Dijk, L.J. van

Dialysate as food: combined amino acid and glucose dialysate improves protein anabolism in renal failure patients on automated peritoneal dialysis. (Article)

2005-12-09T00:00:00Z

Protein-energy malnutrition as a result of anorexia frequently occurs in dialysis patients. In patients who are on peritoneal dialysis (PD), dialysate that contains amino acids (AA) improves protein anabolism when combined with a sufficient oral intake of calories. It was investigated whether protein anabolism can be obtained with a mixture of AA plus glucose (G) as a source of proteins and calories during nocturnal automated PD (APD). A random-order cross-over study was performed in eight APD patients to compare in two periods of 7 d each AA plus G dialysate obtained by cycler-assisted mixing of one bag of 2.5 L of AA (Nutrineal 1.1%, 27 g of AA) and four bags of 2.5 L of G (Physioneal 1.36 to 3.86%) versus G as control dialysate. Whole-body protein turnover was determined using a primed continuous infusion of L-[1-13C]leucine, and 24-h nitrogen balance studies were performed. During AA plus G dialysis, when compared with control, rates of protein synthesis were 1.20 +/- 0.4 and 1.10 +/- 0.2 micromol/kg per min leucine (mean +/- SD), respectively (NS), and protein breakdown rates were 1.60 +/- 0.5 and 1.72 +/- 0.3 micromol/kg per min (NS). Net protein balance (protein synthesis minus protein breakdown) increased on AA plus G in all patients (mean 0.21 +/- 0.12 micromol leucine/kg per min; P < 0.001). The 24-h nitrogen balance changed by 0.96 +/- 1.21 g/d, from -0.60 +/- 2.38 to 0.35 +/- 3.25 g/d (P = 0.061, NS), improving in six patients. In conclusion, APD with AA plus G dialysate improves protein kinetics. This dialysis procedure may improve the nutritional status in malnourished PD patients.

Lamivudine plasma levels in chronic hepatitis B patients (Article)

2003-01-01T00:00:00Z

Lamivudine has recently been registered for the treatment of chronic hepatitis B patients. The main therapeutic outcome in the studies on which the registration was based was a drop of HBV DNA below 10(7) genome equivalents/ml, the level of detection of the insensitive Abbott Genostics assay. However, as we have reported previously, with the use of sensitive PCR-based assays, individual differences in virological response to lamivudine can be detected. As a first step in analysing the chain of events after oral intake of lamivudine we modified and validated a high-pressure liquid chromatography (HPLC) method to evaluate lamivudine plasma levels. Lamivudine levels in chronic hepatitis B patients who participated in a study on the efficacy of lamivudine were comparable to our reference curve, which was derived from eight chronic hepatitis B patients. From the reference curve, a mean area under the curve (AUC) of 4994 mcg/l.h (SD 1524), a mean t(max) of 42 minutes (SD 11), and a mean C(max) of 1.9 mg/l (SD 0.70) were calculated. Lamivudine exerts its action as the active triphosphate inside the hepatocyte after extensive handling. Therefore, additional steps in the pharmacokinetic process should be evaluated to explore the potential mechanisms that are responsible for the diversity in quantitative HBV DNA response to lamivudine.

Facilitation of vertical vergence by horizontal saccades, found in a patient with dissociated vertical deviation. (Article)

1994-03-01T00:00:00Z

Abstract The authors examined vertical vergence in a Is-year-old girl with dissociated vertical deviation, a 60 convergent strabismus, no binocular vision, latent nystagmus, and a minimal left amblyopia. Eye movements were recorded during 4s-periods of (1) both eyes open, alternated with 4speriods of (2a) right eye covered, (2b) left eye covered or (2C) both eyes closed. The patient preferred fixation with the right eye; when this eye was covered, the left eye took over fixation with an almost completely monocular, downward saccade (a horizontal saccade occurred at the same time). The right eye only made a very small saccade, and then started to drift upward with an exponentially decreasing velocity. Enright has shown that fast convergence or divergence may occur when a horizontal saccade is performed at the same time. Similarly, the authors suspected that, in their patient, vertical vergence was facilitated by the horizontal saccade that resulted, in this case of horizontal strabismus, from alternation of fixation. To examine whether this was the case, they compensated for the horizontal strabismus by placing a 30 prism-dioptre base-out prism in front of the left eye (the patient had no binocular vision). With the prism in place, the horizontal saccade that occurred when the right eye was covered was smaller, and only little vertical vergence occurred together with the horizontal saccade. It seems possible that vertical vergence is also facilitated by horizontal saccades.