Melorheostosis and FGF-23: Is there a relationship?

Melorheostosis is a rare chronic bone disease of unknown etiology that often affects lower limbs. Onset usually occurs in childhood or early adolescence. The diagnosis relies on the radiographic finding of hyperostosis within or around the cortex responsible for a "flowing wax" appearance. To our knowledge, Fibroblast growth factor-23 (FGF-23) levels have not yet been quantified in melorheostosis. We report an unusual case of this disease for whom the diagnosis of fibrous dysplasia had been wrongly made for a long period of time and the FGF-23 concentration has been found very high without any disturbance of serum phosphate.     

Uric acid and cardiovascular disease: a renal-cardiac relationship?

Elevated serum uric acid is a frequent finding in patients with kidney disease and cardiovascular disease. Intrarenal ischaemia, induced by hypertension, increased sympathetic nervous system activity, and hyperinsulinaemia have all been implicated in reduced renal clearance of urate. This frequently results in elevated serum uric acid levels. The association of hyperuricaemia with cardiovascular disease remains controversial. Current evidence suggests that serum uric acid may provide additional prognostic information in patients with essential hypertension. However, there has been no test of the hypothesis that a reduction in serum uric acid would prevent cardiovascular disease. Furthermore, a critical review of the current literature does not support a causal role of serum uric acid in the development of cardiovascular disease. Serum uric acid probably reflects and integrates different risk factors and their possible interactions.     

Study on the relationship between serum sexual hormones, interleukin-1 and TNF-α in vasectomy and vasovasostomy rabbits

To investigate the interrelationship of serum interleukin-1 (IL-1), tu-mor necrosis factor-a (TNF-α), testosterone (T) and estradiol (E_2)in infer-tile rabbits. Rabbits were divided into the vasectomy group(VG), the vaso-vasostomy fertility group (VFG), the vasovasostomy infertility group(VIG) and the sham operation (control) group ( SOG ). The results are as-follows: (1) The serum T in VIG is the lowest, which has a significantlylower T than those of the SOG and VFG; The serum T of VIG is higher     

Arterial stiffness and hand osteoarthritis: a novel relationship?

OBJECTIVE: Osteoarthritis (OA) and vascular stiffening may share elements of common pathogenesis, but their potential relatedness has been the focus of little prior inquiry. We tested the hypothesis that these two aging-associated conditions are related to each other. METHOD: We analyzed cross-sectional data from 256 participants of the Baltimore Longitudinal Study of Aging (BLSA), a study of normative aging. All underwent measurement of arterial pulse wave velocity (PWV), an index of vascular stiffness, as well as hand radiographs that were graded for evidence of OA. Twenty total joints across three joint groups (distal interphalangeal [DIP], proximal interphalangeal [PIP], carpal-metacarpal [CMC]) were each assigned a Kellgren-Lawrence grade (K-L) of 0 (normal) through 4 (severe), with K-L grades >or=2 considered evidence of definite OA. Radiographic hand OA was defined as definite OA changes in at least two of the three anatomic hand sites (DIP, PIP, CMC). OA burden was represented by the total number of affected OA joints, and a cumulative K-L grade was aggregated across all hand joint groups. The relationship of PWV with these three measures of hand OA was assessed by linear regression. RESULTS: Upon univariate analysis, the presence of radiographic hand OA (beta=218.1, P<0.01), the total number of OA joints (beta=32.9, P<0.01), and the cumulative K-L grade across all joint groups (beta=12.2, P<0.01) were each associated with increased PWV. These associations, however, were no longer significant in age-adjusted models. CONCLUSION: Although significant individual relationships between PWV and several measures of hand OA were observed, these associations were largely attributable to the confounding effect of age.     

Is there any relationship between serum levels of interleukin-10 and atherosclerosis in hemodialysis patients?

OBJECTIVE: Cardiovascular complications due to atherosclerosis (AS) are the major cause of mortality in hemodialysis (HD) patients. Inflammation may play an important role in the development of AS. Several studies have demonstrated an association between AS and acute-phase proteins and cytokines in the general population and in HD patients. Interleukin-10 (IL-10) is an anti-inflammatory cytokine. The aim of this study was to compare serum levels of inflammatory and anti-inflammatory indicators in HD patients according to the presence or absence of AS. MATERIAL AND METHODS: A total of 33 HD patients were studied. AS was defined as the presence of plaques as detected by Doppler ultrasonography. The patients were subgrouped according to the presence or absence of plaques. Serum levels of IL-1, -2, -6 and -10, C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-alpha) were measured. Risk factors for AS, such as age, gender, hypertension, hyperlipidemia and duration of HD, were also evaluated. RESULTS: Patients with AS had significantly higher high sensitivity (hs)-CRP and lower IL-10 levels. Blood pressure was also elevated in patients with AS. There was an inverse correlation between CRP and IL-10 levels in patients with AS. CONCLUSION: Patients with AS undergoing HD had low serum levels of the anti-inflammatory cytokine IL-10 and high serum levels of hs-CRP. These results may suggest that limitation of the anti-inflammatory response in atherosclerotic uremic patients is a triggering or contributory factor for AS.     

Changes of interleukin-1 β, tumor necrosis factor α and interleukin-6 in brain and plasma after brain injury in rats

Objective: To study the changes of interleukin-1 β(IL-1β), tumor necrosis factor α (TNFα) and interleukin-6 (IL-6) levels in brain and plasma after brain injury and to assess the relationship between the cytokine levels and injury severity in rats. Methods. A total of 51 male Wistar rats, weighing 280-340g, were anesthetized with chloral hydrate(400 mg/kg body weight) through intraperitoneal injection and fixed on a stereotaxic instrument. Severe brain injury was created in 16 rats (severe injury group) and moderate brain injury in 18 rats (moderate injury group) by a fluid percussion model, and cytokine levels of IL-1β, TNFα and IL-6 were measured with biological assay. And sham operation was made on the other 17 rats (control group). Results: In the control group, the levels of IL-1β,TNFα and IL-6 were hardly detected in the cortex of the rats, but in the ipsilateral cortex of the rats in both injury groups, they increased obviously at 8 hours after injury.The increasing degree of these cytokines had no significant difference between the two injury groups. The levels of IL-6 in the plasma of all the rats increased slightly, whereas the levels of IL-1β and TNFα were undetectable. Conc|usions: The increase of IL-1β, TNFα and IL-6 levels is closely related to brain injury. The increased cytokine levels in the central nervous system are not parallel to those in the peripheral blood. It suggests that inflammatory cytokines play important roles in the secondary neural damage after brain injury.     

Foot orthoses and dental appliances—Is there a relationship?

BackgroundThis investigation was aimed at examining whether subjects who wear a combination of functional foot orthoses and dental appliances have less postural sway and furthermore to study if these changes are direction dependent.MethodsCentre of pressure (CoP) displacement in seven subjects, mean age 49 range (39–58) who met the inclusion criteria were evaluated using a pressure platform. Total displacement of the centre of pressure, the reduction in the displacement about the origin, area of the ellipse, total displacement along the x- and y-axes and frequency of sway along the anterior–posterior and mediolateral axes were estimated under four conditions, namely wearing orthoses and appliances, wearing only orthoses, only appliances and finally wearing neither orthoses nor appliances.ResultsIn the six patients who had class II malocclusion there was no significant difference between the displacement (z = 0.314 and p = 0.753) and the frequency (z = 0.680 and p = 0.496) of sway along the medio-lateral or anterior–posterior axes. Under control conditions the mean path length was 780 (SD 415) mm, the mean deviation from origin was 4.76 (SD 5.8) mm and the mean area was 0.83 (SD 1.87) mm²/cm². The mean deviation from origin was seen to reduce under all experimental conditions. Wearing the dental appliance alone was seen to be the most effective although the difference was not statistically significant. The sway area was also seen to reduce under all experimental conditions. The sway was most reduced when participants were wearing orthoses (i.e. conditions 1 and 3) with the reduction being the greatest when the orthoses was worn on its own (i.e. condition 3).ConclusionWhile, foot orthoses have been used for the relief of symptoms either within or extrinsic to the foot, they could have a much wider role in the management of patients with stability problems. Results from this study highlight the need for further research in this exciting and as yet unexplored area.     

Is there a relationship between trauma center volume and mortality?

BACKGROUND: The guidelines for Level I trauma center verification require 1,200 admissions per year. Several studies looking at the relationship between hospital volume and outcomes after injury have reached conflicting conclusions. The goal of our study was to examine the relationship between patient volume and outcomes (mortality and length of hospital stay) in California's trauma centers. METHODS: Data for patients >or= 18 years old admitted after injury (n = 98,245) to a Level I or II trauma center (n = 38) in 1998 and 1999 were obtained from the Patient Discharge Data of the State of California. Hospital volume was derived from the annual number of admissions per center, and covariates including age, sex, mechanism of injury, Injury Severity Score, and trauma center designation were analyzed. RESULTS: Hospital volume was not a significant predictor of death or length of hospital stay. More severely injured patients appeared to have worse outcomes at the highest volume centers. CONCLUSION: In our study, hospital volume was not a good proxy for outcome. Low-volume centers appeared to have outcomes that were comparable to centers with higher volumes. Perhaps institutional outcomes rather than volumes should be used as a criterion for trauma center verification.     

Is there a relationship between weather conditions and aortic dissection?

Background  

Bleeding and rupture of blood vessels has been correlated with weather conditions in the past. This is the first study in the world literature with the aim of investigating the relationship between atmospheric pressure and temperature with the presentation of aortic dissection.     

Is there a relationship between prostate volume and Gleason score?

OBJECTIVES

To review the relationship between the Gleason grade and prostate volume in biopsy and radical prostatectomy (RP) specimens, and thus assess the hypothesis that smaller prostates have a greater incidence of high‐grade tumours.

PATIENTS AND METHODS

We selected 390 patients who had RP at our institution, with a prostate‐specific antigen (PSA) level of <10 ng/mL and who had not had hormonal therapy. We retrospectively reviewed the data for transrectal ultrasonography (TRUS)‐guided prostate biopsies from these patients and the RP specimens. Indications for biopsy included a PSA level of ≥4 ng/mL or an abnormal digital rectal examination. High‐grade tumours were defined as having a Gleason score of ≥7.

RESULTS

The TRUS volume was statistically related to the rate of high‐grade tumours at biopsy and RP. On multivariate analyses, TRUS volume was a significant predictor of high‐grade tumour for biopsy and RP specimens, with an inverse relationship between high‐grade tumours and prostate volume for biopsy and RP specimens.

CONCLUSIONS

Our data suggest that there is a relationship between the rate of high‐grade tumours and prostate volume even in biopsy and RP specimens and it is not an artefact related to the biopsy.     

Vascular access and cardiac disease: is there a relationship?

PURPOSE OF REVIEW: Despite advances in hemodialysis technology, a stable and well functioning vascular access remains the bane of every hemodialysis patient. It is recognized that vascular access contributes to cardiovascular disease mortality through a number of mechanisms. This review describes the relationship between vascular access and cardiovascular disease by reviewing the relationships between infection risk, inflammation and cardiovascular disease, and the cardiovascular changes that occur as a consequence of vascular access. Improved understanding of these mechanisms and their interrelationship is warranted. RECENT FINDINGS: The impact of arteriovenous fistula creation on cardiac structural and hemodynamic changes is described, as is vascular remodelling, which occurs in response to alterations in blood-flow properties. The development of central and peripheral vein stenosis is also a type of vascular remodelling and consequences of such events are not yet well understood. In addition, the contribution of vascular access to increased inflammation and atherosclerotic disease is reviewed. Finally, the hypothesis that vascular access dysfunction may be a predictor of vascular disease is explored. SUMMARY: The relationship between vascular access and cardiac disease exists at different levels, ranging from inflammation promoting atherosclerotic disease to vascular remodelling changes of stenosis formation and left ventricular hypertrophy. Countless research opportunities abound.     

The individual patient and evidence-based medicine – a conflict?

The doctor–patient relationship is characterised by clinical situations that reflect different degrees of impairment of the patient’s quality of life on the one hand and different degrees of threat to the patient’s life on the other. Typical patterns of these situations from absent or minimal to severe impairment of well being or threat to life are described. With regard to this, the doctor–patient communication is still suffering from considerable deficits. For the latter, a possible philosophical framework and reason is given. The potential of evidence-based medicine to ease this conflict by bringing into the game the current best-available scientific evidence is discussed, and some inherent serious limitations of evidence-based medicine are shown. Besides these drawbacks, doctors are usually very reluctant and lazy to integrate evidence-based results into their daily practice. In the author’s view, evidence-based medicine is a reasonably new tool. However, it should not yet be overestimated in its potential to influence and improve daily clinical practice. Received: 9 March 1999 Accepted: 2 September 1999     

Chemonucleolysis and automated percutaneous discectomy – a prospective randomized comparison

In this prospective study 22 patients with painful disc herniations were randomized either to chemonucleolysis (CN) or automated percutaneous discectomy (APD). Preoperatively the Oswestry score was 44 points in the CN group and 41 points in the APD group. Except for a longer duration of preoperative leg pain in the APD group, clinical data were approximately the similar same in the two groups. In the APD group there was one intra-operative complication. Open revision surgery in the same segment was performed once in the CN group and twice in the APD group. Improvement of neurologic deficits and of Owestry score was significant in both groups. At 2 years after surgery the CN treated patients were significantly better with respect to Oswestry score, back pain and leg pain recurrence.

---

Résumé  Etude prospective de 22 patients avec hernie discale douloureuse. Randomisation entre un traitement par chimionucléolyse (CN) ou discectomie percutanée (APD). Avant l"intervention, le score d"Oswestry était de 44 points dans le groupe CN et de 41 points dans le groupe APD. A part une plus longue durée d"évolution douloureuse dans le groupe APD, les données cliniques étaient approximativement les mêmes dans les deux groupes. Il y a eu une complication opératoire dans le groupe APD. Une reprise chirurgicale classique fut nécessaire une fois dans le groupe CN, et deux fois dans le groupe APD. L"amélioration du déficit neurologique et du score d"Oswestry fut significative dans les deux groupes. 2 ans après le traitement, les patients traités par chimionucléolyse avaient des résultats significativement meilleurs compte-tenu du score d"Oswestry et de la récidive de douleurs lombaires ou du membre inférieur.

---

---

Accepted: 16 February 2000