Alteration of the activity of the 11beta-hydroxysteroid dehydrogenase in pregnancy: relevance for the development of pregnancy-induced hypertension?

In this study we evaluated the activity of renal 11beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2) in patients with pregnancy-induced hypertension (PIH). A reduction of the activity of 11beta-HSD2 leads to pseudohyperaldosteronism due to insufficient interconversion of cortisol to its inactive 11-oxo-metabolite cortisone in the renal tubulus cell. We measured urinary free cortisol and cortisone in patients with and without PIH and calculated the urinary free cortisol to free cortisone ratio, which is well accepted as a correlate of the activity of renal 11beta-HSD2. One hundred twenty-six pregnant women were included. Fifty-nine patients had PIH (mean age 31.5 +/- 4.4 yr, blood pressure 158.7 +/- 16.0/100.8 +/- 9.5 mm Hg), and 67 were normotensive (mean age 29.4 +/- 4.6, blood pressure 112.6 +/- 8.9/68.8 +/- 8.6 mm Hg). The excretion rate of cortisol was increased in the PIH group (138.8 +/- 93.0 vs. 106.5 +/- 65.4 nmol/d, P = 0.027), whereas excretion rate of cortisone was similar (362.9 +/- 254.1 vs. 366.5 +/- 221.7 nmol/d, P = 0.933). The free cortisol to free cortisone ratio was significantly higher in the PIH group (0.47 +/- 0.25 vs. 0.31 +/- 0.12, P < 0.00002). Within this group, the patients with blood pressure in the uppermost quartile had a significantly higher free cortisol to free cortisone ratio than those in the lowest quartile [0.61 +/- 0.31 vs. 0.38 +/- 0.15 (P = 0.019) for diastolic, 0.60 +/- 0.29 vs. 0.35 +/- 0.13 (P = 0.012) for systolic, and 0.62 +/- 0.32 vs. 0.39 +/- 0.16 (P = 0.023) for mean blood pressure, respectively]. We conclude that a reduction of the activity of the 11beta-HSD2 is a relevant factor for the development of PIH. Whether the ratio of urinary free cortisol to free cortisone is a useful risk factor for the development of PIH must be investigated in further prospective studies.

[Dermatitis caused by the tropical rat mite (Ornithonyssus bacoti) in Switzerland. Case report]. / Dermatitis, verursacht durch die Tropische Rattenmilbe (Ornithonyssus bacoti) in der Schweiz. Fallbeschreibung.

The tropical rat mite, Ornithonyssus bacoti, has been detected in Switzerland for the first time in 3 patients suffering from a small papulous dermatitis. The lesions, distributed over the whole body, were especially intense on the arms and legs. The sting of O. bacoti was always very painful and the itching lasted for several weeks. The parasites were found on the skin of the patients, on one rat caught near the workroom, and in dust samples collected from the infested site.

[Quantification of visual EEG evaluation by using the concept of optimality (author's transl)]. / Quantifizierung der visuellen Auswertung des kundlichen Wach-EEG

For the visual evaluation of the EEG in children (awake) 17 items are formulated and defined. They are to be examined and determined as beeing either optimal or non-optimal, as it is easier to define what is optimal, than what is normal. The non-optimal items are summed up for a total score. It could be shown that this score discriminates between sample groups of 50 children each, one with "minimal brain dysfunction" and another with normal controls of the same age and sex. There are also several distinct differences within the particular items. The objectivity of the items was proved by fourfold examination of the same sample group. The concept of optimality therefore offers a valid and objective method of quantifying the visual EEG evaluation, thus improving the interpretation of minor abnormalities in the EEG.