Verlaufsbeobachtung des Kollagen- und Knochenstoffwechsels bei Patienten mit zementfreier Hüfttotalendoprothese*

Introduction This study investigated the influence of concentration and activity of several markers of the collagen and bone metabolism and their impact on ingrowth of non-cemented total hip arthroplasty. Methods 40 patients underwent an implantation of a ABG-prosthesis. Before surgery and 1, 2, 12 and 24 weeks after it serum concentrations of PICP, ICTP, IGF-1, ON, b-AP, Calcium, Phosphate, GPT and Creatinin were measured and a collagen ratio (CQ) was calculated. Results PICP decreased until 1st week, increased at 2nd week and decreased again after that time. ICTP increased significantly in 1st week, reached a maximum in 2nd week and decreased after that. b-AP decreased in 1st week but inc…

Acute dialysis: PMN-elastase as a new parameter for controlling individual anticoagulation with low molecular weight heparin (Fragmin).

Despite the improvements in the development of dialyzer membranes with greater hemocompatibility, an activation of the coagulation system occurs when blood comes into contact with exogenous surfaces. The large number of heparin dosage regimens demonstrate the difficulty to adapt general therapeutic guidelines. Low molecular weight heparin (Fragmin®) was administered as a single bolus dose for anticoagulation during 58 acute dialyses. Anti-Xa-activity, the plasma levels of the lysosomal elastase of the polymorphnuclear granulocytes (“PMN-elastase”) and of the thrombin-antithrombin III-complex (TAT) were measured at hourly intervals. Therapeutic anti-Xa-levels did not show evidence of suffici…

Postoperative Reduction of Fibrinolysis as a Prognostic Factor of Fatal Outcome

For the resection of an esophagus carcinoma a mortality rate of 2 to 30% was described, It is still unclear whether an abdominothoracic or transhiatal intervention is superior regarding the outcome. To investigate the prognostic value of fibrinolytic markers, plasmin-α2-antiplasmin (PAP) and D-dimer (DD) values were determined daily in the early postoperative period for 11days. In addition, the course of PAP and DD concentrations was compared with the method of esophagectomy. Of the 28 patients enclosed in the study, 5 died between day 10 and day 34 owing to adult respiratory distress syndrome and septicemia. The PAP and DD concentrations increased in survivors after surgery until day 5 an…

Correlations of blood selenium with hematological parameters in West German adults.

The serum selenium and the whole blood selenium of 72 healthy persons (47 women, 25 men) was determined. There exist sex specific differences of the whole blood selenium between men (98 +/- 19 micrograms Se/L) and women (89 +/- 17 micrograms Se/L). The serum selenium did not show sex specific differences, but sex specific differences are found if the total amount of extracellular selenium is calculated by correction of the serum selenium with the hematocrit. Women have more extra-cellular selenium/L whole blood (40 +/- 8 micrograms Se) than men (36 +/- 7 micrograms Se). Men have more intraerythrocyte selenium (cellular selenium = 67 +/- 14 micrograms Se) in one L whole blood than women (52 …

Immunonephelometric determination of the apolipoprotein A-II.

A fully mechanized immunonephelometric method is described for the rapid and specific determination of apolipoprotein A-II in serum. The method utilizes commercially available sheep antiserum against human apolipoprotein A-II. Nephelometry was performed with the Behring Nephelometer Analyzer (BNA). A single determination can be performed in 12 minutes, requiring 10 microliters sample volume. The measuring range is about 0.08 to 1.25 g/l apolipoprotein A-II. Precision is characterized by intra-assay coefficients of variation of 3.37%, 3.93% and 4.49% for apolipoprotein A-II concentrations of 1.22 g/l, 0.376 g/l and 0.185 g/l, and inter-assay coefficients of variation of 4.27% for an apolipop…

Influence of HMG-CoA reductase inhibitors on markers of coagulation, systemic inflammation and soluble cell adhesion.

Abstract Background: Beneath its lipid-lowering properties additional non-lipid effects of statin therapy are discussed. We therefore examined the impact of statins on laboratory markers of coagulation, inflammation and soluble cell adhesion to further explore these effects in 950 hospitalised patients with angiographically proven CAD. Methods and results: Although no significant differences were found in total cholesterol, LDL and HDL and triglyceride levels a statistically lower value in 277 statin-treated patients was found for von Willebrand factor [162(130/224) vs. 208(154/283)%, P =0.0001], leukocyte count [6.9(5.8/8.4) vs. 7.3(6.1/9.4)/nl, P =0.0005], high sensitive CRP [4.3(1.8/10.8…

Treatment with essential amino acids in patients on chronic hemodialysis: a double blind cross-over study.

Patients on chronic hemodialysis may suffer from a latent protein deficiency, and therapy with essential amino acids has been recommended. In a double blind cross-over study, 13 hemodialysis patients received orally 15.7 g of essential amino acids daily over a 3-month period. Patients were on a liberal diet, containing 1 g of protein per kilogram of body weight per day. Hemodialysis was adequate. Therapy resulted in an increase in urea, uric acid, C3 c complement factor and a fall in C4. Lysine levels increased and phenylalanine fell. Malnutrition could not account for the observed metabolic changes, which are more likely due to uremic metabolic disturbances. A liberal diet of 1 g of protei…

The influence of dopamine on hemodynamics, microcirculation and renal function in patients with hypnotic drug intoxication

The effect of dopamine on hemodynamics (CO, AoPm, TPR, SV, SW, CVP, PAPm, PAEDP), microcirculation (MBF, PS-product) and renal function (VU, CKI, CNa, CK, Cosm, TcH2O) was studied in 8 patients with hypnotic drug poisoning. With increasing doses of dopamine, cardiac output and heart rate increased and the peripheral resistance decreased. An augmentation of stroke volume and left ventricular stroke work was observed in the low dose range only (200--400 mug/min). With increasing doses, central venous pressure as well as mean pulmonary artery pressure and enddiastolic pulmonary artery pressure decreased. No vasoconstriction was found in muscle tissue vessels even with large doses of dopamine. …

Recombinant hirudin as a periprocedural antithrombotic in coronary angioplasty for unstable angina pectoris

Percutaneous transluminal coronary angioplasty is often complicated by thrombotic abrupt vessel closure in patients with unstable angina pectoris. The present multicentre trial was performed to determine the feasibility of two-dose regimens of recombinant hirudin (r-hirudin) compared to standard heparin in patients undergoing coronary angioplasty for unstable angina, and to investigate the effects of the different treatment regimen on markers of coagulation activation. At five participating centres, 61 patients were randomly enrolled in one of two sequential groups of r-hirudin (group 1: 0.3 mg.kg-1 i.v. bolus, 0.12 mg.kg-1.h-1 i.v. infusion; 21 patients; group 2: 0.5 mg.kg-1 i.v. bolus, 0.…

Immunologic findings in workers formerly exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin and its congeners

One hundred ninety-two workers in a German pesticide factory who were exposed to polychlorinated dibenzodioxins and -furans (PCDD/PCDF) were investigated for former and present diseases and laboratory changes of the immune system. Moreover, in a subgroup of 29 highly exposed and 28 control persons, proliferation studies were performed. In addition to assays such as blood count, immunoglobulins, serum electrophoresis, monoclonal bands, surface markers, autoantibodies, and lymphocyte proliferation, two new methods, the rise of tetanus antibody concentration after vaccination and the in vitro resistance of lymphocytes to chromate, were used to diagnose the morphologic and functional state of t…

Significance of hyperlactatemia in acute hypnotic drug poisoning

Lactate concentration, fibrinogen and fibrin(ogen) -- degradation-products in central venous blood were analysed in 35 unconscious patient with acute hypnotic drug poisoning (HDP) and compared with the results in 13 healthy control persons undergoing the same degree of forced diuresis via central venous catheters. Blood samples were taken on admission and at 12 h intervals up to 36 h after admission. Patients with HDP were attributed to the categories of moderate intoxications (n = 17) and severe intoxications (n = 18) according to their clinical condition. On admission, blood lactate was significantly higher in severe intoxication (3.90 +/- 2.94 mmol/l) as compared to the control group (1.…

Vitamin metabolism in patients with a Mainz pouch I: long-term followup.

We assessed whether creation of the Mainz pouch I, which requires 24 to 36 cm. of terminal ileum and 12 cm. of ascending colon including the ileocecal valve, leads to metabolic disturbances.In 137 patients the levels of vitamins A, B1, B2, B6, B12, D and E, folic and bile acids, ammonia, and intracorpuscular vitamin B12 and folic acid were evaluated and a red blood count was performed. Patients were divided into children and adults, and into 3 groups according to number of years after surgery (2 or less, more than 2 to 4 and more than 4).In all patients the levels of vitamins A, B1, B2, B6, D and E, folic and bile acids, and ammonia as well as red blood count were within normal ranges. In t…

Evaluation of an automated chromogenic substrate assay for the rapid determination of hirudin in plasma.

Abstract A fully mechanized chromogenic substrate assay method for the rapid and specific determination of recombinant hirudin (r-hirudin) in citrated plasma on clinical chemistry analyzers (Hitachi 911 and Cobas Mira) is described. In a first step, 12 μl sample volume is mixed with the chromogenic substrate. Due to the almost immediate action of hirudin the inhibitory reaction and the cleavage of the substrate is started simultaneously when bovine thrombin is added in excess. This excludes interferences by antithrombin III or heparin cofactor II. The change in absorbance/min is recorded at 405 nm. The measuring range is about 0.2 – 4.0 mg/l r-hirudin on both analyzers. Precision is charact…

High-Dose ϵ-Aminocaproic Acid Versus Aprotinin: Antifibrinolytic Efficacy in First-Time Coronary Operations

The antifibrinolytic efficacy of a high-dose regimen of epsilon-aminocaproic acid (epsilon-ACA) was compared with aprotinin in first-time coronary operations.In a prospective, double-blinded, randomized study, 20 patients received high-dose epsilon-ACA (10 g both as a loading and cardiopulmonary bypass priming dose, 2.5 g/h until 4 hours after protamine), and another 20 patients received aprotinin (2 x 10(6) KIU [280 mg] for loading and priming, 0.5 x 10(6) KIU/h [70 mg/h]). Ten untreated patients served as controls.Both agents reduced postoperative levels of thrombin/antithrombin III complexes, D-dimers, fibrin degradation products, free plasma hemoglobin (epsilon-ACA versus aprotinin, p =…

Long-term metabolic effects in patients with urinary diversion

The use of intestinal segments in genitourinary reconstruction could influence vitamin metabolism and affect the skeletal bone and its mineral content in the long term. In 137 patients, serum levels of the vitamins A, B1, B2, B6, B12, D, and E and of folic acid, bile acid, and ammonia as well as levels of intracorpuscular vitamin B12 and folic acid were examined and a red blood cell count was performed. The patients were divided into three groups (or = 2 years,2 toor = 4 years, and4 years after surgery) as well as into children and adults. In addition, bone mineral density (dual-photon absorptiometry) was measured in 25 patients. Of these, 16 patients were approximately 16.8 years s/p recta…

Reoperation and the centrifugal pump?

Postperfusion syndrome is still a problem in long cardiac operations using extracorporeal circulation (ECC). To evaluate whether or not centrifugal blood pumping during open heart surgery is beneficial, a randomized, prospective study was undertaken of 50 consecutive patients undergoing elective coronary artery bypass grafting. The patients were divided into two groups of 25 each. In group 1 a centrifugal pump (Biomedicus) was used as arterial blood pump, while in group 2 a roller pump (Stockert) was used. The two groups did not differ significantly and the number of variables during surgery was kept low (identical perfusion set, two surgeons, minimal cardiotomy suction). The parameters stu…

Increased plasma concentration of fibrin monomer in acute myocardial infarction with early reperfusion.

OBJECTIVE To assess whether plasma fibrin monomer (FM) concentration, a marker of thrombin activity, is increased in the first hours after acute coronary occlusion and whether there are differences between patients with and without early reperfusion. DESIGN Thirty-five consecutive patients with acute myocardial infarction (AMI) and early coronary angiography were studied prospectively. METHODS Plasma FM samples taken on admission (< 6 h after onset of chest pain) and 6-14 h after onset of chest pain were analysed using a specific enzyme immunoassay. All of the patients were anticoagulated with heparin intravenously. RESULTS Of the 35 patients, 28 had angiographically documented reperfusion …

Hepatocellular carcinoma after thorotrast exposure: establishment of a new cell line (Mz-Hep-1).

A human hepatoma cell line, associated with thorotrast exposure, from an hepatitis B marker-negative patient was established as a permanent cell line (Mz-Hep-1) in tissue culture. Histology of the primary tumor, as well as phase contrast, transmission and scanning electron microscopy of the cultured cells showed typical characteristics of liver cells. Mz-Hep-1 cells secreted complement components (C2, C3, C4), carcinoembryonic antigen, lactate dehydrogenase, chymotrypsin, haptoglobin and retinol-binding protein and expressed HLA-, transferrin-, blood group B-related determinants and complement component C5 and carcinoembryonic antigen on their cell surface. Mz-Hep-1 cells represent the firs…

Hepatocellular carcinoma: Biochemical and antigenic markers of three established cell lines

Quantitativer immunologischer Schnelltest zum Nachweis von Kreatinkinase-MB im Serum beim Myokardinfarkt

Verbesserung der postoperativen Thromboseprophylaxe in der Unfallchirurgie durch Dosisanpassung niedermolekularen Heparins anhand TAT- und D-Dimer-Verlauf

Von Februar 197 bis Februar 1998 wurde bei 518 Patienten die postoperative Thromboseprophylaxe mit niedermolekularem Heparin anhand der Laborparameter TAT und D-Dimer dosisadaptiert vorgenommen. Es traten vier Thrombosen (1,6%) ohne embolische Komplikation auf. Die praoperativen TAT- und D-Dimer-Werte aller im Gesamtverlauf dosisangepasten lagen im Mittel signifikant hoher als die der ubrigen Patienten. 83% aller Adaptierungen erfolgten dabei zwischen dem vierten und siebten postoperativen Tag.

Creatinkinase ? Isoenzyme: Idiopathisches Auftreten von Creatinkinase-BB-Aktivit�ten im Serum von Patienten

Bei der Differenzierung der Aktivitaten von Creatinkinase-Isoenzymen im Serum von Patienten mit immunologischen Methoden kann das in der Literatur beschriebene Vorkommen von Creatinkinase-BB-Aktivitaten bei verschiedenen Krankheiten bzw. Operationen im allgemeinen nicht bestatigt werden. Jedoch wird bei Patienten hoheren Lebensalters (57–85 Jahre mit einer Ausnahme) mit einer Frequenz von grosenordnungsmasigl:1000 Creatinkinase-BB-Aktivitat gefunden. Die Aktivitaten betragen 15–234 U/l bzw. 19–94% der Gesamt-Creatinkinase-Aktivitaten. Bisher kann kein Zusammenhang mit einer bestimmten Krankheit hergestellt werden. Diese Falle werden dadurch erkannt, das die Bestimmung von CK-MB-Aktivitaten …

Magnesium concentration in saliva — an indicator of digitalis toxicity

In a prospective study salivary magnesium was measured by atomic absorption spectrophotometry in 168 patients on chronic digoxin therapy. Magnesium concentration in saliva was correlated with clinical data and plasma digoxin levels. A significant elevation in salivary magnesium concentration was caused by digoxin therapy (0.58 +/- 0.39 mmol/l, n = 93) in comparison to patients with no digitalis treatment (0.17 +/- 0.07 mmol/l, n = 35). Magnesium concentrations in saliva were significantly higher in toxic patients (1.1 +/- 0.68 mmol/l, n = 32) than in nontoxic patients. Possibly toxic patients showed a magnesium level of saliva of 0.63 +/- 0.39 mmol/l (n = 40). In 89% of the intoxicated pati…

Monitoring prothrombin fragment 1+2 during initiation of oral anticoagulant therapy after intracoronary stenting

Patients with intracoronary stent implantation are treated with aggressive anticoagulant and antiplatelet therapy consisting of high-dose heparin, phenprocoumon, acetylsalicylic acid, dipyridamole, and the infusion of dextran to prevent a subacute thrombotic occlusion of the stented segment. In an effort to optimize this treatment by reducing both imminent bleeding complications and subacute thrombotic occlusion, the concentrations of prothrombin fragment 1 + 2 (F 1 + 2) were determined after intracoronary Palmaz-Schatz stent implantation in 19 consecutive patients. The F 1 + 2 concentrations after stent implantation and before the initiation of oral anticoagulant therapy (OAT) were 0.35 nm…

Influence of blood sampling from venipunctures and catheter systems on serial determinations of prothrombin activation fragment 1 + 2 and thrombin-antithrombin III complex

To evaluate the influence of different blood sampling techniques on test results of thrombin-antithrombin III complex (TAT) and prothrombin fragment 1 + 2 (F1 + 2) serial determinations were performed. In six groups of nonrandomized patients (ten patients each) the concentrations of the coagulation markers of blood samples from central catheters (internal jugular, caval, Shaldon, pulmonary artery) and peripheral cannulas (17G and 18G) were compared with those of blood samples obtained simultaneously from direct venipunctures of the contralateral arm. Medians and 25th-75th percentiles of TAT and F1 + 2 concentrations of plasmas obtained from central catheters were not different from those ta…

ProC Global: the first functional screening assay for the complete protein C pathway.

Abstract In clinical practice, venous thromboembolic complications are much more frequent than bleeding disorders. In fact, disturbances within the protein C pathway due to coagulation factor V (FV) Leiden mutation and deficiency of protein C or protein S are the most frequent abnormalities in hereditary thrombophilia. Furthermore, acquired dysfunctions of the protein C system may predispose the single individual to an increased thrombotic risk. A routine-suited screening assay that would allow the monitoring of the proper interplay of factors in the protein C pathway could add an important factor to the basic coagulation profile. This consists of the prothrombin time and of the activated p…

Untersuchungen zur Aktivit�tskinetik des Isoenzymes CK-MB im Serum nach Myokardinfarkt

We investigated the activity kinetics of CK-total and CK-MB in 83 patients with proven myocardial infarctions. Serial serum samples were taken at intervals of 2--6 h. The activity of isoenzym CK-MB was determined by means of the immunological inhibition method. CK-MB activity was determined in all patients. The mean peak activity of CK-MB was 65 U/l (range: 9-241 U/l). At the time of peak CK-MB activity the mean percentage CK-MB activity was 13.2% (range: 3.4--21.7%). The CK-MB activity reached its peak at 17.4 h (range: 3.0--32.5 h) after the onset of retrosternal pain. This is 1.4 h after peak CK-total activity. The mean disappearance rate constant for CK-MB (n = 31) was found to be 9.3 X…

Reference Values for a Homogeneous Ferritin Assay and Traceability to the 3rd International Recombinant Standard for Ferritin (NIBSC Code 94/572)

Abstract Reference values for two ferritin assays (Tina-quant®a Ferritin, Enzymun®, both Roche Diagnostics, Mannheim, Germany) were established (136 males and 139 females). To rule out inflammation as well as iron deficiency in the reference population, subjects with the C-reactive protein concentration &lt; 5 mg/l, and zinc protoporphyrin &lt; 40 µmol/mol heme and the soluble transferrin receptor &lt; 3 mg/l were selected. Taking into account latent iron deficiency as well as hereditary hemochromatosis the 5–95 percentile range was as follows: male, 27–365 μg/l; female, 13–148 μg/l for Tina-quant®a and 12–151 μg/l for Enzymun®. The Tinaquant® a Ferritin assay showed a very good correlation…

Dose-Adjusted Thrombosis Prophylaxis in Trauma Surgery According to Levels of D-Dimer

In 234 trauma surgery patients, thrombosis prophylaxis with Nadroparin-Calcium low-molecular-weight heparin (LMWH) was adjusted according to levels of D-Dimer. Basic prophylaxis was 2,850 IU per day. If D-Dimer concentrations rose above 2 mg/L after the fourth postoperative (p.o.) day, LMWH was administered twice a day. Color Doppler ultrasound was performed between the fifth and seventh p.o. days. Patients were divided into a high-risk (group 1: hip, femur, or knee replacement surgery, n=102) and a moderate-risk group (group 2: other surgery of the knee, tibia, fibula, or foot, n=132). Group 1 showed significantly higher D-Dimer levels than group 2 (p0.001). Measurement of D-Dimer on days …

Vitamin A (Retinol) und Retinolbindendes-Protein (RBP) im Serum bei Maldigestion, Malabsorption und Lebercirrhose

Bei Normalpersonen und Patienten mit Malabsorption, Maldigestion und Lebercirrhose wurden vor und nach oraler Belastung mit 600 000 E Vitamin-A-palmitat bzw. wasserloslichem Vitamin A im Serum der Spiegel des Vitamin A (Retinol), des Retinol-bindenden Proteins (RBP) und Praealbumin bestimmt. In der Kontrolle steigt das Retinol nach Belastung signifikant an und erreicht nach 5 Std sein Maximum. Das RBP liegt im Mittel bei 42,25 mg/L, der Praealbuminspiegel bei 400 mg/L. Patienten mit Malabsorption und Lebercirrhose zeigen vor und nach Belastung mit Vitamin-A-palmitat einen gegenuber der Kontrolle verminderten Retinolspiegel. In der Gruppe der Maldigestion ist der Nuchternspiegel des Retinols…

In-vitro assessment of centrifugal pumps for ventricular assist.

Currently two major types of centrifugal pumps are commercially available for ventricular assist: the Biomedicus-cone (Group I) and the Centrimed-impeller pump (now Sarns 3M) (Group II). To compare them for blood trauma and hemolysis, an in-vitro experiment was designed with a Stockert roller pump as a standard control (Group III). The in-vitro circuit was constructed consisting of a pump head, electromagnetic flow probe, polyvinyl chloride tubing and a reservoir, identical for all groups. Human ACD blood was used for priming and was circulated with a flow rate of 2 L/min for 24 h. Blood samples were taken at 0, 1, 3, 6, 12, and 24 h and zero control values were subtracted from the resultin…

Pr�vention thromboembolischer Komplikationen in der Unfallchirurgie durch Dosisanpassung von niedermolekularem Heparin anhand TAT- und D-Dimer-Werten

Bei unfallchirurgischen Patienten tritt in bis zu 40% eine tiefe Beinvenenthrombose auf. Das individuelle Risiko kann kaum kalkuliert werden. 518 unfallchirurgische Patienten mit Prophylaxe durch eine tagliche Einzeldosis eines niedermolekularen Heparins (NMH) wurden praoperativ und bis zu 10 Tage postoperativ in einer prospektiven Untersuchung beobachtet. Sie wurden in 2 Gruppen unterteilt: Gruppe I mit Huft- und Oberschenkeloperationen sowie Kniegelenkprothesen und Gruppe II mit Knie- und Unterschenkeloperationen. Bestimmt wurden Thrombin-Antithrombin-Komplex und D-Dimer. Eine 2. Dosis NMH wurde bei Uberschreiten des D-Dimer-Cut-off-Wertes verabreicht. Bei sonographischem Verdacht auf ein…

Aktivitätsbestimmung von Isoenzym CK-MB. Anwendung und Grenzen in der Diagnostik des Myokardinfarktes

Die Abklarung von Aktivitatserhohungen der Kreatinkinase kann in der Differentialdia-gnose des Myokardinfarktes wegen des Vorkommens dieses Enzyms vor allem in der Skelettmuskulatur und in fast alien parenchymatosen Organen erhebliche Schwierigkei-ten bereiten. Eine organbezogene Zuordnung von CK-Aktivitatserhohungen ist deswegen haufig nicht moglich. Eine Verbesserung der diagnostischen Situation wird durch die Bestimmung der Isoenzyme der Kreatinkinase erreicht, da in den einzelnen Organen unterschiedliche Verteilungsmuster der Isoenzyme gefunden werden. Das Isoenzym CK-MB kommt vorwiegend in der Herzmuskulatur vor, hier betragt sein Aktivitatsanteil zwischen 30 und 50% der Gesamtaktivita…

Immunonephelometric determination of the C4b-binding protein.

A fully mechanised immunonephelometric method for the rapid and specific determination of C4b-binding protein (C4b-BP) in citrated plasma is described. The method utilizes commercially available rabbit antiserum against human C4b-BP and a nephelometer analyser. A single determination can be performed within 6 min, requiring 80 microliters sample volume. The measuring range is about 10 to 200% of normal C4b-BP. Precision is characterized by intraassay coefficients of variation between 1.5% and 2.8%, and interassay coefficients of variation between 4.0% and 4.6% for the same C4b-BP concentrations. The nephelometry of C4b-BP was correlated with electroimmunodiffusion (Laurell technique; r = 0.…

Präparative Trennung der L-Ketten von Gamma-G-Globulinen aus Normal- und Myelomseren

L-Ketten normaler Gamma-G-Globuline lassen sich an CM Sephadex in einem konstanten Mengenverhaltnis in zwei Unterfraktionen, L A und L B , auftrennen. Beide Fraktionen pracipitieren mit Anti-L-Kappa und Anti-L-Lambda-Seren. Sie lassen sich in der Acrylamidgelelektrophorese in je drei Proteinbanden auftrennen. Aus Gamma-G-Myelomseren praparierte L-Ketten zeigen an CM Sephadex verschiedene Elutionsbilder: Vermehrung der Fraktion L B mit Uberwiegen der Kappa- oder Lambda-Form, Vermehrung der L A -Fraktion mit alleinigem Nachweis der Kappa-Ketten oder gleiche Quantitaten der L A - und L B -Komponenten mit immunologischem Nachweis reiner Kappa-Ketten. In der Discelektrophorese zeigen die L-Kette…

False-Positive LSD Drug Screening Induced by a Mucolytic Medication

Since the early 1990s, the ingestion of lysergic acid diethylamide (LSD) as an inexpensive alternative to amphetamine derivatives has once again become widespread (1)(2). Consequently, screening of LSD has gained importance in clinical routine. The drug screening of a patient with a severe craniocerebral trauma showed a positive LSD screening by the homogeneous immunoassay CEDIA® DAU LSD (Boehringer Mannheim). In spite of the 3-h half-life of LSD in plasma (3), the drug screening remained positive for several days. These samples …

Growth hormone substitution in growth hormone-deficient adults: Effects on collagen type I synthesis and skin thickness

Growth hormone stimulates collagen type I synthesis. Collagen type I is a common matrix compound in a large number of connective tissues. The aim of our study was to prove whether a stimulation of collagen type I synthesis might be accompanied by a deposition of collagen type I in the skin (cutis). Twenty growth hormone-deficient hypopituitary patients were included in a randomised, double-blind, placebo controlled, prospective, twelve-month study (eighteen patients assessable at the end of the study). The patients were treated with recombinant human growth hormone 0.25 U/kg/week subdivided in daily subcutaneous injections beginning with half the dosage during the first four weeks. During t…

Down-regulation of the expression of endothelial NO synthase is likely to contribute to glucocorticoid-mediated hypertension.

Hypertension is a side effect of systemically administered glucocorticoids, but the underlying molecular mechanism remains poorly understood. Ingestion of dexamethasone by rats telemetrically instrumented increased blood pressure progressively over 7 days. Plasma concentrations of Na + and K + and urinary Na + and K + excretion remained constant, excluding a mineralocorticoid-mediated mechanism. Plasma NO 2 − /NO 3 − (the oxidation products of NO) decreased to 40%, and the expression of endothelial NO synthase (NOS III) was found down-regulated in the aorta and several other tissues of glucocorticoid-treated rats. The vasodilator response of resistance arterioles was tested by intravital m…

Biliary adenocarcinoma

Three human cell lines from adenocarcinomas of the extrahepatic biliary tract were established in permanent tissue culture. Mz-ChA-1 and Mz-ChA-2 were cultured from mechanically dissociated gallbladder adenocarcinoma metastases and SK-ChA-1 was grown from malignant ascites of a patient with primary adenocarcinoma of the extrahepatic biliary tree. Cell doubling times in tissue culture are 3-4 days for Mz-ChA-1 and approximately 2 days for Mz-ChA-2 and SK-ChA-1. All three tumour cell lines were successfully transplanted to nude mice, inducing progressive tumour growth. Histologically, nude mouse tumours resembled the original adenocarcinomas. In vitro formation of gland-like structures were r…

Determination of Human Granulocyte Elastase by the Immunoactivation Method on the Hitachi® 717 Automated Analyser

This paper describes a fully mechanized homogeneous immunoassay using the immunoactivation method for the rapid and specific determination of human granulocyte elastase (EC 3.4.21.37) in plasma. The method uses anti-elastase antibody fragments from sheep, conjugated to horseradish peroxidase. These enzyme-antibody conjugates bind to the elastase-alpha 1-proteinase inhibitor complex present in plasma. A separate sample blank with non-specific sheep antibody fragments conjugated to horseradish peroxidase corrects for errors introduced by the sample matrix. Measurements were performed with the clinical chemistry analyser Hitachi 717. A single determination can be performed in 10 min, requiring…

In Reply: Cardiac Troponin T in End-Stage Renal Disease Patients Undergoing Chronic Maintenance Hemodialysis

Estimation of pharmacokinetic parameters of lithium from saliva and urine

The salivary and urinary excretion of lithium was studied in three healthy male sub;ects after oral administration of two or three different doses. In all individuals the concentration of lithium in salivary fluid was found to be 2.2 to 3.3 times as high as the concentration in plasma. In each sub;ect the saliva:plasma concentration ratio remained constant over more than a 100 fold concentration range for at least 3 months. This ratio was not markedly affected by about tenfold changes in saliva flow rate. Thus, pharmacokinetic parameters obtained from salivary excretion data are in agreement with those obtained from plasma concentration and urinary excretion rate data, and renal clearance o…

Double-blind cross-over study with oral alpha-ketoacids in patients with chronic renal failure.

In 15 ambulatory patients with renal insufficiency (creatinine clearance, 9.9 +/- 3.0 ml/min) the effect of oral supplementation with alpha-ketoacids has been compared with that of placebo. The protein intake amounted to 0.55 g protein per kilogram body weight of high biological value, as estimated by dietary recordings. After a control period of 3 months the patients received, in a double-blind study, 1.05 g alpha-ketoacids/10 kg body weight per day or a placebo for 6 weeks with a subsequent cross-over. Fasting blood samples were analyzed at 3-week intervals for routine laboratory parameters and 17 proteins. Anthropometric and clinical data have been recorded every 3 weeks. While therapy w…

Biochemical bone markers compared with bone density measurement by dual energy X-ray absorptiometry

In contrast to medical imaging, the biochemical markers allow a more frequent determination and are not as invasive as histomorphometric methods. We investigated biochemical markers of type I collagen compared with bone density measurements in 85 females between 41 and 89 years of age (median: 57 years). The bone density measurements were performed by dual energy X-ray absorptiometry (DXA) on the lumbar spine (L1-4). The bone density measurements were stated as a percentage of the norm. All patients were divided into three groups: I =80%; II = 80-130%; III =120%. Based on this classification the median concentration of the I-carboxyterminal propeptide of type I collagen in serum (S-PICP) as…

Isoenzyme der Kreatin-Kinase: Verteilungsmuster in der Skeletmuskulatur und im Serum bei Erkrankungen sowie Sch�digungen der Muskulatur

In operativ gewonnenem Skeletmuskel wurden mit Hilfe der Immun-Prazipitation und der Chromatographie die Isoenzyme der Kreatin-Kinase untersucht. Dabei fanden sich Aktivitaten der CK-MB zwischen 17 und 47 U/g Frischgewicht, entsprechend einem Anteil von 2,1–4,2% der Gesamtaktivitat. Bei Patienten mit Muskeldystrophie, Polymyositis, Hypothyreose, nach arteriellen Embolien, epileptischen Anfallen, Hyperventilationstetanie, Operationen und nach Polytrauma mit und ohne Thoraxverletzungen wurden im Verlaufe die Isoenzyme der CK im Serum mit Hilfe der Immun-Prazipitations- und Immun-Inhibitions-Methode bestimmt. In diesen Krankheitsgruppen liesen sich im Serum bei einem Grosteil der Patienten CK-…

Retinal vascular occlusion and deficiencies in the protein C pathway.

Abstract PURPOSE: To report abnormalities in the protein C pathway and other vascular occlusion risk factors in patients with retinal vascular occlusion. METHODS: In a study, we investigated 76 consecutive patients who had in-patient evaluation of venous or arterial retinal vascular occlusion. All patients underwent comprehensive tests for coagulation disorders including determinations of protein C, protein S, lupus anticoagulants, and resistance to activated protein C and were screened for vascular disease risk factors. Resistance to activated protein C was confirmed by a polymerase chain reaction method to detect the specific factor V R506Q mutation. For comparative purposes, we also scre…

Aktivit�tsbestimmung der Isoenzyme der Aldolase im menschlichen Serum mit Hilfe pr�zipitierender Antik�rper

Die Isoenzyme der Aldolase im Serum wurden mit Hilfe prazipitierender Antikorper bestimmt. Das Isoenzymmuster bei 130 gesunden Personen, aus einem Normwertprogramm ausgewahlt, ergab folgende Werte: Gesamt-Aldolase 0,8, 1,6, 2,5 U/L, Isoenzym A 0,6, 1,2, 1,9 U/L, Isoenzym B 0,0, 0,2 0,7 U/L und Isoenzym C 0,0, 0,1, 0,4 U/L ausgedruckt als $$\bar x$$ ±2s. Der Vergleich der Histogramme zeigt, das die Werteverteilung bei Messung der Gesamtaldolase sich bei Gesunden und Hepatitis-Kranken uberschneidet. Bei Messung der Aldolase B kommt es zu keiner Uberschneidung der Werteverteilung. Eine Differenzierung zwischen Gesunden und Kranken mit akuter Hepatitis ist moglich.

The control of anti-coagulation in acute dialyses with sensitive laboratory parameters.

In seven patients who had to be dialysed between four and 13 times due to acute renal failure, low molecular weight heparin (LMWH) Fragmin was used for anticoagulation. According to dose-finding studies, 80-90 U kg-1 body weight of LMWH as a single bolus were administered initially, producing dose-related levels of 0.3-1.5 anti-factor Xa U ml-1 in plasma. Apart from the anti-Xa activity in the plasma, the thrombin anti-thrombin III complex (TAT complex) and a fibrin degradation product (D-dimer) were measured as parameters of a coagulation activation. A sufficient anti-coagulation during dialysis was supposed to exist at a normal range (5.0 micrograms l-1 or below) of TAT complex. Pathologi…

Effect of long-term treatment with GH on bone metabolism, bone mineral density and bone elasticity in GH-deficient adults

OBJECTIVE Adults with GH deficiency (GHD) commonly have subnormal bone mineral density (BMD), and have been reported to have an increased risk of fractures. It has been suggested that GH replacement therapy may have beneficial effects on bone in such patients. The aim of this study was to investigate the effects of long-term GH replacement therapy on bone metabolism, BMD and bone elasticity in adults with GHD. DESIGN At the start of the study, 20 adults with GHD were randomized to receive either GH, 0.25 IU/kg/week (the ‘GH group’) or placebo (the ‘placebo group’). After 6 months, patients in the placebo group were switched to GH therapy, and all patients received GH for a further 42 months…