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The study deals with the comparison of acid-base parameters in blood of patients on chronic haemodialysis and of bicarbonate dialysate determined by Gas-Check AVL 945, equilibration technique (ET) , and a titrimetric method. The results show that an acceptable agreement exists between AVL and ET with respect to measurements of pH, pCO HC0 and base excess. However, the values obtained for total buffer base related to the actual haemoglobin concentration are significantly lower ( <0.001) when determined by AVL. A titrimetric method is proposed for routine measurement of HCO in bicarbonate dialysate. Values obtained using this method are 3–4 mmol/l higher than those determined by AVL and ET. However, when the values for pK′ and for the solubility coefficient used in the Henderson-Hasselbaich equation are replaced by those for saline-bicarbonate solutions, results obtained using the titrimetric determined values agree well with those obtained by AVL and ET. [ABSTRACT FROM PUBLISHER]

Dairy farm use of antimicrobial drugs (AMD) is a risk for the selection of antimicrobial resistance (AMR); however, these resistance dynamics are not fully understood. A cohort study on two dairy farms enrolled 96 cows with their fecal samples collected three times weekly, for the first 60 days in milk. Enterobacteriaceae were enumerated by spiral plating samples onto MacConkey agar impregnated with 0, 1, 8, 16 and 30 µg/mL ceftiofur. Negative binomial regression analyzed AMR over time. The continuum of ceftiofur concentrations permitted estimation of the minimum inhibitory concentration (MIC) and analysis using interval regression. The most common systemic AMD was ceftiofur, administered in 94% of treatments (15/16 cows). Enterobacteriaceae did not grow in 88% of samples collected from non-AMD treated cows at 8 µg/mL ceftiofur. Samples from AMD treated cows had peak counts of resistant Enterobacteriaceae during AMD treatment and returned to baseline counts by 3-4 days post-treatment at 8 µg/mL. Sensitive Enterobacteriaceae (0-1 µg/mL ceftiofur) were reduced below pre-treated levels for 29-35 days post-AMD treatment. Population MIC peaked during AMD treatment and returned to baseline levels by 7-8 days. We conclude that the effect of systemic ceftiofur on the resistance of Enterobacteriaceae in early lactation dairy cows was limited in duration.

Telomere-specific clones are a valuable resource for the characterization of chromosomal rearrangements. We previously reported a first-generation set of human telomere probes consisting of 34 genomic clones, which were a known distance from the end of the chromosome ( approximately 300 kb), and 7 clones corresponding to the most distal markers on the integrated genetic/physical map (1p, 5p, 6p, 9p, 12p, 15q, and 20q). Subsequently, this resource has been optimized and completed: the size of the genomic clones has been expanded to a target size of 100-200 kb, which is optimal for use in genome-scanning methodologies, and additional probes for the remaining seven telomeres have been identified. For each clone we give an associated mapped sequence-tagged site and provide distances from the telomere estimated using a combination of fiberFISH, interphase FISH, sequence analysis, and radiation-hybrid mapping. This updated set of telomeric clones is an invaluable resource for clinical diagnosis and represents an important contribution to genetic and physical mapping efforts aimed at telomeric regions.

A fetus with lobar holoprosencephaly and lumbosacral meningomyelocele associated with duplication of the short arm of chromosome 3 is reported. The anomalies were detected on fetal ultrasound at 20 weeks' gestation and the autopsy findings correlated well with the prenatal findings. The fetal karyotype was 46,XY,der(3)del(3)(p26) dup(3)(p26p21.3). The association of holoprosencephaly with duplication 3p is well known, but to the best of our knowledge this is the first reported association of meningomyelocele with 3p duplication. These findings suggest that a gene or genes with a crucial role in central nervous system development are located on the short arm of chromosome 3., (Copyright 2000 Wiley-Liss, Inc.)

Purpose: Recent revision of the lissencephaly critical region on chromosome 17p13.3 and confirmation of LIS1 as the causative gene for classical lissencephaly has allowed the development and application of fluorescence in situ hybridization (FISH) probes corresponding directly to this gene., Method: We have analyzed patients with isolated lissencephaly sequence (ILS) by FISH with probes at D17S379, an anonymous locus distal to LIS1, and with LIS1 specific probes., Results: In 110 patients with ILS, a deletion at D17S379 was detected in 23.6%. Of those patients without a deletion, 32 were available for further study with LIS1 probes. Deletions were found in eight additional individuals., Conclusion: The overall deletion mutation rate detectable by FISH with LIS1 probes is approximately 40%. This rate is significantly higher than the deletion rate observed at D17S379. This indicates that FISH studies using probes specific to LIS1 should be undertaken as the initial diagnostic assay for the evaluation of patients with ILS, and the high frequency of deletions raises the possibility of "hotspots" for chromosome breakage in this region.

The balance between reactive oxygen species (ROS) generated during metabolism and their scavengers and trappers is changed in patients on chronic haemodialysis. Recently we found an increased superoxide anion-trapping capacity of uraemic serum before haemodialysis which was decreased during the treatment, probably because of loss of antioxidants into the dialysate. In this study the generation of superoxide anions by polymorphonuclear leukocytes (PMN) was examined. There was a tendency for decreased ROS generation during transient leukopenia regarding all conditions of PMN incubation and stimulation. The changed antioxidative homeostasis is thought to be one factor of decreased red blood cell (RBC) survival and thereby of renal anaemia in patients on chronic haemodialysis. Our results support this hypothesis, indicating an increased haemolysis ratio of RBC after haemodialysis in a strongly artificial singlet oxygen stress.

In a retrospective study of 116 patients with acute renal failure treated by hemodialysis the prognostic value of various clinical data was evaluated by discriminant analysis. With a letality of 73.6% the patient survival was dependent on the frequency of associated organ disorders. The following order was prognostical important: respiratory insufficiency, age, cardio-vascular complications and infection or sepsis. Other problems like gastrointestinal complications, coagulation disorders and hepatic failure were without significant value.

The specialist for general medicine and for internal medicine, respectively, in the primary consultation must express the suspicion of the occurrence of a renal disease on the basis of the anamnesis and the findings of the clinical examination and confirm or exclude it by simple diagnostic tests. It is entered into the individual test component in diagnostics. The securing of the diagnosis, the judgement of the renal function as well as differential-therapeutic considerations for the further care are to be performed by the results of the diagnostic steps II (basic diagnostics, in special questionings by step III). About 100,000 patients with renal diseases are country-wide cared for at present, in whom 11% already suffer from a renal insufficiency. It is referred to the most important recommendations for therapy in bacterial and glomerular renal diseases.

For a patient in the chronic programme of haemodialysis an uncomplicated accession to the vessels is the prerequisite for an optimum medical and social rehabilitation. Each form of a subcutaneous arteriovenous fistula is to be preferred to an epicutaneous shunt prosthesis. The percutaneous puncture of large vessels is necessary for the rapid connection to the dialyses in acute situations. In long-term treatments often all autologous accessions to the vessels are used up. Homologous substitution material for vessels is increasingly used also in patients ongoing dialysis. Apart from the methods for gaining homologous material is reported on first experiences in the application of homologous grafts of the umbilical vein and of a homologous vena saphena graft in patients undergoing dialysis.

The chronic pyelonephritis is an unspecific, bacterial, focal, interstitial nephritis with faculative participation of the pyelon. It is differentiated between an obstructive (secondary) and non-obstructive (primary) form. It is referred to the importance of risk factors and risk groups deriving themselves from this. Without doubt, the chronic pyelonephritis is the most frequent renal disease which is confirmed by new statistics of morbidity. The diagnostics still renders difficulties. In a course poor in symptoms it is not thought of the existence of the disease. For the rational dignostics in practice a step plan is recommended. In every case diagnostics should precede therapy. A therapeutic nihilism is to be avoided. A schematic treatment used without criticism and without taking into consideration individual peculiarities, secondary diseases, pregnancy and so on is to be abandoned. Short-term therapy and long-term prevention must be tuned one to another and possibly rationally combined. A plan for the long-term control in the renal dispensary is proposed.

The diagnostical relevance of the low-molecular proteins ribonuclease, beta 2-microglobulin and lysozyme in serum and urine to detect a reduced glomerular filtration rate was examined in 52 patients with chronic renal diseases. The radioisotope clearance using 99mTc-DTPA was the base reference; the reference values of the low-molecular proteins were estimated in a control group. Ribonuclease was increased above the upper borderline value, if the glomerular filtration rate was lower than 1.24 ml s-1. Creatinine, beta 2-microglobulin and lysozyme remain yet in part in the normal range. The estimation of the ribonuclease in serum is suitable to detect an impaired glomerular filtration rate if the creatinine value is still not increased. Thereby, the diagnostics in renal diseases may be improved in the creatinine-blind area.

Treatment and management of patients with renal insufficiency before and after surgery is often complicated. Early interdisciplinary cooperation between intensive care specialist, surgeon, gynaecologist, urologist and nephrologist is necessary. The mortality rate of patients with acute renal failure is still high (50 to 60%). The increase in patients with chronic renal failure who are in need of haemodialysis involves more surgical procedures in this group even in future.

The permanently growing demands on clinic and laboratory constrain to considerations concerning a rational diagnostics. The spectrum of clinical interrogations which needs a clarification by laboratory diagnostics increases continuously. For the nephrologic diagnostics is again oriented to a step programme, which is adapted to the centrally published references to the development of a comprehensive system of the renal dispensary. It takes into consideration the possibilities of the diagnostics of the specialist for general medicine up to the subspecialist in a county hospital. As to the invasive diagnostics, particularly the renal biopsy, one must be reversed. This is indicated then, when from the result consequences would arise concerning the therapy to be performed or the choice calling etc.

In 9 patients with arterio-venous side-to-end anastomosis on the forearm as vascular access for chronic hemodialysis an uniform symptom complex was observed: retrograde flow of the ectatic vein into the periphery, swelling and pain in this area, partly with trophic skin disorders on the hand. After occlusion of the arterio-venous anastomosis these symptoms could reversed completely with exception of venous dilation.