Protective and therapeutic effect of hydrogen sulfide on hemorrhagic cystitis and testis dysfunction induced with cyclophosphamide

Backround/aimCyclophosphamide (CP) is a drug used for treatment of many malignant diseases. However, it can cause serious side effects such as hemorrhagic cystitis and male infertility. Hydrogen sulfide (H2S) is a gaseous mediator and is suggested to have antioxidant, antiinflammatory, and antiapoptotic effects. In this study, dose-dependent effects of H2S donor sodium hydrosulfide (NaHS) on cyclophosphamide-induced hemorrhagic cystitis and testicular dysfunction were investigated in rats.Material and methodsRats were divided into 5 groups (n = 8): control, CP, NaHS25 μmol/kg, NaHS50 μmol/kg, and NaHS100 μmol/ kg. After treatment for 7 days intraperitoneally (ip), a single ip dose of CP 200 mg/kg was given on the 8th day. Then, treatment was continued for 7 days. In bladder and testicular tissues, IL 6, IL 10, cGMP, NO, H2S, FSH, LH, and testosterone levels were measured by ELISA. Histopathological examination with H&E staining, as well as immunohistochemical staining for acrolein in bladder and caspase-3 and APAF-1 in testis were performed.ResultsNaHS prevented the increased IL 6 and IL 10 values induced by CP as well as prevented the decrease in cGMP values associated with CP. There was no significant change in FSH values, but the LH value, which increased with CP, decreased with 25, 50, and 100 μmol/kg NaHS. In contrast, testosterone decreased in the CP group and increased in the treatment groups. NaHS was effective in many biochemical and histopathological parameters at 25 and 50 μmol/kg doses, and this effect decreased at 100 μmol/kg dose.ConclusionH2S has a protective and therapeutic effect on hemorrhagic cystitis and testicular dysfunction induced by cyclophosphamide. It can be suggested that H2S is a promising molecule in facilitating cancer treatment.     

Viral causes of influenza‐like illness: Insight from a study during the winters 2004–2007

Limited information is available on the viral etiology of influenza‐like illness in southern European countries, and it is still a matter of debate whether certain symptoms can be used to distinguish among the specific viruses that cause influenza‐like illness. The main objective of the present study was to identify the demographic and clinical predictors of influenza‐like illness due to specific viral agents. The study, which was observational in design, was conducted in Rome and Naples, Italy. Cases of influenza‐like illness were defined as individuals with fever >37.5°C and at least one systemic and one respiratory symptom, recruited during the winters of 2004–2005, 2005–2006, and 2006–2007. Influenza and other respiratory viruses were identified using the polymerase chain reaction (PCR), performed on throat swabs. Basic individual information was collected using a standard form. A total of 580 persons were included in the analysis. Viral pathogens were identified in fewer than 50% of the cases. Overall, 240 viral agents were detected: 22.8% were positive for influenza viruses, 10.9% for adenoviruses, 6.0% for parainfluenza viruses, and 1.7% for respiratory syncytial virus. The month of diagnosis, and muscle and joint pain were associated with influenza virus, though the positive predictive value (PPV) was low. Abdominal pain was associated with adenovirus infection. Although the PPV of symptoms for influenza virus infection was low, especially in low activity periods, these findings may help clinicians to improve their ability to perform diagnoses. J. Med. Virol. 81:2066–2071, 2009. © 2009 Wiley‐Liss, Inc.     

Retrieval of a Distal Right Pulmonary Artery Vegetative Embolus Under Transesophageal Echocardiographic Guidance

Transesophageal echocardiography has proved to be a versatile and valuable diagnostic tool. It has successfully been used to guide valvuloplasties and intracardiac biopsies. However, there is no report in the literature that transesophageal echocardiography has previously been used to diagnose and guide the subsequent retrieval of a vegetative embolus from the distal right pulmonary artery. We report a case of tricuspid valve endocarditis with embolization in which transesophageal echocardiography was used to make the diagnosis and guide the retrieval of the vegetative embolism from the distal right pulmonary artery.     

Predictors of poor outcomes in steroid therapy for immunoglobulin A nephropathy

Background: Steroid therapy appears to be beneficial in patients of immunoglobulin A nephropathy (IgAN), as it causes a reduction in the proteinuria and improves the renal survival. Methods: A retrospective review of the 5 year follow‐up data of 60 patients with IgAN who were treated with steroids was conducted. Steroid non‐responders were defined as patients in whom the primary end‐point of a 30% decrease of the estimated glomerular filtration rate from baseline was reached. The patients were divided into two groups, namely, the steroid responder group (n = 47) and the steroid non‐responder group (n = 13), and the clinicopathophysiological characteristics were compared between the two groups. Results: Significant decrease of the proteinuria was observed in the responder group over the 5 year follow‐up period, whereas no significant change of the urinary protein excretion was observed in the non‐responder group during the same period. In regard to the pathological findings, significantly higher ratios of glomerular obsolescence and glomerular tuft adhesion to the Bowman's capsule, and significantly higher severity of interstitial fibrosis at the time of diagnosis in the non‐responder group than in the responder group were found. The rates of glomerular obsolescence and glomerular tuft adhesion to the Bowman's capsule, the severity of interstitial fibrosis, serum albumin and urinary protein excretion were identified as independent risk factors influencing the rate of renal function deterioration. Conclusion: To develop effective therapeutic modalities, it is important to have a thorough understanding of the clinicopathophysiological characteristics of IgAN patients showing poor treatment response to steroids (non‐responder group in this study).     

Removal of Monofilamental and Multifilamental Temporary Pacing Leads Following Open-Heart Surgery: Occurrence of Arrhythmias

This study compared multifilamental and monofilamental temporary pacing leads in a clinical series of 83 patients who underwent valve replacement or coronary artery bypass grafting. The leads were used in the bipolar mode and were implanted into the outer layers of the right ventricular myocardium. The force required for wire removal (newtons), and the arrhythmias which occurred during removal were monitored. During electrode removal, 48% of the patients had transient arrhythmias (46% with monofilamental and 51% with multifilamental leads). The most common was a single ventricular premature contraction. In one case, wire removal caused non-sustained ventricular tachycardia. All the arrhythmias subsided spontaneously. There was no statistical difference between results of the two leads. The force needed for removal was monitored directly by applying force via a graduated spring; they were equal in both groups (2.6 newtons). Both electrode types behaved similarly during wire removal, and the spiral tail of the monofilamental lead did not provoke arrhythmias.     

HYPERNATRIURIA AND KALIURESIS IN ENURETIC CHILDREN AND THE DIURNAL VARIATION

Purpose

We investigate the underlying pathophysiological cause of primary nocturnal enuresis by comparing electrolyte alterations in urine samples of enuretics during the daytime and nighttime compared with those of nonenuretic subjects.

Materials and Methods

Urine output, urine specific gravity and urinary electrolytes in 15 enuretic and 12 nonenuretic children were measured. We collected daytime serum and urine samples of children fed a similar diet between 7 a.m. and 7 p.m., and nighttime between samples 7 p.m. and 7 a.m. Urinary calcium/creatinine ratio, tubular reabsorption of phosphorus and excretions of fractional sodium and potassium were calculated.

Results

There was no significant difference between the calcium/creatinine ratio ratios. There was a significant increase in fractional sodium and fractional potassium values in enuretics compared to nonenuretics during the day and at night. Daytime and nighttime fractional sodium and fractional potassium values in enuretics were similar. In contrast to nonenuretics, enuretic patients had no diurnal variation of fractional sodium. There was significant positive correlation between bedwetting status, and fractional sodium and fractional potassium.

Conclusions

Since sodium and potassium excretions were higher in enuretic patients than nonenuretic children, and no significant diurnal variation in urinary excretion of these ions there might be a difference in the mechanism of reabsorption of sodium and potassium between enuretic and nonenuretic children.     

Quality of Life and Survival Following Intensive Medical Care

SUMMARY The relation between quality of life before admission and theoutcome of admission to the intensive care unit (ICU) was studiedprospectively among 126 patients in a community hospital witha predominantly geriatric patient population. Fifty-four percent of our patients were older than 65 years and 66 per centsuffered from chronic ill health. Their mean APACHE score was18±8 (mean±SD). Quality of life was assessed bythe Karnofsky index of physical performance; the linear analogueself assessment (LASA) score; sleep index; level of employment;sexual activity; housing status. Thirty-seven per cent of thepatients died in ICU and another 10 per cent in hospital. Theone year survival of the entire group was 37 per cent. Survivalrates were significantly higher in patients with a Karnofskyindex of 6 or more, LASA score of 55 or more, in employment,and with sleep index of 2 or more (p<0. 05). The 12-monthsurvival among patients with four favourable indicators was59 per cent, with two or three favourable indicators 36 percent (p<0. 05), and in patients with no favourable indicatorsof quality of life or only one 17 per cent (p<0. 001). Qualityof life in patients who survived longer than six months afterICU care was high (Karnofsky index 7. 9±2.0; LASA score71±20 (mean±SD) and unimpaired when compared withtheir ratings before admission to the unit. These findings indicatethat quality of life before admission is an important predictorof survival and that a high proportion of critically-ill subjectswhose quality of life was relatively good before the episoderequiring admission will be long-term survivors whose qualityof life is comparable to that preceding critical care.     

CIRCULATING MONOCYTE (MACROPHAGE)-SPECIFIC ANTIBODIES IN PATIENTS WITH AUTOIMMUNE THYROID DISEASES

We investigated the presence of circulating monocyte-specific antibodies (monocytotoxic activities) by a complement-dependent cytotoxicity test and the relations between these monocytotoxic activities and other immunological indices in patients with autoimmune thyroid diseases. Antibodies reactive for monocytes (macrophages) were found in the sera from patients with autoimmune thyroid diseases. These antibodies were present in both IgG and IgM fractions and specific for monocytes since they were absorbed by monocytes but not by lymphocytes or granulocytes; furthermore, lymphocytotoxic and granulocytotoxic activities were not changed after the absorption of the sample sera by monocytes. Also, these antibodies did not have cross-reactivity to thyroid-specific antigens demonstrated by absorption tests and their specificity was different from anti HLA-DR antibody demonstrated by a flow cytofluorometric analysis. Monocyte-specific antibodies are reactive for autologous monocytes as well as allogenic monocytes. Patients who had positive monocytotoxic activities had high levels of TSH receptor antibodies (TRAb) and antimicrosomal antibodies in Graves' disease, and monocytotoxic activities were significantly correlated with the levels of TRAb in Graves' disease. These results suggest that the monocyte-specific antibodies (monocytotoxic activities) were significantly correlated with the immunological activities in Graves' disease.