Hemofiltration in myoglobinuric acute renal failure.

The frequency of myoglobinuric renal failure is estimated between 8 and 20%. Despite early onset of therapy often the use of renal substitution by hemodialysis or hemofiltration is required. This study of the clinical course of nine patients with myoglobinuric acute renal failure reveals continuous arterio-venous hemofiltration (CAVH) to have an effective clearance for myoglobin. Thus, the time until recovery of renal function as well as the frequency of secondary complications in rhabdomyolysis induced acute renal failure can be distinctly reduced.

[Rare variants and unusual course of Cushing's syndrome]. / Seltene Varianten und Verlaufsformen des Cushing-Syndroms.

Cushing's syndrome is a rarely observed disease with a poor prognosis when not treated appropriately. Knowledge of clinical features of the different forms of the disease together with a specific and subtle method of cortisol detection is indispensable for an early out-patient diagnostic program. In this study the characteristic features of the rare benign and malignant forms of Cushing's syndrome are presented in typical case-reports. As it has been proven in clinical experience, the necessary diagnostic measures for clarification of the syndrome consists of only few methods reliable concerning their diagnostic validity. The success of any curative treatment of the benign forms or any palliative measure of the malignant forms essentially depends on early diagnosis and differentiation of the various appearances of Cushing's disease.

Clinical aspects of selenium metabolism.

Whereas defined selenium deficiency diseases are well characterized in animals, analogous syndromes in humans are unknown or occur only rarely under conditions of extreme selenium depletion. However, selenium deficiency has since been recognized to play important secondary roles in a variety of human diseases, and several of these can be prevented or treated by means of selenium supplementation. In clinical practice, the selenium status of patients should be monitored routinely, and corrective measures should be instituted to replete the Se body stores of patients where necessary. Interactions of Se with other elements are also of potentially great clinical significance. The importance of such interactions is exemplified by the effects of cadmium on selenium metabolism in spontaneously hypertensive rats.

Differences in plasma and tissue aluminum concentrations due to different aluminum-containing drugs in patients with renal insufficiency and with normal renal function.

The gastrointestinal absorption of aluminum from orally administered aluminum-containing drugs is well documented. Retention of the absorbed aluminum leads to elevated levels of this metal in the tissue of patients with renal failure. We studied two groups of dialysis patients who had received equal amounts of the different aluminum-containing phosphate-binders Aludrox and Antiphosphat. It has recently been shown that Antiphosphat releases only a few aluminum ions in an environment of low pH. Consistent with this finding, we found the aluminum levels to be significantly higher in the plasma, bone, and hair of patients who had received Aludrox as phosphate binder. Subjects with normal renal function excreted most of the ingested and absorbed aluminum. No data are available concerning the tissue load of the element in these subjects. We studied two groups of patients with normal renal function who had received antacid drugs prior to neurosurgery on a brain tumor. The first group of patients were treated with an aluminum-rich antacid (Maalox 70); the other group received an aluminum-poor drug (magaldrate) for 10 days prior to the operation. Analysis of the brain-tissue removed revealed twofold higher aluminum levels in the patients who had received Maalox 70. These results indicate that administration of aluminum-containing drugs leads to a tissue load of aluminum in patients with an impaired renal function as well as in those with a normal function. The extent of the aluminum load depends on the aluminum content and the liberation rate of the drug.

Effects of drugs on magnesium requirements.

A number of drugs can influence Mg metabolism and produce changes in serum Mg concentrations. These alterations must always be considered in the differential diagnosis of cases with Mg disturbances. Hypermagnesemia is seen, particularly after administration of Mg-containing drugs in renal insufficiency. Marked hypomagnesemia can be observed in a great number of patients, particularly in those treated with loop diuretics, osmotic substances and with antineoplastics, such as cisplatin.

Taste sensitivity for sodium chloride in hypotensive, normotensive and hypertensive subjects.

The taste sensitivity for sodium chloride was examined in 103 normotensive, 55 hypertensive and 36 hypotensive subjects. The examination was performed on five areas of the tongue using four different concentrated NaCl solutions (2.5, 5.0, 7.5 and 15%). The results indicate that hypotensive subjects show a much higher salt sensitivity compared to normotensive or hypertensive subjects. The enhanced sensitivity of hypotensives to sodium chloride may reflect a regulatory factor tending to normalize blood pressure. In contrast, the lower sensitivity of hypertensives points to a salt dependency of high blood pressure in these patients.

Cadmium and hypertension.

Cadmium, an environmental trace metal, has been implicated as a possible factor in human hypertension. Although the epidemiological studies on humans exposed to cadmium are biased by certain additional factors, more detailed information is available from animal studies and in vitro experiments. The results demonstrate that cadmium influences the vasopressor-induced reactivity and the stress strain characteristics of the blood vessel wall. Thus, it is conceivable that cadmium might contribute to the elevation of blood pressure. But still more convincing data are necessary to clarify the link between cadmium exposure and the development of human hypertension.

Elemental and trace element distribution in medical samples: analysis by proton-induced X-ray emission.

The analysis of trace elements is performed by proton-induced X-ray emission. The process is most effective if the velocity of the exciting particles--protons--is similar to the velocity of the electron on its orbit in the simple atomic model of Bohr. For K-shell electrons of the elements with 15 less than or equal to z less than or equal to 40 this requires proton energies of a few MeV, available from electrostatic van de Graaf accelerator machines. After knocking out the K-shell electron, the empty place is filled up by electrons jumping from higher orbits with simultaneous emission of characteristic X-rays, which are registered with a cooled Si (Li) detector. By a set of electrodes the beam can be swept across the specimen surface. Therefore this method yields an excellent correlation of trace element distribution within the morphological structure of organic tissue. In the present study the sweep went along a line perpendicular to the arterial wall layers (aortic, renal artery and heart muscle) of normotensive and spontaneously hypertensive rats. Along this line all elements and trace elements are recorded simultaneously. These are P, S, Cl, K, Ca, Fe, Cu, Zn, Br and Sr. The trace element content of the aortic wall and the renal artery, of 22 spontaneously hypertensive and 11 normotensive rats and of human heart muscle was investigated. The results demonstrate that Zn was only detected in the muscle-containing layers of the arteries. There was no different distribution between hypertensive and normotensive rats. However, Ca2+ was mainly detected in the smooth muscle-containing tunica media of hypertensive rats.(ABSTRACT TRUNCATED AT 250 WORDS)