Detection and distribution of heat shock proteins 27 and 90 in human benign and malignant prostatic tissue.

OBJECTIVE: To determine whether it is possible to predict the behaviour of prostate tumours by identifying cellular characteristics, specifically specific heat shock proteins (HSPs). MATERIALS AND METHODS: An immunohistochemical study staining for HSP 27 and 90 was undertaken on 15 benign and 13 malignant samples of freshly frozen prostatic tissue obtained from patients with a similar age range in each group (benign, mean age 71.6 years, range 61-86; malignant, mean age 72.7 years, range 58-87). Gleason scores for the tumours ranged from 2 to 8. RESULTS: Consistent patterns of cytoplasmic staining were seen in all sections of tissue from benign prostatic hyperplasia (BPH). The stroma stained strongly positive for HSP 27, but negatively for HSP 90 and glandular epithelium showed positive apical staining for both HSPs. Stromal patterns in prostatic carcinoma tissue were similar to that of BPH tissue for both HSP 27 and 90. Areas of prostatic intra-epithelial neoplasia stained as strongly as did adjacent areas of BPH. For HSP 27, there was varied staining of individual epithelial cells, suggesting cellular heterogeneity, with an apparent reduction in staining with increasing Gleason score and invasiveness. For HSP 90, this pattern was less marked, with a predominance for positive staining throughout all grades of carcinoma. CONCLUSIONS: The distribution of HSPs, primarily HSP 27, may aid in identifying different cell populations within prostatic carcinomas and thus help forecast biological behaviour.

Citrate regional anticoagulation in haemodialysis.

The use of citrate as an anticoagulant in haemodialysis is for patients who are recognised to be at risk if systemically anticoagulated. This paper describes a trial of use of a technically simple procedure involving the use of small volumes of citrate solution. It introduces the measurement of plasma citrate levels in a population of stable patients on regular dialysis treatment. Using synchronous pre- and post-dialyser blood samples, measurement of the whole blood clotting times demonstrated the restriction of anticoagulation to the extracorporeal circulation. It is concluded that citrate anticoagulation is safe, acceptable and simple for use in haemodialysis for patients at risk from systemic anticoagulation.

Microalbuminuria in a diabetic population.

The aim of the report is to define that diabetic population which is to be recognised as at imminent, and possibly reversible, risk of diabetic nephropathy. The prevalence of 0.63% of diabetes in the Mosgiel practice population is confirmed. Of the 84 diabetics studied eight (9.5%) had proteinuria and an additional nine (10.7%) had microalbuminuria. The means of quantification of microalbuminuria as the urinary albumin/creatinine ratio has been documented for a New Zealand population.

Renal calcium conservation in recurrent stone-formers with idiopathic hypercalciuria.

Urinary excretions of calcium and cyclic AMP were studied in male recurrent stone-formers after an overnight fast and following an oral calcium load. The results from eight patients with established hypercalciuria (greater than 7.5 mmol Ca/24 h) were compared with those from eight age matched normocalciuric stone-formers. The urinary calcium/creatinine ratio was higher in the hypercalciuric group both when fasting and calcium loaded whilst their urinary cyclic AMP was lower in both 24-h and calcium-loaded collections. Five of the eight hypercalciuric patients exhibited an increased urinary calcium/creatinine ratio whilst fasting. These findings support the view that renal calcium wasting, in association with suppression of parathyroid activity, is common among men with idiopathic hypercalciuria. Dietary calcium restriction may lead to bone loss in patients with obligatory renal calcium wasting and enteric adsorption is rarely applicable to the treatment of stone disease. Therefore, the demonstration of a high fasting urinary calcium/creatinine ratio is a strong indication for therapeutic agents which act to suppress renal calcium loss to treat hypercalciuria.

Dialysis encephalopathy associated with polyvalent ion contamination.

The histories of five long term dialysis patients, all of whom showed the characteristic features of dialysis bone disease are considered. One population, on hospital dialysis, also suffered dialysis encephalopathy, whilst the home dialysis population did not. It is postulated that the excessive polyvalent ion content of the water supply to a new hospital building displaced aluminum from the bone stores and precipitated encephalopathy in three patients over three months. The relationship of bone lysis (corticosteroids, immobilisation and orthopaedic procedures) to encephalopathy is considered in the light of this experience.

Urine oxalate levels in a New Zealand reference population and renal stone formers.

Increasing attention is being given to oxalate as a risk factor in urinary calcium stone disease. The accuracy of some methods for measuring urine oxalate is uncertain. Using gas chromatography urine oxalate levels were 0.36 +/- 0.02 and 0.31 +/- 0.02 (mmol/24 h +/- 1 SEM) for men and women respectively of a reference population. In recurrent stone formers urinary oxalate was 0.43 +/- 0.03 in males and 0.38 +/- 0.04 for females whilst solitary stone forming females excreted only 0.31 +/- 0.04 mmol/24 h. The difference between males and females of the reference population was significant (p less than 0.05) as was the difference between reference males and male stone formers.

Haemolysis in chronic renal failure.

In a group of patients with a range of degree of advancement of renal failure, the red cell survival estimated as the half-life of radiochromium-labelled red blood cells (T1/2. 51Cr) was correlated with several indices of renal failure. The T1/2. 51Cr was not improved by a dialysis programme which was otherwise adequate. Furthermore, the correlation of a T1/2. 51Cr to the biochemical indices of renal failure was lost which might suggest that some other factor or factors than those measured was the ultimate correlate with red cell survival. This work adds to the circumstantial evidence in favour of a guanidine or a similarly behaving molecule being the haemolyzing agent. The additional premise is extended that a methionine-rich diet will inhibit the haemolytic factor.

Proteinuria in an Otago diabetic population.

A prospective examination was conducted of a five man group practice in Mosgiel, Otago. The incidence of diabetes was ascertained, and the frequency of proteinuria in that diabetic population. Thirteen percent of those examined showed proteinuria. Proteinuria appeared best related to the presence of retinopathy, and the known duration of the diabetes.

Percutaneous femoral vein catheterization for hemodialysis: a single needle technique.

A method of single needle dialysis using femoral vein cannulation particularly suited for treatment of acute renal failure is described.