Post renal transplant thrombotic microangiopathy: A single centre experience

SUMMARY: Thrombotic microangiopathy (TMA) is a rare complication of renal transplantation. This study is a review of our experience of seven cases of TMA occurring between 1986 and 1995, an incidence of 0.8%. One patient had a recurrence of TMA in her graft having an episode of haemolytic uraemic syndrome as the cause of her original kidney failure. the other six patients had a rejection episode either at the time of diagnosis of TMA or a mean of 12 days prior to the diagnosis of TMA. All patients were treated with plasma exchange and those on cyclosporin had their dose reduced. Two patients had graft loss while the remainder had successful outcomes with stable graft function 3–11 years post diagnosis of TMA. We conclude that, in our experience rejection played a prominent role in the disease pathogenesis and that cyclosporin could be continued successfully albeit at a reduced dosage.     

Glutaric acidemia type II: Neuroimaging and spectroscopy evidence for developmental encephalomyopathy

Glutaric acidemia type II is associated with neonatal hypoketotic hypoglycemia, metabolic acidosis, profound hypotonia, progressive cardiomyopathy, and early death. Deficiency of either electron transfer flavoprotein or electron transport flavoprotein: ubiquinone oxidoreductase leads to intramitochondrial accumulation of metabolites of compounds oxidized by enzymes that transfer electrons to flavoprotein. No detailed results of antemortem neuroimaging or magnetic resonance spectroscopy have been described previously. We investigated a patient with typical neonatal onset glutaric acidemia type II without obvious dysmorphogenesis or renal malformations. Cranial tomographic scan revealed hypoplastic temporal lobes and marked widening of the sylvian fissures (“bat-wing” appearance). Cranial magnetic resonance imaging documented underdeveloped frontal and temporal lobes with delayed myelination and hypoplasia of the corpus callosum. ³¹P-Magnetic resonance spectroscopy of muscle was grossly abnormal with a very low energy state consistent with mitochondrial dysfunction. ¹H-Magnetic resonance spectroscopy of brain revealed elevated intracerebral lactate concentration and abnormally high choline/creatine ratio suggestive of dysmyelination. These findings constitute the first in vivo evidence of a developmental encephalomyopathy in glutaric acidemia type II.     

Active rehabilitation for chronic low back pain: Cognitive-behavioral, physical, or both? First direct post-treatment results from a randomized controlled trial [ISRCTN22714229]

Background  

The treatment of non-specific chronic low back pain is often based on three different models regarding the development and maintenance of pain and especially functional limitations: the deconditioning model, the cognitive behavioral model and the biopsychosocial model.