Interference of different ACE-inhibitors with the diuretic action of furosemide and hydrochlorothiazide

In healthy volunteers the acute effect of furosemide (40 mg i.v.) and hydrochlorothiazide (100 mg p.o.) on diuresis, natriuresis and renal kallikrein and kinin excretion was investigated. Furosemide stimulated markedly diuresis and natriuresis as well as urinary kallikrein and kinin excretion. Pretreatment by captopril (C) reduced the diuretic and natriuretic effect of furosemide significantly probably due to a diminished (about 50%) proximal-tubular secretion of furosemide. Captopril did not alter significantly the furosemide induced changes in urinary kallikrein and kinin excretion. After captopril there was a clear dissociation between aldosterone, which was diminished by captopril continuously, and renal kallikrein and kinins, which were still stimulated by furosemide. These results suggest that renal kallikrein-kinin system is stimulated by furosemide directly and independently of aldosterone secretion. Other ACE-inhibitors like ramipril (5 mg) or enalapril (20 mg) did not influence the stimulatory effects of furosemide on diuresis or kallikrein-kinin excretion. Ramipril at a dose of 10 mg, however, enhanced the initial diuretic effect of furosemide by increased furosemide secretion and increased relative sodium excretion. Hydrochlorothiazide induced a prolonged diuresis which was not changed by either captopril or ramipril. Urinary kallikrein excretion was not stimulated by hydrochlorothiazide. Our results show an important drug interference between captopril and furosemide, which is independent of ACE-inhibition and probably only due to an interference in proximal-tubular secretion of both drugs. Between captopril and hydrochlorothiazide no such interaction could be observed.

[Testicular germinal tumors. Current therapeutic principles]

The cure rate for germinal tumors of the testes are now very high, greater than 80%, all stages and histological types taken as a whole. This calls for a revision of therapeutic indications, in light of these results and modern staging methods. In localized stages, or tumors associated with a good prognosis, therapeutic de-escalation is in progress, in order to limit the side effects. In invasive forms or forms associated with a poor prognosis, the use of more aggressive methods, such as high dose chemotherapy, should further improve prognosis.

Release of tumor necrosis factor, interleukin-2, and gamma-interferon in serum after injection of OKT3 monoclonal antibody in kidney transplant recipients

High levels of tumor necrosis factor-alpha, interleukin-2, and gamma-interferon appeared in the circulation of kidney transplant recipients after the first injection of the monoclonal antibody OKT3. This initial injection was systematically followed by fever. The three cytokines were released in all patients (n = 9), with peak serum levels of tumor necrosis factor occurring 1 hr after OKT3 injection and those of interleukin-2 and gamma-interferon after 2 hr. Cytokines were not released after the second and third OKT3 injections, when CD3+ cells had disappeared from blood. These findings suggest that circulating cytokines are released by T cells after activation by OKT3. These cytokines are probably involved in the systematic reactions observed after injection of OKT3.

Morphometric analysis of mitochondria and boutons in the dentate gyrus molecular layer of aged rats

An electron microscopic morphometric analysis of the volume density of mitochondria and boutons in the dentate gyrus molecular layer was carried out in young (3-4 months old) and aged (26-27 months old) Wistar rats. This study showed that the volume fraction of mitochondria per unit volume of the neuropil in aged rats did not differ significantly from that in young animals. The comparison of different zones of the molecular layer (supragranular, inner, middle and outer zone) showed a significant increase in the mitochondrial volume density from the supragranular to the outer zone in both animal groups. These stereologic results are discussed in relation to the histochemical pattern of the mitochondrial enzymes in young and aged rats. Only in the supragranular zone was there a statistically significant difference in the volume density of boutons, i.e. aged rats showed about a 20% higher volume density than did young rats. It is suspected that this increase in bouton volume density could be due to the age-related atrophy of smaller dendritic shafts previously reported in senescent Fischer rats.

Non-obstructive kidney transplant dysfunction: magnetic resonance evaluation

The value of magnetic resonance imaging in the differential diagnosis of non-obstructive dysfunction of renal allografts was studied in a series of 58 examinations at 0.5 T. Four parameters were evaluated: the corticomedullary differentiation; the relative thickness of the cortex; the evolution, with echo number, of the relative signal intensities of kidney parenchyma and adjacent fatty tissue on images generated by a long time to repeat multiecho sequence; and the proximal vascularization. The loss of corticomedullary differentiation is the major finding in acute rejection, but it is not specific as it is also observed in chronic rejection and in the much rarer acute glomerulonephritis. Thickening of the cortex is helpful for the detection of rejected transplants with visible corticomedullary delineation (26% of the cases). Uncomplicated acute tubular necrosis appears as a normal transplant.

[Effect of water containing calcium and magnesium sulfates on the elimination of cholesterol in the rat]

In the rat, the activity of the thermal water of Capvern and of its ionic components on the modification of the flow rate and composition of hepatic bile has been investigated. Two groups of rats were selected: the first group received per os an overload of the thermal water during six weeks. At that time on empty stomach a great increase of biliary phospholipids was observed. An intraduodenal injection of the thermal water produced a significant and rapid increase of biliary flow rate and biliary cholesterol. the animals of the second group received through intraduodenal injections the thermal water or an anionic solution composed of calcium, of magnesium sulphate or of both salts at their concentration in the thermal water, respectively. We observed an increase in biliary flow rate and biliary calcium concentration in the rats receiving the solution of calcium sulphate only and an increase of choleresis in the rats receiving the thermal water only. These data suggest that the thermal water has a specific action on the metabolism of cholesterol in increasing its biliary elimination particularly through the calcium ion content of the water.

Hyperactivity of donor B cells after neonatal induction of lymphoid chimerism in mice

Balb/c mice made chimaeric by neonatal injection of semi-allogeneic (A/J x Balb/c)F1 hybrid spleen cells develop anti-DNA and rheumatoid factor-like antibodies in the context of hypergammaglobulinaemia with marked elevation of IgG1 and IgE serum levels. Chimaeric mice also display increased levels of antibodies to different haptens and to tobacco mosaic virus (TMV). The allotypic marker of the A/J strain is present on anti-DNA and anti-hapten antibodies. In addition, spleen cells of chimaeric mice spontaneously produce high levels of IgG1 and anti-DNA antibodies in vitro and this hyperactivity is abolished after lysis of donor lymphocytes. These findings indicate that polyclonal activation of donor B cells plays an important role in this model of autoimmunity.

Late mortality and morbidity five to eighteen years after kidney transplantation

The experience with 102 kidney transplants (86 from cadaver donors) functioning more than 5 years in 99 patients followed in one center is reviewed. With the 100% survival point set at 5 years, patient and graft survivals were 92% and 73% at 10 years, and 70% and 56% at 15 years, respectively. Of those 102 recipients, 58 are presently alive with a functioning graft and 18 died with a functioning graft; 26 patients rejected their graft after a mean interval of 8.3 years posttransplant, 11 of them died within 4-45 months following readmission to dialysis. For the whole group, 29 patients died after a mean period of 10 years following transplantation. Main causes of death were vascular catastrophes (48%), malignancies (21%), sepsis (17%), and liver failure (14%). Because vascular accidents, hepatic failure, and sepsis predominated in male patients, the overall late mortality was higher in male (37%) than in female (25%) patients. The high incidence of late complications--including chronic and acute graft rejections--in long-term kidney recipients constitutes a strong argument for maintaining constant supervision of those patients by a medical team with extensive experience with transplantation.

[Magnetic resonance imaging, with surface coil, of a transplanted kidney]

MR appearance of the kidney transplant is evaluated on a series of 80 examinations performed on a supraconductive unit operating at 0.5 T. Normal function kidneys displayed a clearly delineated corticomedullary differentiation (CMD); the ratio between the thickness of cortex and medulla didn't exceed 0.6. The same appearance was observed in non complicated acute tubular necrosis. Complete loss of CMD was the major finding in acute rejection (74% of the cases), but it was not specific as it was also observed in chronic rejection and in acute glomerulonephritis. Cortex thickening was helpful for the detection of rejected transplants with visible CMD. The sensitivity of MR in the detection of acute rejection was 94%. Specificity of MR findings for acute rejection depended on the transplant age: it varied from 100% for examinations performed during the first 3 months after transplantation, to less than 50% for examinations of the second year.

Autoimmune disease after neonatal injection of semi-allogeneic spleen cells in mice: involvement of donor B and T cells and characterization of glomerular deposits

Balb/c neonates injected with semi-allogeneic (A/J x Balb/c) F1 hybrid spleen cells develop an autoimmune disease associated with an immune-complex glomerulonephritis. The successful induction and maintenance of B cell chimerism is required for the occurrence of autoimmunity. The percentage of chimeric mice displaying autoimmune features increases in parallel with the number of cells injected at birth. T cell depleted inocula although readily inducing B cell chimerism were found unable to induce hypergammaglobulinaemia, circulating immune complexes and glomerulonephritis. IgG1 is the most and IgG3 the least represented IgG isotype among the immunoglobulins deposited in the glomeruli. Immunoglobulins bearing donor (A/J) allotype are detected in the glomeruli of six out of 11 chimeric mice. Rheumatoid factor activity is significantly concentrated within the immunoglobulins eluted from the kidneys, whereas anti-DNA activity is not.

[Initial chemotherapy in the treatment of inflammatory breast cancers. 230 cases]

The results of 2 chemotherapeutic regimens used in 170 cases of inflammatory breast cancer were compared with those obtained in 60 historical controls treated with radiotherapy and hormonal therapy. Inflammatory breast cancers could be divided into evolutive phase 2 with limited signs of inflammation and evolutive phase 3 where inflammation involved the whole breast. The 60 controls had been treated between 1967 and 1974 with radiotherapy (45 Gy plus an extra dose of 20 or 30 Gy); premenopausal patients underwent ovarian irradiation. The 91 patients treated with regimen A between 1976 and 1980 received a DVM-type induction chemotherapy (doxorubicin 40 mg/m2 on day 1, vincristin 1 mg/m2 on day 2, and methotrexate 6 mg/m2 on days 3, 4, 5) every 3 or 4 weeks, and a VCF-type maintenance chemotherapy (vincristin 1 mg/m2 on day 1, cyclophosphamide 200 mg/m2 on days 2, 3, 4 and 5-fluorouracil 300 mg/m2 on days 2, 3, 4) every 4 weeks. Premenopausal patients had their ovaries irradiated; postmenopausal patients received tamoxifen. The therapeutic sequence was: 3 DVM - 45 Gy - DVM - 15 Gy - 4 DVM - 4-12 VCF. The 79 patients treated between 1980 and 1982 with regimen B received a DVCMF-type induction therapy (doxorubicin 50 mg/m2 on day 1, vincristin 0.6 mg/m2 on day 2, 5-fluorouracil 300 mg/m2 on days 3, 4, 5, cyclophosphamide 200 mg/m2 on days 3, 4, 5 and methotrexate 10 mg/m2 on days 3, 4, 5) every 4 weeks. Hormonal therapy was the same as with regimen A. The sequence was 3 DVCMF - 45 Gy - DVM - 20-25 Gy - 4 DVM - 4-12 VCF. The survival rate at 3 years was 42% in controls, 53% in regimen A patients and 74% in regimen B patients (P less than 0.05). The relapse-free survival rates in these three groups at 3 years were 15%, 32% and 54% respectively (P less than 0.0008). These results suggest that a multidisciplinary approach and initial chemotherapy are useful in this type of breast cancer. The value of prolonged maintenance treatment is discussed.