The effect of granulocyte-macrophage colony-stimulating factor (GM-CSF) on hepatitis B vaccination in haemodialysis patients.

Haemodialysis patients often fail to respond to hepatitis B vaccination. In this pilot study, 15 patients previously non-responsive to at least three 40 micrograms doses of hepatitis B vaccine were given 0.5, 5 or 10 micrograms kg-1 granulocyte-macrophage colony-stimulating factor (GM-CSF) subcutaneously 24 h prior to booster vaccination with a hepatitis B vaccine. Seven of the 15 patients developed antibody to hepatitis B surface antigen (HBsAb) (35-7240 IU L-1) upon initial vaccination with GM-CSF and two of four individuals responded with low HBsAb titres of 15 and 60 IU L-1 when revaccinated with hepatitis B surface antigen (HBsAg) and twice the dose of GM-CSF. The application of GM-CSF was associated with adverse effects that were, in general, mild to moderate in severity and appeared to be dose dependent. Two patients, both receiving 10 micrograms kg-1 GM-CSF discontinued the study because of severe hypotension.

[A rare form of Kaposi's sarcoma with intestinal symptoms (author's transl)]. / Kaposi-Sarkom: Seltenes Krankheitsbild mit intestinaler Manifestation.

Kaposi's sarcoma is a rare systemic disease with cutaneous and occasional visceral manifestations. A 39 year old male caucasian patient developed Kaposi's sarcoma 10 months after receiving a renal transplant; subacute pancreatitis was suspected because of the clinical symptoms on the first hand. Multiple, miliary, dark and well vascularized lesions appeared on forehead, cheeks, and trunk. In addition flat tumours of 1.5 cm in diameter, well vascularized and with a central indentation were found radiographically and endoscopically in the jejunum and colon. The diagnosis was confirmed bioptically using specimens of rectal mucosa and facial epidermis. The specimens taken were infiltrated by eosinophiles and granulocytes suggesting parasitosis, the correct diagnosis however could be made. After chemotherapy with actinomycin-D, vincristine and cyclophosphamide, cutaneous and visceral lesions vanished completely. Renal and pancreatic function remained normal. There are no symptoms of relapse of the disease 16 months after stop of chemotherapy by now.

Effect of islet transplantation on the glomerular changes in streptozotocin-diabetic rats.

Glomerular changes develop in rats with streptozotocin diabetes. The structure of these lesions (nodular and diffuse glomerulosclerosis, mesangial cell proliferation, basement membrane thickening, glomerular aneurysms, fibrinoid caps, glomerular adhesions) is described in the present paper and the effect of normalization of metabolism by islet transplantation on the glomerular changes is studied with histological, immunohistological and morphometric methods. Isogenous islets were transplanted into the portal vein of streptozotocin-diabetic rats after diabetes of 7 months' duration. The kidneys of normal, diabetic and transplanted animals of the same age were studied 2.5 months later. Studies of the kinetics of immunocomplexes in the mesangium were also performed. The renal changes (glomerulosclerosis, mesangial cell proliferation) were largely reversible after islet transplantation and the blood glucose level and glucose tolerance were normalized. In the diabetic animals the delayed uptake and elimination of immunocomplexes in the mesangium was normalized after the transplantation. It is possible, that the cause of the lesions is a functional disturbance of the mesangium induced by insulin deficiency and/or hyperglycaemia.

[Prophylaxis of gastroduodenal complications after renal transplantation (author's transl)]. / Zur Prophylaxe gastroduodenaler Komplikationen nach Nierentransplantation.

Gastroduodenal bleeding or perforation following renal transplantation constitute a serious complication with a high lethality. 82 patients with terminal renal insufficiency were grouped in 4 categories with increasing gastroduodenal risk factors. Parameters for judging gastroduodenal risk consisted of gastric acid secretion, history and endoscopic demonstration of acute or chronic ulcer disease. 33 transplant candidates of groups I (hypochlorhydria, no ulcer) and II (normochlorhydria, no ulcer) were treated by medical prophylaxis alone. 23/33 were transplanted without prophylactic surgery, 1 patient in group II with erosive duodenitis before transplantation died from bleeding duodenal ulcer. Patients of group III (hyperchlorhydria up to 40 mval/h, MAO, no ulcer) received selective proximal vagomty, patients of group IV (hyperchlorhydria, 40 mval/h MAO and/or ulcer) underwent selective gastric vagotomy and 50% gastric resection. In 25 of 49 patients of group III and IV prophylactic operations were performed without serious complications. In 16 later on transplantated patients no gastrointestinal bleeding occurred. 2 patients of group III without gastric operation had minor bleedings out of erosive lesions in the gastric antrum and duodenal bulb, that could be managed by medical treatment. The positive experience with prophylactic gastric surgery in this limited number of patients seems to advocate a broader application of such a protocol. A considerable rise in gastric secretion was demonstrated in 19/21 patients during the first 3 years following the commencement of dialysis, BAO rose by an average of 72,2%, MAO by 41%. Thus, gastric analysis should be repeated once a year. Erosive gastritis and duodenitis seem to predispose for bleeding episodes after renal transplantation, this diagnosis should prompt prophylactic SPV.

[Regression of diabetic glomerular changes following islet transplantation. A study of rats with streptozotocin diabetes]. / Rückbildung diabetischer Glomerulusveräunderungen nach Inselzell-Transplantation. Eine Studie bei Ratten mit Streptozotocin-Diabetes.

The precise etiology and pathogenesis of diabetic glomerulosclerosis still remain obscure. The aim of the present study was 1. to evaluate the morphologic and functional alterations of mesangial cells in long term diabetic rats and 2. to study the effect of islet transplantation on these lesions. Diabetes was induced in inbred Lewis rats with streptozotocin (65 mg per kg). 7 month later glomeruli of diabetic rats showed hyaline nodular deposits, exsudative lesions and glomerular aneurysms. The thickening of the mesangium measured by point counting method was statistically significant compared with age matched controls. Large quantities of IgG, beta 1c and fibrinogen in a predominantly mesangial pattern could be demonstrated by fluorescence microscopy. After injection of aggregated immunoglobulin the uptake of IgG by the mesangial cells was delayed in the diabetics compared with normal controls. Islet transplantation resulted in a marked reduction of the light microscopic and immunohistological glomerular lesions and restored the phagocytic capacity of the mesangial cells almost completely. From these results it is concluded, that the fundamental defect in diabetic glomerulosclerosis is a metabolically induced functional defect of the mesangial cells.

[Anaesthesia and postoperative care in terminal renal insufficiency. Experiences in 132 cases (author's transl)]. / Anästhesie und postoperative Behandlung bei terminaler Niereninsuffizienz--Erfahrungen bei 132 Patienten.

A retrospective study was carried out examining the complication- and mortality-rate in 132 patients with terminal renal insufficiency who underwent major surgery: partial gastrectomy, bilateral nephrectomy and vascular surgery at the lower extremities. The anaesthetic management consisted primarily of general anesthesia and muscle relaxation except for vascular surgery at lower extremities where continuous epidural anaesthesia was used. The problems of the anaesthetic management and postoperative care including dialysis are discussed. Although this group of patients is at high risk, the complications can be kept at a minimum with appropriate anaesthetic management and postoperative care.

[Preventive gastrectomies before kidney transplantations]. / Prophylaktische Magenoperationen vor Nierentransplantation.

Gastroduodenal bleeding or perforation occurs in 3.5 to 60% of renal transplant patients. Mortality ranges from 35 to 75%. Experience with prophylactic gastric surgery is based on 61 patients with chronic hemodialysis, who were prepared for renal transplantation since 1974. History, presence of ulcer disease or hyperchlorhydria were assumed to represent a gastroduodenal risk. All 20 patients with such a risk-factor received prophylactic gastric surgery (high risk: selective gastric vagotomy + hemigastrectomy in 12, low risk: selective proximal vagotomy in 6; truncal vagotomy + drainage in 2 cases). Postoperatively there were no serious complications, no lethality.

[Macro-element excretion and retention in early weaned piglets with vitamin B6 deficiency]. / Mengenelement-Exkretion und -Retention frühentwöhnter Ferkel bei Vitamin B6-Mangel.

Two metabolic trials using early-weaned piglets were performed to find out whether highly vitamin B6 deficient prest,rter- or starter feeds (0.4 mg vitamin B6/Kg) would affect the excretion and retention of Ca, P, Mg, K and Na as compared with pair-fed control animals given 6.5 mg B6/Kg. The depleted animals showing typical vitamin B6 deficiency symptoms in the course of the trials, were found to excrete in the feces somewhat smaller amounts of minerals during both metabolic periods. Likewise, the deficiency animals had lower renal Ca and P excretion rates. On the whole, the Ca balance gave significantly higher retention values for the depleted piglets. In terms of nitrogen deposition, both Ca and P revealed significantly higher retention under vitamin B6 deficiency.

[The optimal vitamin B 6 requirement of early weaned piglets]. / Zum optimalen Vitamin B6-Bedarf frühentwöhnter Ferkel.

In a two-period rearing trial (1st to 24th and 24th to 45th experimental day) using 72 early-weaned piglets, the optimal vitamin-B6 requirement was determined on the basis of different performance criteria and biochemical parameters. In the corresponding live weight ranges of 3.5 to 10 kg and 10 to 21 kg, the animals allotted in 6 groups were ad lib. fed a prestarter and starter feed, respectively containing 0.5, 1.2, 2.0, 2.8, 3.5 and 6.6 mg vitamin B6 per kg dry matter. For adequate feed intake and weight development, a dietary vitamin B6 content of 2.0 mg/kg and 1.2 mg/kg proved necessary for the 1st and 2nd part of the experiment, respectively. An optimal intermediary metabolic situation and thus an optimum vitamin B6 requirement covering, which was derived from the renal xanthurenic acid excretion and the SGOT activity, was attained only at a vitamin B6 supply level of 3.5 and 2.8 mg/kg for the 1st and 2nd experimental periods, respectively. This corresponds to an average vitamin B6 requirement per animal and day of 0.8 mg for the weight range 3.5 to 10 kg, and of 1.9 mg for the weight range 10 to 21 kg.

[Effect of storage on the vitamin B6 activity of foods (author's transl)]. / Zum vitamin B6-Zerfall beider Lagerung von Lebensmitteln.

In a study of the effect of storage on the vitamin B6 activity of foods, the vitamin B6 content of different foods of plant and animal origin and also of a mixed feed with added pyridoxine were analyzed microbiologically using Saccharomyces carlsbergensis as test organism. Vitamin B6 activity was determined initially, in some of the specimens after storage for 10 months and again in all foods after 40 months. The storage period of 10 months caused a loss of the natural vitamin B6 content of about 25--30%. This loss increased to more than 50% after 40 months storage. The diet containing the high level of synthetic pyridoxine lost 85% of its vitamin B6 content.

[Influence of vitamin B 6 deficiency in early weaned piglets on the digestibility and conversion of protein and energy]. / Zum Einfluss eines Vitamin-B6-mangels frühentwöhnter Ferkel auf die Verdaulichkeit und Verwertung von Eiweiss und Energie.

Early-weaned piglets were subjected during 2 metabolic periods (11th-18th and 32nd-39th days of the experiment) to conversion experiments to study the influence of vitamin B6 depletion on the digestibility of the crude nutrients, metabolizable energy and on nitrogen conversion using the difference procedure. The depleted piglets (0.4 mg vitamin B6/kh diet) and the pair-fed control animals raised under equal conditions (6.5 mg vitamin B6/kh diet) were first fed a pre-starter ration, and from the 24th experimental day, a starter feed. As the period of depletion increased, the vitamin B6 sub-provided piglets revealed deficiency symptoms such as reduced appetite, lethargic behaviour and less movement. Whilst in the first half of the experiment the control animals reached significantly higher weight gains at lower expenditure of dry matter and digestible energy per kg of weight gain, no differences were observed between both groups in the second period. On the other hand, during the 1st metabolic period the digestibility of all crude nutrients and energy in the depleted piglets proved slightly, but significantly higher than in the pair-fed control animals. In the second half of the experiment ther were just casual differences. After a 2-week vitamin B6 deficient nutrition, the piglets had a 4.1% lower nitrogen retention as compared with the pair-fed control. After a depletion period of 5 weeks, this difference reached 14.4%. As nitrogen excretion in the urine increased, a higher renal energy excretion was observed. Thus the vitamin B6 deficient animals had available less metabolizable energy (in % of digestible energy) than the control piglets.