Mycoplasma pneumoniae-associated nephritis in children

 Mycoplasma pneumoniae infection is a rare cause of acute nephritis. Six children (2 girls) aged 5–10 years, admitted for nephritis, had serological tests showing recent Mycoplasma pneumoniae infection. The diagnosis of Mycoplasma pneumoniae infection was based on the presence of serum IgM, detected either by immunofluorescence (IF) (n=1) or enzyme-linked immunosorbent assay (n=5). Four children had a renal biospy, with analysis of parenchymal Mycoplasma pneumoniae components by indirect IF and polymerase chain reaction. Extrarenal symptoms were: respiratory (n=3), ear, nose, and throat (n=2), gastrointestinal (n=3), hepatic (n=1), neurological (n=1), articular (n=1), and hematological (n=3). The patients presented with acute nephritis (1 had a nephrotic syndrome) or with acute renal failure and proteinuria. Pathological findings included type 1 membranoproliferative glomerulonephritis (MPGN, n=1), proliferative endocapillary glomerulonephritis (n=2), and minimal change disease (n=1). The patient with type 1 MPGN progressed rapidly towards end-stage renal failure because of a congenital solitary kidney. Among the patients with endocapillary glomerulonephritis, 1 relapsed 6 months later and remained proteinuric, while the other recovered, as did the child with minimal change disease. The search for Mycoplasma pneumoniae antigens and nucleic acids in renal tissue was negative. However, the absence of the microorganism in the kidney is a common feature of post-streptococcal glomerulonephritis. We conclude that Mycoplasma pneumoniae is a rare yet potential cause of acute glomerulonephritis. Received: 13 September 1996 / Revised: 16 June 1998 / Accepted: 18 June 1998     

Primary and transitional progressive MS: a clinical and MRI cross-sectional study

BACKGROUND: Ten percent of patients with MS have a progressive course from onset with no history of relapses or remissions. A smaller subgroup follow a similar progressive course but have a single relapse at some point (transitional progressive [TP] MS). To date these patients have been excluded from receiving licensed treatments for MS and from most therapeutic trials. OBJECTIVE: To document the clinical and MRI characteristics of a large cohort of progressive patients, including 158 with primary progressive (PP) MS and 33 with TPMS. Data from a small reference group of 20 patients with secondary progressive (SP) MS are also presented for reference. METHODS: Patients were recruited from six European centers. All underwent a clinical assessment including scoring on the Expanded Disability Status Scale (EDSS) and MRI of the brain and spinal cord. RESULTS: The men-to-women ratio was 81:77 (51% men) in the PP group, 14:19 (42% men) in the TP group, and 5:15 (25% men) in the SP group. The mean age at disease onset was significantly higher in the PP group than it was in the other two groups (PP 40.2 years, TP 34.9 years, SP 28.7 years). On MRI the PP group had lower mean brain T2 and T1 hypointensity lesion loads than the SP group (T2 12.02 versus 27.74 cm3, p = 0.001; T1 4.34 versus 7.04 cm3, p = 0.015). The SP and TP cohorts had significantly more T2-weighted lesions in the spinal cord than the PP patients, and the SP cohort had the greatest degree of atrophy. There was a correlation in the PP and TP patients between EDSS score and brain and spinal cord atrophy (r = 0.3, 0.2, p < or = 0.006) but not with brain lesion load. The PP and TP patients who presented with spinal cord pathology had significantly lower brain T2 and T1 lesion loads than those with non-spinal cord presentations (p = 0.002). CONCLUSIONS: The monitoring of disease progression in PPMS is difficult, although measures of atrophy correlate with the EDSS and appear most promising. This study increases our understanding of this unique patient group, which will be further expanded with the acquisition of serial data.     

大麻酚类受体—1在脊髓,背角,背根神经节和周围神经的分布

AIM: The localization of CB1 receptors in the spinal cord, spinal roots, dorsal root ganglion (DRG), and peripheral nerve of the rat was determined. METHODS: We studied the distribution of CB1 cannabinoid receptors by immunohistochemistry using an antibody raised against the N-terminal of the receptor. RESULTS: The spinal cord showed numerous transverse fibers labelled for CB1 receptors throughout and concentrated in the dorsal horn. Lightly-stained cells were observed throughout the spinal cord gray matter. The DRG also showed cells and fibers labelled for CB1 receptors. Labelled fibers were observed in both dorsal and ventral roots as well as in peripheral nerves. CONCLUSION: The presence of CB1 receptors in the DRG, the dorsal root, and the dorsal horn is in accordance with the analgesic effects of cannabinoids. The presence of labelled cells and fibers in the ventral horn and ventral root provides a substrate for cannabinoid-induced muscle relaxant and antispastic effects.     

Glycogen-rich clear cell carcinoma of the breast: A case report and review of the literature

A case of glycogen-rich clear cell carcinoma (GRCC) which arose in the right breast of a 35-year-old Japanese woman is reported. Light microscopic examination of the tumor revealed solid alveolar proliferation of clear cells containing abundant glycogen. Electron microscopy identified aggregates of glycogen particles and numerous empty glycogen lakes. This case is reported with a discussion on the other 42 GRCC cases reported in the international literature.     

Emerging state policy trends related to medical group practice: Alpha Center

This article examines how state health care policy affects new ventures involving medical group practices. It will review briefly traditional state authorities related to the health care sector in general and physician organizations in particular. The article will then discuss state policies related to a range of physician organizations, including those aligned with larger provider systems. State policies related to physician organization in the competitive marketplace include several topics: referral practices, tax exemption, corporate practice of medicine, and antitrust and insurance regulation. Finally, it will discuss the implications of these trends for future enterprises undertaken by medical group practices.     

The effects of nisoldipine on the total ischaemic burden: the results of the ROCKET study

This study was designed to examine the effects of nisoldipine(relative to placebo), a new dihydropyridine calcium entry blockingagent, in the treatment of silent ischaemia in conventionaldoses. A total of 409 patients with proven coronary artery diseasewere screened and of this 64 had at least six episodes or atotal duration of 30 mm of ST segment depression (1 mm lastingat least 1 min) over 48 h. Fifty-two patients ultimately completeda randomized double-blind cross-over study comparing nisoldipine5 mg twice a day, nisoldipine 10 mg daily and placebo. There was a reduction in the ST segment integral and numberof episodes of ST segment depression when compared to placeboon treatment with nisoldipine 5 mg twice a day and nisoldipine10 mg daily. However, the confidence limits were wide and crossedthe no-treatment effect line. In addition, the nisoldipine dosesneither affected the circadian distribution of ischaemic episodesnor caused an alteration of the workload achieved either atpeak exercise or at 1 mm ST segment depression measured 24 hafter nidoldipine 10 mg or 12 h after nisoldipine 5 mg. We conclude that frequent silent ischaemia in patients withproven coronary artery disease is relatively uncommon, it accountsfor approximately 16% of patients with positive exercise. Inthese patients nisoldipine, given as 5mg twice a day and 10mg daily, showed no significant therapeutic effects, eitheron the frequency or severity of silent ischaemia. New formulationsof slow release nisoldipine are consequently being developedso that a fuller 24 h therapeutic profile may be obtained.     

Diagnostische Kriterien für die Borderline-Schizophrenie auf der Basis des SSDBS

Zusammenfassung Die vorliegende Studie benutzte den SSDBS, ein von Khouri et al. (1980) entwickeltes Untersuchungsinstrument zur Erfassung der Borderline-Schizophrenie. In einer Index-Gruppe heterogener Borderline-Syndrome und in 3 Kontrollgruppen mit Schizophrenien, Manien und endogenen Depressionen wurde die Zahl der Borderline-Schizophrenie-positiven Fälle nach dem SSDBS bestimmt. Auf dieser Basis fanden sich signifikante Unterschiede zwischen der Borderline-Gruppe einerseits und den Manien und endogenen Depressionen andererseits, während sich zwischen unseren Borderline-Syndromen und den Schizophrenien keine signifikante Trennung ergab. Dies Resultat blieb auch nach einer diagnostischen Bereinigung aufgrund von Symptomen ersten Ranges bestehen. Das Forschungsproblem der Überlappung der SSDBS-Symptomatologie mit der Symptomatik bei den schizophrenen Patienten wird diskutiert, ebenso das Problem, daß bei Anwendung anderer Borderline-Konzepte eine Überlappung mit affektiven Störungen möglich ist.     

七味开心颗粒对脑损伤-嗅球破坏模型大鼠行为及血浆中ACTH、COR含量的影响

目的 :研究七味开心颗粒的药理作用。方法 :采用脑损伤 -嗅球破坏模型 ,将实验大鼠分为正常组、假手术组、模型组、盐酸氯米帕明组、七味开心颗粒 (高、中、低剂量 )组 ,观察各组大鼠行为学变化及其血浆中促肾上腺皮质激素 (ACTH )和皮质醇 (COR)含量的变化。结果 :在敞箱实验和避暗实验中 ,模型组大鼠行为出现明显变化 ,七味开心颗粒组和盐酸氯米帕明组均可显著拮抗大鼠行为变化 ;模型组大鼠血浆中ACTH、COR含量显著升高 (P<0 01) ,七味开心颗粒组和盐酸氯米帕明组都可抑制ACTH、COR含量的升高 (P<0 01)。结论 :七味开心颗粒可能通过作用于下丘脑 -垂体 -肾上腺皮质轴而发挥抗抑郁作用。     

紫外分光光度法测定复方链霉素软膏中2组分的含量

目的:建立以紫外分光光度法测定复方链霉素软膏中硫酸链霉素和氨苯磺胺含量的方法。方法:采用麦芽酚-硫酸铁铵比色法,以硫酸铁铵为显色剂,于521nm波长处测定硫酸链霉素的吸收度;以0.1mol/L氢氧化钠溶液为溶剂,于251nm波长处测定氨苯磺胺的吸收度。结果:硫酸链霉素、氨苯磺胺检测浓度分别在200～950(r=0.9994)、1.464～7.784(r=0.9998)μg/ml范围内与吸收度呈良好的线性关系;平均加样回收率分别为99.1%(RSD=1.90%)、99.7%(RSD=1.60%)。结论:本方法简便、准确,可用于复方硫酸链霉素软膏的质量控制。     

Role of the superior colliculus in the motor effects of cannabinoids and dopamine

We studied the cellular distribution of CB1 cannabinoid receptors in the superior colliculus of the rat using an antibody raised against the N-terminal of the receptor. The effect of unilateral cannabinoid receptor stimulation in the intermediate layers of the superior colliculus on rotational behavior in rats was also explored. The antibody against CB1 receptors outlined the crossed descending system of the superior colliculus (predorsal bundle output system) as well as the collicular commisure. The potent cannabinoid agonist CP55,940 (5 microgram/0.25 microliter) induced strong contralateral turning when microinjected unilaterally into the lateral intermediate layers of the superior colliculus. The levels of turning obtained with the intracollicular administration of the cannabinoid were comparable to the highest levels obtained with dopamine agonists in the basal ganglia. The D(2) dopamine agonist quinpirole or the D(1) dopamine agonist SKF82958 reversed this contralateral rotation but failed to affect motor behavior on their own. A new motor pathway for cannabinoids is discussed.