bluuebunny/crossref_metadata_2025 huggingface dataset:
A Rapidly Progressive Cataract in a Patient with Autoimmune Hypoparathyroidism and Acute Liver and Renal Failure
Authors: Haviv Yosef S. , Safadi Rifaat , Zamir Ehud
Published: April 2003

Cataract is a well-known complication of hypoparathyroidism, albeit the mechanism is obscure. The progression of cataract is typically slow in patients with idiopathic hypoparathyroidism. We describe a case of an extremely rapid evolution of typical hypocalcemic cataracts in a patient with familial autoimmune hypoparathyroidism during acute idiopathic hepatic and renal failure, while serum calcium and phosphorus were unbalanced. Physicians and ophthalmologists must be aware of cataracts developing rapidly in the setting of such metabolic derangements.
Improvement of Myocardial Fatty Acid Metabolism through L-Carnitine Administration to Chronic Hemodialysis Patients
Authors: Sakurabayashi Tai , Takaesu Yoshiji , Haginoshita Susumu , Takeda Tetsurou , Aoike Ikuo , Miyazaki Shigeru , Koda Yutaka , Yuasa Yasuko , Sakai Shinji , Suzuki Masashi , Takahashi Sachio , Hirasawa Yoshihei , Nakamura Takamichi
Published: April 2003

The concentration of carnitine, which is essential to fatty acid metabolism, can decrease markedly in patients on long-term hemodialysis coincident with life-threatening cardiac damage. However, administration of L-carnitine improves the myocardial function of these patients. To evaluate the underlying events of this phenomenon, we used recently developed technology, 123I-labeled β-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) myocardial scintigraphy, as a test of myocardial fatty acid metabolism. Our results showed that the free carnitine concentration (19.2 ± 6.5 μmol/l) was lower in 11 chronically dialyzed patients than in 8 healthy controls (49.3 ± 7.7 μmol/l, p < 0.0001). Additionally the heart to mediastinal ratio (H/M) of BMIPP was higher for these patients than for the controls (1.91 ± 0.19 vs. 1.52 ± 0.24, p < 0.005), and the patients’ washout rate (WOR) of BMIPP was lower (17.2 ± 6.0 vs. 22.8 ± 4.2%, p < 0.05). After L-carnitine was administered orally to the patients at doses of 1 g/day for 1 month and 0.5 g/day for the following month, the concentration of free carnitine in their sera increased to 85.4 ± 27.0 μmol/l (p < 0.0001). Although the H/M ratio did not change (1.89 ± 0.20) with this treatment, their WOR increased to 21.9 ± 6.6% (p < 0.001), similar to that of controls. The left ventricular end-diastolic dimension and left ventricular fractional shortening remained unchanged, as shown by echocardiography. The results presented here denote that a carnitine deficiency in chronically hemodialyzed patients disrupts their myocardial fatty acid metabolism, which is improved by L-carnitine supplementation.
Dialysis-Associated Renal Cystic Disease Resembling Autosomal Dominant Polycystic Kidney Disease: A Report of Two Cases
Authors: Bakir Asad A. , Hasnain Mohammed , Young Stephanie , Dunea George
Published: April 2003

Acquired renal cystic disease is common in patients receiving dialysis. Characteristically, the kidneys are small or, less often, normal in size, and the cysts are usually less than 0.6 cm in diameter. We present here 2 patients who, after 5 and 7 years on hemodialysis, developed marked renal enlargement, with large cysts in the kidneys and, in 1 patient, in the liver as well; the appearance on ultrasonography and computed tomography was indistinguishable from autosomal dominant polycystic kidney disease. Before starting dialysis the first patient was a 19-year-old man who developed renal shutdown from crescentic glomerulonephritis, and the second patient was a 33-year-old man who developed end-stage renal failure from malignant hypertension. Neither patient had renal cysts at the onset of end-stage renal failure.
Staphylococcus lugdunensis Pulmonary Valve Endocarditis in a Patient on Chronic Hemodialysis
Authors: Kamaraju Sailaja , Nelson Karin , Williams David N. , Ayenew Woubeshet , Modi Kulwant Singh
Published: April 2003

We describe a case of Staphylococcus lugdunensis pulmonary valve endocarditis in a 65-year-old woman on chronic hemodialysis and provide a review of previously reported cases. The patient presented with fever and altered mental status, but had no other localizing symptoms or signs; coagulase-negative staphylococcus (subsequently identified as S. lugdunensis) was isolated from two sets of blood cultures. Transthoracic and transesophageal echocardiograms showed a large (2.3 × 3.1 cm) vegetation on the pulmonary valve with moderate valvular insufficiency. The patient was treated with 6 weeks of antibiotic therapy and is stable 4 months following the completion of therapy; no surgical intervention was performed. Of the 28 previously reported cases of S. lugdunensis endocarditis, only 1 had previously survived with medical therapy alone. This is the 3rd case report of S. lugdunensis endocarditis in a patient on hemodialysis; the presumed portal of entry in this and previously reported cases was the vascular access device. Endocarditis due to this organism is characterized by a high mortality, rapid tissue destruction, and a predilection for native valves. Because the clinical outcome is much more favorable with valvular replacement, speciation of the organism assumes great importance in defining the therapeutic approach.
Outcome of an Opportunistic Infection after Polymicrobial Peritonitis in an HIV-Infected Patient Treated with Peritoneal Dialysis
Authors: Varela Maria P. , Lew Susie Q. , Smith Amy M. , Whyte Rachel L. , Bosch Juan P.
Published: April 2003

The prevalence of human immuodeficiency virus (HIV)-infected patients with end stage renal disease (ESRD) is likely to increase and many of them will be on peritoneal dialysis as renal replacement therapy. Infectious complications are a major problem associated with peritoneal dialysis (PD). It has been speculated that the HIV-positive peritoneal dialysis population may develop peritonitis more frequently than other peritoneal dialysis patients. We present the complications and unexpected good response to medical management of PD-associated peritonitis in a young HIV-infected black male. He had two unusual and serious infections; the first was a polymicrobial peritonitis which predisposed the patient to an unusual infection caused by Corynebacteria JK for which he was successfully treated without catheter removal.
Morphologic Abnormalities in the Brain of Chronically Hemodialyzed Patients without Cerebrovascular Disease
Authors: Kamata Tadashi , Hishida Akira , Takita Takako , Sawada Kei , Ikegaya Naoki , Maruyama Yukitaka , Miyajima Hiroaki , Kaneko Eizo
Published: April 2003

In this study, the authors evaluated the cerebral atrophy in 56 chronic hemodialyzed patients, who did not have clinical episodes or radiologic findings of cerebrovascular diseases, and 42 controls. Using computed tomography (CT) images, brain atrophy index (BAI), the proportion of subarachnoidal plus ventricular space in the cranial cavity, and ventricular area index (VAI), percent area of ventricle in the brain, were calculated. CT of the brain demonstrated an age-dependent increase in BAI in both hemodialyzed patients and controls. BAI and VAI were greater in hemodialyzed patients than healthy controls and the difference was significant at ages under 60 years in BAI and at ages less than 50 years in VAI. The atrophy of the frontal parts of the brain in patients on hemodialysis for 10 years or more was significantly greater than in patients dialyzed for less than 10 years. There was a significant negative correlation between BAI or VAI and hematocrit. These findings indicate that renal failure or hemodialysis itself might cause cerebral atrophy, and that the cerebral atrophy is more prominent in patients on hemodialysis for a long duration and with low hematocrit.
Calcitriol Therapy Modulates the Cellular Immune Responses in Hemodialysis Patients
Authors: Tokuda Noriaki , Kano Motonori , Meiri Hiroyuki , Nomoto Kikuo , Naito Seiji
Published: April 2003

We studied the in vitro and in vivo effects of calcitriol (1,25D) on the cellular immune responses in 19 hemodialysis (HD) patients. In vitro 5-day treatment with 1,25D markedly reduced the HLA-DR expression by peripheral blood CD14+ monocytes from both HD patients and normal subjects in a similar fashion. The HLA-DR expression by monocytes and the phorbol myristate acetate (PMA)-induced superoxide production (SOP) by neutrophils were significantly higher in the HD patients than in the normal subjects (p < 0.01 and p < 0.05, respectively). The phagocytic activity in the HD patients was significantly lower than that in the normal subjects (p < 0.05). Moreover, the mitogen response of HD peripheral blood lymphocytes against pokeweed mitogen (PWM) was significantly lower than that of the controls (p < 0.01) but was only slightly and insignificantly lower against Con A. Oral 1,25D pulse therapy resulted in a marked decrease in the HLA-DR expression by peripheral blood monocytes 2 and 4 days after the first 1,25D administration (p < 0.01) in HD patients. Moreover, the treatment significantly enhanced the PMA-induced SOP 2 days after the treatment (p < 0.01). However, the phagocytic activity by neutrophils and the mitogen responses to Con A and PWM by lymphocytes were not significantly affected by this treatment. These results suggest that 1,25D plays a significant role in the regulation of both the monocyte and neutrophil functions in HD patients.
Systemic Inflammatory Response Syndrome and Acute Renal Failure Associated with Hemophilus influenzae Septic Meningitis
Authors: Nishimura Mitsutoshi , Tsukahara Hirokazu , Hiraoka Masahiro , Osaka Yoko , Ohshima Yusei , Tanizawa Akihiko , Mayumi Mitsufumi
Published: April 2003

Sepsis is often associated with a downward spiral through a spectrum of systemic inflammatory response syndrome (SIRS) culminating in organ failure and death. Here we present a 3-year-old girl with Hemophilus influenzae septic meningitis who developed SIRS and acute renal failure. In the initial stage, the patient showed uremia, cytopenia, disseminated intravascular coagulation, elevation of tissue enzyme and ferritin values, hemophagocytosis and overproduction of nitric oxide. The serum cytokine profile revealed increased levels of soluble interleukin (IL)-2 receptor, IL-6, IL-10 and tumor necrosis factor α. The patient responded positively to early and intensive interventions including antibiotics, repeated exchange transfusions, dexamethasone and high-dose γ-globulin. The above laboratory abnormalities almost normalized with clinical improvement. We consider that SIRS was probably responsible for the sequence of events resulting in renal failure in this case, and suggest that renal failure should be included among the serious complications of SIRS associated with Hemophilus influenzae septic meningitis.
Renal Pseudotumor Simulating Malignancy in a Patient with Adamantiades-Behçet’s Disease
Authors: Aessopos Athanassios , Alatzoglou Kyriaki , Korovesis Konstantinos , Tassiopoulos Stergios , Lefakis Georgios , Ismailou-Parassi Aikaterini
Published: April 2003

Adamantiades-Behçet’s disease is a multisystem recurrent syndrome with vasculitis being the underlying histopathological lesion. We report on a patient with Behçet’s disease who developed a renal mass raising the suspicion of a malignant neoplasm. The pathologic examination revealed an inflammatory pseudotumor. The concurrent presentation of these two entities seems to be more than coincidental.
Cytomegalovirus-Induced Tubulointerstitial Nephritis in a Renal Allograft Treated by Foscarnet Therapy
Authors: Wong Kim Ming , Chan Yiu Han , Chan Siu Kwong , Mak Chun Kei , Chau Ka Foon , Li Chun Sang
Published: April 2003

We report a female patient suffering from cytomegalovirus (CMV)-induced tubulointerstitial nephritis in a renal allograft 70 days after a cadaveric renal transplantation. CMV-induced renal allograft injury reported in the literature mainly related to immune-mediated mechanisms. In our patient, acute tubulointerstitial nephritis, associated with histological evidence of CMV infection, was demonstrated in the renal allograft biopsy. There were no histological features of allograft rejection, cyclosporin nephrotoxicity nor ‘CMV glomerulopathy’. She was successfully treated by foscarnet therapy and a reduction in immunosuppression. Her renal function returned to baseline afterwards.
Distinct Expression of CCR1 and CCR5 in Glomerular and Interstitial Lesions of Human Glomerular Diseases
Authors: Furuichi Kengo , Wada Takashi , Sakai Norihiko , Iwata Yasunori , Yoshimoto Keiichi , Shimizu Miho , Kobayashi Ken-ichi , Takasawa Kazuya , Kida Hiroshi , Takeda Shin-ichi , Mukaida Naofumi , Matsushima Kouji , Yokoyama Hitoshi
Published: April 2003

We investigated the presence of CCR1- and CCR5-positive cells immunohistochemically in the kidneys of 38 patients with several renal diseases, including 13 crescentic glomerulonephritis patients. In addition, we determined cell phenotypes of CCR1- and CCR5-positive cells using a dual immunostaining technique. Urinary levels of their ligands, for CCR1 and CCR5; macrophage inflammatory protein (MIP)-1α, MIP-1β and regulated upon activation in normal T cells expressed and secreted (RANTES) were evaluated by enzyme-linked immunosorbent assay. CCR1- and CCR5-positive cells were detected in both glomeruli and interstitium of the diseased kidneys. Using a dual immunostaining technique, these positive cells were CD68-positive macrophages (MΦ) and CD3-positive T cells. The number of CCR1-positive cells in glomeruli was correlated with urinary levels of MIP-1α. The number of CCR1-positive cells in the interstitium was correlated with both urinary MIP-1α and RANTES levels. CCR1-positive cells in the interstitium remained after glucocorticoid therapy, most of which were MΦ, and were correlated with the intensity of interstitial fibrosis and tubular atrophy. Glomerular CCR5-positive cells were well correlated with extracapillary lesions and urinary MIP-1α levels, while interstitial CCR5-positive cells, mainly CD3-positive T cells, were correlated with interstitial lesions and urinary RANTES levels. Renal CCR5-positive cells were dramatically decreased during convalescence induced by glucocorticoids. These results suggest that chemokine receptor signaling may be pivotal for human renal diseases through the recruitment and activation of MΦ and T cells; CCR5-positive cells may participate in glomerular lesions including extracapillary lesions via MIP-1α and in interstitial lesions via RANTES. CCR1 may be involved in interstitial lesions in resolving phase after glucocorticoid therapy.
Secondary Polycythemia Associated with Idiopathic Membranous Nephropathy
Authors: Lim Chun Soo , Jung Kyung Hae , Kim Yon Su , Ahn Curie , Han Jin Suk , Kim Suhnggwon , Lee Jung Sang
Published: April 2003

A 58-year-old male patient had secondary polycythemia associated with idiopathic nephrotic syndrome. The renal biopsy revealed membranous nephropathy, and the bone marrow biopsy disclosed hypercellular marrow with mild panhyperplasia. The concentration of serum erythropoietin was 8.5 mU/ml. The erythrocytosis was characterized by an increased red cell volume (40.2 ml/kg) and normal arterial oxygen saturation. There were no associated lesions that could induce secondary polycythemia, except the biopsy-proven membranous nephropathy. He was treated with prednisolone and cyclophosphamide, and the nephrotic syndrome was partially remitted after 6 weeks. With partial remission of nephrotic syndrome, the erythrocytosis was resolved. This case illustrates the rarely reported association of the nephrotic syndrome and erythrocytosis, and the resolution of erythrocytosis with improvement of nephrotic syndrome.
Effect of Vitamin-E-Modified Dialysers on Dialyser Clotting, Erythropoietin and Heparin Dosage: A Comparative Crossover Study
Authors: Huraib S. , Tanimu D. , Shaheen F. , Hejaili F. , Giles C. , Pagayon V.
Published: April 2003

We performed a crossover study to compare the effects of different dialysis membranes on 20 patients with frequent dialyser clotting and requiring >5,000 units of heparin per dialysis session. Low-flux dialysers are C15NL (cellulose - Terumo) and E15NL (vitamin-E-coated - Terumo) while high-flux dialysers were F60 (polysulphone) and EE15NL (vitamin-E-coated - Terumo). Ten patients underwent dialysis for 2 months with C15NL then switched to E15NL for 2 months. Similarly, the other 10 patients were started on the high-flux dialyser F60 and then switched over to EE15NL for 2 months. The following parameters were measured at the beginning of the study, 2 weeks, 1 month and then at 2 months: hemoglobin, prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, protein C, protein S, antithrombin III (ATIII) and factor 12 activity. Dialyser clotting, heparin and erythropoietin requirements were assessed during each dialysis session. There was a significant reduction in clotting with E15NL in comparison to C15NL (22.8 +/- 17 and 44.1 +/- 22.8 (p = 0.0233), respectively). Similarly, heparin requirements were less in the vitamin-E-coated (E15NL) dialysers, 4,754 +/- 1,427 vs. 6,011 +/- 856 units (p = 0.0281) and erythropoietin usage was also significantly reduced, 4,630 +/- 2,620 vs. 7,850 +/- 4,069 units (p = 0.049). There was a significant increase in hemoglobin with E15NL compared to C15NL, 115 +/- 10.4 vs. 108 +/- 13.1 (p = 0.0343). When the high-flux dialysers were compared there was a tendency towards less dialyser clotting with the EE15NL compared to F60, though this did not achieve statistical significance (p = 0.0561). We could not demonstrate any significant changes between the different dialysers with regards to PT, PTT, fibrinogen factor 12 activity, protein C, protein S and ATIII. In conclusion, we have shown that the use of vitamin-E-modified dialysers is associated with less clotting in patients with persistent clotting problems. In addition, this was associated with less heparin and erythropoietin requirements.
Complete Resorption of Massive Soft Tissue Calcification in a Hemodialysis Patient after Parathyroidectomy
Authors: Sabeel Abdalla , Al-Homrany Mohammed
Published: April 2003

Massive soft tissue calcification involving the abdomen of a dialysis patient is described. As the result of severe secondary hyperparathyroidism associated with intensive calcifications, the patient was disabled and confined to a wheelchair. Following parathyroidectomy, soft tissue calcifications resolved remarkably, symptoms were relieved and the patient was able to walk. Our patient presented an unusual site of soft tissue calcification in secondary hyperparathyroidism and showed an example of complete resorption of soft tissue calcification after parathyroidectomy.
The Acquisition of Grammatical and Lexical Structures in Children with Cochlear Implants: A Developmental Psycholinguistic Approach
Authors: Szagun Gisela
Published: April 2003

The acquisition of grammatical and lexical structures was studied in a sample of 10 young German-speaking children with cochlear implants (mean implantation age 2 years 3 months). Spontaneous speech samples were collected covering the first 18 months after first tune-up. At the end of this period, 8 children were able to produce two- or multi-word utterances. Furthermore, 8 children had acquired plural inflections on nouns, and 5 children had acquired a substantial portion of verb inflectional morphology. Children did less well acquiring case-marked articles, forms of the copula and modal verbs. Articles were acquired better when they functioned as pronouns. Children had good vocabularies (type/token ratios ≥0.25), and all but one child started language with a preference for content words as opposed to function words.
Maturation of the Mismatch Negativity: Effects of Profound Deafness and Cochlear Implant Use
Authors: Ponton C.W. , Eggermont J.J. , Don M. , Waring M.D. , Kwong B. , Cunningham J. , Trautwein P.
Published: April 2003

The use of cochlear implants to restore auditory sensation in deaf children is increasing, with a trend toward earlier implantation. However, little is known about how auditory deprivation and subsequent cochlear implant use affect the maturing human central auditory system. Our previous studies have demonstrated that the obligatory auditory evoked potentials (AEPs) of implanted children are very different from those of normal-hearing children. Unlike the obligatory potentials, which primarily reflect neural responses to stimulus onset, the mismatch negativity (MMN) provides a neurophysiological measure of auditory short-term memory and discrimination processes. The purpose of this investigation is to review our studies of the effects of auditory deprivation due to profound deafness and cochlear implant use on the maturation of the MMN in children, placed in the context of overall age-related changes in the AEPs. The development and application of a statistical technique to assess the MMN in individuals is also reviewed. Results show that although the morphology of the obligatory AEPs is substantially altered by the absence of a normal N1 peak, the MMN is robustly present in a group of implanted children who have good spoken language perception through their device. Differences exist in the scalp distribution of the MMN between implanted and normal-hearing children. Specifically, the MMN appears to be more symmetrical in amplitude over both hemispheres, whereas it is initially much larger over the contralateral hemisphere in normal-hearing children. These findings suggest that, compared to N1, the MMN is a better measure of basic auditory processes necessary for the development of spoken language perception skills in profoundly deaf children and adults who use a cochlear implant.
Renal Blood Flow Velocity in Preterm and Term Neonates during the Fourth Day of Life: Changes in Relation to Gestational Age and Birth Weight
Authors: Pezzati Marco , Danesi Giovanni , Pozzessere Anna , Biagioli Cosenza Elena , Rubaltelli Firmino F.
Published: April 2003

Measurements of renal artery blood flow velocity have been previously reported during prenatal life and during the first month of life in neonates. Since renal flow velocity increases during the first 3 days of postnatal age we determined, during the fourth day of life, the changes of renal blood flow velocity in relation to gestational age and birth weight in 109 healthy preterm and term infants with gestational age between 26 and 42 weeks and birth weight between 750 and 3,730 g. Renal arteries were insonated about 3 mm from the abdominal aorta, by placement of a microconvex 7-MHz transducer below the costal margin in the dorsolateral area of the right or left flank. Mean flow velocity significantly increased with advancing of gestational age and birth weight. This study provides normative data for renal artery blood flow velocity in healthy preterm and term infants during the fourth day of life.
Effect of Norepinephrine on Fetal Breathing in Sheep
Authors: Weintraub Zalman , Alvaro Ruben E. , Baier R. John , Cates Donald B. , Nowaczyk Bogdan , Martino Cecilia , Rigatto Henrique
Published: April 2003

We tested the hypothesis that the surge of norepinephrine at birth is associated with the establishment of continuous breathing. Therefore, we studied whether the administration of norepinephrine could enhance fetal breathing during administration of oxygen, or 100% O2 plus cord occlusion, and if phenoxybenzamine would reverse these changes. Fetal sheep were instrumented in late gestation to measure electrocortical activity and diaphragmatic electromyography. These parameters and blood gases were measured before and during in utero administration of nitrogen, 100% O2, 100% O2 plus umbilical cord occlusion, and subsequently during umbilical reperfusion and recovery. Nine fetuses (14 experiments) received continuous norepinephrine (0.13 µg/kg/min) throughout the experiment while 9 other fetuses (18 experiments) underwent the same treatment without the hormonal infusion. We found that norepinephrine inhibited the breathing induced by 100% O2 plus cord occlusion, despite a significant increase in the duration of low-voltage electrocortical activity; phenoxybenzamine reverted these changes. The findings suggest that the surge of norepinephrine at birth is probably not the primary mechanism for establishment of continuous breathing.
Platelet Activation during the Early Neonatal Period
Authors: İrken G. , Uysal K. Mutafoǧlu , Olgun N. , Ündar B. , Akkoç N. , Özkan H. , Akyol F. , Çevik N.T.
Published: April 2003

The first week of life is a time when hereditary or more frequently acquired factors lead to some important differences in the hemostatic mechanism of the newborn. It has been well known that ill neonates are prone to both hemorrhage and thrombosis. The aim of this study was to answer the question of whether there is a difference in platelet activation in healthy neonates during the first days of life that may contribute to both hemorrhage and thrombosis in the presence of additional pathologic insults. Platelet activation was determined with flow cytometry using monoclonal antibodies in 63 healthy children (29 neonates, 17 infants, and 17 older children). There was no significant difference in platelet activation among these three age groups (p > 0.05). In addition, platelet activation did not show any significant relationship to age, sex, mode of delivery, or blood bilirubin concentration (p > 0.05). It has been previously reported that platelet activation occurs at the time of birth. We could not find any evidence that healthy newborns during the first 3 days of life exhibit increased platelet activation. Further studies on platelet activation in ill neonates will help to clarify whether platelet activation plays a role in the pathogenesis of thrombotic and/or hemorrhagic disorders.
Developmental Control of Argininosuccinate Lyase Gene by Methylation
Authors: Renouf Sylvie , Fairand Alain , Husson Annie
Published: April 2003

The gene of argininosuccinate lyase (ASL) is expressed in a developmental specific manner in the liver and is regulated by hormones, namely glucocorticoids, glucagon and insulin. To assess the role of DNA methylation in the developmental pattern of ASL gene expression, we analyzed the restriction profile obtained by cleavage of genomic DNA with MspI and HpaII in fetal and adult rat liver, two developmental stages with different levels of expression of the ASL gene. Southern analysis showed that the 5′ region of this gene appeared more methylated in the fetal liver which expressed ASL at a low level than in the adult liver where the ASL gene is highly expressed. Moreover, treatment of fetuses of various gestational stages with the hypomethylating agent 5-azacytidine for 18 h caused an increase of the hepatic ASL activity and mRNA level. The stimulating effect of this drug could be also observed in vitro in cultured fetal hepatocytes. These results suggest a developmental control of the ASL gene by the DNA methylation status.
Predictive Significance of Magnetic Resonance Imaging at 4 Months of Adjusted Age in Infants after a Perinatal Neurologic Insult
Authors: Millet Véronique , Bartoli Jean Michel , Lacroze Valérie , Raybaud Charles , Unal Daniel , Girard Nadine
Published: April 2003

The aim of this prospective study was to evaluate the predictive significance of magnetic resonance imaging (MRI) performed at 4 months of corrected age in 60 neonates after a perinatal neurologic insult. Follow-up ranged from 2 to 5 years of chronological age. MRI examination was normal in 10; isolated external hydrocephalus was found in 15 infants. Twenty-three of these infants developed normally. Focal or multifocal lesions were shown in 6 infants, of whom 2 developed normally. Diffuse brain involvement was present in 29 cases as atrophy (n = 18), leukomalacia (n = 5), basal ganglia lesions (n = 3), and delayed myelination (n = 3). All but 4 infants showed neurologic impairment. MRI performed at 4 months of adjusted age is of prognostic significance in neonates who suffer a moderate or mild neurologic insult.
Use of Teicoplanin in Preterm Neonates with Staphylococcal Late-Onset Neonatal Sepsis
Authors: Degraeuwe Pieter L.J. , Beuman Gert H. , van Tiel Frank H. , Maertzdorf Wiel J. , Blanco Carlos E.
Published: April 2003

Objective: To study the clinical pharmacology of teicoplanin in babies admitted to a newborn intensive care unit, by monitoring serum levels, efficacy and potential side effects. Methods: An open, nonrandomized descriptive study was performed in the neonatal intensive and high care unit of the Universtiy Hospital Maastricht, The Neterlands. Twenty-three preterm neonates, gestational age ranging from 26 to 32 weeks (median 28.4 weeks), postnatal age from 5 to 47 days, and birth weight from 570 to 1,740 g, presenting with (suspected) late onset septicemia, were studied. Of 21 culture-proven septicemias, 20 were caused by staphylococci. The teicoplanin loading dose was 15 mg/kg i.v., followed by a maintenance dose of 8 mg/kg every 24 h. Intravenous gentamicin was also administered pending blood culture. Serum teicoplanin concentrations were measured by fluorescence polarization immunoassay. Clinical and microbiological cure/failure rates were determined and possible side effects were monitored. Results: The study of individual pharmacokinetics during multiple-dose intravenous infusions was rendered impossible by apparently inaccurate dosing. Peak (30 min after end of the infusion) and trough teicoplanin levels were stable throughout the study and averaged 27.8 (interquartile range 23.7–32.9) and 12.3 (interquartile range 9.1–16.8) mg/l, respectively. The microbiological and clinical cure rates were 90% in gram-positive septicemia. There was no apparent toxicity. Conclusions: Inaccurate drug administration was a problem in this study, making a multidose pharmacokinetic study impossible. It is possible that inaccurate drug administration and not current dosage guidelines yielded trough levels below 10 mg/l in 57 (32%) of 176 instances. This pharmaceutical aspect clearly warrants further study. However, microbiological and clinical cure rates were high in gram-positive septicemias. No side effects attributable to teicoplanin therapy were encountered.
Effects of Endotoxemia and Sepsis on Bilirubin Oxidation by Rat Brain Mitochondrial Membranes
Authors: Allen Jeffrey W. , Tommarello Steve , Carcillo Joseph , Hansen Thor Willy Ruud
Published: April 2003

Sepsis is believed to increase the risk of bilirubin brain toxicity, but the mechanism is not known. Adult male Sprague-Dawley rats were injected intraperitoneally with either 20 mg/kg Escherichia coli lipopolysaccharide, ≈5 × 109/kg CFU Listeria monocytogenes or vehicle 48 h prior to sacrifice. Rats were killed with an intraperitoneal injection of pentobarbital. Mitochondrial membrane fractions were produced by homogenization of the brains and differential centrifugation in 0.32 M sucrose. The mitochondrial pellet was resuspended in distilled water and sonicated to rupture the mitochondria. The protein concentration of the suspension was standardized to 2.5 mg/ml. Bilirubin oxidation was assayed in a pH 8.2, 0.1 M barbital buffer containing 10 µM bilirubin, 5 mM EDTA, and 500 U/ml catalase. Optical density was measured at 440 nm before and after a 60-min incubation at 37.5°C. There were no differences between the control, endotoxemic, and septic groups as far as the ability of brain mitochondrial membranes to oxidize bilirubin (bilirubin oxidation rate: 289 ± 11 vs. 295 ± 9 vs. 296 ± 12 pmol/min/mg protein, mean ± SD). We conclude that endotoxemia or sepsis do not change the ability of brain mitochondrial membranes to oxidize bilirubin. If sepsis truly increases the risk of bilirubin encephalopathy in neonatal jaundice, this is likely to involve other mechanisms.
Value of Myocardial Hypoxia Markers (Creatinine Kinase and Its MB-Fraction, Troponin-T, QT-Intervals) and Serum Creatinine for the Retrospective Diagnosis of Perinatal Asphyxia
Authors: Möller J.C. , Thielsen B. , Schaible T.F. , Reiss I. , Kohl M. , Welp T. , Gortner L.
Published: April 2003

Neonatal asphyxia is a major topic of neonatal research. However, no clear-cut physiologic parameters exist which enable an early identification of neonatal infants who are either at risk to develop brain damage or posthypoxic heart failure. Parameters indicating dysfunction of the heart and kidneys as creatinine and creatinine kinase have been evaluated. In our study, 47 asphyxiated infants (umbilical artery pH <7.18 and either a 1-min Apgar score <4 or a 5-min Apgar score <7) were compared to 27 nonasphyxiated controls regarding significant differences in creatinine, creatinine kinase, its MB fraction, and a newly introduced myocardial hypoxia indicator – troponin T – to establish the value of these parameters in the retrospective diagnosis of asphyxia. Further we evaluated two subsets of these 47 asphyxiated infants with either subsequent signs of encephalopathy (seizures) or heart failure. Creatinine, creatinine kinase and troponin T were significantly elevated in asphyxiated infants compared with controls; no differences were found in creatinine kinase and its MB fraction. In asphyxiated infants with heart failure, troponin T was significantly higher than in the other asphyxiated infants. However, none of the parameters studied was significantly different in patients with brain damage compared with asphyxiated infants without neurological sequelae. Troponin T has a high positive predictive value in the postnatal diagnosis of asphyxia. The diagnostic power of troponin T equals that of creatinine. However, troponin T is more sensitive in the identification of infants with asphyxia and cardiocirculatory failure than creatinine. Creatinine kinase and its MB fraction have no diagnostic value.
Glycoproteins of the Human Milk Fat Globule in the Protection of the Breast-Fed Infant against Infections
Authors: Peterson Jerry A. , Patton Stuart , Hamosh Margit
Published: April 2003

Nonimmunological components in human milk can protect breast-fed infants against infection by microorganisms. The structural and functional characteristics of four such components are discussed. The mucin inhibits binding of S-fimbriated Escherichia coli to bucal epithelial cells; lactadherin prevents symptomatic rotavirus-induced infection; glycoaminoglycans inhibit binding of human immunodeficiency virus gp120 to its host cell CD4 receptor, and oligosaccharides provide protection against several pathogens and their toxins.
Hyperglycemia in Extremely- Low-Birth-Weight Infants
Authors: Meetze William , Bowsher Ronald , Compton Joyce , Moorehead Helen
Published: April 2003

The cause of hyperglycemia in extremely-low-birth-weight (ELBW) infants is not well understood. We studied infants weighing <1,000 g to investigate the relationship of hyperglycemia to blood levels of insulin-like growth factor (IGF)-I and IGF-II. We also compared two methods of treatment for hyperglycemia: continuous insulin infusion and reduction of glucose intake.Fifty-six ELBW infants were enrolled on day 2 of life. Intravenous glucose intake was increased incrementally to a maximum of 12 mg/kg/min on day 6. Infants who developed hyperglycemia were randomly assigned to receive reduced glucose intake (n = 11) or insulin infusion (n = 12). Infants whose blood sugar remained normal served as controls (n = 33). Blood was drawn on days 3, 8 and 15 in all infants, and again when they developed hyperglycemia. Nutritional intake and laboratory results for the treatment groups were compared with controls.Hyperglycemic infants had lower birth weights than controls. Hyperglycemic infants treated with glucose reduction remained <60 kcal/kg/day longer than control or insulin infusion groups (8.6 ± 1.3 days vs. 4.1 ± 0.2 and 5.5 ± 0.6 days). No infants became hypoglycemic during insulin infusion. There was no difference in baseline blood levels of IGF-I or IGF-II among the groups, and these growth factors did not change in response to hyperglycemia. Hyperglycemic infants had baseline levels of insulin which were similar to normal controls, and endogenous insulin increased in response to hyperglycemia in 15 of the 23 infants who developed hyperglycemia.IGF-I and IGF-II are not related to hyperglycemia. In our population, hyperglycemic infants did not have baseline insulin deficiency and most had a normal insulin response to hyperglycemia. Insulin infusion appears safe in these infants and helped to maintain normal caloric intake, whereas glucose reduction was associated with a prolonged caloric deprivation.
Platelet-Activating Factor Levels in Term and Preterm Human Milk
Authors: Akisü Mete , Kültürsay Nilgün , Özkayin Nese , Çoker Isil , Hüseyinov Afig
Published: April 2003

It is well known that necrotizing enterocolitis (NEC) is less frequent in newborns being fed human breast milk. Since recent studies indicated that platelet-activating factor (PAF) plays an important role in pathogenesis of NEC, this study was conducted to investigate the PAF levels in human milk. Colostrum and mature human milk (samples obtained in the third week) of three groups of mothers were investigated. The first group had given birth within less than 32 weeks, the second between 33–37 weeks and the third group after 38 weeks of gestation. The PAF levels in colostrum of all three groups were similar (0.95 ± 0.57, 1.05 ± 0.52 and 1.19 ± 0.64 ng/ml, respectively). Mature human milk in groups I and II had similar PAF levels (1.16 ± 0.54 and 1.21 ± 0.60 ng/ml, respectively), however, mature human milk in group III had a significantly higher PAF concentration (2.04 ± 0.59 ng/ml) than both groups’ levels. However, this phenomenon by itself does not explain the protective effect of human milk against NEC.
Gut Regulatory Peptide Levels in Bovine Fetuses and Their Dams between the 3rd and 9th Months of Gestation
Authors: Guilloteau P. , Le Huërou-Luron I. , Le Dréan G. , Gestin M. , Philouze-Romé V. , Artiaga A. , Bernard C. , Chayvialle J.A.
Published: April 2003

Several gut regulatory peptides were measured by radioimmunoassay between 3 and 9 months of gestation in the plasma of 91 bovine fetuses and their dams, in fetal gastric content and in amniotic fluid. During gestation, plasma peptide concentrations did not change in cows. Likewise, fetal plasma concentrations of cholecystokinin, somatostatin, secretin and vasoactive intestinal polypeptide showed no variation while those of gastrin, pancreatic polypeptide and gastric inhibitory polypeptide increased during the last 6 months. Peptide levels in the fetus were higher than or equal to maternal concentrations. At 8–9 months of gestation, gastrin, CCK, secretin and somatostatin concentrations in amniotic fluid were lower than those measured in fetal gastric content and in maternal and fetal plasma. Therefore, a substantial endogenous endocrine production of regulatory peptides by the fetus probably exists as early as the third month of gestation, accompanied by a release into the lumen of the gut.
Postasphyxial Reoxygenation Reduces the Activity of Na+/K+-ATPase in the Erythrocytes of Newborn Piglets
Authors: Vásárhelyi Barna , Dobos Mariann , Temesvári Péter , Ábrahám Csongor , Pintér Sándor , Tulassay Tivadar
Published: April 2003

The aim of our study was to determine whether the impairment of Na+/K+ pump is detectable in erythrocytes during hypoxia and reoxygenation. Acute asphyxia was induced in 10 newborn piglets for 1 h by bilateral pneumothorax. The Na+/K+-ATPase activity, Na+, K+ and ATP content of RBCs were determined in baseline condition (paO2: 60.4 ± 9.3 mm Hg), at the end of the hypoxic period (1 h) (paO2: 30.2 ± 10.3 mm Hg), then hourly during the reoxygenation phase (2, 3, 4 h) (paO2: 54.8 ± 9.0, 56.1 ± 8.7, 57.2 ± 9.6 mm Hg). The Na+/K+-ATPase activity was constant during the first 3 h. However, it decreased at 4 h (676 ± 168 versus baseline 833 ± 141 U, p < 0.05). The highest ATP content was measured also at this point (4.32 ± 0.57 versus baseline 3.27 ± 0.45 mmol/l RBC, p < 0.01). The Na+ content was lower at 1 and 2 h (14.0 ± 1.8; 13.8 ± 1.2 versus baseline 15.7 ± 1.2 mmol/100 g Hb, p < 0.05), but later it became normal. Plasma monovalent cationic levels and intracellular K+ content did not alter during the experiment. Our results indicate that the deterioration of enzyme activity occurs within the same time-frame that previously described morphological alterations in brain tissue develop, so the RBC Na+/K+-ATPase activity might reflect the progress of posthypoxial brain damage.
Detection and Characterisation of Transforming Growth Factor-Beta in Porcine Colostrum
Authors: Xu Ruo-Jun , Doan Q.C. , Regester G.O.
Published: April 2003

Porcine colostrum and milk collected at different stages of lactation were assessed for transforming growth factor-β (TGF-β) activity using an epithelial cell bio-assay. A high level of TGF-β activity was recorded in all colostrum samples after transient acidification treatment, ranging between 126 and 260 ng/ml for samples collected at the time of parturition and 73 ng/ml for the sample collected 12 h after parturition. Without transient acidification treatment TGF-β activity was detected only in 2 samples collected at the time of parturition (12 ng/ml) and 12 h after parturition (9 ng/ml), respectively. TGF-β activity was undetectable in milk collected 5 days after parturition. These results suggest that TGF-β exists mainly in latent form in porcine colostrum and the concentration declines rapidly as lactation proceeds. After enrichment with cation exchange chromatography a low level of TGF-β activity was detected in porcine milk. Further separation by size exclusion chromatography revealed two molecular mass forms of TGF-β in both colostrum and milk samples, a major peak of about 80 kD and a minor peak of about 25 kD representing latent and active forms of TGF-β, respectively. A further experiment showed that the latent form of TGF-β in colostrum can be activated at pH 3.5 or less. It is speculated that TGF-β found in the colostrum may play a physiological role in regulating postnatal adaptation of the gastro-intestinal tract in new
borns.
Beta-Glucuronidase and Hyperbilirubinemia in Breast-Fed Babies
Authors: La Torre Antonio , Targioni Giacomo , Rubaltelli Firmino F.
Published: April 2003

In the present study we analyzed breast milk samples from mothers of breast-fed, healthy, term babies with unexplained prolonged jaundice for β-glucuronidase activity. The differences of enzyme activity were not statistically significant in comparison to a control group of nonjaundiced newborns. We conclude that β-glucuronidase is not the only cause of prolonged jaundice in neonates.
Factors Influencing Pulmonary Surfactant Protein A Levels in Cord Blood, Maternal Blood and Amniotic Fluid
Authors: Cho Kazutoshi , Matsuda Tadashi , Okajima Satoru , Matsumoto Yoshinori , Sagawa Tadashi , Fujimoto Seiichiro , Kobayashi Kunihiko
Published: April 2003

The purpose of this study was to evaluate factors that influence pulmonary surfactant protein A (SP-A) levels in cord blood, maternal blood and amniotic fluid, as well as to establish the normal range of serum SP-A. Labor significantly influenced cord blood SP-A levels. The SP-A levels in maternal blood after delivery were correlated with, but higher than those before delivery. There was a correlation between SP-A levels in amniotic fluid and cord blood. Neonatal serum SP-A was not correlated with maternal SP-A levels. The normal range of SP-A in cord blood was 2.7–21.7 ng/ml following cesarean section without labor, 4.8–50.2 ng/ml after labor at gestational weeks 36–38, and 12.2–44.6 ng/ml at gestational weeks 39–41. SP-A levels in maternal blood before and after delivery and amniotic fluid were 6.0–74.0, 9.6–73.6 and 403.4–24,540 ng/ml, respectively.
Effect of Exchange Transfusion on Brain Perfusion and Electrocortical Brain Activity in Newborn Lambs
Authors: Benders Manon J.N.L. , Meinesz Janneke H. , Dorrepaal Caroline A. , Steendijk Paul , van Bel Frank , van de Bor Margot
Published: April 2003

Changes in brain perfusion (using ultrasonic-determined changes in carotid artery blood flow: Qcar) and electrocortical brain activity (ECBA, obtained by a Lectromed cerebral function monitor) were studied during exchange transfusion using the push-pull method in the newborn lamb. Changes in mean arterial blood pressure (MABP), Qcar, heart rate (HR), and ECBA were observed during all exchange transfusions: MABP, Qcar, and ECBA decreased during the withdrawal period and increased during the infusion period, whereas HR showed the opposite phenomenon. Changes in ECBA appeared to be primarily associated with changes in brain perfusion (p < 0.05). These changes in brain perfusion were, however, caused by changes in MABP (p < 0.0001). We concluded that exchange transfusions caused moderate changes in brain perfusion, however changes in ECBA appeared to be very small, and have probably no clinical importance.
Influence of Inhaled Nitric Oxide and Hyperoxia on Na,K-ATPase Expression and Lung Edema in Newborn Piglets
Authors: Youssef JihanA. , Thibeault DonaldW. , Rezaiekhaligh MohammadH. , Mabry SherryM. , Norberg MichaelI. , Truog WilliamE.
Published: April 2003

This study was undertaken to examine the combined effect of nitric oxide (NO) and hyperoxia on lung edema and Na,K-ATPase expression. Newborn piglets were exposed to room air (FiO2 = 0.21), room air plus 50 ppm NO, hyperoxia (FiO2 ≥ 0.96) or to hyperoxia plus 50 ppm NO for 4–5 days. Animals exposed to NO in room air experienced only a slight decrease in Na,K-ATPase α subunit protein level. Hyperoxia, in the absence of NO, induced both the mRNA and the protein level of Na,K-ATP-ase α subunit and significantly increased wet lung weight, extravascular lung water, and alveolar permeability. NO in hyperoxia decreased the hyperoxic-mediated induction of Na,K-ATPase α subunit mRNA and protein while wet lung weight, extravascular lung water, and alveolar permeability remained elevated. These results suggest that 50 ppm of inhaled NO may not improve hyperoxic-induced lung injury and may interfere with the expression of Na,K-ATPase which constitutes a part of the cellular defense mechanism against oxygen toxicity.
Activities of Enzymes Involved in Glutamine Metabolism in Connection with Energy Production in the Gastrointestinal Tract Epithelium of Newborn, Suckling and Weaned Piglets
Authors: Madej Malgorzata , Lundh Torbjörn , Lindberg Jan Erik
Published: April 2003

Changes in the activity of enzymes involved in glutaminolysis and energy metabolism in the entire gastrointestinal (GI) tract of developing piglets are presented for the first time. The activities of glutaminase, glutamate dehydrogenase, oxoglutarate dehydrogenase, isocitrate dehydrogenase and alanine aminotransferase in the epithelium along the gastrointestinal tract from newborn, suckling (2–4 weeks old) and weaned (9 weeks old) piglets were investigated. The activity of glutaminase in the epithelium from the small intestine and colon was higher (p < 0.05) in weaned piglets than in newborn and suckling piglets. In addition, glutamate dehydrogenase and alanine aminotransferase activities in the small intestinal epithelium were higher (p < 0.05) for weaned piglets than for newborns. The activity of oxoglutarate dehydrogenase in the epithelium of the small intestine was significantly lower in newborn and suckling piglets compared with weaned individuals. The activity of isocitrate dehydrogenase in the epithelium along the gastrointestinal tract was higher (p < 0.05) for suckling and weaned piglets than for newborn piglets. The present data indicate that the utilization of substrates for energy production differs markedly between the stomach, small intestine and colon of growing piglets. Also, the capacity of enzymes in the epithelium of the GI tract to utilize acetyl-CoA as an energy substrate in the tricarboxylic acid cycle increased with piglet age. The epithelium of the GI tract of the newborn, suckling and weaned piglets showed a high capacity to metabolize α-ketoglutarate.