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Background: Antiphospholipid antibodies comprise a family of auto-antibodies mainly characterized by the presence of the lupus anticoagulant (LA) and anticardiolipin antibodies (ACA)., Clinical Appearance: The antiphospholipid antibody syndrome is defined by the appearance of frequent thromboses, repeated fetal losses and thrombocytopenia. Other clinical manifestations associated with APA include migraine, chorea, hemolytic anemia, heart valve disease, Budd-Chiari syndrome, perpetual pancreatitic episodes, intestinal infarctions, malignant hypertension, livedo reticularis, pre-eclampsia, fetal growth retardation or catastrophic antiphospholipid syndrome. LA and ACA occur in a variety of clinical conditions (secondary antiphospholipid antibody syndrome, SAPS), including other autoimmune disorders, infectious diseases, neoplastic disorders, in association with the use of certain drugs or in otherwise healthy individuals (primary antiphospholipid antibody syndrome, PAPS)., Treatment: Patients with thrombosis associated with APA should receive long-term anticoagulation therapy, whereas treatment of asymptomatic patients seems to be not indicated, because only approximately 10% of patients with APA may develop thrombotic complications. In patients with PAPS there is no evidence that the prophylactic administration of immunosuppressive drugs will prevent thromboembolic events.

Background: Serum magnesium analysis does not reflect body content of magnesium. So substitution is based on empirical maneuvers., Patients and Method: In a study on 44 patients urinary magnesium excretion was analyzed before and after oral magnesium substitution (40 mval). The provable hypothesis was the estimation that patients in magnesium deficiency under chronical diuretic treatment (n = 11) would have a lower magnesium excretion than patients of the control group (n = 10). Further analysis was done with patients after orthotopic cardiac transplantation (n = 12) and those suffering from coronary heart disease (n = 11)., Result: After oral administration of magnesium in all 4 groups there was a rise in blood levels, only significant in the patient group under chronic diuretic treatment. Urinary magnesium excretion, however, showed no significant differences. Patients after cardiac transplantation had the lowest rise in urinary magnesium excretion., Conclusion: There was no clear differentiation by means of this oral magnesium substitution test. Magnesium excretion even after oral substitution is of no value to analyze magnesium deficiency.

Complications following renal transplantation are associated with transplant dysfunction; their frequency and the nonspecificity of clinical symptoms underscore the importance of choosing the correct diagnostic procedure. Sequential function scintigraphy with technetium-99m-MAG3 is noninvasive and facilitates the diagnosis of different types of organ rejection, of drug-induced malfunction and of surgical complications.

Since May 1990 a specific enzyme immunoassay (EIA) for NANBH has been developed by recombinant DNA technology which detects antibodies to a virus called hepatitis C virus (HCV). The anti-HCV EIA was manufactured by Ortho-Diagnostic Systems with recombinant antigens from Chiron Corp. based on extraction from high infectious titre chimpanzee plasma RNA after transcription into cDNA. We tested the anti-HCV prevalence of blood donors and hemodialysis patients. The anti-HCV prevalence with the first generation test was 0.52% (Ortho), 0.87% (Abbott) in blood donors and 4.16% in hemodialysis patients. The second generation anti-HCV test (Abbott) with improved sensitivity and specificity comprises 0.25% repeated anti-HCV positive blood donors and 8.2% anti-HCV positive hemodialysis patients.

Aims: Detection of possible effects on renal function parameters of long-term antihypertensive treatment administered to patients with diabetes mellitus., Study Design: Prolongation of an open trial, initially planned for one year, on the effect of felodipine 10 mg/day in diabetics (Fortschr. Med. 109 (1991), 53-56). Continued treatment of 7 hypertensive insulin-dependent diabetics (mean age 58 +/- 3 years, HbA1 8.2 +/- 0.3%) over a period of between 24 and 32 months., Results: The lowered blood pressure (from 160/94 to 150/82 mmHg; p less than 0.05) persisted. In the first 6 months of treatment, urinary albumin excretion (UAE) remained constant. Thereafter it increased (p less than 0.05 as compared with the figure seen after 6 months' treatment) to a degree that varied from one patient to another; overall, the UAE figures showed a relatively large intra-individual fluctuation during long-term therapy. Metabolic parameters remained uninfluenced by felodipine., Conclusions: It cannot be excluded that progression of diabetic renal disease cannot be adequately prevented by long-term treatment with calcium antagonists such as felodipine.

In May 1990 a specific enzyme immunoassay (EIA) for NANBH was developed by recombinant DNA technology which detects antibodies to a virus called hepatitis C virus (HCV). The anti-HCV EIA was manufactured by Ortho Diagnostic Systems with recombinant antigens from Chiron Corp. based on extraction from high infectious titer chimpanzee plasma RNA after transcription into cDNA. We tested the anti-HCV prevalence of blood donors and hemodialysis patients. The anti-HCV prevalence with the first generation test was 0.52% (Ortho), 0.87% (Abbott) in blood donors and 4.16% in hemodialysis patients. The second generation anti-HCV test (Abbott) with improved sensitivity and specificity comprises 0.25% repeated anti-HCV-positive blood donors and 8.2% anti-HCV-positive hemodialysis patients.

In 17 hypertensive, insulin-treated diabetics (eight type 1 diabetics, nine type 2 diabetics) the effectiveness of 10 mg/day felodipine was investigated over a period of one year. In both groups, felodipine brought about a lasting decrease in blood pressure (p less than 0.05). After four weeks' treatment, type 1 diabetics experienced a 143% increase in albumin excretion, and an 83% increase in fractional albuminuria, as compared with the initial values (p less than 0.05). In type 2 diabetics, in contrast, albumin excretion decreased by 25%, fractional albuminuria by 48% (p less than 0.05; p less than 0.01, as compared with type 1 diabetics). After 28 weeks of treatment, the fractionale albuminuria in the two groups had decreased by 27% (p less than 0.05 compared with the short-term response) and 37%, respectively. No change in hormone or metabolic parameters was observed.

From 1979 to 12/1990 795 organ transplants have been performed at our hospital (kidney n:737, liver n:23, heart n:35). Our data reveal vascular problems in 10 percent of the transplanted patients - not concerning the vascular anastomosis. The therapeutic approach should be determined interdisciplinary. Due to the low complication rate of operative or interventionel procedures in this patients, even relative indications--to improve "quality of live"--can be accepted.