Metastasis in the kidney

Renal metastatic tumors are seldom diagnosed. Their differentiation from primary renal tumors means severe problem. In connection with their cases the authors deal with this important problem. Their diagnostic and therapeutic tactics are described and publications in the literature of the past 15 years dealing with similar problems are reviewed.     

Potential clindamycin resistance in clindamycin-susceptible, erythromycin-resistant Staphylococcus aureus: report of a clinical failure

The erm gene product confers clindamycin resistance on Staphylococcus aureus. We report a clindamycin clinical failure where resistance developed on therapy in a D-test-positive strain. D tests of 91 clindamycin-susceptible, erythromycin-resistant S. aureus isolates showed that 68% of methicillin-susceptible and 12.3% of methicillin-resistant S. aureus strains were D-test positive.     

Comparative study on antibodies to human and bacterial 60 kDa heat shock proteins in a large cohort of patients with coronary heart disease and healthy subjects

BACKGROUND: Recent observations indicate an association between antibodies against mycobacterial heat shock protein (hsp65) and coronary heart disease (CHD). Previously, we reported on marked differences in antigen specificity and complement activating ability of anti-hsp65 antibodies and auto-antibodies against human heat shock protein, hsp60. Here, we investigated whether there are differences between antih-sp65 and anti-hsp60 antibodies in their association with CHD. DESIGN: We measured by ELISA the levels of antibodies to hsp65, hsp60 and E. coli-derived GroEL in three groups: Group I, 357 patients with severe CHD who underwent by-pass surgery; Group II, 67 patients with negative coronary angiography; Group III, 321 healthy blood donors. Antibodies against Helicobacter pylori were also measured by commercial ELISA. RESULTS: As calculated by multiple regression analysis, the levels of anti-hsp60 auto-antibodies were significantly higher in Group I compared to Group II (P = 0.007) or Group III (P < 0.0001). By contrast, although concentrations of anti-hsp65 and anti-GroEL antibodies in Group I were higher than in Group III, no significant differences between Group I and Group II were found. Antibodies to the two bacterial hsp strongly correlated to each other, but either did not correlate or weakly correlated to hsp60. In Group I, serum concentrations of anti-H.pylori antibodies significantly correlated with those of anti-hsp65 and anti-GroEL antibodies but they did not correlate with the anti-hsp60 antibodies. CONCLUSIONS: As to their clinical relevance, a remarkable difference become evident between antibodies to human hsp60 and antibodies against bacterial hsp in the extent of association with CHD. On the basis of these findings and some pertinent literature data, an alternative explanation for the association between high level of anti-hsp antibodies and atherosclerotic vascular diseases is raised.     

Biofeedback re-education of faecal continence in children

The purpose of this prospective study was to see if pretreatment anorectal motility can predict successful correction of faecal incontinence with biofeedback. Forty-seven consecutive children, aged 5 to 18 years, were treated. They had been treated for idiopathic constipation with faecal impaction, but had remained incontinent (n=15), had been operated for congenital anorectal malformations of high (n=19) or low (n=2) type, or had a number of organic congenital pelvic abnormalities (n=11). This consecutive series represents our entire experience with biofeedback for faecal incontinence, in the period from January 1 1983 to December 31 1989. In each patient, at the first session, anorectal manometry was performed. Resting pressures in the rectum, upper anal canal and lower anal canal were measured. The threshold of rectal sensation during distension, the maximal pressure during voluntary sphincteric contraction and the time to half decrease of sphineteric pressure because of muscular fatigue were also noted. The patient was then asked to make a voluntary sphincteric contraction, while the rectum was being distended with the volume at threshold for rectal sensation. In subsequent sessions, the rectum was also distended but without warning the patient, who was congratulated when he or she contracted the sphincter immediately after onset of rectal distension. Full continence was the criterion used to classify re-education as a success. Improvement or no change in continence was considered as failure of the treatment. Three parameters only improved after treatment: the threshold for rectal sensation which decreased (P<0.05), the maximal peak of voluntary contraction which increased (P<0.001), and the duration of this contraction which was prolonged (P<0.05). Patients who were to recover had, before treatment, lower threshold of rectal sensation (P<0.01), higher maximum voluntary contraction of the anal sphincter (P<0.05), and tended to have a higher resting tone in the anal canal (P=0.07). In addition, after biofeedback treatment, the decrease of threshold for rectal sensation (P<0.05), increase of maximal voluntary contraction (P<0.005) and maintained contractions (P<0.05) were more important in patients who became continent than in those who remained incontinent. Fifty per cent of the patients were cured from faecal incontinence by biofeed-back re-education. Success was much higher in patients initially seen for constipation and faecal incontinence (92%) than in the other patients (35%) (P<0.01). Patients with constipation had higher pressures in the upper anal canal, in addition to better voluntary contraction, and lower threshold of rectal sensation, both before and after treatment, than patients with other disorders. It is concluded that there is a correlation between cure from faecal incontinence and improvement in anorectal sensitive and dynamic parameters but that this may largely be due to the underlying disorder.

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Résumé Le but de cette étude prospective est de déterminer si l'examen de la motilité ano-rectale avant traitement permet de prédire le succès d'une rééducation par biofeedback de l'incontinence fécale. Une série consécutive de quarante-sept enfants âgés de 5 à 18 ans ont été traités. Ils avaient subi des traitements pour une constipation idiopathique avec impaction fécale mais étaient restés incontinents (n=15), avaient subi une correction chirurgicale pour une malformation ano-rectale congénitale haute (n=19) ou basse (n=2) ou étaient porteurs de plusieurs anomalies congénitales pelviennes (n=11). Cette série consécutive constitue la totalité de notre expérience de rééducation par biofeedback d'incontinences fécales durant la période allant du ler janvier 1983 au 31 décembre 1989. Une manométrie ano-rectale a été réalisée chez chaque patient lors de la première séance. La pression a été mesurée dans le rectum, la partie supérieure du canal anal et la partie inférieure du canal anal. Le seuil de perception au cours de la distension, la pression maximale durant la contraction volontaire et le temps pour entraîner une diminution de moitié de la pression sphinctérienne par fatigue musculaire ont été notés. Les patients ont réalisé une contraction volontaire sur demande alors que le rectum était distendu avec un volume correspondant au seuil de perception déterminé. Lors de séances successives, le rectum a été distendu sans prévenir le patient. Ce dernier a été félicité à chaque fois qu'il contractait son sphincter immédiatement après le début de la distension rectale. Seule une normalisation complète de la continence a été utilisée comme critère d'une rééducation efficace. Une amélioration ou une absence de changement dans la continence ont été considérées comme des échecs thérapeutiques. Seuls trois paramètres ont été améliorés par le traitement: le seuil de perception rectale a été abaissé (P<0,05), le pic de contraction volontaire est augmentée (P<0,001) et la durée de la contraction volontaire est prolongée (P<0,05). Les patients chez lesquels le traitement a été couronné de succès avaient avant celui-ci des seuils de sensation de la pression rectale abaissés (P<0,01), des pressions de contraction volontaire maximales du sphincter anal plus élevées (P<0,05) et avaient une tendance à avoir des pressions de repos du canal anal plus élevées (P=0,07). En plus, après traitement par biofeedback, la diminution du seuil de sensation rectale (P<0,05), l'augmentation de la pression de contraction volontaire (P<0,05) et le maintien d'une contraction (P<0,05) étaient plus importants chez les patients redevenus continents que chez ceux restant incontinents. 50% des patients ont été guéris de leur incontinence fécale par rééducation par biofeedback. Le succès était plus important chez les patients vus initialement pour constipation et incontinence fécale (92%) que chez les autres malades (35%) (P<0,01). Les patients avec une constipation présentaient des pressions plus élevées dans la partie haute du canal anal, une meilleure contraction volontaire et un seuil de perception rectale plus bas avant traitement et après traitement que les patients porteurs d'autres troubles. On conclut de cette étude qu'il y a une corrélation entre la guérison d'une incontinence fécale et l'amélioration des paramètres de sensibilité et dynamiques ano-rectaux mais que ceci dépend largement des troubles sous-jacents.

     

Elucidation of the anatomy of a satiety network: Focus on connectivity of the parabrachial nucleus in the adult rat

We hypothesized that brain regions showing neuronal activation after refeeding comprise major nodes in a satiety network, and tested this hypothesis with two sets of experiments. Detailed c‐Fos mapping comparing fasted and refed rats was performed to identify candidate nodes of the satiety network. In addition to well‐known feeding‐related brain regions such as the arcuate, dorsomedial, and paraventricular hypothalamic nuclei, lateral hypothalamic area, parabrachial nucleus (PB), nucleus of the solitary tract and central amygdalar nucleus, other refeeding activated regions were also identified, such as the parastrial and parasubthalamic nuclei. To begin to understand the connectivity of the satiety network, the interconnectivity of PB with other refeeding‐activated neuronal groups was studied following administration of anterograde or retrograde tracers into the PB. After allowing for tracer transport time, the animals were fasted and then refed before sacrifice. Refeeding‐activated neurons that project to the PB were found in the agranular insular area; bed nuclei of terminal stria; anterior hypothalamic area; arcuate, paraventricular, and dorsomedial hypothalamic nuclei; lateral hypothalamic area; parasubthalamic nucleus; central amygdalar nucleus; area postrema; and nucleus of the solitary tract. Axons originating from the PB were observed to closely associate with refeeding‐activated neurons in the agranular insular area; bed nuclei of terminal stria; anterior hypothalamus; paraventricular, arcuate, and dorsomedial hypothalamic nuclei; lateral hypothalamic area; central amygdalar nucleus; parasubthalamic nucleus; ventral posterior thalamic nucleus; area postrema; and nucleus of the solitary tract. These data indicate that the PB has bidirectional connections with most refeeding‐activated neuronal groups, suggesting that short‐loop feedback circuits exist in this satiety network. J. Comp. Neurol. 524:2803–2827, 2016. © 2016 Wiley Periodicals, Inc.     

Validated UPLC method for the fast and sensitive determination of steroid residues in support of cleaning validation in formulation area

An ultra performance liquid chromatographic (UPLC) method was developed for simultaneous determination of seven steroid (dienogest, finasteride, gestodene, levonorgestrel, estradiol, ethinylestradiol, and norethisterone acetate) active pharmaceutical ingredient (API) residues. A new, generic method is presented, with which it is possible to verify the cleaning process of a steroid producing equipment line used for the production of various pharmaceuticals. The UPLC method was validated using an UPLC™ BEH C18 column with a particle size of 1.7 μm (50 mm × 2.1 mm) and acetonitrile–water (48:52, v/v) as mobile phase at a flow rate of 0.55 ml/min. Method development and method validation for cleaning control analysis are described. The rapid UPLC method is suitable for cleaning control assays within good manufacturing practices (GMP) of the pharmaceutical industry.     

The factorial structure of the Suicide Intent Scale: a comparative study in clinical samples from 11 European regions

Although the Suicide Intent Scale (SIS) is a widely used instrument in research on suicidal behavior, comparative research on the latent structure of the SIS has been neglected. To determine whether a general factor model of the SIS is supported, alternative factor models of the SIS were evaluated comparatively in 11 clinical samples. The SIS was applied as part of a structured clinical interview to patients after an episode of non-fatal suicidal behavior. The samples were drawn from 11 study centers within the frame of the WHO/EURO multicenter study on suicidal behavior. Three different two-factor and two three-factor models of the SIS were examined in each sample using principal component analysis with orthogonal Procrustes rotation. The factorial structure of the 'subjective part' of the SIS (items 9-14) was strongly supported, whereas an acceptable model fit for the 'objective part' was not found. Possible future revisions of 'objective' SIS items may be worth consideration. As a limitation, the results of the study might not generalize to other samples that use different definitions of non-fatal suicidal behavior.