Clinical practice of immunosuppressive treatments in multiple sclerosis: results of a second international questionnaire

Immunosuppressive treatment is a current practice in MS therapy. Mitoxantrone has gained largest acceptance. Differences in clinical indications of mitoxantrone, cyclophosphamide, azathioprine and methotrexate are described.     

Mitogen activated protein (MAP) kinase signal transduction pathways and novel anti-inflammatory targets

Over the last decade important advances have been made in our understanding of the molecular events underlying cellular responses to extracellular signals. Increased understanding of signal transduction mechanisms and gene regulation involved in immune responses has created opportunities for the discovery of novel therapeutic compounds useful in treating inflammatory disorders. One of the best studied signalling routes is the mitogen activated protein (MAP) kinase signal transduction pathway which plays a crucial role in many aspects of immune mediated inflammatory responses. Here, our current understanding of the MAP kinase pathway is reviewed, as well as recent advances in the design of novel agents that are able to modulate the activity of these signalling cascades.     

Infliximab therapy in Crohn's disease: safety issues

Infliximab has become a valuable addition to the therapeutic arsenal for Crohn's disease. Although the rate of adverse events was relatively low in the premarketing trials, several investigators have recently reported experience in large groups of patients. This has shed more light on safety aspects of infliximab therapy, which should change the approach towards patients prior to infliximab infusion. This review discusses some immunological aspects that are relevant for infliximab therapy and provides guidelines for daily practice.     

Effect of hormones on the development of creatine kinase activity in rat skeletal muscle.

Various approaches have been used in order to determine whether or not a certain hormone is a stimulus for the development of the muscle-specific enzyme, creatine kinase. Both thyroxine and glucocorticoids can be considered as naturally occurring stimuli for the synthesis of creatine kinase. The maximum increase of creatine kinase activity after stimulation by glucocorticoids (about 25%) occurs between 5 and 7 days after birth. A single injection of thyroxine has virtually no effect during this period. However, when a pretreatment with thyroxine is given, cortisone acetate administration increases creatine kinase activity to about 155%. The effect of cortisone acetate is due to de novo synthesis of creatine kinase. The augmentation of the effect of cortisone acetate by thyroxine is dependent on DNA synthesis. Thyroxine administration apparently causes the formation of more competent muscle cells. The effects of both hormones are age-dependent. Thyroxine and cortisone acetate administration to fetuses can prematurely evoke to MM isoenzyme of creatine kinase. Both hormones probably play a role in the activation of the M gene during embryonic development. Sex hormones are able to influence neither creatine kinase activity nor muscle growth. However, castration of male rats immediately after birth causes an impairment of growth at older ages. The androgen production by the testes immediately after birth seems to be of main importance for body growth development. It can be concluded from these results that creatine kinase in muscle is under multiple hormonal control, just as is observed for a number of enzymes in other tissues.     

Flexed sitting maneuver for complete lumbar myelography in patients with severe spinal stenosis and apparent block

A new technique has been designed to improve myelography examinations of the entire lumbar spinal canal in patients with severe spinal stenosis using a single needle puncture. When a high-grade obstruction to the caudal flow of contrast material is encountered, the patient is placed in a flexed sitting position for 1 minute. This technique was performed in eight patients with severe lumbar spinal stenosis. It successfully helped depict the lower lumbosacral canal below an apparently complete block in four patients and resulted in improved visualization of the lower sac in four patients with partial block.     

The double puncture: an effective percutaneous technique for removing complex, multiple renal calculi

Percutaneous nephrostolithotomy, which can require a double puncture, is presently the method of choice in our institution for the removal of renal stones. Patients that underwent this procedure were evaluated to identify the possible reasons for the double puncture. Of 200 patients evaluated, 14 needed a second tract. The three variables that determined whether a second puncture was needed, in order of importance, were number and size of the stones, with second tracts needed in patients with multiple stones and staghorn calculi; anatomical variations of the renal collecting system itself, with bifid systems the most significant anatomic variation; and the dexterity of the radiologist in performing the puncture and the ability of the urologist to extract the stone. Second tracts were needed more frequently in patients who presented with stones in both the lower and middle poles of the collecting systems.     

Experience with the Amplatz retrievable vena caval filter. Work in progress

The Amplatz retrievable vena caval filter was designed in an attempt to decrease complications associated with the placement of Mobin-Uddin or Kimray-Greenfield filters. The design allows percutaneous retrieval, thus expanding application of the filter to situations requiring temporary prophylaxis against pulmonary embolism. Filters have been placed in 16 patients, nine (56%) for prophylactic purposes. All filters were easily inserted percutaneously. Complications occurred in three patients; these included complete thrombosis of the inferior vena cava below the filter, misplacement of one filter into the pericaval retroperitoneal tissue, and development of thrombus cranial to the filter. With the current introduction system, the possibility of filter misplacement has been essentially eliminated. No patient experienced symptoms suggestive of pulmonary embolism after filter insertion. One filter retrieval has been performed, with no complications.     

Detection of colonic polyps on single-contrast barium enema study: emphasis on the elderly

A systems approach was employed to improve results of the single-contrast barium enema examination for detection of colonic polyps. Improvements were made in each of the following areas: radiographic-fluoroscopic equipment, fluoroscopic-television images, screen-film combinations, barium suspensions, examination techniques, imaging sequences, and quality controls. Radiologic-endoscopic correlation was undertaken for 137 colonic polyps seen endoscopically in 91 patients. The average age of the patients was 69 years. The sensitivity of the single-contrast examination for detection of all polyps was 80%. Polyps 5-9 mm in size were detected with 66% sensitivity, while 94% of polyps 10 mm or larger were detected. The results indicate that the sensitivity of a suitably performed single-contrast barium enema examination may approach that of the double-contrast study for the detection of colonic polyps, even in an elderly and infirm patient population.