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The effects of dextran on the antithrombin (AT) III activity and blood coagulation, evaluated with thromboelastography, were investigated in 26 patients (anaesthesia risk class I or II) scheduled for minor surgery under general anaesthesia. In the Dextran group the patients were infused first with dextran 7 ml/kg, then with Ringer's acetate. In the Ringer group, the patients received only Ringer's acetate. In the recovery room fluid therapy was continued with 5% dextrose in water until the first postoperative day. Blood loss and fluid replacement were comparable in the groups. Haematocrit (Hcr) decreased significantly in the Dextran group, and the platelet count decreased in both groups during surgery. The median baseline AT III values were similar in the study groups. In the recovery room, the median AT III value was lower in the Dextran than in the Ringer group, 78% and 92%, respectively (P < 0.05). By the following day, the AT III values had returned near the initial level. After surgery, the maximal amplitude of thromboelastogram was 48 mm in the Dextran group, and 58 mm in the Ringer group (P < 0.05). In conclusion, fluid replacement with dextran resulted in modest and short-lived alterations in blood coagulation.

We present SPECT, electroencephalography (EEG) and magnetic resonance imaging (MRI) data of a homogeneous group of 12 young adults with rare focal seizures and a good response to carbamazepine. Our data suggest that the alterations of the rCBF are independent of severity and duration of the epilepsy and of the frequency of seizures. Based on our experimental data, it may be suggested that complex partial epilepsy is a good biological model to investigate the neurogenic control of cerebral flow and metabolism.

A prospective study was made of sequential changes in the metabolism of vitamin D and calcium in 19 allograft recipient during the first year after successful renal transplantation. All but one of the patients received cyclosporine A combined with corticosteroids and azathioprine as immunosuppressive therapy. Shortly after transplantation most patients showed transient hypocalcemia and hypophosphatemia. At the time of transplantation 17 of 19 patients had an elevated plasma intact parathyroid hormone (PTH) level, and at the close of follow-up one in four patients. In six other patients intact PTH was within the reference range, but high in relation to simultaneously measured serum ionized calcium. According, one year after transplantation less than half of the patients showed complete resolution of hyperparathyroidism. The change towards normal in the metabolism of vitamin D began within the first post-transplantation week irrespective of the onset of diuresis. One to two weeks after transplantation 1,25(OH)2D3 and 24,25(OH)2D3 reached the lower limit of normal range. In these renal allograft recipients who received cyclosporine A the long-term values of serum 1,25(OH)2D3 did not differ from those of normal subjects.

Nineteen diabetic (DM) and twenty-two non-diabetic (NDM) uraemic patients undergoing renal transplantation were studied to evaluate coagulation abnormalities. Thirty-three healthy patients admitted for minor surgery served as controls. Antithrombin III (AT III), thromboelastogram (TEG), other haemostatic parameters and the influence of dialysis treatment were assessed in DM and NDM uraemic patients. All uraemic patients were anaemic and bleeding time was slightly prolonged (NS). The level of AT III was raised in the DM group when compared in the healthy controls (P < 0.001). Prothrombin time (PT) percentage was increased in both uraemic groups (P < 0.001) in comparison with the controls. Thrombocytosis was marked in DM patients (P < 0.001) when compared with controls and NDM patients. TEG parameters were similar in all groups. Continuous peritoneal dialysis treatment (CAPD) was associated with elevated total platelet count in NDM (P < 0.05) and DM group (P < 0.05) when compared with haemodialysis (HD) patients. Also, the PT was shortened in DM patients on CAPD vs HD (P < 0.05). AT III level was elevated in NDM patients on CAPD compared with those on HD (P < 0.05). There was no difference in clinical bleeding tendency during renal transplantation. Postoperatively, one patient in NDM group suffered from thrombosis of the graft artery and transplantectomy had to be performed. Our study showed a prethrombotic state in diabetic uraemic patients admitted for renal transplantation. The increased AT III activity may protect these patients against thrombotic complications. The role of CAPD treatment requires further studies.

The effects of alcohol abuse on the bone of women have scarcely been investigated, although women are more prone than men to osteoporosis. We studied 19 noncirrhotic female alcoholics (aged 24 to 48 years) hospitalized for 2 weeks for withdrawal and three groups of control women (n = 182). Sixteen patients and all control subjects had regular menstrual cycles. Forearm bone mineral content (BMC) and axial bone mineral density (BMD) were measured by single-photon absorptiometry and dual-energy x-ray absorptiometry, respectively. Parameters of bone metabolism were analyzed at the beginning and end of the withdrawal period. BMC and BMD did not differ between patients and controls at any of the five measurement sites. On admission, bone formation of the alcoholics was depressed as reflected by osteocalcin levels (-48%, P < .01); it normalized during abstention (P < .01). Urinary hydroxyproline, a parameter of bone resorption, and serum intact parathyroid hormone were at the control level throughout the observation period. Serum ionized calcium level increased by 4% (P < .0001), and serum free fatty acid (FFA) levels decreased by 30% (P < .05) during withdrawal; there was an inverse correlation between changes in these two parameters (r = -.49, P < .05). On admission, serum concentrations of 25-hydroxyvitamin D3 [25-OH-D3] and 1,25-dihydroxyvitamin D3 [1,25-(OH)2-D3] were reduced by 46% (P < .001) and 16% (P = .16); these did not normalize during abstention. In conclusion, provided that liver cirrhosis and gonadal dysfunction are not contributing, even heavy drinking does not seem to decrease bone mass in young and middle-aged women.(ABSTRACT TRUNCATED AT 250 WORDS)

To study the effect of prolonged ethanol consumption on calcium metabolism and on the prevalence of osteoporosis we examined 38 Finnish noncirrhotic male alcoholics (30-55 years of age) with dietary interviews and biochemical measurements and by measuring the bone mineral content of the forearm using single photon absorptiometry (SPA) and the bone mineral density of the spine, humerus and proximal femur using nonquantified computer tomography (CT) and dual-energy x-ray absorptiometry (DEXA). In comparison two groups of healthy controls were studied. The mean daily dietary intake of calcium was 1.3 g in the patients and 1.2 g in the controls. The dietary intake of vitamin D was equal in the study groups, too. The serum levels of calcium, phosphate and parathyroid hormone did not show any difference between the patients and controls but in the alcoholics the urinary excretion of calcium was reduced by 42% (p less than 0.0001) as compared to the controls. The serum levels of 25-hydroxyvitamin D3, 1,25-dihydroxyvitamin D3, and 24,25-dihydroxyvitamin D3 were reduced in the alcoholics by 40% (p less than 0.0001), 23% (p less than 0.01), and 48% (p less than 0.0001), respectively, as compared to the controls. The alcoholic men had normal levels of serum testosterone and they did not have hypercortisolism. The bone mineral content of the dominant forearm measured by SPA was similar in the study groups as were the bone mineral densities (BMD) of the lumbar and humeral areas measured by CT. The BMD at the lumbar, femoral neck, Ward's triangle and trochanter sites measured by DEXA did not differ, either.(ABSTRACT TRUNCATED AT 250 WORDS)

Two prophylactic immunosuppressive drugs, cyclosporine and methylprednisolone (MP), were compared for their effect on the in situ inflammatory reaction of granulation tissue formation and on wound healing. Granulation tissue was generated via implantation of viscous cellulose sponges in Sprague-Dawley rats. The rats were divided into six groups: One group received 40 mg/kg/day of cyclosporine, the second 10 mg/kg/day of cyclosporine, the third 2.5 mg/kg/day of cyclosporine, the fourth 12 mg/kg/day of MP, the fifth received the cyclosporine solvent, and the sixth group was given only saline. All drugs were given i.p. No reduction in the number of inflammatory cells was observed in the cyclosporine-treated sponges compared with the controls, whereas MP suppressed the inflammation strongly. Differential counts demonstrated a relative enrichment of macrophages in the cyclosporine-treated versus the MP-treated or control sponges. Chemical analyses of the sponge extracts agreed well with the cytological data: MP suppressed the total DNA content of the sponges, a marker of total cellularity, as well as the content of acid phosphatase and beta-glucuronidase, both markers of macrophages, but no such suppression was seen in the cyclosporine-treated sponges. The alkaline phosphatase content, a marker for granulocytes, was similar in all groups. A remarkable suppression in the contents of hydroxyproline, reflecting the amount of collagen, and in that of hemoglobin, reflecting the amount of neovascularization, was observed in the MP-treated sponges, whereas no such suppression--but possibly a slight enhancement of the second parameter--was observed in the cyclosporine-treated sponges. We conclude that, in contrast to MP, cyclosporine does not inhibit the inflammatory reaction of granulation tissue formation or the regenerative process of wound healing.

A study on IgE - IgA plasmatic level has been carried out in the acute phase and in remission of minimal changes nephrosis (MCN) and in glomerulonephritis with nephrotic syndrome (NS). The results obtained are the following: 1) Mean values of Ig classes were impaired in comparison with the normal values of children of the same age, both in MCN and in NS. 2) IgE were increased, particularly in children over 6 years in the MCN acute phase; the values decreased within normal after the remission was achieved. 3) IgA, on the contrary, were decreased in the subjects over 6 years, in the MCN acute phase. 4) No significant correlation was found between the two Ig classes. 5) The modifications of the Ig plasmatic level during the remission, after corticosteroid therapy was characterized by IgE reduction; IgA were only slightly, but not significantly, decreased in the same phase.

A case of bronchiolar adenomatosis (benign pulmonary adenomatosis) with unusually widespread pulmonary changes is presented. This disease is rare and occurs equally in both sexes. The tumourous growth is slow and can easily be mistaken for alveolar cell carcinoma, alveolar proteins, tuberculosis, sarcoidosis, or malignant pulmonary adenomatosis. The diagnosis can be made on a histological specimen from the affected lung. In spite of a benign histological picture, the disease may ultimately run an unfavourable course because of its malignant potentialities. A distinction between benign and malignant pulmonary adenomatosis may therefore only be made with certainty by a complete and careful postmortem examination.

Between February 1972 and December 1976 100 proximal gastric vagotomies (PGV) were performed on duodenal ulcer patients after failure of conservative treatment. The diagnosis was verified by preoperative barium meal and endoscopy and by peroperative examination. There was no operative mortality. Mean duration of postoperative hospital stay was 9.6 days. The percentual distribution in Visick-grading at the 1-year follow-up was 90% in class I + II, and 10% in class III + IV. The corresponding figures at the 5-year follow-up were 82% and 18%. The mean postoperative basal acid output did not change from one to five years. The reduction in pentagastrin stimulated acid output was unchanged at the 1- and 5-year follow-up. Neither did the mean acid output after insulin stimulation change between one and five years postoperatively. The mean concentration of serum gastrin was raised at one year but decreased to normal at the 5-year follow-up. Ten patients (10%) had ulcer recurrence during follow-up. Seven of these were successfully treated by gastric resection and three by antacids and cimetidine.

The effects of systemically administered calcitonin (CT) on fracture healing were analyzed in an experimental study on rats. The healing of a fracture was followed from 3 days up to 9 weeks postoperatively. Half of the rats in each age group were given daily CT 10 MRC-U/kg body wt s.c. Mechanical properties of the healing tibial fractures (tension strength) as well as various connective tissue components of the callus tissue were analyzed. No difference in the radiological or microscopical appearance of the fractures was detectable between the animals receiving CT and the controls. In the biochemical analysis matrix production as assessed from the concentrations of nitrogen, hexosamines, and hydroxyproline within the callus followed the usual lines of undistributed fracture union without any difference between the groups with and without CT. No differences could be detected in the mineralization of the callus between the specimens from animals receiving CT and those without. The tensile strength values of the fractures increased almost linearly up to 9 weeks. At 1 week the tensile strength values for fractures union in the animals without CT were approximately 50% higher, but later on no differences could be detected between the groups. These results indicate that although in the early phases of long-term CT therapy collagen synthesis may be impaired, there will be no effect on the net content of collagen or calcifying tissue in the callus or on the mechanical strength of healing fractures.

Most Authors fix the upper limits of normal blood pressure at 90 degrees percentile according to age. Nevertheless in their investigations different instruments were used and they often didn't relate in detail the position of the subject during the measurement. Other factors, influencing blood pressure values, have been often left out: relation with meals, room temperature, pain, drugs, stress, etc. The prevalence of hypertension in pediatric age in literature is 0,6 - 12,4% with several intermediate values. The first very important research concerning the hypertension in pediatric age was carried out by Londe et Coll., conducted among 1593 children (785 males and 798 females); they estimated mean values and percentiles according to age and sex. In the present study the A.A. saw 346 children (161 females and 185 males), 11-15 years old, observed at school, in a comfortable room. Pressure measurement was done twice in the same morning with half an our interval. Systolic pressure, 4 degrees and 5 degrees Korotkoff tones, was noticed. 11% of the children had systolic pressure values under 50 degrees percentile, 35,3% between 50 degrees and 90 degrees percentile and 43,1% had values equal or greater than 90 degrees percentile at the first measurement. The third group went down to 30,6% (106 cases) at the control (after an half an hour). This reduction shows the importance of the emotional factors in the P.A. variations. The 106 children who had systolic and/or diastolic values equal or greater than 90 degrees percentile were controlled again after a week. 92 maintained the same values. They were called for the third sitting 1-6 months later. 45 subjects agreed to our invitation and it was possible to point out that high blood pressure values persisted in 31 children (that is 8,9% of all examined cases). Following correlations were observed: body weight-blood pressure values (either systolic or diastolic ones) and so cutaneous plica-pressure values (p less than 0,01); moreover 50% of the 31 hypertensive children had hypertensive parents; the most frequent subjective symptom (13 cases) was cephalalgia. None of the studied school children showed either clinic or biochemical abnormal data, so that it was possible to define their hypertension as "essential".

The possible myotoxic effect of bupivacaine in combination with tourniquet ischemia was evaluated in 11 patients who underwent surgery of an arm under intravenous regional anesthesia. Eleven patients with the same kind of surgery and tourniquet who had general anesthesia served as controls. Venous blood bupivacaine concentrations in the anesthetized arm were high at the end of tourniquet time (27.2-202 micrograms/m1) and varied from 2.3 to 12.3 micrograms/ml 10 min after tourniquet release. Changes in blood-gas tensions and plasma potassium and lactate concentrations before and just after tourniquet release correlated with the ischemia time. Changes in creatine phosphokinase, lactate dehydrogenase and aspartate aminotransferase activities, possible indices of loss of integrity of muscle cell membranes, varied considerably and did not correlate with the ischemia time. There were no significant differences between the two groups in any of the parameters. Electron microscopy revealed no evidence of muscle degeneration 24 hr after the use of tourniquet with either bupivacaine intravenous regional (n = 4) or general anesthesia (n = 3).

Twenty-two consecutive patients with spinal fractures (eight with spinal cord injuries) were studied. All patients were immobilized in bed for 6 weeks after trauma. The occurrence of deep venous thrombosis (DVT) was detected by the 125I-labeled fibrinogen test and confirmed by venography. F VIII:C, F VIII:Ag, and AT III activities were determined 2, 6, and 10 to 12 days after trauma. All paralyzed patients (n = 8) developed DVT and two of them had pulmonary embolism within 5 days after trauma. F VIII:Ag and F VIII:C disproportionally increased and the values of F VIII:Ag/F VIII:C ratio above 2 predicted DVT. AT III remained normal during the whole immobilization time and the values of DVT(+) and DVT(-) groups were comparable.

In liver transplant patients low plasma protein, acid base abnormalities and high citrate concentrations in the blood affects the binding of ionized calcium. In the present study plasma ionized calcium as well as serum total plasma calcium were measured in ten patients undergoing liver transplantation because of end-stage liver failure. During the operation, ionized calcium fell to as low as 0.46 mmol/l although calcium chloride was administered frequently at doses of 10 mg/kg. Serum total calcium concentration values did not fall but rose well above normal at the end of the operation. The measuring of total serum calcium may thus be dangerously misleading in patients undergoing liver transplantation.

Microscopic haematuria is an urinary finding more and more frequently observed in routine analysis in childhood; the diagnostic problems, most of which unresolved, are yet the principal questions of concern. We have studied 123 patients during five years from 1975 to 1980, and followed them for 1-8 years (mean 4 years). Our experience allowed us to consider "normal" or without remarkable pathologic significance a urinary finding less than or equal to 5.000 RBC/m' at the Addis count. Such findings were pointed out in 55 cases (44%); 27 patients (22%) had 5-10.000 RBC/m', 34 cases (27,6%) presented 10-50.000 RBC/m' and 7 cases (5,7%) had more then 50.000 RBC/m'. The familiar background, the clinical, biological and immunological data, the roentgenographic investigations and the renal biopsy carried out in the 4 groups of patients, led us to the following conclusions: 1) 26% of the 123 cases had a "unexplained;; microscopic haematuria with complete lack of anamnestic data, symptomatology and with normal biological findings. 2) in 65,8% of the cases it was possible to discover frequent upper respiratory tract infections (and allergy in 5,6% of them). 3) in 26% of the patients we discovered a previous or actual genito-urinary (10,5% and 15,5% respectively) infection: 9,4% of 96 urography demonstrated a variable degree of nephro-urological abnormalities. 4) 23 children (18,7%) was selected for renal biopsy, primarily by the hypocomplementemia and positive anti-DNA ab. test, and secondly by elevated degree of microhematuria. The histological and immunohistochemical studies demonstrated the presence of mesangial proliferation glomerulonephritis with IgG-IgA-C3 deposits in 7 cases (30% of the cases biopsied and 5,6% of the total), 69,6% of the cases had only minimal charges with negative immunofluorescence. 5) A mean follow-up of 4 years in two groups of patients (less than or greater than 6 years of age) has demonstrated that microscopic haematuria remains unchanged in 18-19% of both groups. A more marked improvement or normalization has been documented in the children more than 6 years aged (p less than 0,001) while a worsening has been observed in the children less than 6 years aged (p less than 0,005), with a statistically significant difference between the two groups considered.