. , Pillsbury III Harold C.
Published: April 2003

The temporal decay of the acoustic reflex provides the basis for an objective audiological test that differentiates cochlear from retrocochlear pathologies. The classic sign of a neural lesion is a rapid decay of the reflex under conditions of pure-tone stimulation for frequencies of 1,000 Hz and below. This restriction to lower frequencies is due to the fact that even normal ears show decay for higher-frequency signals. At present, it is unclear whether the acoustic reflex decay (ARD) seen in normal ears is related to frequency-specific channels or whether the critical variable is the timing information coded within the channels. This study examined ARD in subjects with normal hearing and middle ear function. The degree of ARD was measured for both modulated and unmodulated carrier frequencies of 500, 1,000, 2,000 and 4,000 Hz with amplitude modulation rates of 50–400 Hz. The dependent variable was the half-life of the decaying reflex (ARD 50%) over a 20-second stimulation interval. Significant ARD was present for high-frequency unmodulated carriers but not for low-frequency carriers. For all listeners, ARD was diminished for all modulated stimuli. The results of this study suggest that resistance to ARD is mediated by both the temporal aspects and frequency of a stimulus.
Effect of Long-Term Noise Exposure on the Developing and Developed Ear in the Rat
Authors: Freeman Sharon , Khvoles Roza , Cherny Lily , Sohmer Haim
Published: April 2003

There have been reports that the developing ear is more sensitive than the adult ear to noise-induced hearing loss. This was investigated by testing auditory function in rats, both electrophysiologically and histologically, following exposure to broad-band noise (12 h/day for 15 days) at different stages of auditory development (neonates and adults), and also in age-matched controls. An exposure of 90 dB SPL broad-band noise caused no long-term change in auditory function in either age group. A higher exposure (102 dB SPL) caused greater long-term changes in hearing in the adult compared to the young noise-exposed rats, although histology showed greater damage to hair cells in the younger animals. Therefore, functionally, the developing ear does not seem more vulnerable than the developed ear to acoustic trauma.
Targeted Deletion of the Cytosolic Cu/Zn-Superoxide Dismutase Gene (Sod1) Increases Susceptibility to Noise-Induced Hearing Loss
Authors: Ohlemiller Kevin K. , McFadden Sandra L. , Ding Da-Lian , Flood Dorothy G. , Reaume Andrew G. , Hoffman Eric K. , Scott Richard W. , Wright James S. , Putcha Girish V. , Salvi Richard J.
Published: April 2003

Reactive oxygen species (ROS) such as superoxide, peroxide and hydroxyl radicals are generated during normal cellular metabolism and are increased in acute injury and in many chronic disease states. When their production is inadequately regulated, ROS accumulate and irreversibly damage cell components, causing impaired cellular function and death. Antioxidant enzymes such as superoxide dismutase (SOD) play a vital role in minimizing ROS levels and ROS-mediated damage. The cytosolic form of Cu/Zn-SOD appears specialized to remove superoxide produced as a result of injury. ‘Knockout’ mice with targeted deletion of Sod1, the gene that codes for Cu/Zn-SOD, develop normally but show enhanced susceptibility to central nervous system injury. Since loud noise is injurious to the cochlea and is associated with elevated cochlear ROS, we hypothesized that Sod1 knockout mice would be more susceptible to noise-induced permanent threshold shifts (PTS) than wild-type and heterozygous control mice. Fifty-nine mice (15 knockout, 29 heterozygous and 15 wild type for Sod1) were exposed to broad-band noise (4.0–45.0 kHz) at 110 dB SPL for 1 h. Hearing sensitivity was evaluated at 5, 10, 20 and 40 kHz using auditory brainstem responses before exposure and 1, 14 and 28 days afterward. Cu/Zn-SOD deficiency led to minor (0–7 dB) threshold elevations prior to noise exposure, and about 10 dB of additional noise-induced PTS at all test frequencies, compared to controls. The distribution of thresholds at 10 and 20 kHz at 28 days following exposure contained three modes, each showing an effect of Cu/Zn-SOD deficiency. Thus another factor, possibly an additional unlinked gene, may account for the majority of the observed PTS. Our results indicate that genes involved in ROS regulation can impact the vulnerability of the cochlea to noise-induced hearing loss.
Probe-Tube Microphone Measures in Patients with Open-Mastoid Surgery: Real-Ear-to-Coupler Differences and Real-Ear Unaided Responses
Authors: Liu Tien-Chen , Lin Kai-Nan
Published: April 2003

Real-ear-to-coupler differences (RECDs) and real-ear unaided responses (REURs) were measured using a probe-tube microphone system in 15 patients who underwent open mastoid surgery. The results show that RECDs are significantly smaller at higher frequencies (1.5, 2.0, 3.0, 4.0 and 6.0 kHz) in mastoid ears. The intrasubject variability of RECDs measures in these patients is on average 2.6 dB larger than for controls. For REURs, mastoid surgery significantly reduced the mean peak resonant frequency without affecting the amplitude and bandwidth. In operated ears, mean resonant frequency is by a factor of 1.4 lower than that for normal ears. Reduced responses (negative gains) at frequencies above the resonance peak occurred in 7 out of the 15 patients. These reduced responses corresponded to the smaller RECD at the middle and high frequencies. The results support the need for individual RECD measures to be made in operated ears instead of using average values from normal subjects. Otherwise, real-ear measures of the aided response should be made for each patient with open-mastoid cavity and the fitting should be done in terms of the target response at the eardrum rather than by defining a target insertion gain.
D-Methionine Attenuates Inner Hair Cell Loss in Carboplatin-Treated Chinchillas
Authors: Lockwood D.S. , Ding D.L. , Wang J. , Salvi R.J.
Published: April 2003

Carboplatin, a second-generation platinum-based antineoplastic drug, preferentially destroys inner hair cells (IHCs) in the chinchilla while sparing outer hair cells (OHCs). D-Methionine (D-Met), a sulfur-containing amino acid, has been shown to protect hair cells from cisplatin damage in rats, but its ability to protect IHCs from carboplatin damage has not yet been evaluated in the chinchilla. We tested whether D-Met would protect the hair cells in the chinchilla from carboplatin. Animals were divided into two groups: a control group that only received carboplatin (100 mg/kg, i.p.) and an experimental group that received 300 mg/kg D-Met (i.p.) 30 min before carboplatin treatment. Ototoxicity was assessed by measuring the amount of IHC and OHC loss. Average IHC loss in the group treated with D-Met was 62% compared with 84% in the untreated control group. Thus, D-Met causes a statistically significant reduction in IHC loss induced by carboplatin.
Electrocochleography Potentials Evoked by Condensation and Rarefaction Clicks Independently Derived by a New Numerical Filtering Approach
Authors: Sparacino Giovanni , Milani Stefano , Magnavita Vincenzo , Arslan Edoardo
Published: April 2003

The cochlear microphonic potential (CM) and the compound action potential (CAP) cannot be measured separately but only in combination. In the literature their individual estimates are conventionally recovered by the so-called CM cancellation technique. This method averages the potential obtained in response to rarefaction and condensation clicks under the assumption that changing the polarity of the clicks only affects the CM sign and does not alter the CAP in any way. However, both theory and evidence suggest that these hypotheses can be critical. In addition, recent contributions in the electrocochleography (ECochG) literature suggested that assessing the influence of stimulus polarity on the evoked CAP may constitute an indicator of clinical usefulness which the CM cancellation method cannot supply. In this work we propose a new algorithm to estimate the cochlear potentials evoked from positive clicks, CAP+ and CM+, and those evoked from negative clicks, CAP– and CM–, by processing the same kind and amount of data employed in the CM cancellation method. The application to real data taken from 3 subjects exhibiting quantitatively and qualitatively different ECochG responses at various levels of stimulation intensity is presented. In addition, simulated problems where the true CAP and CM are known are studied to permit a fair assessment of the proposed technique. Results suggest that the new algorithm is potentially able to point out small differences between CAP+ and CAP–. This encourages its further employment on a larger scale.