Sodium pyruvate is better than sodium chloride as a resuscitation solution in a rodent model of profound hemorrhagic shock.

Pyruvate is an energy substrate that has both inotropic and antioxidant properties. In this study, we tested the hypothesis that survivorship would be better after resuscitation with 1.7% sodium pyruvate than 0.9% sodium chloride in a profound hemorrhagic shock model. The study was performed in a blinded manner. Rats were randomly assigned into two groups (ten in each group), a sodium chloride resuscitation group and a sodium pyruvate resuscitation group. After a 60-min shock period, we infused 80 ml/kg of a resuscitation solution. We continuously monitored mean arterial pressure and heart rate for 50 min after resuscitation. We recognized death by the disappearance of blood pressure pulsation and precordial movement. We performed a comparison of survivorship at 50 min post resuscitation using a Z-test of proportions. Nine (90%) of the animals that received sodium pyruvate were living 50 min after resuscitation, whereas only three (30%) of the animals that received sodium chloride survived to the same time point. We conclude that sodium pyruvate is better than sodium chloride as a resuscitation solution in a model of profound hemorrhagic shock.

Autism and Schizophrenia: Intestinal Disorders.

We examined Dohan's hypothesis that schizophrenia is associated with the absorption of "exorphins" contained in gluten and casein. In addition, because of the work of Reichelt et al. (Reichelt, K.L., Saelid, G., Lindback, J. and Orbeck, H. (1986) Biological Psychiatry 21:1279-1290) and Rodriguez et al. (Rodriguez, Trav, A.L., Barreiro Marin, R, Galvez, Borrero, I.M., del Olmo Romero-Nieva, F. and Diaz Alvarez, A. (1994) Journal of Nervous and Mental Disease Aug; 182(8): 478-479), we carried out similar studies on a group of children with autism. In both syndromes we found similar patterns of peptide containing peaks (Ninhydrin positive) after molecular screening with Sephadex G-15. Immunoglobulin assay of IgA and IgG against gliadin and casein in serum was done. High titer IgG antibodies to gliadin were found in 87% of autistic and 86% of schizophrenic patients and high titer IgG antibodies to bovine casein were found in 90% of autistic and in 93% of schizophrenic patients. High titer IgA antibodies to gluten or casein were found in 30% of children with autism while in schizophrenic patients 86% had elevated IgA antibodies to gluten and 67% to casein; some normal children and adults have these antibodies but only in trace amounts. When schizophrenic patients were treated with dialysis or a gluten-casein free diet, or both (Cade, R., Wagemaker, H., Privette, R.M., Fregly, M., Rogers, J. and Orlando, J. (1990) Psychiatry: A World Prespective 1: 494-500) peptiduria and Brief Psychiatric Rating Scores fell while abnormal behavior diminished. A gluten-casein free diet was accompanied by improvement in 81% of autistic children within 3 months in most of the behavior categories. Our data provide support for the proposal that many patients with schizophrenia or autism suffer due to absorption of exorphins formed in the intestine from incomplete digestion of gluten and casein.

Marathon running: physiological and chemical changes accompanying late-race functional deterioration.

Twenty-one experienced runners were studied before, during and immediately after a marathon race to ascertain whether either depletion of energy substrate or rise in body temperature, or both, contribute to late-race slowing of running pace. Seven runners drank a glucose/electrolyte (GE) solution ad libitum (Na+ 21 mmol l-1, K+ 2.5 mmol l-1, Cl- 17 mmol l-1, PO4(2-) 6 mmol l-1, glucose 28 mmol l-1) throughout the race; 6 drank water and 8 drank the GE solution diluted 1:1 with water. Although average running speeds for the three groups were not significantly different during the first two-thirds (29 km) of the race, rectal temperature was significantly higher (P < 0.05) and reduction of plasma volume was greater (P < 0.05) in runners who replaced sweat losses with water. During the last one-third of the race, the average running pace of the water-replacement group slowed by 37.2%; the pace slowed by 27.9% in the 8 runners who replaced their sweat loss with GE diluted 1:1 with water (1/2 GE) and 18.2% in runners who replaced fluid loss with full-strength solution (GE). Eleven runners (5 in the water group, 4 in the 1/2 GE group and 2 in the GE group) lapsed into a walk/run/walk pace during the last 6 miles of the race. Ten of these had a rectal temperature of 39 degrees C or greater after 29 km of running, and plasma volume in these runners was reduced by more than 10%.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of tryptophan and 5-hydroxytryptophan on the blood pressure of patients with mild to moderate hypertension.

Chronic treatment with L-tryptophan (4 g/day) reduced mean blood pressure in 8 of 9 patients with mild to moderate essential hypertension. No significant side effects of treatment were observed. An additional group of 8 patients was treated chronically with L-5-hydroxytryptophan (800 mg/day), the immediate precursor of serotonin. Five of the 8 patients had a significant reduction in mean arterial pressure. No significant side effects of treatment were observed. The reduction of blood pressure accompanying treatment with L-5-hydroxytryptophan suggests that at least a portion of the antihypertensive effect of L-tryptophan is mediated via serotonin.

Prevention of recurrent urinary tract infections in postmenopausal women.

Twelve postmenopausal women who experienced frequent urinary tract infections were found to have atrophic vaginitis. Four of them who were taking sulfonamide preparations chronically also had an interstitial nephritis manifest by decreasing glomerular filtration rate and eosinophiluria. Treatment consisted of a Betadine douche daily for 1 week, administration of an appropriate nonsulfonamide antibiotic, and institution of estrogen therapy to restore glycogen deposition in the vaginal epithelium and promote return of a normal vaginal pH and bacterial flora. Prior to estrogen therapy, the frequency of infection was four per patient per year. During a follow-up observation period ranging from 2 to 8 years, there have been only four infections in the entire group. When sulfonamides were discontinued in the 4 patients with manifestations of interstitial nephritis, the eosinophiluria cleared, and the glomerular filtration rate increased significantly.

Hepatorenal syndrome. Studies of the effect of vascular volume and intraperitoneal pressure on renal and hepatic function.

Eleven patients with well-documented hepatorenal syndrome were studied by measurement of blood volume, glomerular filtration rate, renal plasma flow, plasma aldosterone concentration, renin substrate concentration, and plasma renin activity. They were then given 750 ml of stored plasma, 750 ml of fresh frozen plasma, and then an infusion of angiotensin II, in random order on successive days. Infusion of fresh frozen plasma improved function more than did stored plasma and in addition returned a very low filtration fraction toward normal. Angiotensin II infusion increased filtration fraction, but decreased glomerular filtration rate, renal plasma flow, and urine flow sharply. Patients were then given a daily infusion of 1,000 ml of fresh frozen plasma for seven to 18 days to expand the blood volume to supranormal levels as assayed by serial measurement of blood volume. Plasma aldosterone levels decreased to a normal range, glomerular filtration rate and renal plasma flow both increased, and urinary excretion of sodium and potassium both returned toward normal. The effect of intraperitoneal pressure was then studied by measuring glomerular filtration rate, renal plasma flow, pressure in the vena cava, hepatic vein free flow, and hepatic vein wedged pressure before, during, and after paracentesis to reduce the intraperitoneal pressure from 30 to 40 cm H2O to 12 to 17 cm H2O. Venous pressures moved parallel to ascitic fluid pressures, and glomerular filtration rate, renal plasma flow, and urine flow all improved sharply; then, as ascitic fluid continued to form, reducing vascular volume, urine flow, glomerular filtration rate, and renal plasma flow all decreased slowly. Six patients then underwent placement of a LeVeen shunt. Improvement in glomerular filtration rate and renal plasma flow and clinical condition was dramatic. During postoperative observation of up to two years, progressive improvement in hepatic function has occurred.

Effect of long-term azathioprine administration in adults with minimal-change glomerulonephritis and nephrotic syndrome resistant to corticosteroids.

Thirteen adult patients with nephrotic syndrome resistant to corticosteroid administration were treated with azathioprine daily for four years. Progressive improvement occurred in all 13 patients so that they were in complete remission after one to three years. The onset of apparent improvement was earlier and the rate of progressive improvement more rapid in patients who had selective proteinuria before therapy than in those whose proteinuria was nonselective. One patient who stopped therapy after 20 months suffered relapse but again responded when azathioprine treatment was restarted. Observation after the four-year therapeutic period ranges from three to 15 years; there have been no relapses during this time.

Effect of aerobic exercise training on patients with systemic arterial hypertension.

One hundred five patients with established diastolic hypertension were enrolled in an exercise program to examine the effect of aerobic conditioning on blood pressure. In four patients, the decrease in mean blood pressure was less than 5 mm Hg; in all others, there was a significant decline in arterial blood pressure. In 58 patients who were not taking drug medication in the pre-exercise period, mean blood pressure decreased by 15 mm Hg. Of 47 patients receiving drug therapy during the pre-exercise period, 24 were able to discontinue all medication. Mean blood pressure in this group fell from 116.9 +/- 6.5 mm Hg to 97.2 +/- 9.2 mm Hg as a result of exercise. In patients still taking antihypertensive drugs, mean pressure decreased from 120.9 +/- 28.8 mm Hg to 104.4 +/- 17.9 mm Hg after three months of exercise. It is concluded that in patients physically and emotionally able to exercise, a significant decline in blood pressure can be achieved.

New method for obtaining uncontaminated urine from women.

Midstream sampling and colony counts have greatly improved precision in diagnosing urinary tract infections. In women, however, contamination by vaginal flora and cells still poses a diagnostic problem. We have devised an instrument for helping collect uncontaminated urine from women and have tested it in three sets of observations. Approximately 96% of 200 women were able to use the device successfully after minimal instruction. Bacterial colony counts and quantitative estimation of vaginal epithelial cells were performed on urine collected by 18 female volunteers using conventional clean-catch technics and on urine collected by the same 18 women using the Clean Streamer. The average bacterial colony count in conventionally collected urine was 8,100/ml while in Clean Streamer collected urine it was 1,722/ml. The average number of vaginal epithelial cells in conventionally collected urine was 22.4/ml while in Clean Streamer collected urine it was 14.1/ml. The difference in both comparisons is statistically significant (P = .01). We believe that use of the Clean Streamer greatly facilitates the ability of a woman to collect a urine sample uncontaminated by vaginal secretions and flora.