Immunosuppressive treatment of allergic nephropathies

Nine patients (three with subacute and six with chronic glomerulonephritis) have been treated with 6-mercaptopurine and azathioprine. The severity of the disease was determined on the evidence of protein excretion, the Addis count and the level of serum complement. The results justify not more than moderate optimism. Cytostatic drugs are applied only if corticosteroid therapy has no effect or is contraindicated. Peptic ulcer and amyloidosis are absolute, obesity and diabetes relative contraindications of steroid therapy. Epilepsy accompanying collagen disease is not a contraindication. Subcapsular cataract provoked by steroids makes no further progress if the steroid therapy has to be continued. Steroids, if administered after the 15th year of age, do not impede growth. A combination of cytostatic agents and corticosteroids seems to be beneficial and is perhaps less dangerous, although a patient developed agranulocytosis after having been treated with a combination of 6-mercaptopurine and prednisolone.     

Frostbite: pathogenesis and treatment

Frostbite, once almost exclusively a military problem, is becoming more prevalent among the general population and should now be considered to be within the scope of the civilian physician's practice. Studies into the epidemiology of civilian frostbite have identified several risk factors that may aid the clinician in the diagnosis and management of cold injuries. Research into the pathophysiology has revealed marked similarities in inflammatory processes to those seen in thermal burns and ischemia/reperfusion injury. Evidence of the role of thromboxanes and prostaglandins has resulted in more active approaches to the medical treatment of frostbite wounds. Although the surgical management of frostbite involves delayed debridement 1 to 3 months after demarcation, recent improvements in radiologic assessment of tissue viability have led to the possibility of earlier surgical intervention. In addition, several adjunctive therapies, including vasodilators, thrombolysis, hyperbaric oxygen, and sympathectomy, are discussed.     

An overview of HIV infection and AIDS: etiology, pathogenesis, diagnosis, epidemiology, and occupational exposure

Thanks to a worldwide collaborative effort among health care providers, academia, governments, and industry, our knowledge base about infection caused by the human immunodeficiency virus (HIV) has expanded exponentially. During the past 2 decades, we have learned about its pathogenesis, virology, immunology, epidemiology and treatment. In the developed world, the approach to persons with HIV disease has evolved from palliative disease care to use of a chronic disease model, where survival is measured by decades, not months or years. More and more, clinical decision-making for HIV-infected patients is driven by comorbidities, including cardiothoracic disease. Thus, our clinically stable HIV population is increasingly accessing those health care services required by any maturing population, including the usual services of cardiothoracic surgeons. In this article, we review the basic facts of HIV disease, with an emphasis on occupational risks and infection control procedures.     

原发性化脓性椎间隙感染发病机理及治疗方法的探讨

目的 :探讨化脓性椎间隙感染的发病机理及治疗方法。方法 :对 11例化脓性椎间隙感染的患者采取前路病灶清除、后路椎板间植骨术并结合大剂量抗生素运用、卧床、制动等方法治疗。结果 :术后 11例患者获得 1～ 2年的随访 ,感染无 1例复发 ,脊柱无后凸畸形 ,植入骨块融合。结论 :前路手术清除病灶、后路椎板间植骨以加强脊柱的稳定性是治疗化脓性椎间隙感染的有效方法。     

Role of diet in the treatment of chronic nephropathies

The effect of the diet poor in protein and containing adequate quantity of essential amino acids in the treatment of chronic uremia is discussed. A diet of high caloric value contains 18–24 g of protein, — this quantity comprising also the minimum daily requirement of essential amino acid. Under the effect of the diet the uremic symptoms subside or disappear completely, and the value of the nonprotein nitrogen of the serum decreases. The good result is due not to the improvement of the kidney function, but the diet produces in the metabolism in the metabolism a favourable change. This new, special diet is an important factor of the complex anti-uremic treatment.     

Diabetic neuropathy: pathogenesis and treatment

Neuropathy is a common and devastating complication of diabetes that contributes to mortality in most cases. Multiple factors are thought to play a major role in the pathogenesis of diabetic neuropathy, including alterations in the endoneural metabolism, defective neurotrophic factors, reduced nerve blood supply, and immune mechanisms. Studies of endoneural metabolism and nerve blood-flow alterations have focused on oxidative stress, the polyol pathway, advanced glycation, protein kinase C, and impaired essential fatty acid metabolism. Although many experimental and clinical studies have been performed to determine the most optimal strategy for preventing and treating diabetic neuropathy, tight glycemic control is the mainstay of therapy. In this article, the proposed pathophysiologic mechanisms and therapeutic approaches in diabetic neuropathy are reviewed and discussed with the relevant literature.     

平山病发病机制及治疗研究进展

平山病(Hirayama disease,HD)又称青年上肢远端肌萎缩(juvecusculr atrophy of distal upper extremity),最早由日本学者平山惠造(Keizo Hirayama)在1959年报道.目前全球报道本病约1500例,主要发生在日本等亚洲国家及欧美国家,多为散发,罕见家族史.平山病是一种良性自限性运动神经元疾病,但临床特点、发病机制以及预后与运动神经元病完全不同.笔者就平山病的临床特点、发病机制以及治疗进展综述如下.     

The challenges of success: adolescents with perinatal HIV infection

The great success in the prevention and treatment of pediatric HIV in high resource countries, and now in low resource countries, has changed the face of the HIV epidemic in children from one of near certain mortality to that of a chronic disease. However, these successes pose new challenges as perinatally HIV‐infected youth survive into adulthood. Increased survival of HIV‐infected children is associated with challenges in maintaining adherence to what is likely life‐long therapy, and in selecting successive antiretroviral drug regimens, given the limited availability of pediatric formulations, limitations in pharmacokinetic and safety data of drugs in children, and the development of extensive drug resistance in multi‐drug‐experienced children. Pediatric HIV care must now focus on morbidity related to long‐term HIV infection and its treatment. Survival into adulthood of perinatally HIV‐infected youth in high resource countries provides important lessons about how the epidemic will change with increasing access to antiretroviral therapy for children in low resource countries. This series of papers will focus on issues related to management of perinatally infected youth and young adults.     

The battle of the bladder: The pathogenesis and treatment of uncomplicated cystitis

An ecological approach to the pathogenesis of uncomplicated urinary tract infections allows awareness of the continual battle being waged in the vagina, urethra, and bladder between the bacterial invaders and the host defense mechanisms. Despite overwhelming odds, the bacteria must be able to persist, colonize, and finally adhere to these various battlefields on their ascent to the bladder itself. The large number of patients presenting to physician offices with acute simple cystitis attests to the fact that the bacteria occasionally win the battle of the bladder. An understanding of the pathophysiology of this constantly raging battle may help us modify our clinical approach to women with simple uncomplicated urinary tract infections.     

Evidence-based assessment of treatment options for children with IgA nephropathies

We present an evidence-based evaluation of published data on therapy for children with various presentations of the IgA nephropathies--idiopathic IgA nephropathy (IgAN) and Henoch-Schonlein purpura nephritis (HSPN). Particular attention has been paid to the outcome markers used in the studies reviewed, with the best evidence provided by markers highly associated with progressive renal failure. No treatment modality for either IgAN or HSPN in pediatric patients has been shown to be effective by a properly designed and administered randomized controlled trial (i.e., the highest level of evidence--level 1). Lower levels of evidence support the use of a variety of corticosteroid regimens, often in combination with other agents, although there are some conflicting studies in this area. No convincing evidence has been published to date to support the use of fish oil, angiotensin-converting enzyme inhibitors or tonsillectomy for the treatment of children with IgAN or HSPN. Well designed randomized controlled trials in children with the IgA nephropathies need to be undertaken.     

HIV infection and surgeons

The human immunodeficiency virus (HIV) causes acquired immunodeficiency syndrome, which remains uniformly fatal in affected individuals. A common route of HIV transmission is via inoculation of contaminated blood, which may occur during surgical procedures. Surgeons may estimate their risk of HIV infection over a 30-year surgical career based on HIV prevalence among surgical patients, percutaneous injury rate per operation, and seroconversion rate. Surgeons can reduce their risk by various means, but the most pragmatic is by reducing the rate of percutaneous injury through optimal surgical technique and proper precautions.

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Resumen El virus de la immunodeficiencia humana causa el síndrome de immunodeficiencia adquirida, el cual sigue siendo uniformemente letal en los individuos afectados. Una ruta común de transmisión del VIH es la inoculación de sangre contaminada, lo cual puede suceder en el curso de procedimientos quirúrgicos. Los cirujanos pueden hacer la estimación de su riesgo de infección por VIH en el curso de una carrera quirúrgica de 30 años, con base en la prevalencia del VIH en los pacientes quirúrgicos, la frecuencia de lesiones percutáneas por operación y la rata de seroconversión. Los cirujanos pueden reducir el riesgo por varios medios, pero el más pragmático es por la reducción en la tasa de lesiones percutáneas mediante una técnica operatoria óptima y la toma de adecuadas precauciones.

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Résumé Le virus HIV est responsable du syndrome d'immunodéficience acquis, une maladie constamment mortelle. Une des voies fréquentes d'inoculation est le sang contaminé, ce qui peut parfois se produire pendant les interventions chirurgicales. Le chirurgien peut estimer le reisque de contamination par l'HIV grâce à la prévalence chez les patients, le taux de blessure peropératoire et le taux de séroconversion. Les chirurgiens peuvent réduire ce risque par différents moyens, mais le moyen le plus efficace pour réduire le risque de piqûre accidentelle pendant l'intervention est d'adopter une technique chirurgicale optimale et des précautions adéquates.