Acute onset of nephrotic syndrome during interferon-α retreatment for chronic active hepatitis C

A 57-year-old woman was scheduled to receive recombinant interferon-α retreatment for chronic active hepatitis C. During the course of therapy, the patient showed rapid onset of oliguria, dizziness, edema, and a pre-shock state. She was subsequently admitted to hospital and was diagnosed as having nephrotic syndrome. After admission, albumin-dominant proteinuria persisted despite the discontinuation of interferon therapy. Light microscopy of a renal needle biopsy specimen showed interstitial lymphoid cell infiltration, but no marked changes of the glomeruli and no staining for immunoglobulin or complement. Electron microscopy showed diffuse effacement of the glomerular epithelial foot processes, leading to a diagnosis of minimal change nephrotic syndrome with interstitial nephritis. Proteinuria resolved after the initiation of oral prednisolone therapy (1 mg/kg per day). The number of patients with chronic hepatitis C requiring interferon retreatment is increasing rapidly. We herein report this rare case of acute onset of nephrotic syndrome during interferon-α retreatment. Received: March 30, 2001 / Accepted: July 6, 2001 Reprint requests to: S. Nishimura     

Association of amino acid substitution pattern in nonstructural protein 5A of hepatitis C virus genotype2a low viral load and response to interferon monotherapy

Patients with low titer (<0.5 mEq/ml) of hepatitis C virus (HCV) genotype 2a achieve high and sustained response (SR) rates to interferon (IFN) monotherapy, but we also encounter patients who are resistant to therapy. We explored the relationship between response to IFN and virological differences in such patients. We evaluated 159 consecutive naive patients with low titer of HCV genotype 2a who received IFN monotherapy. A case-control study matched for age, sex, and viral load was conducted to examine the substitution patterns in amino acid positions (amino acids) 2163-2254 of nonstructural (NS) 5A between nonresponders to ideal IFN dose (>/=500 million units) (nonresponders; NR) and responder to less than ideal dose. Overall, 82.4% achieved SR. The substitution numbers in amino acids 2193-2254 were higher in SR than NR patients (P < 0.05). High proportions of patients with substitution at amino acid 2205 (mainly threonine [T] instead of alanine [A]), dual amino acids 2169 and 2205 (mainly A-T instead of T-A), and those without substitution at amino acids 2227 were NR (P < 0.05). Four of 7 NR patients achieved SR after receiving a second course of IFN. Their amino acids patterns at positions probably associated with sensitivity to IFN did not change at the start of initial and second therapies except for one patient, and they had lower viral load and were treated with higher IFN dose in the second course compared with the initial course. Our results suggest that substitution patterns in NS5A in patients with low titer of HCV genotype 2a may affect their response to IFN, but the response to therapy may be affected by mechanisms other than substitutions in this region.     

COMPARATIVE SEM EVALUATION OF THREE SOLVENTS USED IN ENDODONTIC RETREATMENT: AN EX VIVO STUDY

This study compared, by scanning electron microscopy (SEM), the efficacy of three solvents on the removal of filling materials from dentinal tubules during endodontic retreatment. Forty human maxillary canines with straight canals were prepared according to a crown-down technique and enlarged to a#30 apical file size, before obturation with gutta-percha and a zinc-oxide-eugenol based sealer. The samples were stored for 3 months before being randomly assigned to four groups: chloroform (n=10), orange oil (n=10), eucalyptol (n=10) and control (n=10). Solvents were applied to a reservoir created on the coronal root third using Gates Glidden drills. The total time for retreatment using the solvents was 5 minutes per tooth. Following retreatment the roots were split longitudinally for SEM evaluation. SEM images were digitized, analyzed using Image ProPlus 4.5 software, and the number of dentinal tubules free of filling material from the middle and apical thirds was recorded. No significant difference was found among the solvent groups regarding the number of dentinal tubules free of root filling remnants in the middle and apical root thirds (p>0.05). However, the control group had fewer dentinal tubules free of filling material (p<0.05). Under the tested conditions, it may be concluded that there was no significant difference among the solvents used to obtain dentinal tubules free of filling material remnants.     

Endodontic retreatment of an autotransplanted lower first premolar: a case report

Abstract  – A 24-year-old female with no contributory medical history had been treated by orthodontic alignment and transplantation of the lower left first premolar to the upper left first premolar site to correct for congenitally missing upper premolars. Subsequently, the transplanted premolar was treated by conventional endodontics and apical surgery for persistent periapical periodontitis over a span of 12 years. A combination of conventional endodontic retreatment and periapical surgery resulted in periapical healing. This case outlines the need for careful preoperative case assessment.     

Efficacy of Quantec rotary instruments for gutta-percha removal

AIM: The purpose of this study was to evaluate Quantec SC rotary instruments for removal of gutta-percha during retreatment of straight root canals. METHODOLOGY: The root canals of 30 central incisors were instrumented and obturated before the teeth were randomly divided into three groups of 10 specimens each. Quantec SC rotary instruments and a 16:1 reduction handpiece powered by an electric motor were then used to remove the gutta-percha and sealer from canals. A different speed was used in each group (group 1, 350 r.p.m.; group 2, 700 r.p.m.; and group 3, 1500 r.p.m.). The followings factors were evaluated: time taken to reach working length, time for gutta-percha removal, total time, apically extruded material during filling removal and number of fractured instruments. Radiographs were taken after the filling removal and after the canal wall cleanliness was evaluated. The teeth were grooved longitudinally, divided, and the walls of each half were evaluated visually for cleanliness. They were then digitized using a scanner and the residual debris measured. RESULTS: The group in which a speed of 1500 r.p.m. was used had significantly faster treatment than the other groups. The amount of apically extruded material was not significantly different between groups. The only significant difference between groups for canal cleanliness was the middle third by radiographic evaluation: the group of 350 r.p.m. had larger amount of debris than the others. In group 1, six instruments fractured; in group 2, four instruments fractured; and in group 3, one instrument fractured. CONCLUSIONS: Cleanliness and residual debris were equivalent for each group, but the use of 1500 r.p.m. speed was more rapid and fewer instruments fractured.     

Effectiveness of different techniques for removing gutta-percha during retreatment

AIM: To evaluate the effectiveness of various techniques for removing filling material from root canals in vitro. METHODOLOGY: Eighty extracted mandibular premolar teeth were selected for the study. The teeth were root filled using thermomechanical compaction of gutta-percha. After 8 months, the filling material was removed and canals were reinstrumented using the following techniques: group I - hand instrumentation with K-type files (SybronEndo, Orange, CA, USA); group II - K3 Endo System (SybronEndo); group III - M4 system (SybronEndo) with K-type files (SybronEndo); and group IV - Endo-gripper system (Moyco Union Broach, York, PA, USA) with K-type files (SybronEndo). The amount of filling debris remaining on root canal walls was assessed radiographically; the images were digitized and analysed using AutoCAD 2000 software. Total canal area, area of the cervical, middle and apical thirds, and area of remaining filling material were outlined by one operator. The ratios between these areas were calculated as percentages of remaining debris. Thereafter, data were analysed by means of one-way anova and the post-hoc Duncan test to identify differences between the four techniques. RESULTS: Multiple comparisons of the percentages of remaining filling material in the entire canal did not reveal any significant differences between the methods of removal. However, when each third was analysed separately, significant differences for remaining debris were present between groups. The apical third had the most remaining material, whilst the cervical and middle thirds were significantly cleaner (P = 0.002). Comparison of the techniques revealed that teeth instrumented with K3 rotary instruments had a lower ratio of remaining filling material in the apical third (P = 0.012). CONCLUSION: In the apical third, K3 rotary instruments were more efficient in removing gutta-percha filling material than the other techniques, which were equally effective for the other thirds.     

Uncontrolled trial of sparfloxacin in retreatment of pulmonary tuberculosis

OBJECTIVE: The aim of the present report was to study the role of sparfloxacin in retreatment of pulmonary tuberculosis. METHODOLOGY: Sixteen patients with sputum-smear-positive pulmonary tuberculosis were given sparfloxacin (200 mg daily), along with isoniazid and para-aminosalicylic acid plus additional drugs where indicated. They were followed up and assessed by sputum-smear microscopy and chest X-ray regularly for the entire duration of follow up, which ranged from 15 to 18 months. RESULTS: Twelve patients completed treatment and achieved a satisfactory response in the form of persistent sputum negativity and radiologically quiescent disease. Two patients defaulted after 6 months and one patient discontinued medications because of severe gastrointestinal intolerance. One patient died before completion of the treatment as a result of the sequelae of the disease. CONCLUSIONS: Sparfloxacin can be used as a companion drug along with other drugs in retreatment of pulmonary tuberculosis. The advantages of this drug are a high safety profile, low cost of treatment and easy availability, which are important determinants, especially in developing countries.     

Isolation of yeasts and enteric bacteria in root-filled teeth with chronic apical periodontitis

AIMS: The aim of this study was to determine the occurrence and role of yeasts, enteric gram-negative rods and Enterococcus species in root-filled teeth with chronic apical periodontitis, and the antimicrobial effect of iodine potassium iodide (IKI) irrigation. METHODOLOGY: Forty symptom-free root-filled teeth with chronic apical periodontitis were included in the study. The patients were divided into two groups. In group A the canals were filled with calcium hydroxide for 10-14 days after cleaning and shaping; in group B the canals were irrigated with IKI for 5 min after cleaning and shaping followed by a permanent root filling. Microbiological samples were taken from the canals before and after the chemomechanical preparation and after iodine irrigation (group B). RESULTS: Microbes were isolated from 33 of 40 teeth in the initial sampling. Yeasts were isolated from six teeth, three of them together with E. faecalis. Enteric rods (Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis) were present in three teeth and E. faecalis was isolated from 21 of the 33 culture positive teeth, 11 in pure culture. Growth was detected in 10 teeth of the second samples. Six of the 10 cases were E. faecalis, with five being a pure culture. All third samples (after IKI) except one were negative. The number of microbial cells per sample did not correlate with lesion size. Two flare-ups were recorded, both in teeth with a mixed infection. CONCLUSION: The high prevalence of enteric bacteria and yeasts in root-filled teeth with chronic apical periodontitis was established. IKI improved the antimicrobial effect of the treatment.     

Retreatment of patients with the same chemotherapy: Implications for clinical mechanisms of drug resistance

Background:Patients who relapse after adjutant chemotherapy, orafter attaining remission following treatment of advanced disease, aresometimes retreated with the same type of chemotherapy. The objective of thecurrent review of published reports was to assess the probability of responseto retreatment, and to examine evidence for transient rather than stable formsof clinical drug resistance. Methods:A Medline review of published clinical series wherepatients were retreated with the same chemotherapy that they had receivedpreviously. Results:We located 15 reports of patients with advanced diseasewho were retreated with the same chemotherapy following complete remission andsubsequent relapse, and three reports where patients received the samechemotherapy that was given previously as adjuvant treatment for breastcancer. For patients with advanced disease the median time off-treatment was48 weeks; response rates to retreatment using appropriate criteria were in therange of 18%–100% (median 51%), with a substantialproportion of second complete responses. For patients retreated after adjuvantchemotherapy for breast cancer the median interval between treatments was 84weeks and the response rates were in the rangeof 40%–51%. Conclusions:With the caveat that this type of review is subjectto publication bias, retreatment of patients who relapse after completeresponse to initial therapy, or after adjuvant therapy, is associated with asubstantial probability of response. Together with evidence that moreprolonged or intensive initial therapy rarely leads to more frequent or moreprolonged responses, the current review suggests that some patients maydevelop transient resistance to chemotherapy.     

全程延续督导模式对复治肺结核病人管理中负性情绪、遵医行为和生活质量的影响

[目的]探究全程延续督导模式对复治肺结核病人管理中负性情绪、遵医行为和生活质量的影响。[方法]选取在结核科住院的复治肺结核病人共120例,在遵循结核病规范督导治疗下,引入全程延续督导模式,研究组在干预前及干预后使用焦虑自评量表(SAS)、抑郁自评量表(SDS)及生活质量综合评定问卷(GQOLI-74)进行评价,并在干预前和干预后对遵医行为进行比较。[结果]120例复治肺结核病人负性情绪干预后比干预前均明显降低(P<0.05);生活综合质量评定以及遵医服药比较差异均有统计学意义(P<0.05)。[结论]全程延续督导模式能明显改善复治肺结核病人的负性情绪、提高病人生活质量以及遵医依从性行为。