The artificial kidney and related procedures; a report on clinical experience

The Skeggs-Leonards artificial kidney and related methods were applied by the author in about thirty instances in patients with various kinds of renal disease. The treatment brought about clinical improvement of varying degree and appeared to be life-saving in four of five patients with acute renal failure. Treatment with the artificial kidney is indicated for patients with acute renal failure who develop clinical signs of uremia. The artificial kidney should be applied before the patient's condition has become irreversible. Removal of edema fluid is possible with modern artificial kidney equipment and appears to extend the therapeutic possibilities of the procedure. The artificial kidney may be of help in barbiturate and other intoxications. It affords temporary palliation in certain patients with chronic uremia; it may be used to overcome acute exacerbations of chronic renal disease; it may make it possible to operate on uremic patients who otherwise could not withstand operation.     

胸部创伤并发急性呼吸窘迫综合征21例临床分析

目的:总结胸部创伤并发急性呼吸窘迫综合症(ARDS)患者的诊治经验.方法:回顾性研究2000年1月-2008年12月期间我院21例胸部创伤并发ARDS患者的临床资料.结果:本组21例患者均采取以呼吸机辅助通气为主的综合治疗措施,21例患者中治愈15例,死亡4例,2例放弃治疗.结论:严重的胸部创伤并发ARDS死亡率极高,早期诊断和及时正确地采用机械通气为主的综合治疗是成功救治胸部创伤并发ARDS患者的关键.     

A preliminary report on a bacteriological assay for compound 1080 (sodium monofluoroacetate)

A new, inexpensive, simple and rapid bioassay for sodium monofluoroacetate (compound 1080) was developed using bacteria. Two 1080-sensitive isolates ( Bacillus sp. DHW and Acinetobacter sp. DHW) from local aquatic environments were tested on different agar media using the disc diffusion technique. Both bacteria exhibited zones of growth inhibition surrounding the 1080 discs that were linearly proportional to the concentrations (log₁₀) of 1080. Preliminary studies indicate that this technique can be used for assaying 1080 in environmental and biological samples.     

Trifluoroethylvinyl ether (fluoromar); a preliminary report on clinical experience and animal experiment

In observations of 80 cases in which Fluoromar was used for inhalation anesthesia it was noted that induction was rapid; maintenance although labile, was usually smooth; and recovery of reflexes was rapid. Anesthetic complications were minimal, and postanesthetic complications were limited to nausea and vomiting in no greater incidence than that expected to follow the use of most inhalation anesthetic agents. Fluoromar produces rapid, and not particularly unpleasant, loss of consciousness, and will produce complete anesthesia without supplement. However, the muscular relaxation afforded by Fluoromar is not complete, and delayed recovery from anesthesia may follow attempts to produce relaxation by deepening too greatly the level of anesthesia. The inflammability of Fluoromar is less than that of other inhalation agents.     

Familial adult onset X-linked hypophosphataemic osteomalacia (report of a family; clinical and experimental studies)

From four patients (a great-grandmother, grandmother, her daughter and her grandson) suffering from a very severe form of familial X-linked hypophosphataemic osteomalacia (XLH), belonging to a 23-number-kindred of five generations, the youngest patient a 24-year-old man with an adult onset XLH was treated with phosphate and calcitriol for two years. Phosphate was given in increasing doses (500-6000 mg elemental phosphate) by mouth for a relatively short-term period and calcitriol in high doses per os combined with intermittent intravenous administration. Long-term treatment consisted of daily three grams of phosphate and 1.25 micrograms calcitriol by mouth combined with daily 2 micrograms calcitriol intravenously for one week every month. Dramatic clinical improvement occurred accompanied with definite radiological and scintigraphical changes. Serum phosphate increased from 0.525 +/- 0.478 mmol/l to 1.054 +/- 0.041 mmol/l (p < 0.001) in response to 3000 mg phosphate. A close correlation (r = 0.69) was found between serum phosphate and urinary phosphate excretions (p < 0.001) and an inverse correlation (r = -0.31) was found between serum phosphate and tubular reabsorption of phosphate (p < 0.01). Serum and urinary calcium values, parathormone as well as renal functions did not change. Administration of high doses of phosphate seemed to be an effective and probably safe form of treatment in XLH provided that development of hyperparathyroidism is prevented by the coadministration of high doses of calcitriol.     

Postoperative-postanesthetic recovery rooms; a report on three years of experience

An analysis of the three-year experience of the recovery room at the Cedars of Lebanon Hospital emphasized the importance of this phase of postoperative care. Closer observation and supervision of the patient is provided during a critical period, and specialized nursing care is constantly available. Supportive and corrective therapy can be carried out immediately by the cooperative efforts of the anesthesiologist and surgeon, who are close by. The completely equipped and properly staffed recovery room is the best assurance for reducing postoperative morbidity and mortality.     

Lipoprotein (a) measurements for clinical application

The high degree of size heterogeneity of apo(a), the distinct protein component of lipoprotein (a) [Lp(a)], renders the development and selection of specific antibodies directed to apo(a) more difficult and poses significant challenges to the development of immunoassays to measure its concentration in plasma or serum samples. Apo(a) is extremely variable in size not only between but also within individuals because of the presence of two different, genetically determined apo(a) isoform sizes. Therefore, the antigenic determinants per particle available to interact with the antibodies will vary in the samples and the calibrators, thus contributing to apo(a) size-dependent inaccuracy of different methods. The lack of rigorous validation of the immunoassays and common means of expressing Lp(a) concentrations hinder the harmonization of results obtained by different studies and contribute to the lack of common cut points for identification of individuals at risk for coronary artery disease or for interventions aimed at reducing Lp(a) levels. The aim of our review is to present and critically evaluate the issues surrounding the measurements of Lp(a), their impact on the clinical interpretation of the data, and the obstacles we need to overcome to achieve the standardization of Lp(a) measurements.     

Genetic screening for glucocorticoid-remediable aldosteronism (GRA): experience of three clinical centres in Poland

Glucocorticoid-remediable aldosteronism (GRA), also known as familial hyperaldosteronism type I (FH-I, OMIM 103900), is a monogenic form of inherited hypertension caused by the presence of a chimaeric gene originating from an unequal cross-over between the CYP11B1 (11beta-hydroxylase) and CYP11B2 (aldosterone synthase) genes. The hybrid gene has the CYP11B1 sequence at the 5' end, including the promoter, and the CYP11B2 sequence at the 3' end. The aim of our study was to evaluate the prevalence of GRA in a Polish population of 129 patients with primary hyperaldosteronism (PHA) and 132 patients with essential hypertension (EH), through the use of a PCR-based test revealing the chimaeric gene. None of our PHA or EH patients was positive for the CYP11B1/CYP11B2 chimaeric gene. These data suggest that GRA is unlikely to be a common cause of hypertension in Polish subjects. However, the real prevalence of GRA in Poland, both in the high-risk group of individuals with primary hyperaldosteronism and in the general population, remains to be established.     

Biodegradation of sodium sulfite liquor (NaSSL) and sodium lignosulfonate (NaLS) by a mixed culture of microorganisms

Summary In this work we discuss the aerobic biodegradation of sodium sulfite liquor of (NaSSL) and sodium lignosulfonate (NaLS) in a firwood sulfite waste liquor by a mixed culture of microorganisms consisting of two Trichosporon yeasts and bacteria in the Arthrobacter (two species), Pseudomonas and Chromabacterium genera. Under established process parameters, the NaSSL was biodegradated in one or two stages by mixed cultures. The kinetics in each stage was studied. The optimal ratio of NaLS and sugars in the substrate for the growth of mixed culture was determined. The growth of the monocultures of the bacteria on the NaLS and the growth of the yeasts as monocultures on the NaSSL substrate were examined. UV absorption and IR spectra were employed as analytical methods to follow the microbial degradation of NaLS. The aim of this research was to study the biodegradation process and kinetics and to remove by means of mixed culture the maximum amount of organic matter from NaSSL.     

Development of antidotes for sodium monofluoroacetate (1080)

Baits containing sodium monofluoroacetate (1080) are commonly used in New Zealand during feral pest control operations. However, each year, a number of domestic dogs are unintentionally killed during these control operations, and a suitable antidote to 1080 intoxication is required. The primary toxic mechanism of 1080 is well known. However, as with other pathologies where energy deprivation is the main effect of intoxication, the cascade of effects that arises from this primary mechanism is complex. At present, putative antidotes for 1080 are generally unable to address the primary mechanism of intoxication but such agents may be able to control the cascade of secondary effects, which can result during intoxication. Part of the reason for this is that targeting the cascade can provide a longer window of time for antidote success. We have undertaken studies that identified some of the central nervous system (CNS) and systemic pathophysiological cascades caused by 1080 intoxication. Using this information we designed antidotes, on the basis of preventing different steps in this cascade. In the chicken model targeting systemic changes, in particular reducing effects of nitric oxide derivatives generated in cardiac muscle, proved successful in reducing fatality associated with 1080. In rats and sheep, targeting the CNS with a number of compounds including: glutamate; calcium and dopamine antagonists; gamma amino butyric acid agonists, and astressin-like compounds reduced fatalaties. However, to be successful in the rat and sheep model a given antidote needed to move quickly from systemic circulation across the blood brain barrier and into the CNS. The work also suggests ways in which specific biomarkers of 1080 exposure may be developed with respect to different species.     

Clinical experience with heparinoid sodium pentosan polysulfate (SP54) in the treatment of cerebral ischemia

Fifty-five patients suffering from acute cerebral ischaemia were treated with pentosan polysulphate (SP54) intravenously and subsequently orally. The control group consisting of 35 patients received the infusion solution and vasodilator drugs. The statistically significant changes appearing following infusion of SP54 include the following parameters: haematocrit, blood viscosity and cholesterol concentrations. In individual cases the euglobulin lysis time was shortened within two hours after the beginning of the infusion. As demonstrated by the statistically reliable results in patients treated with SP54 the neurological symptoms improved significantly within the first two weeks after the onset of the disease compared to the control groups. Based on case reports, recommendations are given for the indication and contraindication of SP54 treatment in cerebral ischaemia.     

Simplified user poll and experience report language (SUPER): implementation and application

Biological computing is generally organized as standalone implementationon a PC-type computer or on a central facility (e.g. a universitycomputer center). Services provided by central facilities needto be tailored to the user community. Unless very work-intensiveindividual contacts are used, the feedback must be collectedwith generalized tools, such as questionnaires distributed inthe form of a newslettter. We have developed a method to havesuch polls automated and tailored, as well as having multiple-choicequestions combined with branching after fundamental questions.As the evaluation of the results needs to know the questionsasked, we have also included a method to process the answersand give detailed tables on the answers. SUPER was applied ina poll to query the academic usership in Switzerland on theusage of molecular biology databases.     

The carcinolytic effect of actinomycin C; a report of clinical studies

Actinomycin C was administered to 35 patients with a variety of malignant states. There was no evidence of any toxic reaction. Of 11 patients with Hodgkins disease, four had brief objective remission ranging from two to four months. Individual patients with chronic myelogenous leukemia, multiple myeloma and neuroblastoma had short periods of clinical improvement. The usefulness of actinomycin C appears to be limited. It may best be used in instances of Hodgkin's disease where pancytopenia prevents the use of other agents.