Determinants of renal functional outcome in lupus nephritis: a single centre retrospective study

Background: Lupus nephritis (LN) is a rare disease but is thestrongest predictor of poor outcome in patients with SystemicLupus Erythematosis (SLE). It is associated with significantmorbidity, with 10–20% of patients developing end stagerenal failure. As there is a paucity of randomized clinicaltrial data in LN, and no consistent literature regarding baselinefactors that predict renal outcome, we were prompted to analyseour centre's complete experience of managing LN. Methods: A retrospective analysis was undertaken of all patientspresenting to our renal centre with biopsy proven LN from 1979–2003.Patients were divided into two categories, those with stableor deteriorating renal function over time. Baseline parameterswere correlated with renal outcome. Results: Complete clinical records were available for 45 (40female) patients. Mean (SD) age of onset of SLE was 32 ±14 years, and mean age onset of LN was 36 ± 13 years.Patients were followed up for an average of 74 ± 56 months.Four patients (9%) had WHO Class II LN, 11 (24%) WHO Class IIIand there were 15 (33%) each in Class IV and V, respectivelyon renal biopsy. Five (11%) patients presented with acute renalfailure and all had proliferative changes on biopsy. The chiefarbiters of renal functional deterioration over follow up werelonger time to development of LN (P = 0.04), a high plateletcount and worse baseline renal function (both P = 0.05). Therewas a trend relating low haemoglobin or membranous histologyto poor renal outcome, and Class IV histology to better outcome. Conclusion: The study has identified that longer time to developmentof LN, high platelet count and poorer renal function at baselinesuggest a worse renal outcome in LN. The study was small butLN is a rare condition. A combination of factors is likely toinfluence renal outcome in LN and larger prospective trialsare required to ascertain consistent baseline prognostic markers.     

A prospective study of hip revision surgery using the Exeter long-stem prosthesis: function, subsidence, and complications for 57 patients

Background  

The long-stem Exeter femoral component is commonly used in revision hip surgery. Subsidence of the femoral stem in primary hip arthroplasty has been studied extensively, but much less is known about its significance in revision surgery. This prospective study examined the relationship between radiological subsidence, Western Ontario and McMaster (WOMAC) osteoarthritis index pain score, patient satisfaction and complication rates for the long-stem Exeter hip prosthesis.     

Efficacy of swabbing versus a conventional technique for isolation of Cryptococcus neoformans from decayed wood in tree trunk hollows.

The efficacy of swabbing versus a conventional sedimentation technique was evaluated for sampling of decayed wood in tree trunk hollows for isolation of Cryptococcus neoformans. Of 52 samples of decayed wood, bark or other plant debris originating from 35 living trees, 42 wood samples yielded C. neoformans. The positive samples included 40 collected from 31 Syzygium cumini trees growing along roadsides in Old Delhi, whereas the remaining two were from inside tree trunk fissures of Ficus religiosa in a New Delhi locality. The number of wood samples found positive by swabbing was 40 (95%) as opposed to 32 (76%) by the conventional technique, and this difference was statistically significant (P < 0.01). Also, the conventional technique showed 24% false-negative results, which was in striking contrast to only 5% by swabbing. Furthermore, swabbing yielded a significantly higher C. neoformans mean colony count than did the conventional technique (P < 0.005), thus highlighting greater efficacy of the former technique. The overall prevalence of C. neoformans in the S. cumini trees investigated was 84% (26/31 trees) which is the highest as yet reported from any tree species in India. Varietal identification and serotyping was done with 33 of the C. neoformans isolates, 31 of which came from 23 tree trunk hollows of S. cumini and two from the tree trunk fissures of F. religiosa. Among the S. cumini isolates, 26 were identified as C. neoformans var. gattii (all serotype B except two untypeable ones) and five as C. neoformans var. neoformans, serotype A (= C. neoformans var. grubii). Both of the F. religiosa isolates belonged to C. n. var. neoformans, serotype A. Being a more efficacious, simple, less time-consuming and less hazardous technique, swabbing is recommended for wider use in order to further elucidate the ecology of C. neoformans.     

Preoperative prediction of difficult lap chole: a scoring method

Background  

Laparoscopic cholecystectomy (LC) has become the procedure of choice for management of symptomatic gallstone disease. At times it is easy and can be done quickly. Occasionally it is difficult and takes longer time. But there is no scoring system available to predict the degree of difficulty of LC preoperatively.     

Immunomodulatory studies of a bioactive fraction from the fruit of Prunus cerasus in BALB/c mice

In order to evaluate the role of ethyl acetate fraction (PNRS-EtOAC) obtained from the Prunus cerasus fruit in the modulation of immune responses, detailed studies were carried out using a panel of in vivo assays. Oral administration of PNRS-EtOAC (25-100 mg/kg) stimulated the IgM and IgG titre expressed in the form of hemagglutination antibody (HA) titre. Further, it elicited a dose related increase in the delayed type hypersensitivity reaction (DTH) after 24 and 48 h in BALB/c mice. Besides augmenting the humoral and cell mediated immune response, the concentration of cytokines (IFN-γ, IL-4, and TNF-α) in serum with respect to T cell interactions, i.e. the proliferation of lymphocytes were significantly increased at 50 mg/kg compared with the control. The results in these studies demonstrated the immunostimulatory effect of PNRS-EtOAC in a dose-dependent manner with respect to the macrophage activation possibly expressing the phagocytosis and nitrite production by the enhancement of TNF-α production as a mode of action.     

Primary mucinous carcinoma (PMC) of the skin—a case report

Primary mucinous carcinoma of the skin is a rare malignant adnexal neoplasm. It was first described by Lennox et al. in 1952. It is uncertain whether it is of apocrine or eccrine origin (Wright and Font, Cancer 44:1757–1768, 2; Mendoza and Helwig, Arch Dermatol 103:68–78, 3). Showing morphological similarity to mucinous carcinoma of the breast, it may be difficult to distinguish it from a cutaneous metastatic deposit of mucinous adenocarcinoma from a visceral primary lesion. Hence, it deserves attention not only for its scarcity but also for the challenge in determining its precise diagnosis and hence, planning its management. We present a case of primary mucinous carcinoma of the skin.