The analysis of metabolites in human sweat: analytical methods and potential application to investigation of pressure ischaemia of soft tissues

A straightforward technique was developed for sweat collection applicable to tissues subjected to external load without introducing distortion of underlying tissues, and for analysis of six metabolites in the collected sweat. Chloride was measured colorimetrically and lactate, urea and urate by enzymatic methods on a centrifugal analyser. Sodium and potassium were measured by flame photometry. The methods showed good precision, recovery and linearity. To assess the technique sweat was collected: (i) from the sacrum, ischium, forearm and calf in healthy individuals at 32 degrees C for 1 h; (ii) from the sacrum of healthy subjects at ambient temperature for 9 h; (iii) at ambient temperature from the sacrum of a patient with a history of pressure sores. Sweat rates were greater at the sacrum and ischium than the calf or forearm. There were differences in the concentrations of lactate and urea between sites but these were smaller when expressed as amount secreted. Sweat rates were significantly lower in groups (ii) and (iii), but sweat could be collected reliably. This technique has potential clinical application to the investigation of susceptibility to pressure sores.

Levels of water-soluble antioxidants in astrocytoma and in adjacent tumor-free tissue

The aim of the present study was to investigate the oxidative status in astrocytoma. Samples of brain tissue from the centre to the periphery of the tumor were obtained from 11 astrocytoma patients undergoing computer tomography-guided stereotaxic operation, who had been previously treated with the corticosteroid dexamethasone. Part of the sample was investigated histologically for clarification of tumor type, and the presence of neoplastic and non-neoplastic tissue and necrosis. The rest was used for the quantification of the antioxidants ascorbic acid, uric acid, glutathione and cysteine by high performance liquid chromatography, and for quantification of DNA. Levels of antioxidants were calculated as micrograms/g fresh tissue and mumol/g DNA, a parameter related to cell content. There was significantly more DNA in neoplastic samples than in non-neoplastic ones, indicating increased cell density. Uric acid (micrograms/g fresh tissue) was significantly increased in neoplastic compared with non-neoplastic tissue, and levels were even higher in necrotic tissue. There were no significant differences between neoplastic and non-neoplastic tissue levels of ascorbic acid, glutathione or cysteine, expressed as micrograms/g fresh tissue. However, when levels of these three compounds were expressed as mumol/g DNA, i.e. taking into account the higher cell density, ascorbic acid, glutathione and cysteine were significantly reduced in neoplastic samples compared with non-neoplastic ones. Results thus show that there are differences between the antioxidant levels in astrocytoma and non-neoplastic tissue, providing additional support for the hypothesis that free radicals play a role in tumor growth.

The influence of internal stone structure upon the fracture behaviour of urinary calculi

In vitro extracoporeal shock wave lithotripsy (ESWL) on different types of urinary calculi, in combination with microfocus x-ray and microphotography, illustrates the importance of the internal stone structure. Calculi with a rough surface layered structure (calcium oxalate monohydrate) and untextured calculi (cystine) are characterized by a low stone fragility, whereas coarse-grain calculi (calcium oxalate dihydrate, struvite), and calculi with a smooth surface layered structure (uric acid), are very fragile. Shell-like fragmentation in layered calculi, with smooth surface of the crystalline laminations, suggests that the stone matrix influenced the propagation of the shock wave energy inside the stone.

Hot occupation and nephrolithiasis

We investigated the prevalence of stone disease and urinary stone risk factors in machinists chronically exposed to a hot environment and massive sweating, without interference of nephrotoxic metals or other lithogenic compounds. The study was performed at a glass plant and exposure to heat stress was estimated by the Wet Bulb Globe Temperature climatic index. The prevalence of nephrolithiasis on the entire population of the machinists was 8.5% (20 of 236), while the prevalence on the controls working in normal temperature was 2.4% (4 of 165) (p = 0.03). A high incidence (38.8%) of uric acid stones was present in the workers exposed to heat stress. Among the urinary stone risk indexes determined for 3 days during the 8-hour work shift on a randomly selected sample of 21 workers exposed and 21 workers not exposed to heat stress without any evidence of stone disease significant differences were found in uric acid concentration (722 +/- 195 versus 482 +/- 184 mg./l., p < 0.001), specific gravity (1,026 +/- 4 versus 1,021 +/- 6, p < 0.005) and pH (5.31 +/- 0.28 versus 5.64 +/- 0.54, p < 0.02), respectively. Thus, high uric acid relative supersaturation was present during occupation in hot temperatures (8.67 +/- 3.49) compared to occupation in normal temperatures (4.15 +/- 2.7) (p < 0.001). This study confirms that chronic dehydration represents a real lithogenic risk factor, mainly for uric acid stones, and adequate fluid intake is recommended during hot occupations.

[Treatment of staghorn calculi on the basis of composition and structure]

Most staghorn calculi are infection stones composed of struvite and/or carbonate apatite. Sometimes, cystine, uric acid, whewellite and brushite stones also assume a staghorn configuration when located in the kidney. It is very important in stone crushing to know the composition and architecture of the stones. Struvite stones show a concentric laminal structure and are fragile because of wide interstices of crystals and rich organic matrix. These stones usually contain many bacterial colonies in the interstices of crystals and bacteria break out of the stones when they are crushed. Therefore, perioperative administration of antibiotics is necessary for prevention of bacteremia and sepsis. Whewellite stones and uric acid stones have a smooth surface and reveal compact radial and laminal structure especially in the peripheral layer. They are very hard and are refractory to crushing, and the fragments are large. Cystine stones show a compact radial monomineral texture and are very hard. The fragments made by crushing are large. Therefore, combination therapy of stone crushing and irrigation of alkali solution may be useful for treatment of cystine stones as well as uric acid stones. Calcium phosphate stones, hydroxyapatite or brushite stones, are rare and are formed in hyperparathyroidism, Cushing syndrome and renal tubular acidosis. Hydroxyapatite stones are rich in matrix and fragile. Brushite stones reveal radiate structure and are hard. There is no general method of treatment for staghorn calculi but we should select the most reasonable method including open surgery for each case taking into consideration the stone composition, predisposing factors and possibility of stone residue and recurrence.

In vitro analysis of urinary calculi: type differentiation using computed tomography and bone densitometry

Thirty-six urinary stones were studied by computed tomography and bone densitometry in order to find a correlation between the chemical composition of the stones and the densitometric data. In vitro, the more common cases of lithiasis can be divided into 3 main groups: uric acid, cystine and the calcium salts, e.g. calcium oxalate monohydrate, calcium oxalate dihydrate and calcium phosphate. Struvite stones fall between the second and third groups. Computed tomography and bone densitometry can differentiate between the groups, provided that the value of the "stone mineral or calcium content" is correlated with the true calculated volume of the stone (resulting in the specific stone density) instead of the projection area (resulting in the area density). This is only possible in vitro. The in vivo application of these technologies in the treatment of stones of unknown composition could provide important information, but major restrictive factors pose difficulties. Further clinical studies are necessary, especially to define the role of bone densitometry.

Relationship of oxypurine release to contractile failure in dinitrophenol-treated rat skeletal muscle

The efflux of hypoxanthine and uric acid from skeletal muscle has been noted to follow exercise and metabolic stress both in vivo and in vitro. Since the action of xanthine oxidase and hypoxanthine generates free radicals with potential damaging effect on the muscle membranes, an in vitro model was used to study the relationship of metabolic stress, oxypurine release and muscle contraction. When rat epitrochlearis muscle was exposed to the mitochondrial uncoupler dinitrophenol at 37 degrees C, lactate release was pronounced and hypoxanthine and uric acid appeared in the incubating medium. The twitch tension, in response to supramaximal stimulation, was reduced to less than 5% of the initial value. When the same experiment was repeated at 27 degrees C, hypoxanthine and uric acid formation was inhibited, although lactate release indicated that metabolic stress was still present. Twitch tension was relatively preserved (57% of the initial value). The lower temperature did not alter the decrease in ATP and phosphocreatine levels in the muscle which is produced by dinitrophenol. There was an inverse relationship between oxypurine release and twitch tension in individual muscles (r = 0.80, P < 0.01 for hypoxanthine and r = 0.95, P < 0.0002 for uric acid). Xanthine dehydrogenase/xanthine oxidase was detected in muscle and between 16 and 22% of the activity was in the oxidase form.

Efficacy of in vitro stone fragmentation by extracorporeal, electrohydraulic, and pulsed-dye laser lithotripsy

Fragmentation has become the standard therapy for urinary calculi in the modern era. Stone fragility as well as position and size are important for the determination of a treatment program. To compare the efficacy of stone fragmentation, seven kinds of human urinary calculi with known composition (calcium oxalate monohydrate and dihydrate, dibasic calcium phosphate, uric acid, struvite, calcium phosphate, and cystine) were treated by three fragmentation techniques commonly used, namely extracorporeal shock wave (SWL), electrohydraulic (EHL), and pulsed-dye laser lithotripsy. Uric acid, calcium oxalate dihydrate, and calcium phosphate stones could be destroyed easily by any of these methods. Struvite was soft but sticky and not easy to break into tiny particles. Both dibasic calcium phosphate and calcium oxalate monohydrate stones were resistant to the laser and EHL; SWL is the treatment of choice. For cystine stones, none of the treatments was satisfactory; SWL was the only way to break them into large pieces.

The effect of water loss upon the urate, urea and ammonia content of the egg of the Japanese quail Coturnix coturnix japonica

1. The urate, urea and ammonia content of the whole egg of the Japanese quail was measured in late incubation in eggs subject to different rates of water loss. 2. High rates of water loss substantially increased egg urate content, but had little or no effect on urea or ammonia content. 3. Allopurinol, an inhibitor of urate synthesis, reduced egg urate content to low levels, but produced no effect on urea content, and a small reduction in ammonia content. 4. The urea concentration of the embryo was lower than in allantoic fluid. 5. It is concluded that urate production by the avian embryo is primarily concerned with the modification of allantoic fluid composition.

Influence of season, age, and sex on renal stone formation in South Australia

OBJECTIVE

To investigate trends in renal stone formation in the South Australian population, between 1977 and 1991 (3634 stones), with respect to age, sex and seasonal variation.

RESULTS

The frequency of the different stone types was: calcium oxalate (with or without phosphate), 68%; uric acid, 17%; infection stones (magnesium ammonium phosphate), 12%; and pure calcium phosphate, 3%. No significant seasonal variation was observed with calcium oxalate or calcium phosphate stones. The incidence of uric acid stones increased significantly during summer and autumn (P < 0.001 and P < 0.01 respectively), and that of infection stones decreased significantly during spring and summer (P < 0.05 and P < 0.01 respectively). Calcium oxalate, uric acid and calcium phosphate stones were more frequent in male subjects; male to female ratio 2.8:1, 3.7:1 and 1.4:1 respectively. However, there was an increased frequency of calcium oxalate stones in women 20 to 25 years of age; male to female ratio 0.7:1. Infection stones were more common in female subjects; male to female ratio 0.7:1.

CONCLUSIONS

This study demonstrates significant seasonal variation in uric acid and infection stones. Men are at a higher risk of forming stones than women, with the exception of infection stones. Additionally, with calcium oxalate stones, women may have distinct periods of higher risk. This study confirms that calcium oxalate stones are the most common stone type, which is in accordance with studies from other industrialised countries.

The structure of large lamellar urinary stones. A quantitative chemical analytic study applying a new classification scheme

To study the structural composition of 61 renal and 9 vesical large lamellated non-infection urinary tract stones, samples from successive layers were quantitatively analyzed with standard chemical techniques, but with a new classification based on percentage composition of ions rather than compounds. The commonest pattern of composition (n = 41) was that of the lamellar stones of one stone type (uric acid, oxalate, or phosphate) and group (according to % of indicating ion), followed by bilamellar stones of different stone types (17) or of one stone type but different groups (8). The other stones were trilamellar (3) or quadrilamellar (1) of different stone types. In the 29 stones with lamellae of different type and/or group, the chemical composition of successive layers seemed to confirm the correlation between uric acid and oxalate, rather than phosphate, ions and between oxalate and both uric acid and phosphate ions. An influence on these correlations either positive or negative, may be the responsible factor for specifying the type and group of a forming stone or layer of a stone. The observed ionic correlations within the stones seem to support the choice of the oxalate ion, in the uric acid or phosphate stones, and both of the uric acid and phosphate ions, in the oxalate stones, as indicating ions for grouping in our proposed classification of urinary stones.

A cationic protein from a urate-calcium oxalate stone: isolation and purification of a shared protein

A protein extracted from a urate-calcium oxalate stone by electrodialysis is also excreted in the urine which served as the source material for its purification by FPLC after separation on an ACA44 column. It has an amino acid composition appropriate for a cationic protein. One peptide obtained by cyanogen bromide cleavage has significant (approximately 60%) homology with CD59 protein (protectin). Both proteins have wide distribution, the unknown having been found in bile, cholesterol gallstones, and the wall of the aorta. However, the two proteins appear to be immunologically different.

Nasal secretion of the ozone scavenger uric acid

Uric acid, an important scavenger of ozone, has been identified as the major low molecular weight antioxidant in baseline and cholinergically induced nasal secretions. The purpose of this study was to determine the specific tissue source of uric acid in airway secretions. The secretion of uric acid is increased by cholinergic stimulation and correlates closely with the secretion of lactoferrin (a nasal glandular protein), suggesting that submucosal glands are involved. Indeed, nasal turbinate tissue was found to contain uric acid. However, careful analysis of nasal turbinate tissue failed to reveal the presence of xanthine oxidase, the enzyme responsible for uric acid synthesis. These data suggest that uric acid might be taken up secondarily by glands from plasma. This possibility was strengthened by the observation that lowering the plasma urate level with probenecid concomitantly lowered urate secretion. These findings are consistent with the hypotheses that the principal source of uric acid in nasal secretions is plasma and that uric acid is taken up, concentrated, and secreted by nasal glands.

Extensive, obstructing sodium urate deposition on wall of isolated ileum for replacement of entire ureter

We report a rare case of obstructing sodium urate stones occurring in the form of extensive deposition on the wall of isolated ileum for replacement of the entire ureter. The stones were disintegrated and removed with a rigid ureteroscope and an electrohydraulic lithotriptor. Hyperuriaciduria, excessive alkalization of urine and urinary stagnation due to reflux, mucous retention, and prostatic hyperplasia were considered as the etiologic factors in the stone formation.

[Scanning electron microscopy and microcrystals in articular diseases]

The value of scanning electron microscopy (SEM) in the study of crystals in articular diseases is underlined in several cases of examination of joint fluid, or crystal deposits in articular or periarticular tissues obtained by percutaneous or surgical treatment with chemical and crystallographic correlations. Apatite crystals. Two deposits of hydroxyapatite of the rotator cuff were studied by SEM, crystallographic techniques and chemical analysis. SEM study showed spherical aggregates of various size. Urate crystals. Three tophi were observed by SEM, with crystallographic techniques and chemical analysis. Their needle-shape and their great size (20 m) were characteristic. Calcium pyrophosphate crystals. In a case of typical clinical and radiological features, examination of joint fluid, with chemical correlation showed shorter and thicker crystals than those or urate. The precise identification of crystals is based on sophisticated crystallographic techniques such as X-ray diffraction, although SEM allows an accurate and quite simple morphologic study, most often sufficient.

Bilateral obstructing ureteral uric acid stones in an infant with hereditary renal hypouricemia

We report on a 15-month-old boy with renal hypouricemia who presented with acute renal failure, anuria and sepsis due to bilateral obstructing ureteral uric acid stones. He was treated successfully with extracorporeal shock wave lithotripsy. Metabolic survey of 10 relatives revealed a rare hereditary disorder in 4 siblings: isolated renal hypouricemia and hyperuricosuria. To our knowledge this is the youngest reported case of hereditary renal hypouricemia and 1 of the youngest patients to be treated with extracorporeal shock wave lithotripsy.

In vitro differential metabolism of merbarone by xanthine oxidase and microsomal flavoenzymes. The role of reactive oxygen species

Merbarone (MB), a nonsedating derivative of thiobarbituric acid, was recently found to induce profound hypouricemia. When incubated with xanthine oxidase (XO) and hypoxanthine in vitro, MB is both an inhibitor of XO and degraded by the XO-hypoxanthine interaction. Compared with allopurinol (Ki = 0.025 microM), MB is a very weak inhibitor of XO (Ki = 51 +/- 8 microM). MB interacts with XO in the presence of hypoxanthine to yield three chromatographically separate products. One of these products has been identified by HPLC retention time and spectral characteristics as 2-oxo-2-desthiomerbarone (2-oxo-MB). The other two products are thought to be S-oxide intermediates in the oxidative desulfuration of this drug. Formation of these products was blocked by catalase, suggesting that the conversion was dependent on reactive oxygen species (especially H2O2) generated by the hypoxanthine-XO system. This suggestion was confirmed by incubating MB with H2O2. In vitro studies with rat liver microsomes have documented the formation of 2-oxo-MB and 4'-OH-MB (4'-OH-MB), the latter being identified by the characteristic HPLC retention time of its acetylated derivative. The formation of 4'-OH-MB has many characteristics of a cytochrome P-450-dependent monooxygenase reaction (NADPH requirement and SKF 525-A inhibition); formation of 2-oxo-MB occurs by a different mechanism that is, as yet, uncharacterized. Incubation of kidney microsomes with MB generated 2-oxo-desthiomerbarone but no detectable 4'-OH-MB.(ABSTRACT TRUNCATED AT 250 WORDS)

Rapid development of a tophus following ipsilateral hemiparesis

An 85 year old man with a longstanding history of non-tophaceous gout developed a single large tophus, unassociated with inflammation, on his paretic leg over a six week period following an acute hemiplegia. The rapidity of tophus formation, its localisation to the paretic limb, and the apparent blunting of the acute inflammatory response represent a previously unreported interaction between gout and neurological deficit.

Inflammatory fluids regulate TNF-alpha, but not IL-1 beta, production by human peritoneal macrophages. A study of patients on continuous ambulatory peritoneal dialysis with peritonitis

To gain insight into the factors regulating an inflammatory response in vivo, the activities of peritoneal macrophages and the influence of the inflammatory fluids from which they were harvested were studied in continuous ambulatory peritoneal dialysis (CAPD) patients with peritonitis. Specifically, the production of tumor necrosis factor alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), and prostaglandin E2 (PGE2) by lipopolysaccharide-stimulated human peritoneal macrophages from CAPD patients with peritonitis was examined in the presence of the inflammatory dialysates from which they were isolated. When tested at a dilution of 20%, the dialysates inhibited production of TNF-alpha, a key monokine in the orchestration of the inflammatory response. In contrast to the effect on TNF-alpha, the dialysates did not affect IL-1 beta production by stimulated macrophages. The activity inhibitory for TNF-alpha synthesis was not fully characterized, but a number of known inhibitors were shown not to be responsible for the suppressive activity. The inhibitory activity was detected in cases of noninfective peritonitis and excluded the possibility that a bacterial product was responsible. Hyperosmolality, pH, protein levels, glucose, uremic molecules, cortisol, heparin, and antibiotics were not responsible for the inhibitory activity. The activity had some similarity to the reported actions of alpha-globulins (which are acute phase proteins), PGE2, TNF-alpha soluble receptors, and IL-6, but there was no evidence for their involvement. Whether the selective suppression of TNF-alpha production is a general finding in inflammatory responses will require additional studies. This study nevertheless illustrates the potential for the host to regulate tightly the development of an excessive inflammatory response and thus to limit tissue pathology. However, it is unknown whether an appropriate host defense is compromised.

Antioxidant defenses and its modulation by iron in carrageenan-induced inflammation in rats

The concentration of endogenous antioxidants has been studied in rats with a carrageenan-induced granuloma. This animal model of inflammation allowed us to study the antioxidant defenses and the oxidative stress in plasma and in the site of inflammation (exudate) and their modulation by the levels of iron in the organism after iron-dextran or desferrioxamine administration. In inflamed rats without supplementary treatment, an interrelation between urate, ascorbate and vitamin E levels has been observed and it appears to be an important mechanism to prevent the depletion of the antioxidants. Further, the sulphydryl groups, caeruloplasmin and retinol also contribute to the defense in this experimental model. Iron overload increases the production of malondialdehyde and decreases some antioxidants such as ascorbic acid and SH groups but, on the other hand, it raises the levels of urate and caeruloplasmin. However, the protective effect of desferrioxamine has not been observed, and in our conditions this may be due to the induced mobilization of iron. Our results show that antioxidants have an important role in the prevention of lipid peroxidation by free radicals produced during inflammatory processes. This protective effect depends on the stage of inflammation.