A retrospective analysis of 21 male and 82 female patients with systemic lupus erythematosus (SLE) was performed in order to identify sex-linked differences in disease manifestations. As organ manifestation, cardiac involvement was assessed in 12 of 21 male patients (57%) and in 18 of 82 females (22%; p < 0.05). Renal involvement occurred in 16 male (76%) vs 26 female patients (32%; p < 0.05). Endstage renal disease developed in 5 of the 21 men (24%), but only in 6 of the 82 women (7%) with SLE. The most striking clinical result was the high frequency of thrombembolic complications in male SLE-patients. Twelve out of 21 males (57%) experienced more than 30 thrombembolic events in contrast to 9 events in 5 out of 82 females (6%; p < 0.0001). Persisting elevated IgG-anti-cardiolipin antibodies were found in 48% of male and only 16% of female patients (p < 0.05). In conclusion, these data suggest that SLE in males is characterized by more frequent and severe organ involvement and especially by striking prevalence of partly life-threatening thrombembolic complications.

Adolescent↗

PubMedDate not supplied

Oral versus intraperitoneal application of clindamycin in tunnel infections: a prospective, randomized study in CAPD patients.

OBJECTIVE: To evaluate the potential superiority of either oral or intraperitoneal treatment of catheter tunnel infections (TI), using clindamycin as a first-line antibiotic and ultrasound as a diagnostic tool. DESIGN: This was a prospective, randomized study in continuous ambulatory peritoneal dialysis patients. From August 1993 until August 1995, 16 clinically- and ultrasound-proven episodes of TI were randomly assigned to either an oral or an intraperitoneal (IP) treatment (100 patients, 1414 patient-months). Main criteria for TI diagnosis were purulent drainage from the exit site and/or a positive ultrasound (pericatheter fluid collection of at least 2 mm, 7.5 MHz transducer). Initially, clindamycin (20 mg/kg body weight) was given via the oral (three times per day) or intraperitoneal route (four times per day). In the case of incompatibility or resistance to clindamycin, either oxacillin or ciprofloxacin were used orally or IP. RESULTS: Based on ultrasound criteria, the mean time until a > or = 50% reduction of pericatheter abscess diameter was 26 days (median) (range: 8-28 days) in the oral, and 15 days (8-27 days) in the IP group (p < or = 0.05). Showing no significant difference of pericatheter fluid at study entry with 4 mm (median) (range: 2-6 mm) in the oral group and 4 mm (2-4 mm) in the IP group, the IP treatment resulted in a decrease to 0 mm (0-2 mm) after 28 days (p < 0.05), while the diameter was still 2 mm (0-10 mm) (NS) in the oral group. Disappearance of exit-site infection was also somewhat earlier in the intraperitoneal group (51 vs 15 days, NS). Catheter removal had to be done once in the IP group and twice in the oral group within 6 months after study entry. CONCLUSIONS: The results give evidence for greater efficacy of the IP application of clindamycin as a first-line antibiotic compared to the oral route for the treatment of tunnel infections.

Abscess↗

PubMedDate not supplied

Effect of cyclosporine A on Na+/K(+)-ATPase, Na+/K+/2Cl- cotransporter, and H+/K(+)-ATPase in MDCK cells and two subtypes, C7 and C11.

We investigated the influence of cyclosporine A (CsA) on key plasma membrane ion transport systems Na+/K(+)-ATPase, Na+/K+/2Cl- cotransporter, and H+/K(+)-ATPase in MDCK cells and two subtypes, C7 and C11, serving as a model system to study principal (C7) and intercalated (C11) cell properties of the distal nephron. The transport activity of Na+/K(+)-ATPase was significantly decreased in all cell types on CsA administration (8 x 10(-6) M) for 2 days, whereas the protein levels of Na+/K(+)-ATPase alpha-subunit in plasma membranes isolated from MDCK, C7, and C11 cells remained unchanged. The transport activity of Na+/K+/2Cl- cotransporter was significantly inhibited by CsA only in MDCK and C11 cells, but again plasma membrane protein levels were not altered. In contrast, C7 cell plasma membranes showed an increase of transport protein content, although the Na+/K+/2Cl- cotransporter activity was not affected by CsA. The H+/K(+)-ATPase transport activity remained unchanged in all three cell types. These data indicate that in C7 cells CsA might induce insertion of transporters into the plasma membrane, thus compensating the decrease of transport activity observed in MDCK and C11 cells. Furthermore, CsA significantly inhibited cell proliferation at 4 x 10(-6) M for C7 and C11 cells and at 8 x 10(-6) M for MDCK cells. Proliferation was completely abolished at 1.6 x 10(-5) M CsA. After 48 h of CsA incubation, the intracellular sodium concentration increased in all three different cell types; however, it stayed within the physiological range of mammalian cells. We, therefore, suggest that CsA is capable of reducing Na+/K(+)-ATPase and Na+/K+/2Cl- cotransporter activities in cells of the distal nephron, thereby contributing to the hyperkalemia observed in patients treated with CsA.

Animals↗