Quality of life during and between hemodialysis treatments: role of L-carnitine supplementation.

End-stage renal disease affects every aspect of a patient's life, including perception of health and quality of life. It is likely that a hemodialysis patient's perceptions of health-related quality of life directly influence compliance with medical, nursing, and nutritional prescriptions. Because L-carnitine supplementation is known to enhance muscle strength and energy in hemodialysis patients, we hypothesized that L-carnitine supplementation would enhance a hemodialysis patient's perception of health-related quality of life. To test this hypothesis, 1 g L-carnitine or placebo was administered orally to 101 patients immediately before and after every hemodialysis treatment for 6 months. To assess health-related quality of life from the patient's perspective, the Medical Outcomes Study Short Form 36 instrument was administered before the study and at 1.5-month intervals for the duration of the study. In addition, a 10-item questionnaire designed to assess common intradialytic symptoms was administered at the end of each dialysis treatment. Other parameters analyzed included Kt/V(urea) and level of nutrition. In the 6-month group, oral L-carnitine supplementation had an early positive effect on general health (P < 0.02) and physical function (P < 0.03), but the perceived effect was not sustained throughout the 6 months of the study. In the 3-month group, L-carnitine supplementation improved vitality (P < 0.02) and general health (P < 0.01). There was no association between Kt/V(urea) and perceived health-related quality of life. Serum albumin concentration was directly correlated to how patients perceived the quality of their lives.

The relation of the structure of progestational steroids to nucleolar differentiation in human endometrium.

PIP: The relation of the structure of progestational steroids to nucleolar differentiation in human endometrium was studies by electron m icroscopy. Emdometrial biopsies were obtained from normal volunteers wi th regular menses and were cultured with the steroids to screen for nucl eolar basket formation. Progesterone, chlormadinone and medroxyprogeste rone induced the fine structural changes characteristic of postovulatory human endometrium when added to cultures of proliferative human endometrium. Progesterone, chlormadinone, medroxyprogesterone acetate, 19-norprogesterone and 19-norchlormadinone induced nucleolar differentiation, giant mitochondria and glycogen accumulation. Norethindrone, norethynodrel, dimethisterone, norgestrel and ethynodiol diacetate did not induce nuceolar differentiation but glycogen did accumulate and enlarged mitochondria were seen. These results suggest that the acyl group in the 17 beta position of the D ring of the progestational steroids is associated with nucleolar basket formation and that when this radicle is absent nucleolar differentiation does not occur and that glycogen accumulation and secretion of glycogen by the endometrial epithelial cell is a phenomenon separate from nucleolar differentiation.^ieng