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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.

Two juvenile patients affected for the first time with pernicious catatonia were treated repeatedly with combined hemofiltration and hemodialysis. During the first two or three sessions, the distinct psychopathological improvement only persisted during the session itself and in a lesser degree during the following hours. It was only after further treatments that the therapy effect lasted longer and passed over into a continuous remission tendency. The findings might support a toxin hypothesis (in a broad sense) with respect to the genesis of catatonia and encourage a continuation of the studies.

The laboratory diagnostic spectre in diseases of the kidneys and the urinary bladder is demonstrated in form of a 3-step-programme. The concentration of suitable investigation methods in complexes allows a rational and economical diagnostics for patient and physician. A standardisation of the diagnostics in out-patient department and clinic essentially contributes to the reduction of excessive work in overcharged laboratories as well as to the shortening of the patient's stay in the hospital.

Studies were conducted into the effects of various forms of flow reduction upon both pressure in shunt and functional properties of 134 arteriovenous bridging grafts on the upper arm for haemodialysis of deantigenised, form-fixed, preserved segments of varicose veins with silicone-coated inner surfaces. Strongest pressure reduction and best clinical results were obtained from composite grafts with a short, narrow segment on the inflow side.

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.

Against the background of more recent insights into the general importance of urinary infections, specific reference is made to the demands made, in that context, on gynaecology and obstetrics. An attempt is made to expound the epidemiological chain of causes, ranging from defloration cystitis and including gestational processes as well as all sorts of gynaecological effects up to possible diseases in the menopause. The high probability of secondary diseases in adult age should be the point of departure for conclusions regarding "prophylaxis". Description of a stepwise programme for diagnosis, therefore, is followed by discussion of aspects relating to urine collection, differentiation between significant bacteriuria courses, assessment of asymptomatic bacteriuria, distribution of germs, and demands on monitoring action. Therapies are discussed separately for gynaecological patients and pregnant women. In conclusion, major emphasis is laid on the need for taking widest possible advantage of advisory centres for pregnant women and contraception consultative services for early detection of renal diseases and hypertension as well as for more efficient follow-up or extended medical care for patients whose urinary infections has been (re)discovered and treated by obstetricians or gynaecologists.

The indication to a Scribner shunt as vascular access for hemodialysis has been reduced significantly by the use of central-venous catheters and creation of subcutaneous access methods. In 13 patients suffering from septic complications of the central-venous vascular access catheters a Scribner shunt was created for continuation of hemodialysis. After removal of infected catheters and specific antibiotic therapy the sepsis could be controlled in 12 patients within 4-18 days.

For the practicing physician pyelonephritis is a frequently observed clinical picture which still has its diagnostic problems. With the help of a step programme a reasonable diagnostics is striven for which gives the possibility of an early recognition in the general surgery and a far-reaching clarification of the clinical picture in the out-patient department.

Fever reactions in dialysis patients may partly be traced back to the transmission of pyrogens from the rinsing solution compartment into the sanguiferous system. The pyrogen concentration increases with the germ contents of the rinsing solution, which, therefore, should be kept as low as possible by suitable desinfection measures. For the artificial kidney Gambro AK 3 a hot water desinfection of 90 minutes at 90 degrees C or a formalin desinfection of 30 minutes, respectively, for the artificial kidney Leuven IIIC the formalin or peracetic acid desinfection of 30 minutes each proved to be sufficient.

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.