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Comparative Studies of Nicotinohydroxamic Acid and Neomycin on Ammonia and Urea Metabolism in Rats
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY uu,;c;ci,vu of psychological response to treatment and return to a pre-treatment level of consciousness by the time the patient is discharged from the hospital. In this study the combined committees on drugs and anesthesia have given excellent general guidelines that are of great value to anyone involved in pediatric surgery. I strongly recommend that a copy of this article be provided to the anesthesia staff in every hospital to serve as a vehicle for standardizing the anesthetic management of children. W. J. C.
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY Comparative Studie§ of Nicotinohydroxamic Acid and Neomycin on Ammonia and Urea Metabolism in Rats K. HARADA, Y. MURAWAKI AND C. HIRAYAMA, Second Department of Internal Medicine, Tottori University School of' Medicine, Yonago, Japan Res. Comm. Chem. Path. Pharm., 49: 309-312 (Aug.) 1985 The effect of oral administrations of nicotinohydroxamic acid and neomycin on ammonia and urea metabolism was investigated in the rat. Nicotinohydroxamic acid and neomycin lowered the blood ammonia level, nicotinohydroxamic acid increased urinary excretion of urea and depressed urease activity in the stomach and colon, and neomycin had a smaller effect on urinary excretion of urea but depressed urease activity in the colon. W. W. K. 3 figures, 15 references
Monthly Changes in the Effect of BCG on the Migration of Polymorphonuclear Leucocytes
J.-P. BUREAU, G. LABRECQUE, L. GARRELLY AND M. COUPE, Laboratoire de cytogie clinique, Faculte de medecine, Uniuersite de Montpellier-Nimes, Unite INSERM U-236, Montpellier, France, and Ecole de pharmacie, Universite Laval, Quebec, Canada Res. Comm. Chem. Path. Pharm., 49: 317-320 (Aug.) 1985 Monthly changes in the migration of polymorphonuclear leukocytes produced by subcutaneous implantation of bacillus Calmette-Guerin-impregnated rayonemade disks were examined during 15 months. In experiments performed at 09h00 the higher polymorphonuclear leukocytes count of 40.2 ± 8.4 polymorphonudear leukocytes per 10,000 µm. 2 was found in December whereas the lowest count of 14.0 ± 4.6 polymorphonuclear leukocytes per 10,000 µm. 2 was obtained in April. Mechanisms that could explain the circannual variation are suggested. W. W. K. 1 figure, 11 references
447
Clinical Significance of the Elevated Anion
B. E.
BRENNER, Division of Emergency Medicine, Department of Medicine, UCLA School of Medicine, UCLA Medical Center, Los Angeles, California
Amer. J. Med., 79: 289-296 (Sept.) 1985 The anion gap is the difference between measured and unmeasured cations and anions. An elevation of the anion gap commonly reflects organic acidosis and serious disease. Commonly diagnosed causes of an elevated anion gap may be uremia, metabolic poisons, ketoacidosis or lactic acidosis. All consecutive patients with electrolyte measurements obtained on an outpatient basis during 71 days were evaluated to compare various baseline characteristics to general admission rate, admission rate to the intensive care unit, length of stay and mortality rates. Patients with a normal (571) anion gap (8 to 16 mEq./1.) were contrasted with those (100) with a high anion gap (more than 16 mEq./1.). No differences were noted between the groups with regard to age or length of stay in the hospital but in those with a high anion gap there were an increased severity and frequency of multiple electrolyte disorders, and higher general admission rates (66 versus 51 per cent), rates of admission to an intensive care unit (25 versus 14 per cent) and mortality within 1 week of hospitalization (12 versus 0.5 per cent). Patients without severe electrolyte abnormalities and a high anion gap had higher admission rates and a 50-fold increased mortality rate compared to those with a normal anion gap without severe electrolyte disturbances. There was no difference between patients with a high anion gap and no severe electrolyte disturbances, and those with a normal anion gap and severe electrolyte disturbances regarding general admission rate, admission to the intensive care unit and mortality rate. The combination of a high anion gap and severely abnormal electrolyte disorder increased the general admission rate and admission to the intensive care unit but not the mortality rate in the first week. A high anion gap may be most important in regard to mortality during week 1 of hospitalization but the mortality rate was unaffected by the magnitude of the anion gap. An elevated anion gap is associated with severe, acute disease and in the absence of an elevated anion gap death rarely occurs during week 1 after hospitalization from an emergency outpatient facility. The biochemical pathogenesis of the association between mortality and a high anion gap remains unclear in the majority of the patients. Patients with an elevated anion gap or severe electrolyte abnormalities should be given careful consideration for admission to the hospital or intensive care unit in view of the increased risk for mortality even in the absence of identifiable organic acidosis. However, hospitalization of a patient should not be determined on the basis of an abnormal anion gap alone, which seems reassuring regarding the prognosis during week 1 after hospitalization, since this may be partly owing to the support of the resources of the intensive care unit or hospital. M. G. F. 1 figure, 4 tables, 21 references
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY Comparative Studie§ of Nicotinohydroxamic Acid and Neomycin on Ammonia and Urea Metabolism in Rats K. HARADA, Y. MURAWAKI AND C. HIRAYAMA, Second Department of Internal Medicine, Tottori University School of' Medicine, Yonago, Japan Res. Comm. Chem. Path. Pharm., 49: 309-312 (Aug.) 1985 The effect of oral administrations of nicotinohydroxamic acid and neomycin on ammonia and urea metabolism was investigated in the rat. Nicotinohydroxamic acid and neomycin lowered the blood ammonia level, nicotinohydroxamic acid increased urinary excretion of urea and depressed urease activity in the stomach and colon, and neomycin had a smaller effect on urinary excretion of urea but depressed urease activity in the colon. W. W. K. 3 figures, 15 references
Monthly Changes in the Effect of BCG on the Migration of Polymorphonuclear Leucocytes
J.-P. BUREAU, G. LABRECQUE, L. GARRELLY AND M. COUPE, Laboratoire de cytogie clinique, Faculte de medecine, Uniuersite de Montpellier-Nimes, Unite INSERM U-236, Montpellier, France, and Ecole de pharmacie, Universite Laval, Quebec, Canada Res. Comm. Chem. Path. Pharm., 49: 317-320 (Aug.) 1985 Monthly changes in the migration of polymorphonuclear leukocytes produced by subcutaneous implantation of bacillus Calmette-Guerin-impregnated rayonemade disks were examined during 15 months. In experiments performed at 09h00 the higher polymorphonuclear leukocytes count of 40.2 ± 8.4 polymorphonudear leukocytes per 10,000 µm. 2 was found in December whereas the lowest count of 14.0 ± 4.6 polymorphonuclear leukocytes per 10,000 µm. 2 was obtained in April. Mechanisms that could explain the circannual variation are suggested. W. W. K. 1 figure, 11 references
447
Clinical Significance of the Elevated Anion
B. E.
BRENNER, Division of Emergency Medicine, Department of Medicine, UCLA School of Medicine, UCLA Medical Center, Los Angeles, California
Amer. J. Med., 79: 289-296 (Sept.) 1985 The anion gap is the difference between measured and unmeasured cations and anions. An elevation of the anion gap commonly reflects organic acidosis and serious disease. Commonly diagnosed causes of an elevated anion gap may be uremia, metabolic poisons, ketoacidosis or lactic acidosis. All consecutive patients with electrolyte measurements obtained on an outpatient basis during 71 days were evaluated to compare various baseline characteristics to general admission rate, admission rate to the intensive care unit, length of stay and mortality rates. Patients with a normal (571) anion gap (8 to 16 mEq./1.) were contrasted with those (100) with a high anion gap (more than 16 mEq./1.). No differences were noted between the groups with regard to age or length of stay in the hospital but in those with a high anion gap there were an increased severity and frequency of multiple electrolyte disorders, and higher general admission rates (66 versus 51 per cent), rates of admission to an intensive care unit (25 versus 14 per cent) and mortality within 1 week of hospitalization (12 versus 0.5 per cent). Patients without severe electrolyte abnormalities and a high anion gap had higher admission rates and a 50-fold increased mortality rate compared to those with a normal anion gap without severe electrolyte disturbances. There was no difference between patients with a high anion gap and no severe electrolyte disturbances, and those with a normal anion gap and severe electrolyte disturbances regarding general admission rate, admission to the intensive care unit and mortality rate. The combination of a high anion gap and severely abnormal electrolyte disorder increased the general admission rate and admission to the intensive care unit but not the mortality rate in the first week. A high anion gap may be most important in regard to mortality during week 1 of hospitalization but the mortality rate was unaffected by the magnitude of the anion gap. An elevated anion gap is associated with severe, acute disease and in the absence of an elevated anion gap death rarely occurs during week 1 after hospitalization from an emergency outpatient facility. The biochemical pathogenesis of the association between mortality and a high anion gap remains unclear in the majority of the patients. Patients with an elevated anion gap or severe electrolyte abnormalities should be given careful consideration for admission to the hospital or intensive care unit in view of the increased risk for mortality even in the absence of identifiable organic acidosis. However, hospitalization of a patient should not be determined on the basis of an abnormal anion gap alone, which seems reassuring regarding the prognosis during week 1 after hospitalization, since this may be partly owing to the support of the resources of the intensive care unit or hospital. M. G. F. 1 figure, 4 tables, 21 references