Short- and long-term efficacy of levamisole in children with steroid-sensitive nephrotic syndrome

Purpose

In this study, we aimed to evaluate short- and long-term effects of levamisole therapy in steroid-sensitive nephrotic syndrome (SSNS) in children.

Methods

The study consisted of 29 SSNS patients who had been treated with levamisole for 12 months. Laboratory values and clinical data were analyzed for three separate periods for each patient: 1 year prior to the initiation of levamisole therapy (Pre-Lev), during 1 year of levamisole therapy (During-Lev), and the year following cessation of levamisole therapy (End-Lev).

Results

The level of proteinuria fell from median 135.0 (24.0–633.0) mg/h/m² Pre-Lev to median 4.4 (2.4–654.0) mg/h/m² During-Lev and median 4.8 (2.2–105.0) mg/h/m² End-Lev (p = 0.0001, for each). Median relapse frequency fell from 4.0 (3.0–8.0) relapses/patient per year Pre-Lev to 0.0 (0.0–2.0) During-Lev (p = 0.0001) with 23/29 patients having no relapse and 0.0 (0.0–1.0) End-Lev (p = 0.0001) with 18/29 patients without relapse. During-Lev, all children had marked diminution in annual steroid burden from a median of 5582.0 (2137.0–17340.0) mg/m² per year Pre-Lev to 2166.0 (840.0–9325.0) mg/m² per year (p = 0.0001). End-Lev, the annual steroid burden also continued to fall, to 0.0 (0.0–5386.0) mg/m² per year (p = 0.0001). The age and duration of NS were significantly higher in the children with relapses than in the children with sustained remission (p = 0.009 and p = 0.014, respectively). The side effects that are expected during levamisole therapy did not occur in our patients.

Conclusion

Thus, our study showed that levamisole is a safe and effective steroid-sparing agent, with long-lasting effect even 12 months after withdrawal.     

Influence of Escherichia coli Endotoxin‐Induced Endotoxaemia on the Pharmacokinetics of Enrofloxacin after Intravenous Administration in Rabbits

The main goal of present study was to determine the effects of an Escherichia coli endotoxin‐induced endotoxaemic status on disposition of enrofloxacin after a single intravenous dose (5 mg/kg) in rabbits. Septic shock was induced by the i.v. bolus administration at a single dose of E. coli lipopolysaccharide. Six adult New Zealand White rabbits were used. Concentrations of drug in plasma were determined by HPLC. The plasma pharmacokinetic values for enrofloxacin were best represented using a two‐compartment open model. Total plasma clearance (Cl_T) decreased from 2.11 (l/h/kg) in healthy animals to 1.50 (l/h/kg) in rabbits with septic shock, which is related to an increase in the AUC_0→∞. In endotoxaemic rabbits, volume of distribution at steady state (V_dss = 3.61 l/kg) was significantly lower (P < 0.05) than in healthy animals (V_dss = 4.97 l/kg). However, the elimination half‐life of enrofloxacin was not affected by lipopolysaccharide administration.     

Comparison of splinting and splinting plus low-level laser therapy in idiopathic carpal tunnel syndrome

This study aimed to compare the short-term efficacy of splinting (S) and splinting plus low-level laser therapy (SLLLT) in mild or moderate idiopathic carpal tunnel syndrome (CTS) with a prospective, randomized controlled study. The patients with unilateral, mild, or moderate idiopathic CTS who experienced symptoms over 3 months were included in the study. The SLLLT group received ten sessions of laser therapy and splinting while S group was given only splints. The patients were evaluated at the baseline and after 3 months of the treatment. Follow-up parameters were nerve conduction study (NCS), Boston Questionnaire (BQ), grip strength, and clinical response criteria. Forty-five patients with CTS completed the study. Twenty-four patients were in S and 21 patients were in SLLLT group. In the third-month control, SLLLT group had significant improvements on both clinical and NCS parameters (median motor nerve distal latency, median sensory nerve conduction velocities, BQ symptom severity scale, and BQ functional capacity scale) while S group had only symptomatic healing (BQ symptom severity scale). The grip strength of splinting group was decreased significantly. According to clinical response criteria, in SLLLT group, five (23.8%) patients had full and 12 (57.1%) had partial recovery; four (19%) patients had no change or worsened. In S group, one patient (4.2%) had full and 17 (70.8%) partial recovery; six (25%) patients had no change or worsened. Additionally, applied laser therapy provided better outcomes on NCS but not in clinical parameters in patients with CTS.     

Huge endometriosis presenting like an ovarian tumor: CT appearance

A 32-year-old female with a clinical history of abdominal swelling underwent CT of the abdomen. A huge biloculated cystic mass with a mural nodule in the abdominal and pelvic region was seen. The lesion showed slightly homogeneous enhancement. The imaging findings suggested an ovarian tumor. Histopathological evaluation after surgical resection revealed that the lesion was a bilateral ovarian endometriosis.     

Heterogeneous appearance of VEGF (vascular endothelial growth factor) immunopositivity in cyst capsules of endometrioma

The aim of the research was to reveal vascular endothelial growth factor (VEGF) immunolocalization in endometrioma cysts and endometrial tissues. The study group (group1) included 15 patients laparoscopically operated on for endometrioma and the control group (group 2) included 13 patients prepared for diagnostic laparoscopy for primary infertility. Biopsies from endometrioma cyst capsules, disease-free peritoneum and pipelle biopsies from the endometrium were taken from group 1. Biopsies from parietal peritoneum and endometrium were taken from group 2. Results showed VEGF immunoreactivity of peritoneal biopsies of group 1 was more intense than that of the control biopsies. A positive correlation was seen between the diameter of cyst capsules and VEGF labeling intensity and as the size of cyst enlarged, the appearance of non-homogeneous distribution of VEGF immunolocalization became more frequent. We conclude that the variation of VEGF immunolocalization in endometrioma cysts may be attributed to other possible angiogenic molecules in the pathogenesis and may cause unexpected responses to anti-angiogenic therapies.     

Effect of ligamenta flava hypertrophy on lumbar disc herniation with contralateral symptoms and signs: a clinical and morphometric study

Introduction

The purpose of this study was to determine whether ligamentum flavum hypertrophy among disc herniated patients causes contralateral pain symptoms. For this reason we measured the thickness of the ligament in disc herniated patients with ipsilateral or contralateral symptoms.

Material and methods

Two hundred disc herniated patients with ipsilateral symptoms as group I were compared with five disc herniated patients with only contralateral symptoms as group II. Ligamenta flava thicknesses and spinal canal diameters of both groups were measured on magnetic resonance imaging (MRI) with a micro-caliper.

Results

Both groups underwent surgery only on the disc herniated side. The total thicknesses of the ligamenta flava in group II was thicker than in group I. There was no spinal stenosis in either group and no significance difference between the groups. Statistically significant differences were found for both ipsilateral and contralateral thickness of the ligament flava in both groups. We also compared thickness of the ligamenta flava for each level of disc herniation in group I; ligamenta flava hypertrophy was more common at L3-L4 and L4-L5 levels of vertebrae in females.

Conclusions

Aetiology of contralateral sciatica among disc herniated patients may be related to hypertrophy of the ligamenta flava, especially on the opposite side. Surgical approaches of the disc herniated side alone may be sufficient for a good outcome.     

Coagulation activation and expression of CD40 ligand on platelets upon in vitro lipopolysaccharide-challenge in patients with unstable angina

BACKGROUND: Elevated markers of inflammation and coagulation are found in patients with coronary heart disease. A role of inflammatory stimulation on coagulation time and expression of CD40 ligand on platelets in acute coronary syndromes has not been described yet. METHODS AND RESULTS: Whole blood samples of 9 patients with coronary heart disease and stable angina, 10 patients with unstable angina, 7 patients with acute myocardial infarction and 7 patients without coronary heart disease were incubated with lipopolysaccharide (LPS). Coagulation time was measured in arterial and coronary blood with the ReoRox(R), a viscometric whole blood coagulometer. CD40L and CD62P expression on platelets and platelet-monocyte aggregates were measured by flow cytometry. Without LPS, patients with unstable angina showed a significantly decreased coagulation time in arterial and coronary blood compared to patients without coronary heart disease. After incubation with LPS, in patients with unstable angina, a significantly decreased coagulation time in coronary blood was observed compared to patients with stable angina or patients without coronary heart disease. CD40L expression on platelets in patients with unstable angina was significantly higher in arterial and coronary blood compared to patients with stable angina. No significant differences between the patient groups were observed concerning CD62P expression on platelets, tissue factor binding on monocytes, platelet-monocyte aggregates and plasma levels of platelet factor 4. CONCLUSIONS: Patients with unstable angina show an enhanced coagulation activation and an upregulation of CD40L on platelets. This may be of importance in the understanding of coronary plaque rupture and formation of coronary thrombosis.     

Unusually large cisterna chyli: US and MRI findings

We report a rare appearance of cisterna chyli appearing as a giant cystic structure on routine abdominal ultrasonography (US). Diagnosis was established with color Doppler US and after magnetic resonance imaging. This report describes an unusual appearance of the cisterna chyli that radiologists should be familiar with, especially on the routine conventional gray-scale US to avoid mistaking it for a pathologic condition.     

Effect of hypothermia on blood-brain barrier permeability following traumatic brain injury in chronically ethanol-treated rats

The objective of this study was to investigate the effect of hypothermia on the blood-brain barrier (BBB) disruption caused by traumatic brain injury (TBI) in chronically ethanol-treated rats. BBB permeability was measured using Evans blue (EB) dye. Arterial blood pressure levels of animals in hypothermic groups decreased significantly. The EB dye extravasation into the brain significantly increased in hypothermia and at 6 and 24 h after TBI. In ethanol-treated rats that were subjected to TBI, hypothermia led to a significant decrease in EB dye content in the brain at 24 h but not at 6 h after TBI when compared with TBI alone.     

DNA-responsive uniform latex particles based on p-chloromethylstyrene

In this study, DNA binding properties of poly(ethylenimine) (PEI)-attached uniform poly(p-chloromethystyrene) (PCMS) particles were investigated. Spherical PCMS latex particles with an average size of 1.75 microm were obtained by the dispersion polymerization of p-chloromethylstyrene (CMS). PEI was covalently attached onto the PCMS particles via a direct chemical reaction between amine and chloromethyl groups, with the equilibrium binding capacities up to 41 mg PEI/g PCMS. In aqueous media, PEI attached-uniform PCMS particles showed an irreversible aggregation behaviour in the presence of DNA. To predict unknown DNA concentration, the aggregation response of these particles to the presence of DNA was quantified by spectrophotometry. Plain PCMS and PEI attached-uniform PCMS particles were also utilized as sorbents in DNA adsorption experiments conducted at +4 degrees C in a phosphate buffer medium at pH 7.4. DNA immobilization capacities up to 45 mg DNA/g PCMS could be achieved with the PEI attached particles.