bluuebunny/crossref_metadata_2025 huggingface dataset:
Origins of Renal Physiology in the USA
Authors: Giebisch Gerhard , Berliner Robert W.
Published: April 2003

Research in renal physiology began later in the USA than in Europe. Initial studies in the early 1900s dealt with the pathophysiology of renal failure. Micropuncture study of single nephron function was initiated in the laboratory of A.N. Richards in the early 1920s and with the later addition of microperfusion provided important insights into the site and mechanisms of solute transport. In parallel, with the leadership of Homer Smith, the development of noninvasive clearance methods to measure glomerular filtration rate and renal blood flow initiated a fruitful period of quantification of renal hemodynamics and of transport by the tubules. The steady progress of renal physiology in the USA owes much to the generous support of basic reasearch by the National Institutes of Health. It is also worthy of mention that progress in renal physiology in the US owes much to work carried out in clinical departments and to the type of comparative studies exemplified by work at the Mt. Desert Island Biological Laboratory.
The Low Countries – 16th/17th Century
Authors: De Broe Marc E. , De Weerdt Dirk L. , Ysebaert Dirk K. , Vercauteren Sven R. , De Greef Kathleen E. , De Broe Luc C.
Published: April 2003

Andreas Vesalius and Jan Baptist Van Helmont are the two major personalities who contributed substantially and in a different way to the early development of renal anatomy/physiology of the 16th/17th century in the Southern Low Countries. The importance of A. Vesalius’ publication ‘de humani corporis fabrica libri septem’ cannot be overestimated. The kidney was an intriguing organ to Vesalius, the function of which he could not fully grasp. J.B. Van Helmont was the first to demonstrate the importance of the measurement of the specific gravity of the urine and relating it to physiological and pathophysiological conditions. He made accurate clinical observations supported by autopsy examinations concerning the role of the kidney in the generation of dropsy.
A History of Eclampsia, Toxemia and the Kidney in Pregnancy
Authors: Purkerson Mabel L. , Vekerdy Lilla
Published: April 2003

Eclampsia, accompanied by convulsions, is one of the most dangerous complications of pregnant women. This condition was known to the ancient Greeks, who named it eclampsia. Prior to the 18th century, the term eclampsia was used only to refer to the visual phenomena which accompanied the neurologic aspects of the malady. Rayer’s landmark contribution (1839–1841) provided evidence for renal involvement with the observation of protein in the urine of pregnant, edematous women. Lever (1843) reported finding proteinuria in eclampsia and concluded that disappearance of proteinuria after delivery of the child was evidence that eclampsia was different from Bright’s disease.
Hyposthenuria: Sándor Korányi’s Concept of Renal Insufficiency
Authors: Sonkodi S.
Published: April 2003

Around the turn of the 19th century, the Hungarian physiologist and clinician, Sándor Korányi, started to use physicochemical methods to estimate renal function. In parallel with the deterioration of renal function, he found characteristic changes in the freezing point depression of urine, which he termed hyposthenuria. On the basis of these findings, he was the first to introduce the functional concept of renal insufficiency.
Diagnosis of Renal Disease at the Beginning of the 20th Century
Authors: Cioffi M. , Esposito L. , De Santo D. , Giannattasio P. , Cappabianca F. , Mangiacapra S. , Materiale T. , Conte G.
Published: April 2003

At the beginning of this century, the diagnosis of various renal diseases was made with relative accuracy although neither plasma markers of glomerular filtration nor renal biopsy nor imaging were available. Renal edema was identified by high albuminuria, hyalin cylinders, high urine density and oliguria. Renal hematuria was detected by cylinders of erythrocytes. Hallmarks of chronic renal insufficiency, recognized at autopsy by atrophic kidneys, were hyposthenuria, polyuria and slight albuminuria without edema associated with arterial hypertension, anemia, retinopathy and left ventricular hypertrophy. The detection of increased plasma volume in experimental toxic nephritis by St. Moscati proposed the underlying mechanism of arterial hypertension. Experimental and clinical research in the preinsulin era indicated the central role of the kidney in the functional alterations induced by diabetes. Indeed, glucosuria was known to appear only when glycemia was relatively high. The kidney appeared enlarged and hyperemic, i.e. the so-called glomerular hyperfiltration. Glucosuria was directly correlated with diuresis but it markedly decreased in renal insufficiency. In diabetes complicated by nephropathy, tolerance to carbohydrates improved. Correction of glucosuria by dietary treatment was followed by a prompt rise in body weight, due to retention that counterbalanced the previous losses. Diabetic ketoacidosis, determined by the measurement of urinary ketonic body excretion, was treated with sodium bicarbonate (30–50 g/day in severe acidosis) up to achieving an alkaline urine pH. It was known that high doses of sodium bicarbonate might induce edema which gradually disappeared with a reduction in the alkaline administration. Clinical significance of sodium balance was, in fact, recognized: the external NaCl balance between alimentary ingestion and urinary excretion was neutral in normal conditions and became positive at high body temperature or negative during reabsorption of exudates.
The Early Years of Chronic Dialysis:The Seattle Contribution
Authors: Blagg Christopher R.
Published: April 2003

Long-term hemodialysis for chronic renal failure first became possible with development of the Teflon shunt by Belding Scribner and coworkers at the University of Washington, Seattle, in 1960. Over the next 4 years, many of the advances in dialysis occurred in Seattle. These included recognition and treatment of complications such as malignant hypertension, gouty episodes due to uric acid accumulation, subcutaneous calcification, anemia, iron overload, and peripheral neuropathy. Technical advances included improving the shunt, and in collaboration with Professor A.L. Babb, development of a proportioning system to make dialysate from concentrate and water and the first automated home hemodialysis machine. Dr. Boen and Dr. Tenckhoff developed automated peritoneal dialysis equipment and peritoneal access devices. The world’s first outpatient dialysis center, the Seattle Artificial Kidney Center, was established in 1962, and used an anonymous lay committee to select from medically suitable patients those to be treated by the center. This triage was an important step in the development of biomedical ethics, and in 1964, Scribner’s presidential address to the American Society for Artificial Internal Organs discussed the problems of patient selection, termination of treatment, patient suicide, death with dignity, and selection for transplantation.
Current Status of Renal Replacement Therapy for Acute Renal Failure
Authors: Mehta Ravindra L. , Letteri Joseph M.
Published: April 2003

Although the management of acute renal failure (ARF) constitutes a major component of the activities of practicing nephrologists, minimal information is available on the dialysis techniques utilized to treat ARF in the USA. It is evident from several recent publications that there are wide variations in the dialytic and nondialytic management of ARF. In order to obtain a better understanding of the current practice for dialytic management of ARF, the National Kidney Foundation (NKF) Council on Dialysis commissioned a survey of NKF members. This article describes the results of this survey and provides a snapshot of the current management practices for ARF. It is our hope that this information will provide a baseline for further research in this area.
Trimethoprim-Sulfamethoxazole Therapy in Outpatients: Is Hyperkalemia a Significant Problem?
Authors: Alappan Rajendran , Buller Gregory K. , Perazella Mark A.
Published: April 2003

A prospective, randomized clinical study was undertaken to determine the effect of standard-dose trimethoprim-sulfamethoxazole combination treatment on serum potassium concentrations in outpatients treated in an ambulatory clinic. Ninety-seven patients were treated with oral antibiotics for a variety of infections. Fifty-one patients treated with trimethoprim-sulfamethoxazole (trimethoprim, 320 mg/day; sulfamethoxazole, 1,600 mg/day) constituted the treatment group, while 46 patients treated with other antibiotics served as controls. Serum potassium, sodium, and chloride concentrations, serum carbon dioxide content, blood urea nitrogen level, serum creatinine level, and serum glucose concentration were measured. The baseline serum potassium concentration in the treatment group was 4.30 ± (SD) 0.36 mmol/l, and it increased significantly (p < 0.001) to 4.66 ± 0.45 mmol/l on day 5 of therapy. Subgroup analysis of mean serum potassium concentration on day 5 of therapy failed to detect clinically relevant hyperkalemia. In patients with a serum creatinine level equal to or greater than 1.1 mg/dl (K+, 4.83 ± 0.48 mmol/l), a nonsignificant difference (p = 0.3) in the potassium concentration was noted on day 5 as comapred with patients with a serum creatinine level <1.1 mg/dl (K+, 4.63 ± 0.44 mmol/l). Although diabetics had a higher serum potassium concentration (K+, 4.91 ± 0.44 mmol/l) than nondiabetics (K+, 4.61 ± 0.44 mmol/l), the difference was not statistically significant (p = 0.055). Patients aged ≥50 years (K+, 4.82 ± 0.59 mmol/l) had a significantly different (p = 0.046) serum potassium concentration on day 5 than patients aged <50 years (K+, 4.55 ± 0.28 mmol/l). In contrast, the baseline serum potassium concentration in the control group was 4.37 ± 0.45 mmol/l, and it decreased (p = 0.1) to 4.22 ± 0.4 mmol/l on 5 days of drug therapy. Trimethoprim-sulfamethoxazole therapy, when used to treat a variety of infections, leads to an increase in serum potassium concentration in most patients. After 5 days of therapy with this drug, the treatment group developed a statistically significant rise in the serum potassium concentration as compared with the control group. However, severe hyperkalemia (K+ ≥5.5 mmol/l) occurred in only 3 patiens (6%) treated with trimethoprim-sulfamethoxazole. In addition, none of the subgroups of treated patients developed clinically important hyperkalemia. This suggests that outpatients, in contrast to acquired immunodeficiency syndrome patients and hospitalized patients with mild renal insufficiency, develop severe or life-threatening hyperkalemia less commonly when treated with this antimicrobial regimen. However, outpatients having risk factors which may predispose to the development of hyperkalemia should be carefully monitored when treated with trimethoprim-sulfamethoxazole.
Growth Factors in Continuous Ambulatory Peritoneal Dialysis Effluent
Authors: Lai Kar Neng , Lai Ka Bik , Szeto Cheuk Chun , Lam Christopher W.K. , Leung Joseph C.K.
Published: April 2003

Recent studies reveal conflicting results on the change of solute transfer with time on continuous ambulatory peritoneal dialysis (CAPD) and recurrent peritonitis. Herein, we performed a cross-sectional study of 76 patients on CAPD to examine their peritoneal permeability by measuring the dialysate to serum ratio of creatinine (D/P) and the mass transfer area coefficients of creatinine (MTACCr) or glucose (MTACGlu). Transforming growth factor-β1 (TGF-β1), platelet-derived growth factor (PDGF), and epidermal growth factor (EGF) were measured in the dialysate by ELISA. TGF-β1 mRNA in peritoneal macrophages were determined by a quantitative polymerase chain reaction. We failed to observe any correlation between the duration on dialysis and the peritoneal permeability in those patients with no previous peritonitis. Frequency of peritonitis episode did not affect the MTACCr, MTACGlu, or D/P. The MTACCr correlated well with MTACGlu (r = 0.78, p = 0.001) and with D/P (r = 0.98, p < 0.0001). No inverse correlation was demonstrated between dialysate PDGF or EGF and the peritoneal permeability. A positive correlation was demonstrated between the dialysate TGF-β1 and MTACCr, MTACGlu or D/P (r = 0.64, 0.54, and 0.64 respectively, p < 0.001). The dialysate TGF-β1 levels in patients with low D/P (≤0.5) were only half of that in patients with normal or high D/P (p = 0.0002). The dialysate levels of TGF-β1 did not correlate with PDGF or EGF. These findings raise the possibility that, other than diffusion across the peritoneal membrane from circulation, there could also be an intrinsic production of TGF-β1 by peritoneal cells in these CAPD patients. Our findings raise the speculation that TGF-β1 in dialysate from stable CAPD patients may exert an inhibitory action to fibroblast. Such action of TGF-β1 could reduce the risk of peritoneal sclerosis and hence, maintains a satisfactory peritoneal permeability to small solutes.
Decreased Glomerular Proteinase Activity in the Streptozotocin Diabetic Rat
Authors: Song Ruo H. , Singh Ashok K. , Leehey David J.
Published: April 2003

Decreased glomerular proteinase activity may contribute to matrix accumulation in diabetes. Male Sprague-Dawley rats were rendered diabetic by injection of streptozotocin (STZ) 65 mg/kg i.v.; age-matched, sham-injected rats served as controls. Glomeruli from diabetic rats 1 month after STZ injection demonstrated significant decreases in collagenase and cathepsin B activities compared to control glomeruli. Treatment with insulin resulted in a slight (but not significant) increase in collagenase activity and normalized cathepsin B activity. We conclude that decreased glomerular collagenase and cathepsin B activities are present in STZ diabetes. These alterations may contribute to mesangial matrix accumulation.
Chronic Rheumatoid Arthritis Complicated by Myeloperoxidase Antineutrophil Cytoplasmic Antibody-Associated Nephritis
Authors: Yorioka Noriaki , Taniguchi Yoshihiko , Amimoto Dai , Miyata Hideki , Yamakido Michio , Taguchi Takashi
Published: April 2003

We report a myeloperoxidase antineutrophil cytoplasmic antibody-positive rheumatoid arthritis patient who developed necrotizing crescentic glomerulonephritis. Steroid therapy was given combined with an immunosuppressant agent, and double-filtration plasmapheresis was started with the aim of removing antibodies from the blood. This therapeutic regimen was found to be useful.
Correlations among Expression of Glomerular Intercellular Adhesion Molecule 1 (ICAM-1), Levels of Serum Soluble ICAM-1, and Renal Histopathology in Patients with IgA Nephropathy
Authors: Nguyen Tat Thang , Shou Ichiyu , Funabiki Kazuhiko , Shirato Isao , Kubota Kiichi , Tomino Yasuhiko
Published: April 2003

The purpose of the present study was to evaluate the correlations among expression of intercellular adhesion molecule 1 (ICAM-1) in glomeruli, levels of soluble ICAM-1 (sICAM-1) in sera, and renal injuries in patients with IgA nephropathy. The levels of sICAM-1 in sera from 27 patients with IgA nephropathy and 7 healthy controls were measured by the human soluble ICAM-1 immunoassay. The expression of ICAM-1 in glomeruli was detected by indirect immunofluorescence. We observed marked expression of ICAM-1 in glomerular capillary walls and mesangial areas in patients with advanced-stage, but not in those with mild IgA nephropathy. Since the histopathological changes in the advanced stage of this disease were characterized by diffuse mesangial cell proliferation and tubulointerstitial injury, the expression of ICAM-1 in the glomeruli may be of value in evaluating the degree of renal lesions in patients with IgA nephropathy. However, there was no significant change in the levels of serum sICAM-1 among mild-stage and advanced-stage patients and healthy controls. It appears that the measurement of serum sICAM-1 is not useful in evaluating the degree of renal injuries in patients with IgA nephropathy.
Serum Hepatocyte Growth Factor Levels in Patients with Renal Diseases
Authors: Nishida Masashi , Kawakatsu Hidekazu , Ishiwari Kohhei , Tamai Megumi , Sawada Tadashi , Nishimura Masato , Yoshimura Manabu
Published: April 2003

The serum levels of hepatocyte growth factor (HGF) were determined in patients with various renal diseases. In patients with acute-phase acute renal failure (ARF) and chronic tubulointerstitial nephritis (chronic TIN), the serum HGF levels were 0.55 ± 0.24 and 0.44 ± 0.37 ng/ml (mean ± SD), respectively, and were significantly higher than that in the control group (0.12 ± 0.12 ng/ml). The serum HGF level tended to be high also in patients with active-phase steroid-sensitive nephrotic syndrome (SSNS). The serum levels of HGF were not elevated in patients with IgA nephropathy (IgAN), Henoch-Schönlein purpura nephritis (HSPN), membranoproliferative glomerulonephritis (MPGN), poststreptococcal acute glomerulonephritis (PSAGN), unilateral renal atrophy, unilateral nephrectomy, or proximal tubular dysfunction. These observations suggest that glomerular disorders cause no apparent elevation of the serum HGF level, and that elevation of the serum HGF level may be associated with tubulointerstitial damage in renal diseases.
Short- and Long-Term Outcome of Total Parathyroidectomy with Immediate Autografting versus Subtotal Parathyroidectomy in Patients with End-Stage Renal Disease
Authors: Hargrove Gaylene M. , Pasieka Janice L. , Hanley David A. , Murphy M. Brendan
Published: April 2003

A retrospective study was performed in 36 patients with end-stage renal disease (ESRD) comparing total parathyroidectomy followed by immediate autografting into the forearm (total PTX + IA) with parathyroidectomy (subtotal PTX) over a five-year period. Twenty-eight patients underwent subtotal PTX and 8 had total PTX + IA. The two surgical methods were evaluated with respect to preoperative severity of hyperparathyroidism, perioperative morbidity, and the incidence of recurrent hyperparathyroidism. Eleven patients in total (30.6%) developed recurrent hyperparathyroidism; 2/8 (25%) in the total PTX + IA group compared to 9/28 (32.1%) in the subtotal PTX group (p = 0.699). The median time to recurrence was longer in the total PTX + IA group (39 vs. 16 months), and the median long-term postoperative PTH value was lower (81 vs. 199 ng/l), but these differences did not reach statistical significance. In conclusion, the incidence of recurrent hyperparathyroidism is high regardless of surgical modality. However, total PTX + IA may produce more favorable results with respect to median postoperative PTH level and time to recurrence.
Mycobacterium fortuitum Peritonitis in Two Patients Receiving Continuous Ambulatory Peritoneal Dialysis
Authors: Vera Gilberto , Lew Susie Q.
Published: April 2003

We present two cases of non-resolving peritonitis treated with a standard peritonitis protocol. The organism identified from the peritoneal effluent was Mycobacterium fortuitum, a group IV (Runyon’s classification) rapidly growing, nontuberculous mycobacterium. M. fortuitum is ubiquitous and can be isolated from a number of natural sources. Risk factors these two patients had for developing M. fortuitum peritonitis included underdialysis, the immunocompromised state associated with end stage renal disease, prior or prolonged broad spectrum antibiotic treatment, and possible exposure to environmental factors, since both were hospitalized at about the same time. The isolates were resistant to the conventional antibiotics recommended for the treatment of this mycobacterium. Both patients, however, responded to catheter removal and antibiotics administered according to the sensitivities of the mycobacterium isolated.
Antioxidant Effect of Zinc on Acute Renal Failure Induced by Ischemia-Reperfusion Injury in Rats
Authors: Ogawa Toshihisa , Mimura Yoshikazu
Published: April 2003

Zinc may have an antioxidant effect mediated by induction of metallothionein. Based on the assumption that metallothionein can scavenge oxygen free radicals, we examined whether zinc administration prior to renal ischemia would improve renal dysfunction caused by ischemia-reperfusion injury in rats. Wistar rats weighing 265 g were treated with an intraperitoneal injection of 20 mg/kg zinc 24 h prior to the renal ischemia-reperfusion procedure, which was achieved by a 30-min clamping of the bilateral renal vessels and subsequent 90-min reperfusion. Thirty-minute renal clearance tests were performed before and after renal ischemia in zinc- (n = 11) and saline-treated (n = 8) rats. Thiobarbituric acid reactive substance, conjugated diene, and metallothionein levels in the renal tissues were also determined. Sham-operated rats (n = 5 in each treatment) served as control for the ischemia-reperfusion rats. Ischemia-reperfusion resulted in significantly lower glomerular filtration rate values and marked increases in tissue concentrations of thiobarbituric acid reactive substance and conjugated diene compared with sham-operation. Zinc administration improved the reduced glomerular filtration rate values seen after the ischemia-reperfusion procedure, but not to the extent of pre-ischemic levels. Zinc pretreatment significantly reduced the increased levels of thiobarbituric acid reactive substance and conjugated diene during ischemia-reperfusion and increased metallothionein levels compared with saline injection. These findings suggest that zinc has an antioxidant effect mediated through the induction of metallothionein, but appears only to have a minor protective effect on renal function induced by renal ischemia-reperfusion injury.
Seasonal Blood Pressure and Body Weight Variation in Patients on Chronic Hemodialysis
Authors: Tozawa Masahiko , Iseki Kunitoshi , Iseki Chiho , Morita Osamu , Yoshi Shinichro , Fukiyama Koshiro
Published: April 2003

Aim: The relation of ambient temperature (AMT) and relative humidity to systolic blood pressure (SBP), diastolic blood pressure (DBP), body weight (BW), and body weight gain between dialysis sessions (ΔBW) was examined in hemodialysis patients by Fourier analysis. Methods and Results: The authors recruited 144 dialysis patients from a hemodialysis center in Okinawa, Japan where there is distinct seasonal variation in monthly AMT but a constant intradiurnal temperature change throughout the year. All patients had been undergoing chronic and regular hemodialysis three times per week. SBP, DBP, and BW before dialysis sessions and ΔBW were recorded in 1994. Mean monthly Okinawa AMT in 1994 was highest in Augsut and lowest in February and March, and the mean monthly relative humidity in 1994 was highest in June and lowest in January. Mean SBP and DBP were lowest in August and June respectively, and greatest in December. BW was lowest in July and September, and greatest in February and March; ΔBW was lowest in July and greatest in January. These seasonal patterns were well reproduced by the first Fourier component. The cross-correlation coefficient showed that monthly mean AMT and SBP, DBP, BW, and ΔBW were correlated with a lag time of 5 or 6 months. The cross correlation coefficient showed that relative humidity and SBP, DBP and ΔBW were also correlated with a 6-month lag time. In analyzing subgroups of patients according to the presence or absence of antihypertensive medications, a seasonal change was observed in the SBP and DBP of patients not being treated with antihypertensives, and in the DBP of patients taking antihypertensive medications, but not in the SBP of patients taking antihypertensive medications. Conclusion: Seasonal variations in SBP, DBP, BW and ΔBW were evident. AMT and the relative humidity correlated strongly with SBP, DBP, BW and ΔBW. The clinical implications of these findings in hemodialysis patients warrant further investigation.
Ehrlichia chaffeensis in a Renal Transplant Recipient
Authors: Sadikot Roxiana , Shaver Mary Jo , Reeves W. Brian
Published: April 2003

Since its first description in human beings in 1986, ehrlichiosis is now increasingly recognized as a cause of tick-borne febrile illnesses. However, the disease has been reported only rarely in immunosuppressed patients. We report a case of human ehrlichiosis in a patient with a cadaveric renal transplant. The diagnosis was confirmed initially by a positive polymerase chain reaction (PCR) for E. chaffeensis. The antibody titer became positive several weeks later. The patient responded promptly to treatment with doxycycline. Ehrlichiosis should be considered in the differential diagnosis of an acute febrile illness in transplant recipients. PCR provides a rapid means to confirm the diagnosis, particularly in settings in which antibody response may be suppressed.
High-Resolution Ultrastructural Comparison of Renal Glomerular and Tubular Basement Membranes
Authors: Ogawa Saeko , Ota Zensuke , Shikata Kenichi , Hironaka Kazue , Hayashi Yoshiko , Ota Kosuke , Kushiro Masahiko , Miyatake Nobuyuki , Kishimoto Noboru , Makino Hirofumi
Published: April 2003

Background/Aims: Glomerular basement membranes (GBM) and tubular basement membranes (TBM) consist of a fine meshwork composed mainly of type IV collagen. Each segment of tubules has specialized physiologic functions, and thus we investigated the ultrastructure of various basement membranes in rat kidneys. Methods: Since purifying basement membranes from different tubule segments is technically challenging, we employed tissue negative staining rather than conventional negative staining to compare the ultrastructures of proximal and distal TBM and GBM in normal rats. We also assessed the distribution of extracellular matrix components including type IV collagen, laminin, heparan sulfate proteoglycan, and fibronectin in the basement membranes by immunohistochemistry. Results: TBM and GBM of normal rats showed a fine meshwork structure consisting of fibrils forming small round to oval pores. Short- and long-pore diameters in proximal tubules were 3.3 ± 0.5 and 3.9 ± 0.6 nm, respectively, and in distal tubules 3.5 ± 0.7 and 4.3 ± 0.8 nm, respectively. For GBM the respective diameters were 2.5 ± 0.5 and 3.0 ± 0.5 nm. Immunohistochemical analysis showed no significant difference in distribution of extracellular matrix components between proximal and distal TBM. However, immunofluorescence scores of α1 chain of type IV collagen, fibronectin, and laminin were higher in the TBM than in the GBM. On the other hand, heparan sulfate proteoglycan was higher in the GBM. Conclusion: Ultrastructural differences in renal basement membranes may be related to differences in physiologic function in each segment.
Granulocyte-Macrophage Colony-Stimulating Factor as an Adjuvant to Hepatitis B Vaccination in Maintenance Hemodialysis Patients
Authors: Anandh Urnila , Bastani Bahar , Ballal Sudarsham
Published: April 2003

Patients on maintenance hemodialysis (HD) have poor seroconversion rate after hepatitis B vaccination. The present study was designed to test the efficacy of granulocyte-macrophage colony-stimulating factor (GM-CSF) as an adjuvant to hepatitis B vaccination for improving seroconversion rate in maintenance HD patients. Twelve chronic HD patients were randomly assigned to receive either hepatitis B vaccination alone or hepatitis B vaccination 24 h after 1 dose of GM-CSF for primary immunization. A group of 16 chronic HD patients who had not seroconverted after a standard two-dose hepatitis B vaccination were randomly assigned either to a booster dose of hepatitis B vaccine alone or a booster dose given 24 h after one dose of GM-CSF. In the primary immunization group only 2 of 6 patients (33%) who had received vaccination alone, versus 5 of 6 patients (83%) who had received hepatitis B vaccine after one dose of GM-CSF, developed seroprotective antibody titers. Moreover, seroprotective antibody titers (IU/ml) were significantly higher in the latter group (275 ± 286.5 vs. 14 ± 22, p < 0.05). In patients who had not seroconverted with prior hepatitis B vaccination, GM-CSF adjuvant therapy significantly increased the seroconversion rate versus booster dose alone (87.5 vs. 25%, respectively, p < 0.02), with significantly higher seroprotective antibody titers (84 ± 80 vs. 19 ± 33 IU/ml, respectively, p < 0.05). These findings suggest that administration of one dose of GM-CSF, as adjuvant therapy, prior to primary or booster dose hepatitis B vaccination may significantly increase seroconversion rate and seroprotective antibody titers in chronic HD patients.
Significance of Glomerular Deposition of C3c and C3d in IgA Nephropathy
Authors: Nakagawa Hiroko , Suzuki Satoru , Haneda Masakazu , Gejyo Fumitake , Kikkawa Ryuichi
Published: April 2003

Background: Complement activation plays an important role in the pathogenesis of IgA nephropathy. The clinico-pathological significance of the glomerular deposition of complement breakdown products, C3c and C3d in IgA nephropathy remains to be clarified. Methods: We examined the relationship between glomerular staining patterns of C3c and C3d and clinico-pathological findings with 163 patients with IgA nephropathy. Renal biopsy specimens were stained with C3c and C3d by immunofluorescence, and patients were divided into the following two groups: the intensity of C3c deposition stronger than C3d deposition, or equal to it (group A); the intensity of C3d deposition stronger than C3c deposition (group B). Results: In group A, the incidence of severe hematuria (over 20 urinary red blood cells in high-power field microscope (×400)) or of higher urinary fibrinogen degenerated products (over 0.1 μg/ml) was significantly higher than that in group B. In addition, group A showed a significant decrease in the glomerular filtration rate. Group A also showed a significantly higher incidence of glomerular endocapillary proliferation than in group B. Conclusion: These findings suggest that the glomerular deposition of C3c is associated with the inflammatory active phase of glomeruli in IgA nephropathy.
Acute Tubular Necrosis due to Captopril
Authors: Al Shohaib Saad , Raweily Essam
Published: April 2003

Angiotensin-converting enzyme (ACE) inhibitors are standard therapy for congestive cardiac failure. ACE inhibitors have been used worldwide and are usually safe and have relatively few side effects. Hypotension can develop with the first dose of captopril and can lead to symptomatic renal hypoperfusion with subsequent acute renal failure (ARF). The case of a 65-year-old patient with congestive heart failure who developed acute renal failure following the first dose of captopril is described. He required hemodialysis for 8 weeks for the improvement of his renal function and urinary output. The renal biopsy confirmed the presence of acute tubular necrosis. The reversibility of captopril-induced ARF is confirmed and the patient made an uneventful recovery. An immunoallergic mechanism is not thought to have been responsible for this adverse effect. It is advised that caution should be exerted in giving ACE inhibitors to elderly patients with congestive heart failure, particularly if they are on diuretics. Routine biochemical monitoring is suggested before and during captopril therapy.
Urinary Deoxypyridinoline Excretion for the Evaluation of Bone Turnover in Chronic Renal Failure
Authors: Coen Giorgio , Mantella Daniela , Calabria Santo , Sardella Daniela , Manni Micaela , Fassino Valeria , D’Anello Emanuela , Giustini Marco , Taggi Franco
Published: April 2003

Background: The urinary excretion of deoxypyridinoline (DPD) was evaluated in predialysis chronic renal failure (CRF), together with intact PTH and several classic markers of bone turnover in order to assess whether urine free and total DPD excretion are equivalent parameters of bone turnover in CRF, and to evaluate the relationship between urine DPD excretion, PTH and the other bone markers. Methods: The study was carried out in 94 patients with different degrees of renal failure due to various kidney diseases. Besides urinary DPD expressed as free DPD, total DPD, free/total DPD, free DPD/Cr and total DPD/Cr, the following determinations were made: intact PTH, bone alkaline phosphatase (BALP), total alkaline phosphatase (AP), osteocalcin (BGP), serum C-terminal telopeptide of collagen type I (ICTP) and hydroxyproline (OHpro). The patients were divided into 3 groups according to the increasing severity of renal failure (Ccr >40, 40–20, <20 ml/min). Results: The ratio free/total DPD decreased (NS) with advancing renal failure, and was inversely correlated with total DPD excretion. While PTH increased progressively to about four times the values observed in the Ccr >40 group, there was a parallel increase only in BGP and ICTP, parameters retained in the serum with decreasing renal function, while AP, BALP, total DPD and OHpro did not change. However, significant correlations between total DPD/Cr and PTH, BALP, BGP and ICTP were also found. Conclusions: In CRF free DPD is an unreliable index of bone turnover due to a probable interference in its production from the peptide-bound DPD. Total DPD or total DPD/Cr are better used. In spite of the significant correlations observed in advanced renal failure between PTH and most of the parameters examined, a resistance of bone tissue to PTH action in CRF must be considered.
Aspergillus Peritonitis in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Basok Anna , Schneider Ella , Hausmann Michael , Rapoport Jayson
Published: April 2003

Aspergillus peritonitis is a rare and serious cause of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. We report 3 cases of aspergillus peritonitis in CAPD which were successfully treated by catheter removal and amphotericin. Two of the 3 patients returned temporarily to CAPD, but were subsequently transferred to hemodialysis because of membrane failure. A novel finding in 2 of the 3 cases was a positive Limulus amebocyte lysate test, despite negative bacterial cultures. We discuss the possible relevance of this finding to the diagnosis of aspergillus infections and emphasize the importance of early catheter removal for successful treatment of this condition.
Treatment of Life-Threatening Lithium Toxicity with High-Volume Continuous Venovenous Hemofiltration
Authors: van Bommel Eric F.H. , Kalmeijer Mathijs D. , Ponssen Huibert H.
Published: April 2003

There is still debate as to the preferred extracorporeal treatment modality for severe lithium intoxication. Because lithium is readily diffusable, intermittent hemodialysis is usually performed. However, this bares the risk of a post-dialysis rebound concentration and, in the case of severe lithium poisoning collapse, aggravation of hemodynamic instability. Because of the relatively slow but continuous solute removal, continuous renal replacement therapy (CRRT) may be advantageous. We report the first case in the literature of severe lithium intoxication treated effectively with high-volume continuous venovenous hemofiltration (HV-CVVH). Results compared favorably to other forms of CRRT in terms of lithium clearance. Ease of implementation, the excellent tolerability and the superior lithium clearance without rebound phenomenon may make HV-CVVH the preferred treatment modality for severe lithium poisoning.
Borderline-Struktur und die Dissoziabilität der Psyche1
Authors: Huber Roland
Published: April 2003

Leider
besteht für diesen Artikel keine Zusammenfassung. Als Einstieg stellen wir den
Textanfang zur Verfügung. Meine Ausführungen bedeuten für die jungianische Psychologie eine gute Botschaft; aber nicht nur. Meine Hauptthese ist hier nicht bescheidener als diese: Die Analytische Psychologie ist von ihrer inneren Struktur her eine Psychologie mit einer besonderen Nähe und damit auch mit der Chance eines besonderen tiefenpsychologischen Zugangs zur Borderlinepathologie. Ich werde zu zeigen versuchen, dass eine offensichtliche Affinität besteht zwischen den psychischen Gesetzmässigkeiten und Erscheinungsformen, die in der Psychologie Jungs grosse Beachtung finden und der Seelenlage, wie sie für Borderline- und z.T. auch für andere Persönlichkeitsstörungen typisch ist. Zugespitzt lässt sich sagen: Die Seelenverhältnisse im Falle einer Borderlinestruktur sind in hohem Masse dergestalt, wie die jungianische Psychologie das Funktionieren der Seele sieht.
Vom Umgang mit Träumen in der psychotherapeutischen Praxis
Authors: Asper Kathrin
Published: April 2003

Leider besteht für diesen Artikel keine Zusammenfassung. Als Einstieg stellen wir den Textanfang zur Verfügung.Unter Frühstörung verstehe ich das Misslingen des Dialogs zwischen Mutter und Kind. Etwas stört den emotional fein abgestimmten Dialog zwischen dem Baby und der Bezugsperson. Dieses «Etwas» basiert auf mannigfaltigen Ursachen. Grob gesehen ist zwischen der Grundausstattung des Kindes und den Umweltfaktoren zu unterscheiden. Die Grundausstattung ist das, was ein Kind mitbringt; sie ist schwer zu messen, ist aber eine Tatsache, die sich zum Beispiel darin äussert, dass ein Kind mit belastenden Startbedingungen diese relativ problemlos bewältigt, während ein anderes in seiner Entwicklung sehr stark davon betroffen ist [Tress, 1986]. Die Umweltfaktoren indessen und die spezifische Verarbeitungsart der Betroffenen lassen sich im Laufe einer analytisch-therapeutischen Behandlung nachvollziehen: durch die Symptome, den Grad der Integration der Ich-Funktionen, die Erhebung einer genauen Anamnese, die Reflexion des Übertragungs- und Gegenübertragungsgeschehens sowie durch Träume und anderes Material, wie zum Beispiel den bildnerischen Ausdruck.
Der kognitive Ansatz in der Komplextheorie von C.G. Jung und seine Bedeutung für die Psychotherapie
Authors: Tschudi Laurent
Published: April 2003

Leider besteht für diesen Artikel keine Zusammenfassung. Als Einstieg stellen wir den Textanfang zur Verfügung. Im Zusammenhang mit der psychotherapeutischen Funktion der Analytischen Psychologie stellt sich in letzter Zeit immer häufiger die Frage nach deren psychotherapeutischer Vorgehensweise, d.h. nach der Methode und anzuwendenden Technik. Gleichzeitig wird auch nach ihrer Wirksamkeit gefragt. Diesbezüglich wird von Jungschen Psychologen teils auch heute noch einseitig auf einige Äusserungen Jungs verwiesen, wonach es für den therapeutischen Erfolg unter Voraussetzung einer entsprechenden Ausbildung des Therapeuten vor allem auf dessen Persönlichkeit ankomme [Jung, 1976b, § 198]. Daher brauche es für die Psychotherapie keine eigentliche Technik, eine solche könnte im Gegenteil eher schädlich sein. Jung habe nämlich gewarnt: «Man möge keine Rezepte aus der Psychoanalyse machen!» [Jung, 1971b, § 631]. Denn er vertrat die Ansicht, «dass die Psychotherapie nicht eine einfache und eindeutige Methode ist», sondern vielmehr «in gewissem Sinne ein dialektisches Verfahren ..., d.h. ein Zwiegespräch oder eine Auseinandersetzung zwischen zwei Personen» [Jung, 1976b, § 1]. Da der Therapeut beim dialektischen Verfahren «nicht mehr das handelnde Subjekt, sondern ein Miterlebender eines individuellen Entwicklungsprozesses» sei, müsse er in «diesem Falle auf alle seine Voraussetzungen und Techniken verzichten», d.h. alle Methoden meiden [Jung, 1976b, §§ 6–7].
Development of Transient Evoked Otoacoustic Emissions in the Neonatal Rat
Authors: Khvoles Roza , Freeman Sharon , Sohmer Haim
Published: April 2003

Otoacoustic emissions (OAEs) represent acoustic energy generated by the cochlear amplifier which contributes to auditory sensitivity and frequency discrimination. Therefore the OAEs can serve as a noninvasive tool to study the cochlear amplifier. While transient evoked OAEs (TEOAEs) are generally recorded clinically in man, it has been difficult to record them in animals and instead cubic distortion product OAEs (DPOAEs) have been experimentally studied in animals. In a previous study, we perfected a method of recording TEOAEs routinely in rats and this technique was used here to study the development of OAEs in neonatal rats. TEOAEs were recorded and compared to the DPOAEs on several postnatal days. With increasing postnatal age, TEOAE peak-to-peak amplitude and spectral energy in the 2- to 4-kHz band increased, their threshold decreased and their input-output functions became less monotonic with a change in slope (notch and/or plateau) in the mid-intensity region. The DPOAEs to higher frequencies appeared first, then the TEOAEs, followed by the DPOAEs to lower frequencies. With age, their amplitude also increased, thresholds decreased and a notch appeared in their input-output functions. The TEOAEs were measurable during the continuum of the appearance of the DPOAEs and the developmental sequences of both types of OAEs were similar. This may be evidence that similar mechanisms account for their maturation which probably initially involves a reduction in the air-bone gap with maturation of the outer and middle ears, and then elevation of the endocochlear potential and additional micromechanical maturations.
Mechanical Modeling and Dynamical Behavior of the Human Middle Ear
Authors: Eiber Albrecht
Published: April 2003

Very serious injuries may result from impulse noise applied to the human ear. To assess the hazard of a given impulse, its effects on the displacements and the velocities of the structures in the middle and inner ear have to be evaluated. Thus, it is necessary to consider the temporal pattern of applied pressure and the resulting temporal response of the ossicular displacements and velocities. These investigations have to be carried out in the time domain because the relations in the frequency domain known from steady-state motion do not hold. Mechanical models based on the finite-element approach and the multibody system method are presented to describe the spatial motions of the eardrum and the ossicles in the middle ear. The motion of all points of the ossicular chain can be calculated using these models. The free vibrations as well as the general solution of the excited system, consisting of a transient and a steady-state part, are analyzed. Three different sound pressure sources are considered and the dynamical response of the ossicular chain evaluated. It is not sufficient to assess a particular impulse only by its peak pressure and a characteristic time duration since the temporal response of the middle ear is strongly dependent on the waveform of sound pressure. In particular, it is shown that in most of the cases the first negative part of the pressure waveform is expected to cause the worst damage.
Temporal Processing Deficits in Remediation-Resistant Reading-Impaired Children
Authors: Cacace Anthony T. , McFarland Dennis J. , Ouimet John R. , Schrieber Edward J. , Marro Peggy
Published: April 2003

There is considerable interest in whether a deficit in temporal processing underlies specific learning and language disabilities in school-aged children. This view is particularly controversial in the area of developmental reading problems. The temporal-processing hypothesis was tested in a sample of normal children, 9–11 years of age, and in a sample of age-matched children with reading impairments, by assessing temporal-order discrimination. Five different binary temporal-order tasks were evaluated in the auditory and visual sensory modalities. Other basic discrimination abilities for single auditory stimuli were also assessed, including just noticeable differences (JNDs) for frequency and intensity and a simple threshold detection task. In these tasks, the temporal dimension was the duration of the individual stimuli (20 and 200 ms). All data were obtained using forced- choice psychophysical methods, either in a single-track adaptive format or using psychometric functions. The results from these experiments showed that children with reading impairments had deficits in temporal-order discrimination, but these effects were not modality specific. These same children also had significantly elevated frequency and intensity JNDs and their performance on these tasks were not dependent on stimulus duration. No group differences were observed on the threshold detection task, and the derived measurements of temporal integration (i.e. the threshold difference between the 20- and 200-ms stimuli) were considered normal, averaging 11.7 dB. As a whole, discrimination deficits observed in the reading-impaired group only occurred with suprathreshold stimuli. The deficits were neither modality specific nor temporal (duration) specific.
Speech Sound Representation in the Brain
Authors: Kraus Nina , Cheour Marie
Published: April 2003

Biologic processes underlying speech sound perception and learning have been addressed using the mismatch negativity (MMN) evoked response. First is a consideration of how the acoustic properties of the signal affect the neural mechanisms and brain regions engaged. Because the MMN differs depending on the acoustic characteristics of the stimuli used to elicit the response, it has been used to probe mechanisms underlying the neural representation of stimuli along the auditory pathway. Second is a consideration of neurophysiologic correlates of speech sound perception and learning. Detailed is a ‘behavioral-neurophysiologic, acoustic-phonetic approach’, used to link perception with underlying physiologic processes in humans. The focus here is on children and what has been learned about normal maturation of speech sound perception and its disruption in certain children with learning disorders. The last topic is a consideration of central nervous system changes with perceptual learning. This includes long-term experience with one’s native language and short-term auditory training in the laboratory. Limitations and future challenges are discussed.
Mismatch Negativity and N100 Monitoring: Potential Clinical Value and Methodological Advances
Authors: Morlet Dominique , Bouchet Patrick , Fischer Catherine
Published: April 2003

Continuous long-term recording of brainstem (BAEPs), middle-latency (MLAEPs) and long-latency auditory evoked potentials, including the mismatch negativity (MMN), brings additional information on the immediate functional state and the outcome of patients in coma or recovering after surgery, in relation with clinical observations and therapeutics. A recently designed monitoring system is introduced, aimed at the continuous recording of late auditory potentials (N100 and MMN) as well as BAEPs and MLAEPs. Specific methodological aspects are emphasized. Long-term monitoring data from one patient recorded in the recovery room after surgery are displayed, allowing an illustration of the techniques used and of the problems raised.
Mismatch Negativity in Aging and in Alzheimer’s and Parkinson’s Diseases
Authors: Pekkonen Eero
Published: April 2003

Mismatch negativity (MMN) is an auditory event-related potential (ERP) that reflects automatic stimulus discrimination in the human auditory system. By varying the interstimulus intervals (ISIs), the MMN can be used as an index of auditory sensory memory. This paper focuses on MMN findings in aging and in Alzheimer’s (AD) and Parkinson’s diseases (PD). The accumulated data suggest that MMN to duration deviance, unlike MMN to frequency deviance, is reduced in amplitude in aging at short ISIs. The attenuated MMN to frequency deviance observed at long ISIs in elderly subjects seems to be caused by age-related memory trace decay. Existing results suggest that automatic discrimination for the frequency change is not affected in the early phase of AD, whereas the memory trace seems to decay faster in AD patients. The present findings on PD are not as conclusive, although they tentatively suggest deteriorated automatic change detection. The MMN appears to offer an objective tool for studying auditory processing and memory trace decay in different neurological disorders.