Controlled trials of hemoperfusion for intoxication.
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Biomedical subjects
Publications and source records attributed to G Brunner.
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UDP-glucuronlytransferase, E.C. 2.4.1.17, has been solubilised from the microsomal fraction of liver homogenate from phenobarbital pretreated rabbits by lipase or detergent treatments. A 110-fold purification of the enzyme with respect to the crude homogenate was achieved by precipitation and column separations. The cholate-detergent solubilised enzyme was far more stable than that prepared by the lipase method. The partially purified UDP-glucuronyltransferase has been covalently bound to cyanogen bromide-activated agarose in the form of large haemocompatible beads to the extent of 0.22 mg protein per mg agarose dryweight, equivalent to about 25 mg of swollen gel. The acceptors for glucuronidation employed were the non-physiological phenolic compounds p-nitrophenol and 1-naphthol, and an exogenous and endogenous substance of physiological importance, namely paracetamol and phenol respectively. The immobilised enzyme exhibited at least 80% of the original activity of the solubilised enzyme, and the catalytic function was preserved for a much longer period of time in the carrier-bound form. The system described in this publication could well be applied in an extracorporeal liver assist device for the replacement of glucuronidation function.
The adsorptive capacities of some ion-exchange resins and activated charcoal towards the hypnotic drugs, phenobarbital, glutethimide, carbromal, and methaqualone, have been investigated. Furthermore, the properties of some of these resins and charcoal, encapsulated in an agarose matrix in the form of beads, have been compared with those of the adsorbent phases in their native states. In general, the adsorptive capacities of charcoal were at least as good as, and frequently better than those of the resins. Amberlite XAD-type resins had a higher affinity than Dowex-type resins for all the drugs tested, except for phenobarbital, which was not adsorbed to a satisfactory extent onto Amberlite XAD-4. The encapsulation of adsorbent phases into agarose beads of diameter 5-10 mm results in a reduction of the adsorbtion of the drugs. Nonetheless, the remaining adsorptive capacity is sufficient for application in an extracorporeal detoxification system. Moreover, the overwhelming advantage of good haemocompatibility is provided by the agarose-encapsulated adsorbents.
The cerebral angiograms of 11 patients suffering from collagen disease are presented. Panarteriitis nodosa was diagnosed in 4 cases, Lupus erythematodes in 2 cases. With 5 patients immunovasculitis with cerebral affection was found, which was, however, not to be classified in detail. More or less characteristic features are to be expected in the angiogram; they might harden the suspicion of collagen disease, although they are not likely to prove its diagnosis. An interpretation of the radiological findings should--in addition to the morphology--primarily take into account the distribution type of the vessel wall lesions. Clinically as well as by means of angiography it is difficult to differentiate between collagen disease and cerebral arteriitis of different aetiology; this applies particularly to the alterations in cases of embolic circumscribed encephalitis in sepsis lenta. The diagnostic value of angiography in cases of collagen disease with cerebral affection is discussed, the criteria of cerebral arteriitis of different aetiology are dealth with.
A method is described for the encapsulation of ion-exchange and adsorbent resins of native particle diameter 0.2-1.0 mm into agarose spheres of diameter 5-10 mm. Plasma components diffuse rapidly through the agarose coating, but blood corpuscles have no direct access to the resins. At least 0.3 g of resin can be incorporated into 1 g of the agarose beads, so that the effective surface area with regard to erythrocytes, thrombocytes, and leucocytes is reduced by a factor of at least 5, and up to 20, depending on the native resin particle size. Pulverised active charcoal, or resins in powder form can also be encapsulated in this manner. The haemocompatibility of the agarose coating seems to be considerably more acceptable than that of the adsorbents in their native state.
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Sensitive, reliable and convenient assays are described for the study of human liver microsomal UDP-glucuronyltransferase. Using 14C-1-naphthol as substrate about 2 mg of a liver biopsy specimen and for 14C-morphine about 20 mg of tissue will suffice for enzyme estimation. Lack of inhibition of 1-naphthol glucuronidation by morphine suggests that the substrates are glucuronidated by different forms of the enzyme. Enzyme levels in the native and activated state were studied in biopsies from patients grouped according to histopathological and clinical criteria. The enzyme assays may help to characterize UDP-glucuronyltransferases in human tissues and their induction by drugs and environmental chemicals, as well as their alteration in various diseases.
Aliphatic mercaptans (aethanthiol, methanthiol, dimethylsulphide) can be measured in serum with a simple and rapid gaschromatographic method. The test takes 30 minutes. Aethantiol was found to be increased ten-fold (P less than 0.0001) in patients with acute hepatic failure (endogenous coma), while in exogenous hepatic coma it was always normal or decreased. Mild increase in aethanthiol concentration (two or threefold) was also found in chronic aggressive hepatitis, cirrhosis and obstructive jaundice. Methanthiol concentration was elevated in patients with endogenous and exogenous hepatic coma. Values for methanthiol are, however, of only limited use, because methionine is converted in small amounts to methanthiol during the test procedures. Dimethylsulphide is found in only very severe cases of endogenous or exogenous hepatic coma and can be considered to be a prognostically unfavourable sign. Determination of mercaptans makes it possible to differentiate exactly between endogenous and exogenous hepatic coma. Its value also lies in the recognition of the severity of endogenous intoxication and it is suitable for serial and control determination of the effectiveness of therapeutic measures.
The subcellular localization of gamma-glutamyltransferase in calf thymocytes was investigated and compared with that of alkaline phosphodiesterase I, alkaline nitrophenyl phosphatase, succinate-tetrazolium oxidoreductase (succinate-INT reductase) and lactate dehydrogenase after two different methods of cell disruption and differential centrifugation. Most of the activity was recovered in the crude membrane fractions (43.0%), but significant amounts co-pelleted with the large-granule (mitochondria) fractions (31%). The specific activity of the gamma-glutamyltransferase in the purified plasma membrane was 30-50 times that of the enzyme in the cell homogenate and had a similar subcellular distribution to the plasma-membrane markers, alkaline phosphodiesterase I and alkaline nitrophenyl phosphatase. It was concluded that gamma-glutamyltransferase was primary a plasma-membrane-bound enzyme, and that its location in other subcellular fractions was probably due to their contamination with plasma-membrane vesicles.
A method is reported by which agarose beads of diameter 1000 to 10000 microns can be prepared from Sepharose (R) 4B (native bead diameter 40 to 190 microns). Haemoperfusion experiments indicate that the enlarged beads are relatively haemocompatible; platelet loss is considerably less than that reported for many other bio-materials employed in haemoperfusion, and haemolysis is slight even after perfusion for several hours at flow-rates in excess of 25 ml/min. The beads can be activated by cyanogen bromide for the immobilisation of proteins. The sites for protein fixation are not restricted to the outside surface of the beads; small water soluble molecules, and serum proteins diffuse quite rapidly through the enlarged beads. A possible medical application of the large beads is in extracorporeal detoxification by chromatographic extraction or enzymatic modification, particularly of lipophilic toxins, using the enlarged beads as a carrier-matrix. The results described in this publication prove the viability of this concept. Such methods should be especially useful as artificial supports in fulminant hepatic failure.
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Free-flow electrophoresis was used to subfractionate membrane vesicles from calf thymocyte plasma membranes. The fractionation resulted in a separation of vesicle populations bearing four different enzymes: alkaline nitrophenyl-phosphatase (orthophosphoric-monoester phosphohydrolase (alkalin optimum) EC 3.1.3.1), gamma-glutamyltransferase (EC 2.3.2.2), (Mg2+ + Na+ + K+)-ATPase (ATP phosphohydrolase, EC 3.6.1.3) and acyl-CoA:lysophosphatidylcholine acyltransferase (acyl-CoA:1-acylglycero-3-phosphocholine-O-acyltransferase, EC 2.3.1.23). The specific content of cholesterol and total phospholipid coincided with the distribution of membrane-bound protein. However, vesicles migrating towards the cathode had a higher molar ratio of cholesterol to phospholipid (0.75) compared to those migrating to the anode (0.55). Sodium dodecyl sulphate-gel electrophoresis of pooled vesicle fractions also demonstrates distinct differences in their protein pattern. Electron-micrographic thin sections show that the vesicle populations have a similar morphology and size distribution. These results are discussed in terms of heterogeneity of the original thymocytes, contamination with intracellular membranes and a heterogeneous structure of the plasma membrane.
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In contrast to the situation in disseminated lupus erythematodes, in pseudo-LE syndrome the serum-complement factors C'3 and C'4 are elevated and not decreased in the active stage of the disease. Although both diseases are defined and easily distinguished by the demonstration of the specific pathognomonic autoantibodies, at least in the active stage, they can also be distinguished by determining these two complement factors. The finding also demonstrates a different pathogenesis of the two diseases. The serum concentration of C'3 activator is elevated both in LE and pseudo-LE. In the former, determining C'4 is a more sensitive test than that of C'3.
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