Bilateral renal vein thrombosis and pulmonary embolism secondary to membranous glomerulonephritis treated with percutaneous catheter thrombectomy and localized thrombolytic therapy.

Renal vein thrombosis (RVT) is a rare event but is prevalent in patients with nephrotic syndrome. Bilateral RVT is even rarer. The literature is relatively sparse in terms of the management of RVT because of its rarity and consists of a few case reports and case series. We present a case with bilateral RVT complicated by a pulmonary embolism in a patient with membranous glomerulonephritis (MGN). A 19-year-old female presented with acute flank pain and worsening renal function after a couple of weeks in hospital while being treated with diuretics for anasarca secondary to MGN. Venography was used for diagnosis. The patient underwent percutaneous catheter thrombectomy and localized thrombolysis achieving resolution of pain and improvement of renal function. The patient was then anticoagulated for life with warfarin.

HIV and pulmonary arterial hypertension: a systematic review.

OBJECTIVES: HIV-related pulmonary arterial hypertension (PAH) is a rare entity but is associated with significant morbidity and mortality. The literature describing the outcomes of therapy for this disease is limited to case series and cohort studies. The objective of this study was to systematically review and synthesize the literature on HIV-related PAH. METHODS: MEDLINE, EMBASE, PapersFirst, the Cochrane collaboration and the Cochrane Register of controlled trials were searched with pre-defined search terms. Randomized controlled trials, observational cohort studies, case-control studies and case reports were considered for inclusion in the qualitative analysis. RESULTS: A total of 180 case reports of PAH in HIV-infected patients were identified. Twenty-six were excluded and thus 154 case reports were included in the qualitative analysis. Thirteen cohort, one case series and two case-control studies were also identified and included in the review. The average baseline CD4 count at the time of diagnosis of PAH was 352 ± 304 cells/µL. The average time from diagnosis of HIV infection to diagnosis of PAH was 4.3 ± 4.0 years. Predominant chest X-ray findings included cardiomegaly (80%) and pulmonary arterial enlargement (75%). Highly active antiretroviral therapy, bosentan, and prostaglandin therapy have all been reported to be beneficial in improving haemodynamic and functional status in HIV-related PAH. CONCLUSION: HIV-related PAH is a rare entity with clinical, laboratory, imaging and pathological manifestations similar to those of idiopathic PAH. The evidence for various treatments is limited to cohort, case series and case-control studies. Randomized controlled trials are needed to properly assess the utility of these therapies in the treatment of HIV-related PAH.

Thrombolysis versus primary percutaneous coronary intervention for ST elevation myocardial infarctions at Chilliwack General Hospital.

BACKGROUND: Studies have shown that primary percutaneous coronary intervention (PCI), when performed by an experienced operator immediately after admission in a high-volume tertiary care centre, results in lower in-hospital mortality, and decreased risk of reinfarction and stroke. Furthermore, for those communities without a PCI centre, transport of patients to a PCI centre within 90 min is superior to thrombolysis. Chilliwack General Hospital (CGH, Chilliwack, British Columbia) has a unique situation - the travel time to the nearest coronary catheterization centre (Royal Columbian Hospital, New Westminster, British Columbia) is between 60 min and 120 min. OBJECTIVES: To compare access to and use of thrombolysis versus PCI in individuals with ST elevation myocardial infarctions (STEMIs) at CGH. METHODS: A retrospective chart review was conducted on patients who presented to the emergency department at CGH with STEMIs between January 1, 2004, and December 31, 2005. Of the 67 patients who had a STEMI during this time period, 40 patients met inclusion criteria, of whom, 32 received thrombolytics and eight received PCI. RESULTS: The average door-to-thrombolysis time was 46 min (95% CI 32 min to 60 min). A door-to-thrombolysis time of less then 30 min was achieved in 15 of 32 patients (47%). The average door-to-balloon time was 186 min (95% CI 166 min to 206 min). A door-to-balloon time of less than 90 min was not achieved in any of the eight patients who received PCI. CONCLUSIONS: CGH did not meet the American Heart Association guidelines for a door-to-balloon time of less than 90 min.

The effect of the zeolite clinoptilolite on serum chemistry and hematopoiesis in mice.

Zeolites are natural or synthetic crystalline alumosilicates with ion exchanging properties. Supplied in fodder, they promote biomass production and animal health. Our aim was to assess the effects of the natural zeolite, clinoptilolite, on hematopoiesis, serum electrolytes and essential biochemical indicators of kidney and liver function in mice. Two preparations differing in particle size were tested: a powderized form obtained by countercurrent mechanical treatment of the clinoptilolite (MTCp) and normally ground clinoptilolite (NGCp). Young adult mice were supplied with food containing 12.5, 25 or 50% clinoptilolite powder. Control animals received the same food ration without the clinoptilolite. After 10, 20, 30 and 40 days, six animals from each group were exsanguinated to obtain blood for hematological and serum for biochemical measurements as well as to collect femoral bone marrow for determination of hematopoietic activity. Clinoptilolite ingestion was well tolerated, as judged by comparable body masses of treated and control animals. A 20% increase of the potassium level was detected in mice receiving the zeolite-rich diet, without other changes in serum chemistry. Erythrocyte, hemoglobin and platelet levels in peripheral blood were not materially affected. NGCp caused leukocytosis, with concomitant decline of the GM-CFU content in the bone marrow, which was attributed to intestinal irritation by rough zeolite particles. The mechanically treated clinoptilolite preparation caused similar, albeit less pronounced, changes. In a limited experiment, mice having transplanted mammary carcinoma in the terminal stage showed increased potassium and decreased sodium and chloride levels, severe anemia and leukocytosis, decreased bone marrow cellularity and diminished content of hematopoietic progenitor cells in the marrow. The clinoptilolite preparations ameliorated the sodium and chloride decline, whereas the effects on hematopoiesis were erratic.

Effects of a membrane-metallopeptidase blocking agent thiorphan in long-term cultures of human bone marrow.

Thiorphan [(DL-3-mercapto-2-benzylpropanoyl)-glycine], a drug blocking the activity of membrane metalloendopeptidase EC 3.4.24.11 (CD10, CALLA), was added to long-term cultures of human bone marrow. Progression of the cultures was assessed by cell counts, cytology and clonogenic (GM-CFU) ability of the non-adherent cells in the supernatant and by morphology of the adherent stromal layer. A stimulatory effect on hematopoiesis was noted.

Effect of opioid peptide methionine-enkephalin in long-term cultures of human bone marrow.

Methionine enkephalin, an opioid peptide belonging to the family of neuropeptides, has been shown to function as a neurotransmitter, hormone and growth factor. The present work explored its effects in long-term culture of bone marrow cells, harvested from a patient with acute lymphoid leukemia (ALL-L3) in the second complete remission. Nine cultivation flasks were established and maintained for five weeks, with medium renewal once a week. At each re-feeding, methionine-enkephalin was added to the cultures in final concentrations 10(-8), 10(-10) or 10(-12) M, and granulocyte-macrophage progenitor cells (GM-CFU) were determined among the harvested, nonadherent cell populations. The total number of nonadherent cells was 8% to 42% higher in the treated cultures than in the control, nontreated cultures, and the GM-CFU counts were three to four times higher. Those changes, although evident, did not reach statistical significance because of the small group sizes. In 1 of 9 cultures the adherent cell layer was atypical, the cell population consisted of small cells resembling the lymphoblasts, and the cell count was 2-8 times higher than in the controls. That aberrant culture has presumably arisen from residual leukemic cells remaining in the bone marrow after chemotherapy. The findings support the idea that opioid peptides, including methionine-enkephalin, participate in regulation of hematopoiesis. Two mechanisms may have accounted for the observed effects of enkephalin on cultured bone marrow cells: an indirect action, via interleukins secreted from the stromal cells upon stimulation of the opioid receptors, or a direct action on hematopoietic precursors.

Characterization of phosphate transport in Streptomyces granaticolor.

Transport of inorganic phosphate in Streptomyces granaticolor was characterized in two growth stages; kinetic parameters were determined and two transport systems were found in both stages, with the following values: KT1 = 0.06 mM, Jlim1 = 0.95 nmol min-1 (mg DS)-1, and KT2 = 1.80 mM, Jlim2 = 25 nmol min-1 (mg DS)-1. Both systems require metabolic energy and substrates, such as sugars or polyols; when alanine was used or the energy source was omitted, the kinetic parameters changed in both systems. Both systems were inhibited by the ionophore cccp with identical k(i). KCN, an inhibitor or terminal cytochrome oxidase, inhibited the uptake of phosphate only partially, the uptake was inhibited completely when also the inhibitor of the alternative oxidative pathway (salicylhydroxamic acid) was added. Antimycin A inhibited the uptake completely. Arsenate inhibited competitively.

Effect of hydrogen peroxide on sugar transport in Schizosaccharomyces pombe. Absence of membrane lipid peroxidation.

Stationary unaerated cells of S. pombe containing endogenous substrates but not energized by any exogenous ones take up 2-deoxy-D-glucose, 6-deoxy-D-glucose, D-xylose and D-arabinose actively over diffusion equilibrium. The active uptake is inhibited by 20-100 mmol/L H2O2 which causes an increase in KT but has no effect on Jmax. This "competitive inhibition" indicates that H2O2 affects directly the sugar binding sites of the transporters. The ATP-binding site of the plasma membrane H(+)-ATPase is also affected by 100 mmol/L H2O2; the KT decreases 7-fold, Jmax about 2.5-fold. These effects are not likely to be mediated by membrane lipid peroxidation which appears to be lacking in S. pombe, and this lack may be one of the reasons for the high resistance of this yeast to H2O2. Because of this S. pombe represents a suitable system for studying direct effects of oxidants on membrane proteins.

Famotidine-associated mental confusion in elderly patients.

Central nervous system effects, such as mental confusion and hallucinations, have been reported with both cimetidine and ranitidine. Elderly patients with renal or hepatic dysfunction are more susceptible to these adverse reactions. We report two cases of reversible mental confusion in elderly patients with mild renal insufficiency following intravenous famotidine therapy, possibly explained by an increased permeability of the blood-brain barrier in patients with decreased renal function.

Comparative efficacy and safety of immediate-release and controlled-release hydralazine in black hypertensive patients.

Twenty-nine black hypertensive patients were randomized to treatment with controlled-release hydralazine capsules administered BID or QD, or immediate-release hydralazine tablets administered TID, for at least four weeks in a double-blind, parallel study. Hydralazine was begun after a two-week to four-week period in which blood pressure was not adequately controlled with diuretics alone. Each patient initially received 75 mg/day of the assigned drug. The dosage could be increased to 150 or 300 mg/day at weekly intervals if sitting diastolic blood pressure was not adequately controlled (greater than 90 mmHg). A beta-blocker (80 mg/day of nadolol) was added only for patients who had beta-blocker-responsive adverse effects that could not be controlled otherwise. Nine patients were considered unevaluable because of protocol violations or withdrawal from the study before completion of four weeks of treatment, primarily because of adverse effects. Twenty patients were included in the efficacy evaluation. Controlled-release hydralazine BID produced statistically significant mean falls from baseline in sitting diastolic blood pressure and in standing systolic blood pressure and an almost significant drop in standing diastolic blood pressure. Although the other two treatment groups also had substantial falls in all blood pressure measurements, the changes from baseline were not statistically significant. No significant difference in response was noted between patients who received a beta-blocker and those who did not. There were no statistically significant differences among the three treatment groups in incidence and severity of adverse effects or electrocardiographic abnormalities. A statistically, but not clinically, significant fall in hemoglobin, hematocrit, and red blood cell count was observed in all three treatment groups.

Clinical studies of a new, low-dose formulation of metolazone for the treatment of hypertension.

Two multicenter, double-blind, randomized studies were performed to determine the antihypertensive efficacy and effects on laboratory values of a new, shorter-acting formulation of metolazone in patients with mild to moderate hypertension. After baseline placebo-control periods, 105 patients were randomly assigned to receive single daily doses of either placebo or 0.5, 1.0, or 2.0 mg of the new formulation of metolazone for six weeks in one study, and 164 patients were randomized to receive 0.5, 1.0, or 2.0 mg of the new formulation of metolazone or 2.5 mg of the older, long-acting metolazone in the other. Mean blood pressure reductions in all three metolazone groups were statistically and clinically significant. Blood pressures of 51% to 58% of patients in the 0.5-mg metolazone group were controlled (diastolic blood pressure less than 90 or a fall of greater than or equal to 10 mmHg from baseline). Reductions in mean serum potassium levels were dose-related. We conclude that 0.5 mg of metolazone is safe and effective therapy for hypertension; it will significantly reduce systolic and diastolic blood pressure and minimizes changes in laboratory test values.

Effects of suspension density on microbial metabolic processes.

Respiration of yeasts Saccharomyces cerevisiae, Rhodotorula glutinis, Endomyces magnusii, and Candida utilis, and of bacteria Escherichia coli and Bacillus megaterium, anaerobic production of CO2 by S. cerevisiae, active transport of quinovose by R. glutinis and of L-proline and L-leucine by S. cerevisiae were highly dependent on cell suspension density. Respiration of S. cerevisiae in the presence of glucose decreased in a biphasic fashion from 140 to 40 nmol O2 per mg dry solid per min as suspension density increased from 0.01 to 2 mg/mL. Higher partial pressures of oxygen further enhanced the trend. The active transports were affected monophasically in the maximum rate of uptake which was as much as ten times greater at low than at high suspension densities. A component of the external medium is suspected to cause the decrease of metabolic functions at higher cell densities, acting as a noncompetitive inhibitor. The component was present and mutually active in suspensions of the various yeasts as well as of bacteria. Its properties and results of model experiments suggest it to be dissolved carbon dioxide.

Monosaccharide transport systems in the yeast Rhodotorula glutinis.

By using D-glucose, D-xylose, D-galactose and D-fructose in the strictly aerobic yeast Rhodotorula glutinis and by comparing the half-saturation constants with inhibition constants the yeast was shown to possess a single common system for D-xylose and D-galactose (Km's and Ki's all between 0.5 and 1.1 mM) but another distinct transport system for D-fructose. The transport of D-glucose has a special position in that glucose blocks apparently allotopically all the other systems observed although it uses at least one of them for its own transport. The different character of D-glucose uptake is underlined by its relative independence of pH (its "Km" is completely pH-insensitive) in contrast with all other sugars. At low concentrations, all sugars show mutual positive cooperativity in uptake, suggesting at least two transport sites plus possibly a modifier site on the carrier.