Donor Preconditioning After the Onset of Brain Death With Dopamine Derivate n-Octanoyl Dopamine Improves Early Posttransplant Graft Function in the Rat.

Heart transplantation is the therapy of choice for end-stage heart failure. However, hemodynamic instability, which has been demonstrated in brain-dead donors (BDD), could also affect the posttransplant graft function. We tested the hypothesis that treatment of the BDD with the dopamine derivate n-octanoyl-dopamine (NOD) improves donor cardiac and graft function after transplantation. Donor rats were given a continuous intravenous infusion of either NOD (0.882 mg/kg/h, BDD+NOD, n = 6) or a physiological saline vehicle (BDD, n = 9) for 5 h after the induction of brain death by inflation of a subdural balloon catheter. Controls were sham-operated (n = 9). In BDD, decreased left-ventricular contractility (ejection fraction; maximum rate of rise of left-ventricular pressure; preload recruitable stroke work), relaxation (maximum rate of fall of left-ventricular pressure; Tau), and increased end-diastolic stiffness were significantly improved after the NOD treatment. Following the transplantation, the NOD-treatment of BDD improved impaired systolic function and ventricular relaxation. Additionally, after transplantation increased interleukin-6, tumor necrosis factor TNF-α, NF-kappaB-p65, and nuclear factor (NF)-kappaB-p105 gene expression, and increased caspase-3, TNF-α and NF-kappaB protein expression could be significantly downregulated by the NOD treatment compared to BDD. BDD postconditioning with NOD through downregulation of the pro-apoptotic factor caspase-3, pro-inflammatory cytokines, and NF-kappaB may protect the heart against the myocardial injuries associated with brain death and ischemia/reperfusion.

Dimethyl sulfoxide and ethylene glycol promote membrane phase change during cryopreservation.

Fourier transform infrared spectroscopy (FTIR) and cryomicroscopy were used to study the effects of dimethyl sulfoxide and ethylene glycol on cell pellets of human pulmonary microvascular endothelial cells during freezing from 4 degree C to -60 degree C at 1 degree C per min. FTIR analysis showed that membranes undergo a phase change in the presence of cryoprotective agents (CPAs) which was not observed in the absence of CPAs. Cryomicroscopy revealed the formation of intracellular ice and concomitant cell volume changes. Intracellular ice was detected in the majority of the cells both in the presence and absence of CPAs. Membrane phase changes were found to be most pronounced at intermediate concentrations of cryoprotective agents; for dimethyl sulfoxide at around 1 M and for ethylene glycol at around 1.5 M. At those concentrations cell survival after thawing exhibited a maximum. The results indicate that CPAs promote rather than prevent cell dehydration during freezing.

Ovarian superstimulation, transrectal ultrasound-guided oocyte recovery, and IVF in rhinoceros.

Numerous reports on reproductive pathology in all rhinoceros species illustrate the abundance of female infertility in captive populations. In infertile rhinoceroses, oocyte collection and embryo production could represent the best remaining option for these animals to reproduce and to contribute to the genetic pool. We report here on superstimulation, repeated oocyte recovery, and attempted in vitro fertilization (IVF) in white and black rhinoceroses. Four anestrous rhinoceroses (two white, two black) with unknown follicular status were treated with gonadotropin-releasing hormone analogue, deslorelin acetate, for 6 to 7 d. Number and size of follicles in superstimulated females was significantly higher and larger compared with those in nonstimulated anestrous females (n=9). Ovum pick-up was achieved by transrectal ultrasound-guided follicle aspiration. Up to 15 follicles were aspirated per ovary. During six ovum pick-ups, a total of 29 cumulus-oocyte complexes (COCs) were harvested with a range of 2 to 9 COCs per collection. No postsurgical complications were noted on the rhinoceros ovaries using this minimally invasive approach. Various in vitro maturation (IVM) and IVF protocols were tested on the collected COCs. Despite the low total number of COCs available for IVM and IVF in this study, we can report the first rhinoceros embryo ever produced in vitro. The production of a 4-cell embryo demonstrated the potential of transrectal ultrasound-guided oocyte recovery as a valuable tool for in vitro production of rhinoceros embryos from otherwise infertile females.

Requirement for, and patterns of, pyruvate and glutamine metabolism in the domestic dog oocyte in vitro.

Supplementation of energy substrates to culture medium is essential for resumption and completion of meiosis in vitro for many mammalian species. Objectives were to study the dog oocyte, specifically the influences of pyruvate and glutamine on maturation and the utilization of these two substrates at various developmental stages and incubation times. Ovarian oocytes (n=681) were obtained from spayed bitches and cultured for 48 hr in TCM 199 medium containing various concentrations of pyruvate (0-2.5 mM) and glutamine (0-4 mM) before being assessed for nuclear status. For analyzing metabolic activity, 259 dog oocytes were cultured for 0, 12, 24, 36, or 48 hr, assessed for pyruvate and glutamine metabolism using the hanging drop method and then evaluated for nuclear status. Neither pyruvate nor glutamine had influence (P > 0.05) on oocyte maturation in vitro (IVM). However, both culture interval and meiotic status influenced pyruvate uptake (P < 0.05). Specifically, pyruvate uptake declined as the oocyte progressed from the germinal vesicle (GV) to metaphase II (MII) stage. Glutamine oxidation decreased as culture duration progressed (P < 0.05). In summary, pyruvate or glutamine is not required to promote successful IVM of dog oocytes. But, both substrates are being metabolized, and in patterns different to the domestic cat, another carnivore species. Pyruvate played an important role earlier in the maturational process, and less glutamine was oxidized as the oocyte neared nuclear maturation. These variations emphasize the importance of defining species specificities in carnivores before expecting consistently successful IVM/IVF.

Acrosomal integrity and capacitation are not influenced by sperm cryopreservation in the giant panda.

Sperm cryopreservation and artificial insemination are important management tools for giant panda breeding and the preservation of extant genetic diversity. This study examined the influence of freeze-thawing on sperm function, specifically capacitation. Sperm from nine giant pandas were assessed before and after rapid (- 40 and - 100 degrees C/min) cryopreservation by incubation in HEPES-buffered Ham's F10 medium with and without the capacitation accelerators, 3-isobutyl-1-methylxanthine (IBMX) and dibutyryl cyclic AMP (dbcAMP). At 0, 3 and 6 h of exposure, aliquots were assessed for sperm motility traits and capacitation, defined as the proportion of sperm with intact acrosomes following exposure to solubilised zonae pellucidae (ursid or felid) or calcium ionophore subtracted from the proportion of sperm with intact acrosomes before exposure. Although mean+/-S.E.M. sperm motility post-thaw (56.1 +/- 3.9% at 0 h) was less (P < 0.05) than pre-freeze (71.7 +/- 6.0%), there was no difference (P > 0.05) in the proportion of acrosome-intact sperm (fresh, 93.0 +/- 1.7% versus cryopreserved-thawed, 81.7 +/- 4.7% at 0 h). Incidence of capacitation was greater (P < 0.05) in fresh sperm incubated with capacitation accelerators IBMX and dbcAMP (9 h: 50.9 +/- 1.1) compared with fresh sperm incubated without accelerators (9 h: 41.2 +/- 1.1%). Frozen-thawed sperm preincubated without accelerators underwent capacitation (49.6 +/- 1.1%) to a greater extent (P < 0.05) compared with these fresh counterparts. Thawed samples with (9 h: 45.9 +/- 1.4%) and without accelerators (9 h: 41.2 +/- 1.1%) did not differ (P > 0.05) during the 9-h incubation. We conclude that giant panda spermatozoa (1) undergo capacitation in vitro with or without chemical accelerators and (2) withstand a rapid cryopreservation protocol, including retaining normal acrosomal integrity and functional capacitation ability.

Sperm capacitation in vitro in the eld's deer.

Sperm capacitation was examined in the endangered Eld's deer (Cervus eldi thamin). Sperm motility and viability (percentage of sperm cells with intact membranes) were assessed in vitro over time after attempting to induce capacitation in TALP alone and TALP supplemented with calcium (10 mM CaCl2), dibutyryl cAMP (1 mM dbcAMP), or fetal calf serum (20% FCS). Sperm aliquots were evaluated at 0, 3, 6, 9, and 12 h for motility, viability, and ability to acrosome react after exposure to calcium ionophore (A23187, CI; 10 microM) or lysophosphatidylcholine (LC; 100 microg/mL). Fresh sperm aliquots in TALP + 10 mM CaCl2 exposed to CI had fewer (P < 0.05) intact acrosomes than the TALP control (TALP alone) or dbcAMP and FCS treatments after 9 h. Mean (+/- SEM) percentage of intact acrosomes of spermatozoa incubated in medium with increased CaCl2 declined (P < 0.05) from 80.2 +/- 2.6% (0 h) to 49.7 +/- 7.3% after prolonged incubation (9 h). The proportion of capacitated fresh spermatozoa was not influenced by LC treatment. Capacitation was not induced (P > 0.05) by any of the presumptive sperm capacitators after freeze-thawing. Likewise, neither CI nor LC induced the acrosome reaction (AR) in these spermatozoa, suggesting that the freeze-thawing process may have caused membrane damage. Results revealed that the supplementation of medium with CaCl2 evokes capacitation in some spermatozoa. However, Eld's deer spermatozoa appear remarkably resistant to conventional stimulators of capacitation and the AR.

Oocyte metabolism predicts the development of cat embryos to blastocyst in vitro.

Current methods for detecting complete oocyte maturation and developmental competence are inadequate. The objectives of this study were to (1) examine the relationship between cat oocyte energy metabolism and development in vitro after fertilization and (2) determine if cumulus cell metabolism could be used to predict development of individual oocytes after fertilization in vitro. The hanging drop method was used to assess metabolism of three different types of cat oocytes: immature (IMO), in vitro matured (IVM), and in vivo matured (IVOM). Stage of oocyte nuclear maturation or developmental competence was assessed after metabolic analysis. Glycolysis and oxidation of glucose, glutamine, palmitate, and lactate increased with the resumption of oocyte meiotic maturation (P<0.05). Pyruvate was the preferred substrate, but uptake was not linked to maturation. IVM oocytes had impaired glucose and palmitate metabolism compared to IVOM oocytes (P<0.05). Oocyte glycolytic activity and oocyte glucose oxidation correlated well with embryo development after insemination in vitro (P<0.05). Furthermore, oocytes that had similar glucose metabolism and that were grouped together for culture on this basis had higher (P<0.05) overall rates of development than oocytes grouped randomly. There was no correlation (P>0.05) between cumulus cell metabolism and individual oocyte development after in vitro fertilization. The data reveal that energy metabolism is linked to oocyte maturation in the cat and that glucose metabolic activity can indicate those oocytes most likely to fertilize and develop in vitro. Measuring cumulus cell metabolism does not accurately predict individual oocyte development after insemination in vitro.

Circannual variations in intraovarian oocyte but not epididymal sperm quality in the domestic Cat.

Ovaries and testes were collected throughout the year from domestic cats spayed and neutered at local veterinary clinics. Fresh oocytes recovered from minced ovaries were subjected to in vitro maturation and then stained to determine stage of maturation or were inseminated with conspecific sperm. The cauda and corpus regions of each epididymis were dissected into pieces and placed in medium; 30 min later, the epididymal tissue was removed, the medium centrifuged, and the sperm pellet resuspended. Samples were assessed for total sperm count and sperm motility traits, morphology, acrosomal integrity, and ability to penetrate cat oocytes in vitro. Fewer excellent (grade I) oocytes were recovered per ovarian pair during September-November (mean +/- SEM, 19.2 +/- 2.1%) than during January-July (36.8 +/- 3.6%, p < 0.05), while the remaining months had intermediate percentages of grade I oocytes (p > 0.05). A high percentage of oocytes recovered from November-April completed nuclear maturation (64.3 +/- 6.8%), which was different (p < 0.05) from the values for May-July (32.2 +/- 3.8%) and August-October (10.4 +/- 2.9%). Percentage of oocytes with bound sperm was lowest (p < 0.01) in September and October (32.0 +/- 3.1%) compared to February and March (91.4 +/- 1.7%). Percentage of oocytes with sperm within the perivitelline space was highest (p < 0.05) in May-August (33.8 +/- 4.6%) compared to all other months. In contrast, the period of highest (p < 0.01) fertilization (i.e., >/= 4-cell embryo formation) was March-April (51.7 +/- 3.1%) as compared to May-July (17.2 +/- 1.8%) or November-January (12.4 +/- 2.6%). Negligible numbers of oocytes recovered during August-October developed beyond the 2-cell stage (1.1 +/- 0.3%). Blastocyst development from cleaved embryos was highest during February-April (44.3 +/- 2.3%) and lowest during August-October (0.6 +/- 0.1%; p < 0.01). Sperm recovered from the epididymides throughout the year did not differ (p > 0.05) in concentration or in any of the motility, structural, or functional variables evaluated. In summary, cat oocyte nuclear maturation in vitro is depressed during August-October, and the ability to form cleaved embryos remains low even when the capacity to achieve nuclear maturation is relatively high (November-January and May-July). In contrast, male cats are capable of consistently producing viable, progressively motile sperm throughout the year.

Reactivating tammar wallaby blastocysts oxidize fatty acids and amino acids.

The tammar wallaby, Macropus eugenii, has a ruminant-like digestive system which may make a significant concentration of amino acids and fatty acids available to the blastocyst via uterine fluids. Fluorescent and radioisotope analyses were performed to determine the rate of glutamine and palmitate use by blastocysts recovered on day 0, 3, 4, 5 and 10 after reactivation induced by removal of pouch young (RPY). Between day 0 and 4 glutamine uptake increased from 15.6 +/- 6.6 to 36.1 +/- 2.7 pmol per embryo h-1 (P < 0.01) and ammonium production increased from 8.2 +/- 4.3 to 26.6 +/- 3.0 pmol per embryo h-1 (P < 0.01). Glutamine oxidation did not increase until day 10 after RPY (P < 0.01), but the percentage of glutamine oxidized increased from 4.5 +/- 3.1% during diapause to 31.2 +/- 12.6% (P < 0.01) by day 5 after RPY and increased further to 51.0 +/- 15.8% (P < 0.01) by day 10 after RPY. Palmitate oxidation also increased from 0.3 +/- 0.1 by day 0 blastocysts to 3.8 +/- 1.7 pmol per embryo h-1 (P < 0.01) by day 4 blastocysts. This increase provides a greater potential for ATP production, possibly to supply increased demand due to the coincident resumption of mitoses. The ATP:ADP ratio within blastocysts had reduced by the time of the first measurement at day 3 (0.5 +/- 0.2 pmol per embryo h-1; P < 0.01) compared with day 0 blastocysts (1.4 +/- 0.3 pmol per embryo h-1). It is likely that metabolism of amino acids and fatty acids contributes to the energy supply during reactivation of tammar wallaby blastocysts after embryonic diapause.

Mouse embryos used as a bioassay to determine control of marsupial embryonic diapause.

Mouse blastocysts appear to be under direct inhibition from the uterine environment, whereas no evidence of direct inhibition during diapause in the tammar wallaby has been observed. Normally developing (day 4) and quiescent mouse blastocysts were incubated for up to 12 hr in media supplemented with BSA, wallaby plasma, wallaby day 0 (day of removal of pouch young; RPY), day 5, or day 10 endometrial exudates at a concentration of 2 mg/ml of protein, and analyzed for rates of carbohydrate metabolism using fluorescence and radioisotopes. Rates of glucose uptake and lactate production by day 4 blastocysts increase after incubation with day 10 and day 5 wallaby exudates compared with rates by blastocysts incubated in BSA. Pyruvate uptake increased after 8 hr irrespective of incubation media, except for embryos incubated in day 0 exudate, which maintained levels significantly lower than BSA-incubated embryos. Quiescent mouse embryos displayed a high ATP/ADP ratio during diapause (1.06 +/- 0.24) which decreased after 4 hr incubation in all media (0.42 +/- 0.05; P < 0.01) but embryos incubated in day 0 exudate media remained at a significantly higher level than embryos incubated in BSA. These results indicate that quiescent tammar endometrial exudate is not capable of initiating diapause in mouse embryos at the concentration used, but is able to slow the rate of reactivation of quiescent blastocysts. Importantly, reactivated wallaby exudate increases mouse blastocyst glucose metabolism and lactate production. It is possible that the quiescent tammar endometrial environment has an inhibitory factor necessary to maintain diapause in the tammar blastocyst.

[Prophylaxis and therapy of infectious complications of lung surgery]. / Prophylaxe und Therapie von infektiösen Komplikationen in der Lungenchirurgie.

Postoperative infections are a dreaded complication in pulmonal surgery. Besides the optimal preparation of the patients and careful operative technique, perioperative antibiotic prophylaxis represents an important factor in avoiding infectious consequences. Owing particularly to the high proportion of patients with malignant, consumptious illnesses in thorax surgery, immune deficiencies must be reckoned with in this group of patients. The spectrum of germs to be expected within the framework of pulmonal surgery determines to some extent which antibiotic shall be used. We have investigated the efficacy of a standardized antibiotic prophylaxis using cefotaxime (Claforan) in 200 pulmonal patients. Pleural empyema is a rare, but nonetheless important infectious illness, as a consequence of pulmonal operations, or also following pneumonia. Whilst the early stages of an empyema can often be successfully treated using only drainage treatment, chronic empyema usually requires a thoracotomy with empyema dissection and excortication, as well as subsequent irrigation-suction drainage treatment. In spite of specific surgical sanitation and irrigation-suction drainage treatment, therapy is often complicated by persistent germs in the thoracic cavity. Instillation therapy with taurolidine can lead to faster healing of the infection in such cases. Purulent mediastinitis is an extremely rare illness, but dreaded owing to its high mortality. The causes of the illness lie in injuries of the trachea, of the bronchial tubes, and of the oesophagus. With the introduction of medial sternotomy as operative entry, mediastinitis as a postoperative complication has increased noticeably in frequency. Mediastinitis occurs as a descending infection as a consequence of odontogenic affections. Owing to frequently late diagnosis, infection is usually advanced, so that simple drainage treatment of the mediastinum no longer suffices in many cases. We introduce our concept of treatment using our own patient collective.

Reactivating tammar wallaby blastocysts oxidize glucose.

Metabolic reactivation of the tammar blastocyst appears to be characterized by a change in the pathway of glucose metabolism rather than an absolute increase in substrate uptake. The switch in type of metabolism used was examined to gain information on the timing and physiology of blastocyst reactivation. Fluorescent and radioisotope techniques were used sequentially to determine the activity of pathways of glucose metabolism by individual wallaby blastocysts during diapause and 3, 4, 5, 6, 7, 8, and 10 days after removal of pouch young (RPY). Maternal endometrial and luteal cell metabolism and circulating hormone levels were measured and correlated with blastocyst activity. Observed differences between rates of blastocyst reactivation could be explained by variation in the maternal response between animals. While blastocysts recovered 4 days after RPY oxidized more glucose compared with Day 0 blastocysts (p < 0.05), rates of glycolysis did not change until Day 10. Blastocysts recovered between 4 and 10 days after RPY oxidized a significantly greater percentage of the glucose taken up (p < 0.01). The reduced ATP:ADP ratio within blastocysts recovered 3 days after RPY (p < 0.05) indicates that conditions are suitable for blastocysts to undergo a metabolic switch from glycolytic to oxidative metabolism of glucose on Day 4 after RPY. The increased oxidation results in greater ATP production, which plausibly fuels the increased energy requirements of wallaby blastocysts during the early stages of reactivation.

Carbohydrate uptake by quiescent and reactivated mouse blastocysts.

The mouse, Mus musculus, can maintain blastocysts in embryonic diapause in the uterus while suckling young. This study used microfluorimetry to simultaneously examine glucose and pyruvate uptake by quiescent blastocysts, and at four hourly intervals after administration of the reactivating stimulus, oestradiol-17 beta. Following the non-invasive analysis of energy metabolism, blastocysts were incubated in colcemid (0.2 mg/ml), and mitotic activity determined. Mitoses and cell numbers in reactivated embryos increased significantly within 8 and 12 hours, respectively, after oestradiol-17 beta administration, compared to those of diapause (control) blastocysts (0.5 +/- 0.1 vs. 0.22 +/- 0.03 mitoses/embryo; P < 0.05, and 141.8 +/- 1.5 vs. 133.8 +/- 2.4 cells/ embryo; P < 0.05). Similarly, pyruvate uptake by reactivating blastocysts (9.3 +/- 1.1) was significantly higher than controls (5.8 +/- 0.8 pmol/embryo/hour; P < 0.05), within 4 hours of oestradiol-17 beta, but by 16 hours after oestradiol-17 beta administration, pyruvate uptake by reactivating blastocysts was no longer significantly different from the delayed controls. In contrast, significant differences in glucose uptake between the reactivated and control groups were not evident until 16 hours after oestradiol-17 beta (reactivating, 14.9 +/- 1.5; control, 10.6 +/- 1.7 pmol/embryo/hour; P < 0.05). These results demonstrate that pyruvate rather than glucose could supply the additional energy required during the first 12 hours of reactivation in the mouse, but from 16 hours after injection of the reactivating stimulus oestradiol-17 beta, glucose is the predominant energy source.

Efficient transfer of genetic material into mammalian cells using Starburst polyamidoamine dendrimers.

Starburst polyamidoamine dendrimers are a new class of synthetic polymers with unique structural and physical characteristics. These polymers were investigated for the ability to bind DNA and enhance DNA transfer and expression in a variety of mammalian cell lines. Twenty different types of polyamidoamine dendrimers were synthesized, and the polymer structure was confirmed using well-defined analytical techniques. The efficiency of plasmid DNA transfection using dendrimers was examined using two reporter gene systems: firefly luciferase and bacterial beta-galactosidase. The transfections were performed using various dendrimers, and levels of expression of the reporter protein were determined. Highly efficient transfection of a broad range of eukaryotic cells and cell lines was achieved with minimal cytotoxicity using the DNA/dendrimer complexes. However, the ability to transfect cells was restricted to certain types of dendrimers and in some situations required the presence of additional compounds, such as DEAE-dextran, that appeared to alter the nature of the complex. A few cell lines demonstrated enhanced transfection with the addition of chloroquine, indicating endosomal localization of the complexes. The capability of a dendrimer to transfect cells appeared to depend on the size, shape, and number of primary amino groups on the surface of the polymer. However, the specific dendrimer most efficient in achieving transfection varied between different types of cells. These studies demonstrate that Starburst dendrimers can transfect a wide variety of cell types in vitro and offer an efficient method for producing permanently transfected cell lines.

Metabolic assessment of wallaby blastocysts during embryonic diapause and subsequent reactivation.

The metabolism of tammar wallaby (Macropus eugenii) blastocysts was analysed by means of quantitative fluorescence microscopy during embryonic diapause and 2, 3, 4, 5, 8 and 10 days after reactivation to determine nutrient preferences during metabolic reactivation of the blastocyst. The surface area of quiescent blastocysts was 0.16 +/- 0.02 mm2 (mean +/- s.e.m.), and increased to 0.44 +/- 0.04 mm2 (P < 0.05) by Day 8 after removal of the sucking stimulus of the pouch young (RPY). Day-10 blastocysts, analysed over two successive breeding seasons, were significantly different in size from each other (Group A, 1992: 4.44 +/- 1.47 mm2; Group B, 1993: 18.87 +/- 4.62 mm2; P < 0.01), and both groups were significantly different in size from diapausing blastocysts (P < 0.01). There was no significant difference in carbohydrate uptake or production by blastocysts during the first five days after RPY. Glucose uptake by blastocysts recovered 8 days after RPY (61.9 +/- 30.0 pmol embryo-1 h-1) was significantly greater than that by Day-0 blastocysts (17.9 +/- 5.5 pmol embryo-1 h-1) and glucose uptake by both groups of Day-10 blastocysts (Group A, 174.0 +/- 28.4 pmol embryo-1 h-1; Group B, 616.0 +/- 239.0 pmol embryo-1 h-1) was significantly different from that by Day-0 blastocysts (P < 0.01). Pyruvate uptake by Day-10 blastocysts (Group A, 46.0 +/- 32.2 pmol embryo-1 h-1; Group B, 250.0 +/- 136.0 pmol embryo-1 h-1; P < 0.01) increased significantly compared with that by Day-0 blastocysts (6.4 +/- 1.6 pmol embryo-1 h-1; P < 0.01). Lactate production by Day-10 blastocysts (Group A, 186.7 +/- 30.3 pmol embryo-1 h-1; Group B, 285 +/- 129 pmol embryo-1 h-1; P > 0.01) was also significantly different from that by quiescent blastocysts (41.20 +/- 9.6 pmol embryo-1 h-1). There was a linear relationship between surface area and glucose uptake and surface area and pyruvate uptake (r2 = 0.965 and r2 = 0.971 respectively). Despite increases in carbohydrate uptake, there was a proportional decrease in lactate production indicating an increase in oxidative metabolism during reactivation. This suggests that there may be a metabolic switch at, or around, Day 5 after RPY.

[Osteo-onychodysostosis. One more report about a family case (author's transl)]. / Ostéo-onychodysostose. Une nouvelle observation familiale.

A 9 year-old boy takes medical advice because of underdevelopment and intellectual insufficiency. The diagnosis of osteo-onychodysostosis (nail-patella syndrome) clinically expected is confirmed by X-ray examination. The main radiological signs of this disease are reminded of. You can also find a few remarks about family contex, frequency of the lesions and heredity.