[Review of respiratory mechanics in animals. 3. Methodical and physiologic aspects of the use of the impulse oscilloresistometry system (OIS)]

The impulse oscillometry system (IOS) which was originally developed for human medicine was found to be suitable for analysing respiratory mechanics in spontaneously breathing animals. This technique is non-invasive.

METHODOLOGICAL ASPECTS

In order to use the IOS-technique in animals, a tightly fitting face mask is necessary. Furthermore, a flexible tube needs to be inserted into the measuring system. While the tube does not influence the measured results significantly, the face mask may affect the measurements. Therefore, its influence on the measured respiratory impedance must be taken into account. To prevent methodological errors, the head and body position of the animal should be standardised during the IOS-measurement. Since the methodological variability of the system is very small, the measuring results are highly reproducible. PHYSIOLOGICAL ASPECTS: In growing subjects, all parameters of respiratory mechanics depend on body weight. Since respiratory physiology is influenced by circadian rhythms, measurements of different days are only comparable when they have been done each day at the same hour. Comparing the respiratory impedance of different animals of similar age and body weight, a considerable inter-individual variability was observed. Due to the low level of physiological intra-individual variability, the method seems to be especially useful for studying influences on the respiratory system (i.e. pharmaceutics, therapeutics) in long-term studies using the same group of subjects.

Ibuprofen does not impair renal function in patients undergoing infrarenal aortic surgery with epidural anaesthesia

OBJECTIVE

To investigate the effect of preoperative ibuprofen administration on renal function during and after infrarenal aortic surgery under thoracolumbar epidural anaesthesia (EPA).

DESIGN

A prospective randomised, double-blinded clinical study.

SETTING

Operation room and intensive care unit in a university hospital.

PATIENTS

Twenty-six consecutive patients scheduled for elective infrarenal aortic surgery.

INTERVENTIONS

The patients were prospectively randomised to receive 400 mg ibuprofen intravenously (i.v.) or a placebo aliquot before surgery.

MEASUREMENTS AND RESULTS

We assessed renal function by calculating creatinine clearance, and fractional sodium excretion before surgery (baseline), 1 h after cross-clamping (intraoperative), 6 h after cross-clamping (postoperative) and 24 h after cross-clamping (on the 1 st postoperative day). At each point in time, we additionally registered haemodynamics and determined the plasma concentration of 6-keto-PGF1alpha (stable metabolite of prostacyclin, PGI2), bicyclic PGE2 (stable metabolite of PGE1 E2), active renin, aldosterone and vasopressin by radioimmunoassays. Throughout the observation period the renal function parameters mostly remained within the normal range without a significant difference between ibuprofen- and placebo-treated patients (creatinine clearance: baseline 41 +/- 3 vs 38 +/- 6, intraoperative 57 +/- 8 vs 64 +/- 11, postoperative 64 +/- 9 vs 56 +/- 9, first postoperative day 43 +/- 5 vs 47 +/- 6 ml x min x m(-2), means +/- SEM). The plasma levels of 6-keto-PGF1alpha (68 +/- 8 vs 380 +/- 71* ng x l(-1)), bicyclic PGE2 (57 +/- 5 vs 88 +/- 9* ng x l(-1)) and vasopressin (14 +/- 7 vs 45 +/- 10* ng x l(-1), p < 0.0125), however, were significantly higher during the intraoperative period in the placebo-treated patients.

CONCLUSION

The inhibition of endogenous prostaglandin release by ibuprofen does not substantially impair renal function during infrarenal aortic surgery under EPA.

Specificity of cardiac troponins I and T in renal disease

We investigated and compared serum levels of cardiac troponins I(cTnl) and cardiac troponin T (cTnT) in 85 renal patients (chronic renal impairment n = 23, continuous ambulatory peritoneal dialysis n = 20, hemodialysis n = 42). Patients with the following conditions were excluded: myocardial infarction, angina pectoris, liver disease, malignant neoplasms, enforced physical activity, skeletal muscle trauma, myositis, rhabdomyolysis and seizures. Troponin T was measured by the second generation cTnT-ELISA with a cut-off value = 0.1 microgram/l. Troponin I was measured by a cTnI immunoassay analyser with a cut-off value = 2.0 micrograms/l. Additionally, creatine kinase (CK), CK-MB activity, CK-MB mass concentration and myoglobin levels were measured. Specificity was determined as the fraction of true-negative cases compared to the total number of false-positive and true-negative cases. Specificity for cTnT was 96% [78-100] in patients with renal impairment (creatinine > 150 mumol/l), 95% [75-100] in continuous ambulatory peritoneal dialysis patients, but in hemodialysis patients it was 75% [53-92] for short-term hemodialysis (< 1 year) and 46% [24-68] for long-term hemodialysis (> 1 year). There was a weak correlation between cTnT levels and duration of hemodialysis therapy (r = 0.35, n = 34, p < 0.04). Specificity for cTnI in renal impairment patients was 96% [78-100] and 100% [84-100] in continuous ambulatory peritoneal dialysis and all hemodialysis patients. None of the studied markers showed higher specificity than cTnI. Only myoglobin was less specific than cTnT in hemodialysis patients. Different clearances of the troponins during dialysis (investigated by pre-hemodialysis and post-hemodialysis levels) cannot explain the discordant results of cTnT and cTnI.

CONCLUSION

Cardiac troponin I exhibits higher specificity than cardiac troponin T in hemodialysis patients. Uremic myopathy could explain falsely elevated troponin T levels in hemodialysis patients.

The potential role of procalcitonin and interleukin 8 in the prediction of infected necrosis in acute pancreatitis

BACKGROUND

Infection of pancreatic necrosis has a major impact on clinical course, management, and outcome in acute pancreatitis. Currently, guided fine needle aspiration is the only means for an early and accurate diagnosis of infected necrosis. Procalcitonin (PCT), a 116 amino acid propeptide of calcitonin, and interleukin 8 (IL-8), a strong neutrophil activating cytokine, are markers of severe inflammation and sepsis.

AIMS

To analyse the clinical value of PCT and IL-8 as biochemical parameters for predicting infected necrosis in acute pancreatitis.

PATIENTS AND METHODS

Fifty patients with acute pancreatitis entered this prospective study and were stratified into three groups according to morphological and bacteriological findings: 18 patients with oedematous pancreatitis (group I), 14 patients with sterile necrosis (group II), and 18 patients who developed infected necrosis a median of 13.5 days after the onset of symptoms (group III). After admission serum samples were drawn daily for two weeks. Concentrations of PCT and IL-8 were measured by chemoluminescent immunoassays (upper reference range 0.5 ng/ml for PCT and 70 pg/ml for IL-8). The routine parameter C-reactive protein was determined by laser nephelometry (upper reference range 10 mg/l).

RESULTS

Median concentrations of PCT and IL-8 were significantly higher in patients with infected necrosis than in those with sterile necrosis during the observation period, whereas there was no difference in C-reactive protein. In oedematous pancreatitis overall median concentrations of all three parameters were low. By receiver operating characteristics best cut off levels for predicting infected necrosis or persisting pancreatic sepsis were 1.8 ng/ml for PCT and 112 pg/ml for IL-8. If these cut off levels were reached on at least two days, sensitivity, specificity, and accuracy for the prediction of infected necrosis were 94%, 91%, and 92% for PCT and 72%, 75%, and 74% for IL-8, respectively. After surgical treatment of infected necrosis median PCT and IL-8 values continued to be significantly higher in patients with persisting pancreatic sepsis (n = 11) compared with those having an uneventful postoperative course (n = 7). For the preoperative differentiation between infected necrosis and sterile necrosis guided fine needle aspiration was performed in 24 patients with necrotising pancreatitis and reached a diagnostic accuracy of 84% compared with 87% for PCT, and 68% for IL-8. There was no correlation between the aetiology of acute pancreatitis or the extent of necrosis and PCT or IL-8.

CONCLUSION

PCT and IL-8 are found in high concentrations in infected necrosis and associated systemic complications in patients with acute pancreatitis. The course of PCT shows the closest correlation with the presence of infected necrosis. Monitoring of serum PCT is a potential new marker for the non-invasive and accurate prediction of infected necrosis as well as for the selection of patients with persisting septic complications after surgical debridement.

Importance of the serovar-specific plasmid for virulence of salmonella strains in calves

To evaluate the influence of serovar-specific plasmids on salmonella virulence in calves, experiments were performed involving infection, by the oral route, with mixtures of strains containing equal counts of a plasmid-carrying and a plasmid-free strain of the same serovar. The concentration ratio between the plasmid-carrying and the plasmid-free strain which had developed in the organs of the infected animals was used for a comparative evaluation of virulence and pathogenetic behaviour of the strains. While in the S. typhimurium strains studied, the presence of the plasmid was accompanied by a significantly increased colonization and multiplication of the agent in the host's body, examination of S. enteritidis and S. dublin revealed that the plasmid-free strains exhibited identical or even significantly higher bacterial counts than the plasmid-carrying strains in organs. The fact that plasmid-free salmonella strains with a high virulence for calves have been found demonstrates that the presence of a serovar-specific plasmid is not an indispensable requirement for the development of salmonellosis in calves.

[Long-chain fatty acids of Pasteurella multocida nad Pasteurella haemolytica]

The relative contents of long-chain fatty acids in P. multocida and P. haemolytica were investigated. A dependence on the composition of the broth was established. Accordingly, comparative quantitative studies on fatty acid contents have to be conducted using bacteria grown with the same lot of broth medium. As for P. multocida, there were significant differences between the serovars (C14 in TDHM and C16, delta 2C18 in BPL). These differences are, however, not significant to replace serotyping. Highly significant differences were also detected between P. multocida isolates from nasal swabs and pneumonic lungs (interims of C14, delta C16 on BPL and BRU). The largest differences were measured for strains grown on BRU, which is interpreted as an expression of virulence. Significant differences were found between biotypes A and T of P. haemolytica, namely for C14, C16 in TDHM, and C14, delta C16, C16, C18 in BPL medium.

[Efficacy of maternal Salmonella antibodies and experimental oral infection of chicks with Salmonella enteritidis]

Distribution of maternally transmitted Salmonella antibodies and their protective effects were studied in the progeny of broiler breeder birds which had been vaccinated with live S. Typhimurium and inactivated S. Enteritidis vaccines. Vaccination resulted in a significant increase of the antibody concentration in yolk of hatching eggs and in serum and jejunum of the progeny of immunized breeder birds. Higher antibody titres for isotypes IgG and IgA were still seen on day 21 of age. Antibody production of isotypes IgA and IgM by the chickens themselves was found between 14 and 21 days of age. Two challenge models (10(2) cfu/bird on day 1 of age and a seeder bird model, respectively) were used to evaluate the efficacy of maternal antibodies against challenge with S. Enteritidis. Using both models numbers of challenge organisms were lower in the caeca of the progeny of immunized parent birds between day 7 and day 21 of age (maximum about 1.5 log10 units) compared with control chicks. The results indicate the efficacy of maternally transferred antibodies but it remains the question of their practical relevance. The effects of acquired maternal antibodies on an active immunization of the progeny of immunized breeder birds with live Salmonella vaccines are discussed.

S phase determination in intact colonic crypts by histone H3 messenger RNA in situ hybridization and confocal microscopy

Proliferating cells have a restricted three-dimensional spatial distribution within the crypt, which is the proliferative unit of the colon. Accurate quantitative and spatial analyses of S phase cells in the colon have therefore been limited by histological techniques. To overcome these limitations, S phase cells in microdissected intact colonic crypts of control, modified-starved, and refed rats were labeled by histone H3 in situ hybridization and analyzed by confocal microscopy. High-resolution digital images of the crypt cell nuclei stained with cyanine nucleic acid and of the labeled S phase cells were produced from confocal microscopic optical crypt sections. The S phase labeling index (LI) per whole crypt significantly (P < 0.001) discriminated the proliferative differences between control, modified-starved, and refed rats and correlated (r = 0.92) with the LI determined from histological crypt sections of the same rats. The variance component of the LI attributable to differences between whole crypts, 0.44 (95% confidence interval, 0.38-0.51), was considerably smaller than that attributable to differences between histological crypt sections, 6.07 (95% confidence interval, 5.18-6.96). Confocal microscopy and histone H3 in situ hybridization of intact three-dimensional crypts enables precise in vitro quantitation and spatial analysis of the total and S phase crypt cells.

[Concept of freedom of infection of animal flocks]

Totally negative results of epidemiological investigation of random samples do not prove the absence of the infection as the pathogen may be restricted to only a few animals in the herd for a long time. The statement "absence of infection" is critical for such situations. The question is raised, whether the statement "absence of infection" should be generally avoided. Classification of herds and flocks according to the prevalence of the pathogen would be more valid for the implementation of control measures.

Signal-averaged electrocardiogram in patients with insulin-dependent (type 1) diabetes mellitus with and without diabetic neuropathy

The purpose of this study was to investigate the presence of ventricular late potentials derived from signal-averaged ECG in patients with IDDM with and without diabetic neuropathy. Eighty patients with IDDM but without evidence of cardiac disease and 80 age-matched healthy control subjects were investigated. The corrected QT interval was measured from the standard surface electrocardiogram. Ventricular late potentials were derived from signal-averaged electrocardiogram. Out of the 80 diabetic patients, 20 had an autonomic neuropathy, 20 had an isolated peripheral neuropathy, and 40 had no symptoms of neuropathy. The corrected QT interval was significantly prolonged in patients with an autonomic neuropathy as compared with the control group (436 +/- 23 ms(x 5) vs 384 +/- 23 ms(x 5), p < 0.001). In the other patient groups there was no significant prolongation of the corrected QT interval. Ventricular late potentials were present in 3 diabetic patients with an isolated peripheral neuropathy and in 1 control subject (NS). No diabetic patient with an autonomic neuropathy had ventricular late potentials. Our data did not indicate an increased incidence of ventricular late potentials derived from signal-averaged electrocardiogram in diabetic patients independent of a coexisting diabetic neuropathy or a prolonged corrected QT interval.

Participants' perceptions of a phase I colon cancer chemoprevention trial

To assess participants' perceptions of a phase I colon cancer chemoprevention trial using a calcium intervention, questionnaires were mailed to trial participants at the conclusion of the study. Responses to questionnaire items reported here include (1) perceived benefits and barriers of participation, (2) interest in participating in future trials, (3) willingness to pay trial expenses out of pocket, and (4) posttrial continuation of the calcium regimen. The study found that the most highly rated trial benefit was the perception of potential colon cancer prevention; the trial barrier reported to be the most troublesome was inappropriate or mistaken billing for study visits. Three fourths of the subjects expressed an interest in future trials of the same duration. For trials of longer duration, this percentage decreased to 66%. Approximately half did not object to participation in future trials involving placebos, and just over one third indicated that they would either definitely (8%) or probably (27%) have joined the calcium trial even if they had to pay some study expenses out of pocket. Over 90% indicated they would continue taking the calcium pills if calcium is shown to be effective. The level of perceived benefits was positively associated with reported interest in participating in future trials of the same and longer durations, and the level of reported difficulty with trial pills and procedures was inversely related to interest in future placebo-controlled trials. The results of this study, in conjunction with results of prospective studies of trial participation, may be applied in future chemoprevention trials to facilitate recruitment, reduce attrition, and promote positive trial experiences for participants by emphasizing frequently reported benefits and minimizing frequently reported barriers.

Cell kinetic analysis of intact rat colonic crypts by confocal microscopy and immunofluorescence

BACKGROUND & AIMS

Precise quantitative and spatial analysis of cell cycle-related biomarkers in colonic crypts is often vital for studies of colon carcinogenesis and cancer prevention. To overcome the limitations of histology, confocal laser microscopy of microdissected whole crypts was used to quantitate S phase and mitotic cells.

METHODS

Microdissected distal colonic crypts were studied in a modified rat starvation refeeding model. S phase cells were labeled in vivo with 5-bromodeoxyuridine. Mitotic cells were labeled with MPM2 (antibody to mitosis-specific epitope) and also assessed for chromatin morphology with propidium iodide. Sequential optical crypt sections, produced by confocal microscopy, were digitally imaged. S phase labeling indices per whole crypt were also compared with those derived by conventional immunohistochemistry.

RESULTS

S phase and mitotic cells were clearly discriminated without background staining. The labeled S phase cell number and fraction per whole crypt were significantly decreased with starvation and increased with refeeding. Variability in the labeling index between whole crypts analyzed by confocal microscopy was significantly smaller than between histological crypt sections. Consequently, the intervention contributed to 92.2% of the total variability of the labeling index in whole crypts but only to 59% of the variability in histological sections.

CONCLUSIONS

Major limitations of histology are overcome by crypt microdissection and confocal microscopic analysis. The total crypt cell population as well as labeled M phase and S phase cells can be imaged, localized, and quantitated with improved precision.

[Immunization with potential Salmonella enteritidis mutants-- 2. Investigations on the attenuation and immunogenicity for mice and young hens]

Adenine-amino acid auxotrophic Salmonella Enteritidis double mutants were investigated for their in vivo stability, attenuation und immunogenicity using NMRI-mice and SPF-chicks. All mutants used were stable in vivo and attenuated. Two mutants were selected for immunization experiments in chickens according to their protective ability after a single intraperitoneal immunization in NMRI-mice using a homologous and heterologous challenge. After two oral immunizations and homologous oral challenge with the S. Enteritidis wild type strain 6403Nalr, a significant difference (p < 0.01) was demonstrated between the mean caecal bacterial counts of immunized and control chicks. Examination of liver samples revealed a significantly lower degree of colonization of internal organs (p < 0.01) in immunized birds. There was no evidence of cross protection against S. Typhimurium using S. Enteritidis mutants.

World Health Organisation--supervised interlaboratory comparison of ELISAs for the serological detection of Salmonella enterica serotype Enteritidis in chickens

A collaborative exercise, supervised by the World Health Organisation, was set up to compare ELISAs used for the serological detection of Salmonella enteritica serotype Enteritidis in chickens. The aim was to ascertain how far agreement could be reached on the interpretation of optical density readings for high titre, intermediate titre and low titre sera. Two sets of sera were sent to 14 participants. The first set compared high, medium and low titre sera raised in specified-pathogen-free and commercial broiler breeder chickens. The second set comprised 20 sera of different antibody titres raised in commercial birds reared under laboratory conditions and sent blind. Both indirect and double-antibody sandwich blocking ELISAs were used with a number of different detecting antigens. With a few exceptions good agreement was reached on the interpretation of results obtained from high and low titre sera from the optical density obtained with a single serum dilution. Differences were observed in the interpretation of medium titre sera. The results suggested that most ELISAs produce reasonably comparable results and that practical problems may arise from interpretation of the results mainly as a result of the choice of the criteria used for differentiating sera obtained from infected and uninfected chickens. These problems are discussed.

Calcium carbonate treatment of diarrhoea in intestinal bypass patients

OBJECTIVE

To study the effect of supplemental calcium carbonate on faecal water, calcium, bile acid and lipid concentration and output in intestinal bypass subjects with diarrhoea.

DESIGN

Prospective, single-arm treatment trial of oral calcium carbonate, 2400 or 3600 mg Ca2+ per day, given for 12 weeks.

METHODS

Faecal constituents were determined in wet or lyophilized stool of 24-h collections at baseline and at 12 weeks of study. Calcium was measured by absorption spectrophotometry. Bile acids, long-chain fatty acids and short-chain fatty acids were analysed by gas chromatography.

RESULTS

In 15 subjects, calcium supplementation reduced bowel frequency by a mean of 49%, faecal wet weight by a mean of 50% (1292 to 646 g per day), and dry weight by a mean of 36%, P < 0.001. Faecal water concentration was reduced from 76.4 +/- 1% to 70.2 +/- 2%, P < 0.01. Faecal water concentration was inversely correlated with dry faecal calcium concentration (r = -0.75 P = 0.00001).

CONCLUSION

Calcium reduces the diarrhoea of intestinal bypass patients. It is suggested that the constipating effect of calcium may be related to reduction in faecal water.

Calcium supplementation modifies the relative amounts of bile acids in bile and affects key aspects of human colon physiology

Use of calcium supplements has increased dramatically in recent years yet little is known about the effect of calcium supplementation on colon physiology. We supplemented 22 individuals with a history of resected adenocarcinoma of the colon, but currently free of cancer, with 2000 or 3000 mg calcium for 16 wk. The effects of supplementation on duodenal bile acids and important fecal characteristics including total fecal output, wet and dry weight, pH, bile acids (in solids and in fecal water), and concentrations and total excretion of calcium, magnesium, phosphates (organic and inorganic), unesterified fatty acids and total fat were determined. Calcium supplementation significantly decreased the proportion of water in the stool (P = 0.03), doubled fecal excretion of calcium (P = 0.006), and increased excretion of organic phosphate (P = 0.035) but not magnesium. Calcium supplementation significantly decreased the proportion of chenodeoxycholic acid in bile (P = 0.007) and decreased the ratio of lithocholate to deoxycholate in feces (P = 0.06). The concentration of primary bile acids in fecal water decreased after 16 wk Ca supplementation. Together with other reports of a "healthier" bile acid profile with respect to colon cancer when changes such as those observed in this study were achieved, these results suggest a protective effect of calcium supplementation against this disease.

Influence of prior infection on the dynamics of bacterial counts in calves experimentally infected with Salmonella dublin

The aim of this investigation was to obtain information on the influence of immunity gained from a previous infection in calves on the dynamics of a subsequent salmonella infection. Immune and non-immune animals were orally infected with virulent S. dublin. After infection clinical symptoms and the development of bacterial counts in intestinal contents and intestinal mucosa, as well as in intestinal lymph nodes, spleen and liver were compared. The protection of the immune animals became evident as milder courses of infection and in lower bacterial counts in all examined organs. The greatest absolute and relative difference between the counts of immune animals and controls was in the intestinal mucosa. While absolute counts were lower, the proportion of bacteria was higher in the lymph nodes of immune animals. This apparently more intensive penetration in immune animals was feigned by a general and immunity independent negative correlation between concentration of salmonella in the mucosa and of salmonella found in the intestinal lymph nodes. This time course of counts provided evidence that enhanced defence of immune calves was particularly pronounced 3 and 4 days after the onset of infection.

Histone H3 messenger RNA in situ hybridization correlates with in vivo bromodeoxyuridine labeling of S-phase cells in rat colonic epithelium

Measurements of cell cycle phase fractions, particularly S-phase, are useful for studies of cell biology and carcinogenesis. Up-regulation of histone gene expression is tightly coupled to the G1-S-phase transition of the cell cycle, and mRNA levels rise 30-100-fold during S-phase. Labeling of histone H3 mRNA using in situ hybridization (ISH) was assessed as a measure of S-phase cells and compared with that found using in vivo 5-bromodeoxyuridine (BrdUrd) labeling in formalin-fixed rat colonic crypts under baseline, modified 72-h starvation, and 24-h refeeding conditions. The labeling index scored in single-labeled sections by histone H3 ISH tightly correlated with that found by in vivo BrdUrd labeling (r = 0.99, p < 0.0001) and clearly discriminated between the control, starved, and refed states (P < 0.001). In 180 crypt sections double labeled using histone H3 ISH and BrdUrd, 92% of 1572 labeled cells exhibited both nuclear BrdUrd and cytoplasmic histone H3 label. It is concluded that histone H3 ISH is an accurate measure of the S-phase fraction and provides an alternative to in vivo BrdUrd labeling in rat colon. This finding warrants validation in human studies.

Na-K/2Cl transporter inhibition for reduction of postischemic kidney failure tested in autologous reperfusion

Postischemic kidney function may be influenced by donor conditioning. The sulfamoyl-benzoate "piretanide" (P) is a diuretic agent with an inhibitory effect on the luminal Na-K-2CL-transporter system in the ascending part of the loop of Henle. A clinical pilot study demonstrated a lower rate of organ dysfunction following transplantation in humans when the donor organs were pretreated with piretanide. In an experimental ex vivo model the effect of piretanide on immediate organ function following long or short cold ischemia was studied. Porcine kidneys (n = 36) were removed after in situ transaortal hypothermic flushing with 21 Eurocollins solution. Following short storage (1 h, n = 18) or long storage (24 h, n = 18) the kidneys were reperfused with intraoperatively drawn heparinized autologous blood diluted with Ringer's lactate to a hematocrit of 25%. Urine flow was higher in the piretanide-pretreated group (p), especially after long storage. The electrolyte loss was comparable in both groups. Postischemic endogenous creatinine clearance was significantly elevated in the treatment group (4.45 +/- 0.6 ml/min per 100 mg in P vs 1.91 +/- 0.4 ml/min per 100 mg, in control, P < 0.05 Mann-Whitney test). Renal hemodynamics were improved by piretanide, resulting in significantly lower resistance and allowing higher flow during pressure-controlled perfusion. O2 consumption, representing general metabolic activity, was higher after long storage, indicating an earlier recovery from cold ischemia. In this ex vivo model, autologous reperfusion of porcine kidneys could be improved by piretanide pretreatment. Autoregulation of kidney vasculature was maintained as well as functional parameters such as creatinine clearance or gluconeogenesis. Therefore, piretanide may be used in larger clinical trials to further improve organ quality in times of donor shortage.

[Is radical prostatectomy a suitable model for determination of PSA half-life?]

A review of the literature relating to PSA half-life reveals great variability in absolute values and pharmacokinetic models. A critical view is needed, however, since some authors suggest that the PSA half-life has implications for diagnosis and prognosis after radical prostatectomy. The aim of our study, therefore, was to characterize the value of PSA half-life determination after radical prostatectomy. Serial serum PSA detections were performed in 16 patients with localized prostatic cancer who had undergone radical prostatectomy. Serum PSA was detected on days 0, 1, 2, 3, 6, 9, 12, 15, 18, after radical prostatectomy. In all patients elimination of PSA from serum followed a biphasic logarithmic decay pattern indicating a two-compartment model of first order elimination kinetics (t1 = 1.01 +/- 0.06 days, t2 = 3.42 +/- 0.23 days; P < 0.00001). In this two-compartment model 56.3 +/- 4.8% of the preoperative PSA serum concentration was cleared by the first compartment. To find a biological correlative for the first compartment a mathematical model was developed to approximate the effect of operative blood and plasma loss on PSA serum concentration. In this model changes of hematocrit were used to estimate blood and plasma loss. These calculations showed that 50.12 +/- 3.04% of the preoperative PSA serum concentration was excreted by operative blood loss. This value was not significantly different from the clearance rate calculated for the first compartment. It is, therefore, concluded that the determination of PSA half-life after radical prostatectomy without correction of the operation-related PSA loss is only of limited value.