[Critical shortage of personnel in nephrology. Assessment of causes of the crisis and suggestion for solution]. / Bemanningskrise i nefrologien. Beskrivelse av årsaken til krisen og forslag til løsning.

The heavier work load for qualified nephrologists in Norway over the last ten years is described and compared with the number of positions. The increase in the number of dialysis treatments, care of renal transplant patients and other tasks performed by qualified nephrologists is roughly doubled from 1985 to 1995. By contrast the number of employed qualified nephrologists to pursue the work has only increased by 20% over the same period. As of today there is a lack of capacity to educate new nephrologists to fill up forthcoming vacancies. When the actual need for nephrologists is taken into account, the discrepancy is much more serious and will become even more so over the next ten years if no immediate action is taken. We suggest the establishment of six new educational positions. Altogether, these six new positions will provide the capacity to educate a reasonable number of trained nephrologists to meet future challenges, to the benefit of patients.

BK and JC viruses in human immunodeficiency virus type 1-infected persons: prevalence, excretion, viremia, and viral regulatory regions.

Human polyomavirus BK (BKV) and JC (JCV) infections were examined in persons infected with human immunodeficiency virus type 1 (HIV-1). High frequencies of BKV (24%) and JCV viruria (16%) were detected by polymerase chain reaction (PCR). BKV viruria was not found in an immunocompetent control group, in contrast to a frequency of JCV viruria of 20%. The degree of HIV-induced immunodeficiency did not influence the prevalence of BKV viruria, in contrast to cytomegalovirus viruria, suggesting BKV reactivation is an early manifestation in HIV infection as well as a temporal sequence of opportunistic infections. BKV DNA but not JCV DNA was detected in peripheral blood mononuclear cells (PBMC) in 2 of 42 subjects by a sensitive nested PCR. Sequencing of viral noncoding control regions (NCCRs) revealed predominantly archetypal and TU type BKV NCCRs but only archetypal JCV NCCRs. A new, naturally occurring BKV NCCR variant was detected in 1 urine specimen and 2 PBMC samples, indicating a stable and biologically significant rearrangement. Serum levels of BKV antibodies do not seem to be diagnostically useful in HIV-infected persons.

Iron chelation with a deferoxamine conjugate in hemorrhagic shock.

Oxygen-derived radicals are cytotoxic, highly reactive molecules that contribute to cellular death and injury in hemorrhagic shock. Iron released into the plasma in hemorrhagic shock may contribute to cellular damage by catalyzing lipid peroxidation of cell membranes. Deferoxamine (DFO) chelation of transitional metal ions prevents formation of these radicals and may diminish reperfusion injury. The conjugation of DFO to pentastarch (PS) decreases DFO toxicity and extends its half-life making it a potentially useful resuscitative fluid. A porcine hemorrhagic shock model was used to evaluate the effects of five resuscitative fluids on survival and hepatic function. Swine (11-16 kg) underwent splenectomy, liver biopsy, and placement of arterial and venous catheters. Awake animals were bled at 1 ml/kg/min to a MAP of 45 mm Hg, maintained for 1 hr, and resuscitated over 30 min with one of five fluids: Lactated Ringer's (LR); LR + free DFO 2.5 mg/ml (LR + DFO) (n = 6); 5% PS in LR (PS) (n = 6); 5% PS + free DFO (PS + DFO) 7.5 mg/ml (n = 6); 5% PS/DFO conjugate (7.5 mg/ml) in LR (n = 6). LR and LR + DFO received 3 ml/ml shed blood; PS, PS + DFO, and PS/DFO received 1 ml/ml shed blood. No shed blood was returned to the animals. There was no significant differences between groups in MAP, HR, CVP, and T pre- and post-resuscitation. No LR lived to sacrifice at 24 hr. Thirty-three percent of LR + DFO and PS + DFO animals died within minutes of receiving the free DFO containing resuscitative fluid, presumably from acute DFO toxicity.(ABSTRACT TRUNCATED AT 250 WORDS)

Aneurysmal rupture of a femoropopliteal saphenous vein graft.

A case of a nonanastomotic, atheromatous aneurysm in a femoropopliteal saphenous vein graft is presented. This disease is unusual, especially in nonsmokers with normal lipid levels, and, in this case, may be related to mechanical graft failure 22 years after implantation. The aneurysm was excised and the arterial continuity reestablished with a prosthetic graft.

The use of polymorphic DNA and protein markers for the third complement component for determining linkage of familial hypercholesterolaemia.

We have used DNA and protein polymorphisms for the third complement component (C3) to assess the potential of DNA markers in the diagnosis and study of familial hypercholesterolaemia (FH), and to confirm the reported linkage between FH and C3. The inheritance of FH and the C3 gene has been studied in 10 families by combining information from both the protein and DNA polymorphisms. Our results confirm that the C3 gene is loosely linked to the gene causing FH (lod score maximum of 2.0) at a recombination distance of 0.15. When these results are combined with previously published data the overall lod score maximum is 4.75 at a recombination distance of 0.2, meaning that the two genes will be inherited together in only about 80% of children. These results confirm that the gene that causes familial hypercholesterolaemia is linked to C3 and is therefore on chromosome 19, but C3 is not close enough to be used as a diagnostic marker.