Ordered nanopore arrays with large interpore distances via one-step anodization.

Preparation of pre-patterned alumina substrates using bottom-up techniques compatible with nanotechnology applications is still a challenge. We present a novel methodology to achieve superior order in 'anodic' alumina with large interpore distances by a convenient one-step anodization process. The use of transparent insulators renders such anodic layers applicable as templates for nanostructured photovoltaic or photoelectrochemical devices.

Plasma lipids are not oxidized during hemodialysis.

Lipid peroxidation products, both lipid hydroperoxides and thiobarbituric acid reactive substances (TBARS) were determined in the plasma of 31 uremic patients treated with maintenance hemodialysis. Whereas patients had significantly elevated TBARS compared to 93 healthy controls (4.25 +/- 1.53 vs. 1.66 +/- 0.50 mumol/l; p < 0.01) lipid hydroperoxides were not detected in the plasma of patients before dialysis. After hemodialysis, a slight increase in TBARS was observed (4.50 +/- 1.97 mumol/l, p > 0.01). However, when the TBARS were corrected for hemoconcentration by relating TBARS to the plasma cholesterol concentrations a statistically significant decrease of TBARS was observed (1.02 +/- 0.63 mumol TBARS/mmol cholesterol vs. 0.84 +/- 0.60 mumol TBARS/mmol cholesterol; p < 0.01) after 240 min of hemodialysis. There was no evidence for the formation of plasma lipid hydroperoxides in the extracorporeal circulation. It is therefore suggested that elevated TBARS in chronic renal failure are not caused by the dialysis therapy.

[Comparative studies with quantitative computed tomography and dual-energy x-ray absorptiometry on bone density in renal osteopathy]. / Vergleichende Untersuchungen mit der quantitativen Computertomographie und der Dual-Energy-X-Ray-Absorptiometrie zur Knochendichte bei renaler Osteopathie.

Measurements of bone density were carried out in 25 patients on dialysis for terminal renal insufficiency, using quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA). Unlike in subjects with normal kidneys, there was no significant correlation between these methods in this series. Ten patients showed an increase in bone density of the vertebral spongiosa on QCT measurements, which was interpreted as due to osteosclerotic bone changes in renal osteopathy. QCT showed advantages over DXA in demonstrating these changes.

[Long-term blood pressure measurement for evaluating the first dose response of captopril and ramipril in patients with a stimulated renin system]. / Langzeitblutdruckmessung zur Beurteilung der First-dose-response von Captopril und Ramipril bei Patienten mit stimuliertem Renin-System.

First-dose-response of captopril 1 x 25 mg (no prodrug) and ramipril 1 x 2.5 mg (prodrug) were compared in two groups of 17 patients with moderate or severe hypertension and stimulated renin-angiotensin system (because of continuous diuretic therapy) by means of 24-h blood-pressure measurement at the 1st and 7th day of therapy. In the ramipril-group the antihypertensive effect started after 2 h, had its maximum (mean: -13/-8 mmHg) after 4 h and remained unchanged for 8 h. The antihypertensive effect was significant for 24 h. There was a slightly but not significant improved blood-pressure reduction at the 7th day compared to the 1st. The captopril-group showed a fast and marked decrease of blood pressure within the first hour, and reached its maximum (mean: -18/-10 mmHg) after 2 h. After 7 h there was no antihypertensive effect detectable. At the 7th day blood-pressure reduction was less pronounced compared to the 1st day. The results show that initial decrease of blood pressure in risk-patients is less severe with prodrug-ACE-inhibitors with slow onset of action so that counterregulation can be activated and prevent severe, fast, ACE-inhibitor-induced hypotension. 24-h-blood-pressure measurement is a sufficient method to evaluate first-dose-response of ACE-inhibitors.

[Comparison of 24-hour blood pressure measurement with ergometry in patients with hypertension]. / Vergleich der 24-Stunden-Blutdruckmessung mit der Ergometrie bei Patienten mit Hypertonie.

24-h-Ambulatory blood pressure monitoring and bicycle ergometry were compared in 112 patients with untreated mild to moderate essential hypertension. Patients with high blood-pressure values above 220 mmHg during ergometry showed a significantly higher number of blood-pressure peaks above 180 mmHg. There was no significant correlation between the level of the blood-pressure rise during ergometry and the mean values of blood pressure during the 24-h period neither in the night- or the daytime period, nor of the peak values of the 24-h profile. Blood-pressure values during ergometry in patients with high numbers of systolic blood-pressure peaks above 180 mmHg during ambulatory monitoring did not differ significantly from patients with blood-pressure peaks above 180 mmHg during ambulatory monitoring. Patients with marked blood-pressure rise during ergometry seem to demonstrate a higher number of blood-pressure peaks during daytime. On the other hand, patients with an elevated number of blood-pressure peaks do not necessarily show a high blood-pressure rise during ergometry.

[Diagnostic significance of absent nocturnal blood pressure decrease in 24-hour long-term blood pressure measurement]. / Diagnostische Bedeutung des fehlenden nächtlichen Blutdruckabfalls in der 24-Stunden-Langzeitblutdruckmessung.

Patients (pts) with essential hypertension normally exhibit a typical diurnal variation with a nocturnal blood-pressure (BP) decreased. A lack of this periodicity is often reported in pts with secondary hypertension. 24-h BP measurement was therefore performed in 308 pts with essential hypertension, and in 172 pts with secondary hypertension, in order to evaluate the diagnostic value of nocturnal BP decrease. Diagnoses of the secondary hypertensives were: renoparenchymatous hypertension (n = 29), diabetic nephropathy (n = 24), morbus Conn (n = 6), renal artery stenosis (n = 32), pheochromocytoma (n = 5), hemodialysis pts (n = 30), and kidney transplantation (n = 44). Pts with essential hypertension showed a mean systolic and diastolic BP decrease during the nighttime period of 22 +/- 7 mmHg and 17 +/- 5 mmHg, respectively. In contrast, the corresponding values in secondary hypertension were 5.7 +/- 9.2 mmHg (systolic decrease) and 5.2 +/- 5.9 (diastolic decrease). Pts with pheochromocytoma who had a nighttime increase in BP demonstrated the greatest difference from the essential hypertensives, followed by pts with either diabetic nephropathy or after kidney transplantation. A lack of nocturnal BP decline (less than 10% of the daytime values) was detected in 69.8% of pts with secondary hypertension, but only in 5.2% of pts with essential hypertension. In summary, these results suggest that the absence of a nighttime decline in BP during 24-h ambulatory monitoring is an indication of secondary hypertension and should lead to further investigations. Furthermore, a nightly hypertension is associated with a higher risk of complications.(ABSTRACT TRUNCATED AT 250 WORDS)

[Panhypogammaglobulinemia: a rare complication of parenteral gold therapy]. / Panhypogammaglobulinämie: Eine seltene Komplikation der parenteralen Gold-Therapie.

Secondary antibody deficiency is one of the rare adverse effects of chrysotherapy in rheumatoid arthritis. The plasma levels of all immunoglobulins fall into ranges significantly lower than the tolerable physiological minimum. The long-lasting panhypogammaglobulinemia can increase the risk of infection in the patient and, therefore, should be closely monitored. Hence, a record of immunoglobulin levels before and during therapy with gold compounds seems to be mandatory.

[Localization and extent of tissue damage caused by extracorporeal lithotripsy (ESWL)]. / Lokalisation und Ausmass einer Gewebeschädigung durch die extrakorporale Lithotrypsie (ESWL).

Extracorporeal shock wave lithotripsy (ESWL) causes proteinuria. In our study we investigated the protein fractions and the electrolyte composition of the urine in patients who had been treated with ESWL. The aim was to obtain information on the degree and the localisation of the glomerular, tubular or vascular destruction caused by ESWL in humans. A total of 34 patients with stones had been treated with ESWL. As parameters we used: urine output, creatinine clearance, total protein, albumin, immunoglobulin G, N-acetyl-beta-D-glucosaminidase (beta-NAG), alpha-1-microglobulin, the fractional excretion of Na+ and apolipoprotein-A-1. After ESWL treatment proteinuria and albuminuria are found. Our parameters show no deterioration of the glomerula or the tubulus. The increase in apolipoprotein-A-1, a postglomerular parameter, however, is interpreted as a manifestation of vascular destruction after ESWL; this is normally temporary, leaving no permanent damage.

[Importance of 24-hour blood pressure monitoring in secondary hypertension]. / Bedeutung der 24-Stunden-Blutdruckmessung bei sekundärer Hypertonie.

A typical diurnal variation in blood pressure is observed in patients with essential hypertension. Attenuation or lack of circadian periodicity might be expected in patients with secondary hypertension. Therefore, non invasive ambulatory blood-pressure monitoring was performed in 172 patients with secondary hypertension and in 201 patients with essential hypertension. The following patients with secondary hypertension were investigated: renoparenchymatous nephropathy (n = 29), diabetic nephropathy (n = 24), morbus Conn (n = 6), renal artery stenosis (n = 32), pheochromocytoma (n = 5), hemodialysis patients (n = 30), and patients after kidney transplantation (n = 44). In addition, 36 pregnant women (17 normotensives, 19 hypertensives) were studied. 98.5% of patients with essential hypertension showed a nightly decline in blood pressure of at least 15 mmHg (systolic + diastolic), whereas 70% of patients with secondary hypertension showed either an attenuated circadian rhythm or no circadian rhythm. Patients with pheochromocytoma who had a nighttime increase in blood pressure demonstrated the greatest difference in the essential hypertension collective, followed by patients with diabetic nephropathy and patients after kidney transplantation. After successful treatment of the condition leading to hypertension, circadian periodicity returned in some patients. In summary, these results suggest that the absence of a nighttime decline in blood pressure during 24-h-ambulatory monitoring is an indication of secondary hypertension, which should be further investigated. As a practical consequence, antihypertensive drugs should also be applied in an evening dose in secondary hypertensives. Noninvasive ambulatory blood-pressure monitoring is recommended for treatment control, especially in patients who need an efficient blood-pressure control.

[The significance of 24-hour blood pressure monitoring in the diagnosis and therapy of arterial hypertension]. / Bedeutung der 24-Stunden-Blutdruckmessung in der Diagnostik und Therapie der arteriellen Hypertonie.

The use of ABPM allows an improved assessment of blood pressure (BP) and therefore of the individual cardiovascular risk. It is able to identify patients who truly need therapy more exactly. Mostly patients with white coat hypertension who don't need therapy are identified. Furthermore, ABPM correlates more closely to target organ damage and to cardiovascular morbidity and mortality. This may be helpful to treat especially those patients who truly need therapy. BP exhibits a typical circadian rhythm with the highest values during the early morning hours and a decline during the night. A change of the day/night rhythm during shift work leads to an adaptation of BP rhythm. The early morning rise of BP and heart rate is accompanied by hemodynamic, rheological and biochemical alterations, which together may contribute to the increased frequency of vascular complications during the morning hours. The nightly decline of BP is often absent in patients with secondary hypertension and cardiac or renal organ damage. A lack of the nocturnal BP decline should therefore lead to further patients' evaluation. Elevated nocturnal BP seems to worsen the prognosis. ABPM offers better individual control of BP in patients on treatment and therefore is helpful to optimize the treatment. A more exact individual BP control during the awakening and sleeping period is possible as well as an avoidance of overtreatment. Patients could be protected both from prescription of too many drugs and from lowering BP too much. A further advantage lies in an improved control of patients with nocturnal hypertension.

Comparison of the antihypertensive efficiency of nitrendipine, metoprolol, mepindolol and enalapril using ambulatory 24-hour blood pressure monitoring.

In a randomized 6-month study of 201 patients, the antihypertensive efficiency of the calcium antagonist nitrendipine, the beta 1-selective blocker metoprolol, mepindolol, the beta blocker with intrinsic activity and the angiotensin-converting enzyme inhibitor enalapril were compared as monitored by 24-hour ambulatory blood pressure (BP) measurements. The study was designed so that a comparable decrease in casual BP values was obtained with all 4 drugs. If normotension was not achieved with monotherapy, a diuretic also was administered. Pretreatment casual BP and mean 24-hour ambulatory BP values did not differ between the 4 groups. Normotension as assessed by casual BP measurements was observed in all 4 groups after 6 months of therapy, there being no significant differences between the groups. However, significantly more diuretics were required in the mepindolol (n = 14) and in the enalapril (n = 20) groups compared to the nitrendipine (n = 5) and metoprolol (n = 7) groups. Despite comparable casual BP control, the 4 groups differed significantly in their mean 24-hour measurements. The greatest systolic and diastolic BP decreases were seen in the metoprolol group. Metoprolol was also the most effective drug in decreasing the frequency of systolic pressure peaks greater than 180 mm Hg. Both beta blockers and enalapril significantly decreased the morning BP increase compared to the values before treatment, while nitrendipine did not. These data show that casual BP measurement is not a good predictor of 24-hour BP in patients taking hypertensive therapy. Despite an equal degree of "office" BP control, different antihypertensive regimens do not confer the same degree of "nonoffice" BP control.

Lipolytic effects of heparin and low molecular weight heparin and their importance in hemodialysis.

The incidence and the degree of uremic hypertriglyceridemia in a hemodialysis population are exacerbated by the use of UF heparin as anticoagulant therapy. This hypertriglyceridemia is associated with an increase in the levels of triglyceride-rich remnant particles that are thought to be particularly atherogenic. Since arteriosclerosis and its related diseases are the major causes of morbidity and mortality in this dialysis population, the LMW heparins with their reduced stimulation of plasma lipolytic activity may provide a clinically superior alternative to UF heparin for anticoagulation therapy in long-term hemodialysis. One may also speculate that it may be more advantageous to use LMW heparin for all long-term treatments with heparin.