Simple bone cysts in children treated with methylprednisolone acetate

Eleven children with simple bone cysts in the proximal humerus metaphysis were treated with intracavity infiltration of methylprednisolone acetate. Nine patients were treated once; the remainder required second injections. Five lesions resolved completely, while six healed sufficiently to eliminate the risk of pathologic fracture, and to permit physical activities without restrictions. Simple bone cysts can be treated satisfactorily with injection of methylprednisolone acetate, thus obviating surgery.     

拉米夫定联合甲泼尼龙片及来氟米特治疗乙型肝炎病毒相关性肾炎

目的 探讨拉米夫定联合甲泼尼龙片及来氟米特治疗乙型肝炎病毒相关性肾炎的疗效和安全性,以寻找HBV-GN有效的治疗方案指导以后的临床治疗.方法 选择20例HBV-GN患者,通过肾穿刺检查确定病理类型,观察在常规治疗的基础上加用拉米夫定联合甲泼尼龙片及来氟米特的近期疗效,疗程1年,观察治疗前后尿蛋白定量、血清白蛋白、肝肾功能、HBV标志物及HBV-DNA的变化情况及所有不良反应.结果 HBV-GN的病理分型:MsPGN6例(30％),IgAN6例(30％),MN5例(25％),MPGN3例(15％).以拉米夫定联合甲泼尼龙片及来氟米特治疗乙型肝炎病毒相关性肾炎总有效率80％ (16/20),显效率60％(12/20),未发现严重不良反应.结论 成人HBV-GN病理类型以IgAN、MsPGN为主,HBV-GN患者治疗前、后尿蛋白定量的多少并不取决于其病理类型及乙肝病毒活跃程度,拉米夫定联合甲泼尼龙片及来氟米特治疗HBV-GN的疗效与病理类型及乙肝病毒活跃程度无关;以拉米夫定联合糖皮质激素及来氟米特治疗HBV-GN疗效显著,安全、费用较低,值得临床推广应用.     

Systemic hypertension in patients with glomerulonephritis

Although systemic hypertension is very common in patients with glomerulonephritis there is a dispute if this alteration is consequence of the glomerulonephritis "per se" or is a consequence of the renal failure secondary to the glomerular lesion. With the aim to analyze the factors associated with systemic hypertension, 196 patients with different forms of nephritis were studied. The systemic arterial pressure was measured by standard sphygmomanometer, renal function was evaluated by the determination of the serum creatinine concentration or creatinine clearance. The diagnosis of the type of glomerulonephritis was made on the basis of an examination of kidney biopsy specimens. The prevalence of arterial hypertension among patients with glomerulonephritis was 62.7%. The hypertensive patients were older (hypertensive = 30.6 +/- 12.8; normotensive = 25.4 +/- 1.6 years; P = 0.03). The prevalence of arterial hypertension was lower in patients with minimal glomerular lesion (12.5%), though their ages were also lower (18.1 +/- 3.6 and 29.1 +/- 1.03 years; P = 0.03). Arterial hypertension did not correlate with the serum levels of creatinine and albumin; creatinine clearance and 24-h proteinuria. IN CONCLUSION: In the patients with glomerulonephritis, the presence of arterial hypertension was associated with a higher mean age whereas the intensity of proteinuria, the level of renal function or the type of glomerulonephritis was not different between the two groups.     

Increased release of myeloperoxidase in vitro from neutrophils of patients with myeloperoxidase-specific anti-neutrophil cytoplasmic antibody (MPO-ANCA) related glomerulonephritis

Summary: In order to elucidate the role of neutrophils in the pathogenesis of MPO-specific anti-neutrophil cytoplasmic antibody (MPO-ANCA) related glomerulonephritis (GN), MPO release, beta-glucuronidase (BGL) release, superoxide anion (O₂⁻) production from the neutrophils of patients with MPO-ANCA related GN were measured. the effect of plasma on MPO release from neutrophils was also studied in patients with MPO-ANCA related GN. Neutrophils and plasma were obtained from patients with MPO-ANCA related GN, GN unrelated to MPO-ANCA and healthy controls. MPO release from the neutrophils of patients with MPO-ANCA related GN was higher than that of controls significantly. This was also higher than that in patients with GN unrelated to MPG-ANCA, but this was not statistically significant. Superoxide anion production from neutrophils of patients with MPO-ANCA related GN was significantly higher than that in patients with GN unrelated MPO-ANCA, However, BGL release was not significantly different among three groups. Furthermore, MPO release and O₂⁻ production increased in parallel with clinical activity of MPO-ANCA related GN. Neutrophils of patients with MPO-ANCA related GN showed to be significantly more sensitive to FMLP on MPO release than those in the other two groups. However, plasma from MPO-ANCA related GN increased the sensitivity to FMLP on MPO release, but not BGL release, in neutrophils obtained from healthy controls, whereas it suppressed MPO release from neutrophils with MPO-ANCA related GN. This suggests that in patients with MPO-ANCA related GN MPO can be highly released from activated neutrophils and that the plasma of patients with MPO-ANCA contains factor(s) which modulate reactivity of neutrophils.     

Histologic characterization of acute spinal cord injury treated with intravenous methylprednisolone

OBJECTIVE: Many substances have been investigated for attenuation of spinal cord injury after acute trauma; however, pharmacologically only steroid administration has shown clinical benefits. This study attempts to characterize local spinal cord histologic response to human dose equivalent (HDE) intravenous methylprednisolone (MP) administration in a rodent model of acute spinal cord injury. DESIGN: Forty-eight Sprague-Dawley rats were divided equally into control and experimental groups. Each group was subdivided into eight sets of three animals each, according to postinjury intervals. Paraplegia after lower thoracic laminectomy was achieved using a standardized weight drop technique. INTERVENTION: Within one hour, experimental animals were treated with HDE MP followed by 23-hour continuous infusion of HDE MP. Spinal cords were harvested at variable intervals postinjury and prepared for histologic/immunohistochemistry examination. MAIN OUTCOME MEASUREMENTS: Edema, necrosis, and glial fibrillary acidic protein (GFAP) positivity in the specimens from treated/control groups were graded by microscopy and immunohistochemistry staining and compared in a blinded manner by a qualified neuropathologist and senior authors. RESULTS: Minimal differences were observed between control and MP-treated animals at zero and four hours. At eight hours, increased white matter and medullary edema was evident in control versus MP-treated rats. This trend continued through twelve, sixteen, twenty-four, forty-eight, and seventy-two hours. No difference was observed in the astrocytic response to injury by GFAP immunohistochemistry between the groups. CONCLUSIONS: Histologically, MP reduces the development of severe edema and preserves spinal cord architecture adjacent to the site of injury. In contrast, MP does not alter the development of spinal cord necrosis or astrocytic response at the zone of injury.     

Lymphocyte function in patients with chronic glomerulonephritis

Lymphocyte suppressive activity after stimulation with Con A and lymphocyte function as the effectors in the ADCC test had been examined in 68 patients with chronic glomerulonephritis (GN) and in 20 healthy controls. Lymphocyte suppressive activity was lower in patients with chronic GN than in the healthy individuals. In regard to chronic proliferative GN and mesangial GN the difference was statistically significant. The lymphocyte efficiency in the ADCC test was generally adequate in patients with chronic GN and none of the morphological types showed significant deviation from the control group. In the general analysis of patients with chronic proliferative, mesangial, membrano-proliferative and membranous GN a decrease of lymphocyte suppressive activity below the lower standard limit has been detected (45% of cases). A similar defect in lymphocyte function in the ADCC test has been found in 18.6%. A statistically significant relationship between the lymphocyte function disorders and the high clinical dynamism of GN has been noticed, although in some cases there was a deviation from this tendency. It is supposed that circulating immune complexes, detected in some patients with chronic GN are not the only decisive factors responsible for defects in lymphocyte function.     

Antimyeloperoxidase antibodies in patients with extracapillary glomerulonephritis

The sera of 64 patients with extracapillary glomerulonephritis were investigated by enzyme-linked immunosorbent assay for the presence of antibody to human neutrophil myeloperoxidase (MPO). In all, circulating anti-MPO were found in 30% and antineutrophil cytoplasm antibodies (ANCA) detected by indirect immunofluorescence in 44% of the patients. Autoantibody to components of neutrophil granulocytes was not found in patients with other forms of glomerulonephritis. The incidence of ANCA (16/23) was higher than that of anti-MPO (5/23) in patients with a diagnosis of Wegener's granulomatosis. By contrast, anti-MPO was found in a majority of vasculitis patients without extrarenal symptoms (6/9), including 3 patients treated with hydralazine. One of the patients treated with hydralazine had circulating ANCA in combination with anti-MPO. Anti-MPO was also found in 1 out of 6 patients with Goodpasture's syndrome. The findings emphasize that autoantibodies to distinct components of neutrophil granulocytes partly differ with regard to diagnostic specificity.     

Circulating anti-entactin antibodies in patients with glomerulonephritis

Sera from 305 consecutive patients in a renal biopsy series were analyzed for the presence of anti-entactin antibodies by ELISA. Of these patients, 59% had primary glomerulonephritis, 21% had secondary glomerulonephritis, while 20% had other nephropathies (noninflammatory conditions like amyloidosis, diabetic nephropathy, nephrosclerosis, etc.). Forty-one of these patients (13.4%) were positive for IgG/IgM antibodies against entactin: 60% of them had primary glomerulonephritis, 35% had secondary glomerulonephritis, while the remaining 3 patients had other nephropathies. Fifteen (70%) of the 23 patients with primary glomerulonephritis had proliferative glomerulonephritis (PGN), whereas 13 (87%) of the 15 patients with secondary glomerulonephritis were due to systemic connective tissue diseases (SCTD): 7 due to SLE, 4 due to SLE like SCTD and two due to other SCTD. There was a peak of incidence corresponding to the group aged 18 to 30 years. A majority of these patients (12 of the total 17) had primary glomerulonephritis and were associated with nephrotic or subnephrotic grade proteinuria, poorly or nonresponsive to immunosuppressive treatment and associated, in several cases, with progressive deterioration of renal function. In addition, there was a tendency to another peak in the age group 51 to 60 years. Most of these patients (6 of the total 8) had glomerulonephritis secondary, mainly, to SLE or SLE like SCTD with milder degree of proteinuria and better preserved renal functions. Anti-entactin antibodies were not found in certain glomerulonephritides like IgA nephropathy and those secondary to systemic vasculitides and in control subjects (healthy subjects, and patients with a variety of non-renal disorders including inflammatory diseases).(ABSTRACT TRUNCATED AT 250 WORDS)     

腰椎管狭窄症手术中甲基强的松龙预防性应用的临床研究

目的探讨甲基强的松龙(MP)预防性用药对腰椎管狭窄症行椎管探查减压及神经根管减压术后后遗症的影响.方法我院从1994年至2004年行腰椎管狭窄症手术患者共140例.单纯椎板及神经根管减压75例(对照组),术后常规采用地塞米松、速尿、甘露醇等消肿方法治疗;行减压+椎弓根螺钉内固定+椎间融合或后外侧植骨融合+MP预防性用药65例(MP组).随访观察两组患者术后并发症及后遗症的发生情况.结果随访6个月～10年,平均5.3年.对照组发生切口感染1例,并发脑脊液漏3例,神经根袖损伤4例,神经根不同程度牵拉伤10例,18例出现后遗症,表现为不同程度疼痛、麻木、肌力下降,后遗症发生率为24.0%;MP组发生神经根袖损伤3例,神经根不同程度牵拉伤8例,但均无术后疼痛,仅3例后遗麻木,无1例患者出现应激性溃疡,后遗症发生率为4.62%,显著低于对照组(P＜0.01).结论腰椎管狭窄症手术时预防性应用MP能明显提高神经根对牵拉碰擦等医源性接触的耐受性,可明显减少术后根性疼痛及下肢神经症状的发生率.     

Non-Goodpasture anti-GBM antibodies in patients with glomerulonephritis

The sera of 206 consecutive patients with biopsy-proven glomerulonephritis were tested by ELISA for the presence of Goodpasture and non-Goodpasture anti-GBM antibodies. Antigens were solubilised from human GBM with purified bacterial collagenase and with 6 mol/l guanidine-HCl respectively. Only 12 sera reacted when collagenase-resistant GBM proteins were used as antigens in ELISA. Sera from two of these patients also reacted with the Goodpasture antigen, that is the globular domain of collagen IV, purified from collagenase extracts of GBM. These two patients had classical Goodpasture syndrome with linear crescentic nephritis. The other ten sera did not react with the Goodpasture antigen and immunofluorescence microscopy showed granular glomerular immune deposits. Antibodies against antigens present in 6 mol/l guanidine-HCl extracts of human GBM were much more frequent, particularly in lupus nephritis and IgA nephropathy, but relatively common also in patients with glomerulonephritis associated with systemic connective tissue and systemic vasculitic disorders. In contrast, these non-Goodpasture antibodies were only sporadic in primary forms of glomerulonephritis such as minimal-change nephropathy, membranous glomerulopathy, or acute post-infectious glomerulonephritis. The presence of circulating IgG, IgA or IgM antibodies against 6 mol/l guanidine-HCl extractable GBM antigens correlated with granular deposits of corresponding immunoglobulins in both mesangial and capillary loop regions of glomeruli, indicating a possible pathogenic role for non-Goodpasture anti-GBM antibodies in several forms of glomerulonephritis.     

Plasma lipids in patients with chronic glomerulonephritis

The author examined 78 patients with chronic glomerulonephritis and verified their diagnosis on the basis of the kidney biopsy data. With regard to the severity of the tubular interstitial component the patients were enrolled in three groups. It was stated that with the increasing changes developed in the tubular interstitial component, the levels of total cholesterol, cholesterol of high density lipoproteins, low density lipoproteins and triglyceride elevated. In the group of the patients with minimal changes in the tubular interstitial component, the number of those in whom plasma lipid levels were below the upper normal limits was higher than in two other groups. A direct proportional relationship between the levels of plasma lipids and severity of the tubular interstitial component indicated the immediate role of the renal tissue in the pathogenesis of lipid turnover disorders in patients with chronic glomerulonephritis.     

Clinical and histological observation of HBV glomerulonephritis treated with interferon-beta

Hepatitis B virus carriers, a 30-year-old man (case 1) and a 31-year-old man (case 2), associated with nephrotic syndrome were treated with interferon-beta. The nephrotic syndrome did not respond to corticosteroid therapy. Their HBs-Ag, HBe-Ag and HBc-Ab were positive. Renal biopsies revealed membranous glomerulonephritis in case 1 and mixed membranous and proliferative glomerulonephritis in case 2. Direct immunofluorescence studies showed strong granular staining of the GBM with IgG and using sandwich technique with anti-HBe antiserum, granular deposits were seen throughout the GBM. Patients were administrated mainly 3-6 x 10(6) IU/day interferon-beta intravenously for four weeks. After transitory elevation of serum transaminase, HBe-Ag and DNA-polymerase have disappeared with development of HBe-Ab (seroconversion) about six months after the end of interferon-beta administration. Then nephrotic syndrome has recovered in incomplete remission after a year and a half follow-up. The secondary renal biopsy in case 1 showed less intense deposits of HBe-Ag along GBM. These facts suggest that the improvement of proteinuria is associated with the decrease in HBV replication due to interferon therapy.     

Circulating autoantibodies in patients with extracapillary glomerulonephritis.

Circulating autoantibodies, namely c-ANCA, MPO-ANCA, anti-Goodpasture (anti-NC1), and anti-entactin antibodies were analysed in sera from 82 consecutive patients with crescentic involvement of more than 50% glomeruli in renal biopsy specimens. Sixty-eight (approximately 83%) patients possessed one or more of these autoantibodies. About two-thirds of all patients had ANCA (c-ANCA, MPO-ANCA or both). Most of the remaining positive patients had anti-NC1 antibodies. Very few patients had anti-entactin antibodies, thereby suggesting a poor association of these antibodies with extracapillary glomerulonephritis (ECGN). Thus two different categories of patients, one possessing ANCA and the other anti-NC1 antibodies, could be recognised. Patients with anti-NC1 antibodies were characterised by linear immune deposits along the glomerular basement membrane and the clinical outcome was invariably grim. On the other hand, despite no significant difference in renal morphology from patients with anti-NC1 antibodies, the disease in patients with ANCA, in general, had a milder course. Among patients with ANCA, those with c-ANCA mainly had systemic small-vessel vasculitis with widespread systemic manifestations, whereas most patients with renal restricted primary ECGN with non-linear immune deposits possessed MPO-ANCA. Furthermore, patients with c-ANCA had a more severe disease than those with MPO-ANCA. These observations indicate that a continuous spectrum of diseases exists between idiopathic small-vessel vasculitides and primary non-linear ECGN. Our study also demonstrates that the presence of auto-antibodies is a dominant feature of severe ECGN and that the type of immunological injury is more important than the extent of crescentic involvement of glomeruli in determining the course of illness in patients with ECGN.