Wiener klinische Wochenschrift. Supplementum最新文献

The determination of fructosamine in serum is an accepted tool for the metabolic monitoring of diabetic patients. It provides an estimation of the glycemia state during the preceding 10 to 20 days. The turn-over of serum proteins is in general faster than that of hemoglobin. Therefore, fructosamine is faster responding than HbA1c to recompensation or fluctuations in glycemic control as observed in labile metabolic situations. On the other hand, under conditions of stable metabolic control fructosamine values correlate closely to HbA1c. The relation between the two parameters can be visualized in a nomogram of HbA1c, fructosamine and glucose or be expressed by a quotient (Glyc-Q = Fructosamine*2.2/HbA1c). A deviation from the stable metabolic situation (Glyc-Q = 100) reflects a trend in the recent development of glycemia: a Glyc-Q of greater than 120 is obtained in the state of decompensation, whereas in recompensation the Glyc-Q decreases significantly to values below 80. We propose to use the Glyc-Q in situations where a fast assessment of the glycemic state or an estimation of the development of glycemia within short intervals of observation are required.

The stability of fructosamine has been analysed in sera of 24 patients. Fructosamine concentrations increased daily with a constant rate of formation. Synthesis of fructosamine in vitro strongly depended on the incubation temperature and was directly proportional to the glucose concentration of the sample. It is recommended to store sera for the determination of fructosamine at 4 degrees C or - 20 degrees C.

The performance of the assay and the clinical usefulness of a new short-term index (Fructosamine Plus: FP) of metabolic control in diabetes was evaluated. The FP concentration was determined with the Hitachi 704, Cobas Mira, and Cobas Fara analyzers. The "within run" and "between run" CVs were less than 2.67% and less than 4.26%, respectively. The reference interval (determined from data on 125 blood donors) was 191 to 288 mumol/l (mean 240 mumol/l). In poorly controlled diabetic patients FP was significantly higher than in the well controlled ones. Moreover FP was significantly correlated with HbA1c and blood glucose levels. Our preliminary data seem to demonstrate that relating FP to total protein does not improve the clinical value of the new index.

During the last years fructosamine has been presented as a measurement of diabetic long term control, particularly a shorter half life of fructosamine was seen as an advantage over HbAlc (half life of fructosamine: 16 days, half life of HbAlc: 28 days). Due to diurnal variations of fructosamine levels especially in dependence of variations of the albumin-and protein concentrations the interpretation of this parameter was somewhat limited. Recently a new colorimetric fructosamine-assay was developed. We investigated the diurnal variations of fructosamine in 28 patients with type II diabetes. Fructosamine, glucose, albumin, total protein and creatinine were measured at the times towards 3, 6, 9, 12 a.m. and 3, 6, 9, and 12 p.m. In relation to the 6 a.m. fructosamine value (= 100%) the fructosamine levels showed a daily variation from -4% at 3 a.m. to +11% at 9 a.m. Correcting fructosamine levels with total protein or with albumin reduced the variations to -1% to +6% or -3% to +9%. Daily profiles of the new fructosamine assay show a daily variation which can be minimized by correcting with protein-or with albumin concentrations. For clinical routine the daily variations especially of the corrected fructosamine levels are neglectible.

In 127 patients, we investigated the influence of hyperlipemia on observed fructosamine values. An in vitro influence of the lipids on the fructosamine reading could be excluded for cholesterol, HDL-cholesterol and triglycerides. However, in patients with type I diabetes, both, cholesterol and triglycerides significantly (p less than 0.05) correlated with fructosamine. This may be explained by in vivo effects of hyperglycemia on lipids or lipoproteins. For a given level of hyperglycemia, fructosamine is slightly more sensitive than HbA1c.

In 106 patients suffering from acute respiratory failure of different severity 157 bedside balloon occlusion pulmonary angiographic studies have been performed through a pulmonary artery catheter to assess the frequency and extent of intravascular occlusive disease. The vascular alterations in acute respiratory failure impair the prognosis essentially. The decreasing pulmonary vascular cross-section causes a greater pulmonary vascular resistance and consecutive pulmonary artery hypertension and finally right heart failure. In 33% of patients multiple thrombosis and in 15.1% singularly pulmonary artery filling defects could be shown. In 21.7% a decreased background opacification caused by extensive microthrombosis was present. Only in 30.2% the angiography was interpreted as normal. The mortality rate was significant higher in patients with multiple macro- and microthrombosis (82.9% respectively 52.2%) compared to patients with singular pulmonary artery filling defects and normal angiography (37.5% respectively 28.1%). The angiographic result was further correlated with the severity of the acute respiratory failure, the haemodynamic and haemostasiologic data, the degree of consolidation in the chest-X-ray and the post mortem angiographic studies.

In nuclear medicine new trends in the diagnosis of renal function are based on the introduction of new radiopharmaceuticals, improvements in the methodological part of the procedure and precise pharmacological intervention in response to given indications. Tc99m mercaptoacetyltriglycine (Tc99m MAG3) was tested as replacement for I123 orthoiodohippuric acid (I123 oIH) both in the form of a HPLC purified substance and as an impure kit preparation. HPLC purified Tc99m MAG3 clearance determinations in anuric patients showed a low extrarenal excretion amounting to only about 5% of the total clearance in normal patients. Kit preparations yielded about 90% of the labelled product; impurities were pertechnetate, reduced hydrolyzed Tc99m and chemically unidentified labelled products which showed a significantly lower renal, but increased hepatobiliary excretion in comparison with Tc99m MAG3. The renal clearance with kit preparations of Tc99m MAG3 was 55% of the clearance with oIH at a comparable urinary excretion. Significantly higher protein binding and therefore, a decrease in the distribution volume of Tc99m was found in comparison with I123 oIH. No difference was recorded between the two substances with respect to the renogram curves in normal subjects, apart from a modest delay in the elimination of Tc99m MAG3. For clinical purposes kit preparations of Tc99m MAG3 proved equal to I123 oIH. The influence of angiotensin converting enzyme (ACE) inhibitors (captopril) leads to characteristic changes in the renograms of patients with Goldblatt hypertension. Quantitative criteria for the evidence of haemodynamically significant renal artery stenosis were derived from investigations without and with captopril (25 mg) (I123 oIH and Tc99m DTPA) in 21 patients with essential hypertension. The criteria were defined as follows: a delay in peak activity (Tmax) in the I123 oIH captopril renogram exceeding 2 minutes as compared with the baseline value and/or a lower uptake of Tc99m DTPA in comparison with the uptake of I123 oIH (uptake quotient I123 oIH/Tc99m DTPA greater than 1.2). The diagnostic and prognostic potential of the captopril renogram was compared with that of the captopril test by investigating 34 patients with renal artery stenosis (23 uni-, 11 bilateral) (atherosclerosis: 23, fibromuscular hyperplasia: 11). The captopril renogram was positive more often (n = 12) than the captopril test (n = 4) in patients without renal functional impairment of the stenosed kidney. Similar results were obtained with both methods in patients with atrophic kidneys: captopril renography was positive in all cases with a positive captopril test.(ABSTRACT TRUNCATED AT 400 WORDS)

A classification of peripheral nerve sheath tumors in the skin is based on analysis of light-, electron microscopy, immunohistochemistry and cellular composition of the different tumor types. Not only Schwann cells, but also perineurial cells and fibroblasts may be involved in tumor formation. Schwann cell rich and connective tissue cell rich tumors are distinguished. Generally all tumors show low proliferating activity as investigated by H3-Thymidine autoradiography. Only in few connective tissue cell rich tumors higher labelling indices can be demonstrated. These findings are correlated with the clinical course and prognosis of the different tumor types. The question remains, whether connective tissue cell rich tumors are at higher risk for malignant transformation.