Bilateral calcified renal artery aneurysms in a patient with von Recklinghausen's disease.

Case A 68-year-old woman with family history of fibromatous skinlesions was referred for the evaluation of hypertension. Withdetection of multiple fibromatous skin lesions and caféau lait spots, a diagnosis of von Recklinghausen's disease wasmade. Because     

Prevalence of Helicobacter pylori in patients with chronic renal failure

The prevalence of Helicobacter pylori (H. pylori) was investigatedin 164 consecutive patients with different degrees of renalfunction; group I (normal renal function) n=84, group II (chronicrenal failure, CL_CR 5<90 ml/min) n=45, group III (haemodialysistherapy) n=35, to test the hypothesis that the resulting differentconcentrations of urea in the gastric juice would have an influenceon the colonization of the gastric mucosa by these urea-splittingbacteria. As every individual method for the detection of H.pylori shows disadvantages, the results of the detection methodsused (urease test, Warthin-Starry stain, bacterial cultivation,direct examination of the processed sample by phase-contrastmicroscopy) were combined in a cumulative evaluation. Thesecalculated cumulative indices for the antrum and corpus showedno statistically significant differences between the studiedgroups. The prevalence of H. pylori ranged from 34 to 54%. Thehistopathological findings were similar in all groups. In spiteof the fact that patients with renal dysfunction had significantlyhigher levels of serum gastrin (P<0.05), there was no influenceon the gastric juice pH value. The relationship between thecumulative index and ammonia concentration in gastric juicewas found to be linear (P<0.05). The higher urea levels inthe blood and gastric juice of patients with renal failure donot seem to be a risk factor for infection with H. pylori.     

WHOQOL-BREF 量表评价艾灸治疗膝骨性关节炎的临床疗效研究

目的:研究应用WHOQOL-BREF评价艾灸治疗膝骨性关节炎的临床疗效,为艾灸治疗膝骨性关节炎提供临床疗效依据.方法:2007年1月至2008年6月,将90例膝骨性关节炎患者随机分为治疗组和对照组.治疗组45例,男16例,女29例;平均年龄(62.5±7.4)岁;平均病程(26.5±14.6)个月;治疗前Lysholm膝关节功能评分平均(65.5±3.5)分.对照组45例,男11例,女34例;平均年龄(62.5±9.3)岁;平均病程(24.6±6.6)个月;治疗前Lysholm膝关节功能评分平均(66.3±2.3)分.应用生存质量WHOQOL-BREF量表对符合纳入标准的研究时象进行评价,同时应用Lysholm膝关节评分标准进行辅助评价.所有数据使用SPSS 11.5软件包进行统计分析.结果:应用艾灸治疗膝骨性关节炎的患者生存质量在WHOQOL-BREF量表评分结果,治疗组生理状况、心理状态以及对自身健康状况总的主观感觉等方面明显高于对照组(P＜0.05).参照Lysholm临床疗效评分,治疗后治疗组明显高于保守组(t=0.65,P＜0.05).结论:应用艾灸治疗膝关节骨性关节炎,简单又无创,经济实用,对轻、中度关节病变,既可防止痛变进一步发展,又可改善关节功能、提高生存质量.     

Increased serum concentrations of pro-gastrin-releasing peptide in patients with renal dysfunction

BACKGROUND: Gastrin-releasing peptide has a prominent role as a tumour markerin the diagnosis of small-cell lung carcinoma. This study wasdesigned to assess the validity of a newly developed enzyme-linkedimmunosorbent assay (ELISA) for pro-gastrin-releasing peptidein patients with renal and systemic diseases. METHODS: Pro-gastrin-releasing peptide concentrations in sera from normalsubjects and patients with small-cell lung carcinoma, diabetesmellitus, rheumatoid arthritis, systemic lupus erythematosus,chronic glomerulonephritis, or undialysed or dialysed chronicrenal failure were measured with the TND-4 Kit, a newly developedELISA for pro-gastrin-releasing peptide. RESULTS: All of the patients with normal renal function, whether theyhad diabetes mellitus (n=16), rheumatoid arthritis (n=10), systemiclupus erythematosus (n=12) or chronic glomerulonephritis (n=14),had serum pro-gastrin-releasing peptide concentrations lessthan 46 ng/l, the upper limit in normal subjects. In contrast,14 of 16 patients (88%) with small-cell lung carcinoma, whohad normal renal function, and 25 of 26 (96%) patients withchronic renal failure on haemodialysis had serum pro-gastrin-releasingpeptide concentrations greater than 46 ng/l. The highest serumpro-gastrin-releasing peptide levels in patients with chronicrenal failure, before and after initiating haemodialysis were183 and 290 ng/l respectively. Ten of 16 (63%) small-cell lungcarcinoma patients had serum pro-gastrin-releasing peptide concentrationsgreater than 290 ng/l, the highest level in haemodialysed patients.Serum pro-gastrin-releasing peptide concentrations were alsoelevated in patients with chronic glomerulonephritis or diabetesmellitus when their serum creatinine concentrations were greaterthan 120 µmol/l. And, there was a significant correlation,y=23.5+0.15x(n=22, r=0.82, P<0.001), between serum pro-gastrin-releasingpeptide (y, in ng/l) and serum creatinine (x, in µmol/l)concentrations in those patients with renal dysfunction. Thecorrelation between serum pro-gastrin-releasing peptide andserum urea nitrogen concentrations was likewise significant. CONCLUSIONS: The evaluation of patients as to their renal functional statemay be mandatory when serum pro-gastrin-releasing peptide levelsare to be applied as one of the diagnostic tools for small-celllung carcinoma or as a marker monitoring their clinical courses.     

Ultrasonography-guided rectus sheath block in paediatric anaesthesia--a new approach to an old technique

Background. The purpose of this study was an anatomical andclinical evaluation of ultrasonography-guided rectus sheathblocks in children. Method. A total of 30 children were included in the sono-anatomicalpart of the study. The depth of the anterior and posterior rectussheath was evaluated with a portable SonSite 180 plus ultrasoundmachine and a 5–10 MHz linear probe. In total, 20 consecutivechildren undergoing umbilical hernia repair were included inthe clinical part of this study. After induction of generalanaesthesia children received a rectus sheath block under real-timeultrasonographic guidance by placing 0.1 ml kg^–1 bilaterallyin the space between the posterior aspect of the sheath andthe rectus abdominis muscle. Results. Ultrasonographic visualization of the posterior rectussheath was possible in all children. The correlation betweenthe depth of the posterior rectus sheath and weight (adjustedr²=0.175), height (adjusted r²=0.314) and body surface area(adjusted r²=0.241) was poor. The ultrasound-guided rectus sheathblockade provided sufficient analgesia in all children withno need for additional analgesia in the perioperative period. Conclusion. The bilateral placement of levobupivacaine 0.25%0.1 ml kg^–1 in the space between the posterior aspectof the rectus sheath and the rectus abdominis muscle under real-timeultrasonographic guidance provides sufficient analgesia forumbilical hernia repair. The unpredictable depth of the posteriorrectus sheath in children is a good argument for the use ofultrasonography in this regional anaesthetic technique in children.      

Drug interaction between sevelamer and cyclosporin.

This letter was originally published in NDT volume 19, issue7, but without the Reply. The publisher would like to apologisefor this error and would now like to publish the paper againto include the Reply. Sir, We read with interest the original report     

Renal magnification by EGF

A paper recently published by Groenestege and colleagues [8]used positional cloning to determine the cause of a rare inheritedmagnesium-wasting syndrome, autosomal recessive renal hypomagnesemia.The results showed that certain mutations in the epidermal growthfactor (EGF) gene cause this disease. This suggests, perhapssurprisingly, that EGF and its receptor comprise a previouslyunrecognized signaling pathway in the human kidney that participatesimportantly in magnesium homeostasis. The EGF gene is highlyexpressed along the distal convoluted tubule (DCT), an importantsite for regulating urinary magnesium excretion. The productof the gene is a large membrane-bound molecule, expressed atboth the apical and basolateral surfaces. A portion of the extracellulardomain can be cleaved     

Schistosomal-specific nephropathy in Syrian golden hamsters: treatment by induction of antigen excess

One hundred and twenty Syrian golden hamsters were infectedwith Schistosoma mansoni cercariae and 20 served as negativecontrols (group I). Of the S. mansoni-infected hamsters, 20served as positive controls (group II) and 100 hamsters weretreated for 12 weeks post-infection by loading with S. mansoniadult worm antigen. Animals were divided into groups accordingto the dose of adult worm antigen injected: group III (5-foldincrease in circulating antigen concentration), group IV (10-foldincrease), group V (20-fold increase), group VI (40-fold increase),and group VII (80-fold increase). Each of the groups was subdividedinto four groups (sacrificed at 1, 2, 4 or 7 days after initiationof antigen loading or the corresponding time points in the caseof the control groups). At sacrifice, blood and urine were obtainedfor laboratory assessment (serum creatinine, protein, albumin,cholesterol and urinary proteins). Kidney, liver and spleentissue specimens were obtained for light, immunofluorescentand electron microscopic examinations. At sacrifice, significantproteinuria, hypoalburninaemia and hypercholesterolaemia wereobserved in S. mansoni-infected hamsters when compared withnegative control animals. Histopathologic assessment showedchanges compatible with those previously reported, mainly immunecomplex glomerular deposits, mesangial proliferation and renalamyloid deposits. Significant laboratory improvement was observedin animals treated with antigen loading, especially those treatedwith 80-fold antigen excess and sacrificed at 7 days postinitiationof treatment. Histopathologic evaluation showed significantlyless immune complex glomerular deposits, less mesangial hyperplasia,and less amyloid deposits in hamsters treated with antigen loading.It is concluded that induction of antigen excess by antigenloading induces biochemical and histopathologic regression ofschistosomal-specific nephropathy in S. mansoni-infected Syriangolden hamsters.     

Immunological studies of IgA nephropathy in blacks reveal elevations of serum IgA2 as well as IgA1

Although IgA nephropathy (IgAN) is recognized worldwide as themost common primary glomerulonephritis, the prevalence of thisdisease among American blacks is strikingly low despite thefrequency of other renal disorders. We have previously describedthe clinical features of 27 black patients enrolled in a multicentreIgAN database; in this paper we report several immunologicalparameters of the disease in this population. Quantificationof serum immunoglobulins revealed significantly higher concentrationsof total IgA, IgAl and IgA2 (P=0.0001, 0.002 and 0.005 respectively)in the patients, but no significant increases in IgG or IgM.Examination of immunoglobulin synthesis by peripheral bloodlymphocytes indicated relatively few differences in the secretionof immunoglobulins by patients compared to healthy Americanblacks. The spontaneous production of total IgA, IgA1, and IgA2in patients was depressed compared to the control subjects (P=0.02,0.04, 0.03,), yet the ratio of IgA1:IgA2 was normal. Stimulationwith poke-weed mitogen enhanced secretion of immunoglobulinin both subject groups. However, a significantly greater IgA1:IgA2ratio was noted in the patients (P=0.002). Circulating immunecomplexes containing C3 and IgA as well as C3 and IgM were elevatedin the patients (P=0.0006, 0.0003 and 0.02, respectively). Theseimmunological aberrancies did not correlate with clinical manifestationsof disease. These data suggest the immune abnormalities of blackIgAN patients are similar to, but not identical with, thoseof white patients.     

Is the afferent arteriole the main location of nitric oxide action and synthesis in humans?

Sir, I read with great interest the recently published paper by Delleset al. [1] on the role of nitric oxide (NO) in regulating renalhaemodynamics in humans. The authors focused their attentionon the changes that NO synthase inhibition with N^G-monomethyl-L-arginine     

Reply

Sir, We read with interest the comments made on our paper [1] byCipleu et al., who raise the issue of the elegibility of stenosesfor surgical or endovascular treatment (PTA) in arteriovenousfistulae (AVFs). Cipleu et al. were concerned by the very high rate     

Erratum

A most unfortunate error occurred in the paper Zhang, G. andEl Nahas, A.M. ‘The effect of rhubarb extract on experimentalrenal fibrosis’, NDT 1996, 11: 186–190. Figure 3 did not show the changes the authors had been referringto in their paper. This was due to a mix-up of reproductionsin the evaluation and production process for which we apologizeto the authors.     

EFFECTS OF ENFLURANE ON CARDIOVASCULAR FUNCTION

Throughout the text of this paper, and in figure 3, the indexof myocardial contractility, dp/dt IIP, should have been expressedas a ratio, dp/dt: IIP.     

Ultrasonographic detection of thickened joint capsules and tendons as marker of dialysis-related amyloidosis: a cross-sectional and longitudinal study

Dialysis-related amyloidosis is characterized by a ß₂-microglobulin(ß₂M) infiltration of joint synovia, tendons and capsules.We report a cross-sectional ultrasonographic evaluation of supraspinatustendon and femoral neck capsule thickness in 49 patients onlong-term haemodialysis. Ultrasonographic evaluation was repeated21±4 (SD) months later in 16 patients. Normal valuesfor the supraspinatus tendon and femoral neck capsule were definedin a group of control subjects without history or signs of jointdisease. Among the 49 patients, aged 21–86 (median 59) years, dialysedfor 1–228 (median 97) months, 33 had at least one abnormaljoint. The prevalence of patients with at least one and at leasttwo abnormal joints, the number of abnormal joints per patient,and the thickness of the supraspinatus tendon and femoral neckcapsule increased significantly with dialysis duration (P<0.001 for all parameters considered). By multiple linear regressionanalysis, mean thickness of the supraspinatus tendon was positivelyrelated to both dialysis duration (P< 0.0001) and age (P= 0.036) independently. All (n=11) patients with radiological and/or histological evidenceof dialysis-related amyloidosis at the time of ultrasonographyhad thickened supraspinatus tendon and/or femoral neck capsule;which were also thickened in an additional 22 patients withoutradiological evidence of dialysis-related amyloidosis. Threedied within 5–10 months of the ultrasonographic investigation: post-mortem examination of the periarticular tissue confirmedthat the detected thickening was due in all three to ß₂Mamyloid infiltration. Sixteen patients underwent a second ultrasonographic evaluation21±4 months later. In nine patients on dialysis for <60months at the time of the first evaluation, mean femoral neckcapsule thickness increased significantly (7.0±0.8 to8.2±2.3mm, P = 0.017) whereas mean supraspinatus tendonthickness increment was not significant (6.6±0.4 to 7±0.8mm, P=0.23). In the seven other subjects dialysed for <60months, neither the supraspinatus tendon nor femoral neck capsulethickness changed. We suggest that ultrasonographic measurement of supraspinatustendon and femoral neck capsule thickness is a useful, non-invasivetool to detect and monitor dialysis-related amyloidosis.     

Onset of acetaminophen analgesia: comparison of oral and intravenous routes after third molar surgery

Background. The purpose of this randomized double-blind studywas to compare the efficacy and safety of propacetamol 2 g (ani.v. acetaminophen 1 g formulation) administered as a 2-minbolus injection (n=50) or a 15-min infusion (n=50) with oralacetaminophen 1 g (n=50) or placebo (n=25) for analgesia afterthird molar surgery in patients with moderate to severe painafter impacted third molar removal. Methods. All patients were evaluated for efficacy during theinitial 6 h period after treatment administration (T₀) and forsafety during the entire week after T₀. Results. The onset of analgesia after propacetamol was shorter(3 min for bolus administration, 5 min for 15-min infusion)than after oral acetaminophen (11 min). Active treatments weresignificantly better for all parameters (pain relief, pain intensity,patient's global evaluation, duration of analgesia) than placebo(P<0.05). Adverse events were more frequent after propacetamol,especially pain at the injection site. Propacetamol bolus resultedin a much higher incidence of local adverse events than theinfusion (propacetamol bolus 90% vs propacetamol infusion 52%)with no clinically significant benefits in terms of analgesicefficacy. Conclusion. I.V. propacetamol, administered as a 15-min infusion,is a fast-acting analgesic agent. It is more effective in termsof onset of analgesia than a similar dose of oral acetaminophen.     

Early initiation of dialysis fails to prolong survival in patients with end-stage renal failure

Sir, We write to express our concern about a letter recently publishedin NDT by Van Biesen et al. [1]. In this letter regarding initiationof dialysis, attention was drawn to our recent paper on thissubject [2]. In our study, we concluded that starting dialysisfor end-stage renal failure based on patients’ symptomsrather than level of renal function did not disadvantage thesepatients in terms of survival. Van Biesen et al. made two specific     

A NEW VALVELESS ALL-PURPOSE VENTILATOR: Clinical Evaluation

Preliminary clinical evaluation of a new ventilator, which embodiesa new valveless design principle and a circuit which is opento atmosphere, has been performed on adult patients undergoingsurgery. Using normal respiratory fresh gas flows (100ml kg^–1min^–1) PaCO₂ and PaO₂ were the same as with a conventionalventilator. High frequency ventilation (HFV) up to 100 b.p.m.caused no statistically significant changes in PacO₂ and PaO₂.The peak airway pressures were 30% less than with a Manley ventilatorand decreased by a further 40% during HFV. PEEP, NEEP, CPAPand IMV were easily applied.