Urinary tetrahydroaldosterone as a screening method for primary aldosteronism: a comparative study.

Background: The major aldosterone metabolite 3 alpha,5 beta tetrahydroaldosterone reflects up to 45% of the aldosterone secretion. Its 24-h urinary excretion is likely to provide an accurate index of the daily aldosterone production and to be an indicator for primary aldosteronism (PA).

Methods: In a prospective study, the validity of tetrahydroaldosterone as a screening test for PA was evaluated in comparison to serum potassium, plasma aldosterone, plasma renin activity, plasma aldosterone/renin activity ratio (PARR), as well as 24-h urinary aldosterone-18-glucuronide and free aldosterone.

Coexisting hyperparathyroidism, renal osteodystrophy and psoriatic arthritis.

We report the case of a 60-year-old woman with hyperparathyroidism, renal osteodystrophy and psoriatic arthritis. The coexistence of findings of hyperparathyroidism and renal osteodystrophy has been described and there are also reports of patients suffering from renal arthropathy mimicking hyperparathyroidism. To our knowledge, there is no description to date of a case displaying findings of the co-occurrence of these conditions in a patient.

Role of 21-deoxyaldosterone in human hypertension.

21-Deoxyaldosterone has been postulated to be a precursor of aldosterone in an alternative biosynthesis pathway and Kelly's-M1 is considered to be its metabolite. In healthy volunteers, the excretion rate of 21-deoxyaldosterone and of Kelly's-M1 are significantly lower than the aldosterone metabolites, aldosterone-18-glucuronide and tetrahydro-aldosterone and than the aldosterone precursor 18-OH-corticosterone. Essential hypertension patients (with low and normal renin) excrete comparable values of 21-deoxyaldosterone and Kelly's-M1 as normotensives.

[Retroperitoneal fibrosis].

A 53-year-old man without previous significant illness developed severe backache. Neither physiotherapy nor nonsteroidal anti-inflammatory drugs improved his condition so that he had been regularly taking pain-killing medication. 6 months later elevated retention values were detected and the patient was admitted to hospital.

[Cor triatriatum sinistrum--value of pulmonary vein flow in hemodynamic assessment].

We report on two patients (a 52-year-old female and a 32-year-old male) with cor triatriatum sinistrum, both clinically inconspicuous. The former had undergone strenuous athletic training without difficulty for eight years of her youth. In both cases, cor triatriatum sinistrum was found by chance during transthoracic echocardiography undertaken for hypertension.

Characterization of "refilling types" by continuous blood volume monitoring during hemodialysis.

Fluid removal during HD is frequently associated with acute hypotension due to insufficient mobilization of extravascular fluid and subsequent hypovolemia. Large variability in vascular refilling makes dialysis therapy difficult and requires a better understanding of fluid distribution in the individual hemodialysis (HD) patient. Blood volume monitoring was performed by continuous measurement of blood density with a DMA 46 Density Meter (Fa.

[Opisthorchis felineus--the cat liver fluke. Differential diagnosis of right-side upper abdominal pain].

For several weeks a 58-year-old woman had suffered from intermittent right upper abdominal and flank pain, loss of appetite, weight loss (2 kg in 8 weeks), as well as constipation. She had a mild eosinophilia of 0.48/nl, while the blood picture and differential count were normal.

Low-molecular-weight protein-permeable cuprammonium rayon haemofilter.

Searching for a dialyser membrane with a cut-off similar to that of the human glomerulus, a modified cuprammonium rayon (AM-75-UP) and a polyacrylonitrile (PAN-15-DX) haemofilter were tested in vivo for the ability to eliminate substances of a molecular weight (MW) of 10-65 kilodaltons (kDa). Endogenous marker substances of a defined MW (beta-2-microglobulin 11.8 kDa; retinol binding protein 21 kDa; alpha-1-microglobulin 26.

Transmembranous transport and adsorption of beta-2-microglobulin during hemodialysis using polysulfone, polyacrylonitrile, polymethylmethacrylate and cuprammonium rayon membranes.

Beta-2-microglobulin (b2M) was identified as a causative agent of amyloidosis associated with long-term hemodialysis (HD). Therefore, we examined handling of b2M during a 4-hour hemodialysis session. We compared b2M adsoprtion and diffusive/convective elimination between high-flux membranes such as polysulfone (PS; F 60, Fresenius), polyacrylonitrile (AN 69; Filtral, Hospal) and polyacrylonitrile (PAN, PAN 12CX2, Asahi) and less permeable membranes such as cuprammonium rayon (CR; AM 160 H, Asahi) and polymethylmethacrylate (PMMA; BK-1.

Allergy to dialysis materials.

One hundred and six unselected patients were screened for allergic symptoms, specific IgE against ethylene oxide (ETO), isocyanates (ISO), formaldehyde (FA), phthalates (PHT), total IgE and eosinophil count. Complement activation was measured during cellulosic dialysis in atopic patients and in a control group. Sixteen patients demonstrated mild allergic symptoms during dialysis treatment.

Pharmacokinetics of intravenous enoximone in dialysis patients.

The new vasodilator and inotropic drug enoximone was given to dialysis patients as a single intravenous dose of 1 mg/kg. Plasma concentrations were measured up to 240 min. The mother compound enoximone reached a high plasma concentration intravenously, followed by a quick decline of the plasma concentration curve (t1/2 = 1.

Beta-2-microglobulin adsorption and release in-vitro: influence of membrane material, osmolality and heparin.

We studied the effects of cuprammonium rayon (CR), polyacrylonitrile (PAN), polysulfone (PS), changes in osmolality, and heparin dosage on beta-2-microglobulin (b2M) handling in an in-vitro model that excluded convective transport and minimized diffusive transport. Both PAN and PS exhibited high adsorption capacity for b2M. Osmolality changes had no effect on b2M adsorption or release.

[Hypokalemia as the principal symptom of covert vomiting. Clinical and diagnostic aspects].

In ten adults (nine females), referred for hypokalemia as the cardinal symptom of uncertain etiology and normal blood pressure, surreptitious self-induced vomiting was demonstrated as the main cause. In the majority of such patients, the pathognomonic pattern of serum and urine electrolytes (in the unstable phase--loss of gastric juice) allows diagnosis without hospitalization. If there are atypical urinary electrolyte values or the patients deny vomiting, hospitalization or part-hospitalization is recommended, with parenteral administration of 1 litre physiological saline daily under weight control, and (if necessary) toxicological urine tests for diuretics if there is a high urinary chloride level.

Polyacrylonitrile complement activation attenuated by simultaneous ultrafiltration and adsorption.

The highly permeable synthetic polyacrylonitrile (PAN) membrane (Filtral; Hospal, Basle) is regarded as biocompatible for its slight complement activation and leucocyte sequestration. The low C3a and C5a concentrations during PAN dialysis may be due to a lack of complement activation potential of this polymer, but also to elimination of activated complement components by the dialyser through adsorption and/or ultrafiltration (mol wt of C3a and C4a 9000 daltons; of C5a 11,000 daltons). Comparing arteriovenous differences throughout the study, higher concentrations of C3a (+23%; n.

Permeability and secondary membrane formation of a high flux polysulfone hemofilter.

It has been assumed that the molecular weight (MW) cut-off of a newly fabricated polysulfone capillary dialyzer (F60, Fresenius, FRG) is similar to that of the human glomerulus. We recently tested the device in vivo and found this not to be so, based on the device's ability to eliminate substances of a MW of 10,000 to 60,000 daltons. One of the reasons for this discrepancy was found to be the influence of secondary membrane formation on solute permeability.

Three cases of hemodialysis-associated hypersensitivity reactions.

According to the United States Food and Drug Administration, untoward reactions to capillary hemodialyzers occur at a rate of 3.5 of every 100,000 dialyzers sold. Allergic symptoms immediately after initiation of dialysis consist of burning retrosternal pain, sensation of diffuse heat, cold perspiration, periorbital and facial edema, flushing, laryngeal stridor, bronchial hypersecretion, hypotension, bradycardia, and loss of consciousness.

Effects of haemodialysis on the pharmacokinetics of muzolimine.

Unlabelled: High ceiling diuretics allow a better control of fluid balance in dialysis patients with a minimum urine flow of 500 ml/day. The pharmacokinetics of the high ceiling, long acting diuretic muzolimine (M) was investigated in 6 patients on regular dialysis therapy.

Methods: Concentrations of unchanged M in plasma were determined by high performance thin-layer chromatography (HPTLC) after a single oral dose of 240 mg up to 26 h: A) during and after the performance of dialysis lasting for 3 h, B) 20 h after finishing haemodialysis therapy (non-blind randomized cross-over study).

Dissociation in the excretion of different aldosterone metabolites and unmetabolized ('free') aldosterone in hypertension.

1. The determination of aldosterone-18-glucuronide (pH 1-labile aldosterone) was complemented by concomitant measurements of free urinary aldosterone and tetrahydroaldosterone in 307 patients, most of whom were hypertensive. In 38 cases (12.