Tenofovir-associated renal and bone toxicity

Objectives The aims of the study were to describe the clinical presentation and renal and bone abnormalities in a case series of HIV-infected patients receiving treatment with tenofovir (TDF), and to recommend appropriate screening for toxicity related to TDF.
Methods Patients were identified from referrals to a specialist HIV renal clinic. Patients were included if treatment with TDF was assessed as the primary cause of the renal function impairment and clinical data were available prior to and following discontinuation of TDF treatment. Data were collected from case note review and clinic databases.
Results Twenty-two patients (1.6% of all those who received TDF) were identified with TDF-associated renal toxicity. All had normal serum creatinine prior to TDF therapy. All presented with proteinuria. On stopping TDF, renal function improved. Eight patients had confirmed Fanconi syndrome. Twelve patients presented with bone pain and osteomalacia was confirmed on an isotope bone scan in seven of these patients. The findings (in those patients tested) of tubular proteinuria, reduced tubular transport maximum of phosphate (TmP), and glycosuria were all consistent with the proximal tubule being the site of toxicity.
Conclusion Renal toxicity remains a concern in patients treated with TDF. Clinical presentation may be with renal dysfunction, Fanconi syndrome or osteomalacia. Our investigations suggest proximal tubular toxicity as a common pathogenic mechanism.     

Respiratory problems 2 years after acute bronchiolitis in infancy

We assessed the clinical progress of 55 children 2 years after admission to hospital with acute bronchiolitis and performed lung function tests on 40. During the 2 year follow up period 75% of the children had wheezed, 36% had 2 or more lower respiratory symptoms lasting more than 2 weeks, 33% had more than 100 days of lower respiratory symptoms, and 13% were readmitted to hospital with acute respiratory disease. In addition 60% of the children were hyperinflated on lung function tests. Many of the children with hyperinflation at the 2 year assessment had not been hyperinflated 1 year earlier, suggesting variable airways obstruction. Reversibility of airways obstruction was also assessed by response to nebulised salbutamol. Nine children had a fall greater than 15% in airways resistance after salbutamol and these children had the highest baseline airways resistances. Airways resistance was higher in the children with a family history of atopy.     

Initial qualitative evaluation of computed radiography in an intensive care unit

The first computed radiography (CR) unit in Australia was installed at St Vincent's Hospital, Melbourne, in February 1994. An initial qualitative evaluation of the attitude of the intensive care unit (ICU) physicians to the CR unit was conducted in June 1994 by use of a survey. The results of the survey of ICU physicians indicated that images were available faster than under the previous system and that the use of the CR system was preferred to evaluate chest tubes and line placements. While it is recognized that a further detailed radiological evaluation of the CR system is required to establish the diagnostic performance of CR compared with conventional film, some comments on the implementation of the system and ICU physician attitudes to the CR system are put forward for consideration by other hospitals examining the possible use of CR systems.     

Detection of human herpesvirus-8 DNA in oral ulcer tissues of HIV-infected individuals

OBJECTIVE: To determine the frequency of detection of human herpesvirus-8 (HHV-8) in HIV-related oral ulcers. DESIGN: Analysis of archived biopsy material. METHODS: Nested polymerase chain reaction of DNA extracts. RESULTS: HHV-8 DNA was detected in six of 10 oral ulcers of HIV-positive patients without oral Kaposi's sarcoma (KS) lesions and five of 11 oral KS lesions. The positive non-KS samples were derived from various oral sites. CONCLUSIONS: In HIV-positive people, HHV-8 can infect oral tissues that are not affected by KS.     

Emergency open cholecystectomy is associated with markedly lower incidence of postoperative nausea and vomiting (PONV) than elective open cholecystectomy: a retrospective cohort study

Background

An upper limb arteriovenous (AV) fistula is the access of choice for haemodialysis (HD). There have been few reports of saphenofemoral AV fistulas (SFAVF) over the last 10-20 years because of previous suggestions of poor patencies and needling difficulties. Here, we describe our clinical experience with SFAVF.

Methods

SFAVFs were evaluated using the following variables: immediate results, early and late complications, intraoperative and postoperative complications (up to day 30), efficiency of the fistula after the onset of needling and complications associated to its use.

Results

Fifty-six SFAVF fistulas were created in 48 patients. Eight patients had two fistulas: 8 patent (16%), 10 transplanted (20%), 12 deaths (24%), 1 low flow (2%) and 20 thrombosis (39%) (first two months of preparation). One patient had severe hypotension during surgery, which caused thrombosis of the fistula, which was successfully thrombectomised, four thrombosed fistulae were successfully thrombectomised and revised on the first postoperative day. After 59 months of follow-up, primary patency was 44%.

Conclusion

SFAVF is an adequate alternative for patients without the possibility for other access in the upper limbs, allowing efficient dialysis with good long-term patency with a low complication rate.     

Partial obstruction of the seminal path, a frequent cause of oligozoospermia in men

The objective of this clinical study was to determine the real frequency and clinical importance of partial obstruction of the seminal path in patients with oligozoospermia. We have designed a prospective clinical study including men with oligozoospermia seen at an andrological consultation in both private and institutional hospitals. A testicular biopsy was done on all patients under local anaesthesia. A complete study for sterility was also done [hormonal determinations: follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, testicular ultrasound, semen analysis, testicular Doppler ultrasound, etc.]. We have made a quantitative and qualitative evaluation of testicular biopsy (percentage of tubules with Sertoli cell only or with hyalinization; mean tubular diameter; number of spermatogonia, primary spermatocytes, young spermatids, mature spermatids and Sertoli cells; and evaluation of testicular interstitium: number of Leydig cell clusters, presence of angiectasis, presence of perivascular inflammation). Sixty one per cent of all oligozoospermia cases were obstructive. The principal cause of obstructive oligozoospermia was the presence of testicular varicocele. In obstructive oligozoospermia, the tubular diameter and number of mature spermatids are statistically significantly higher than in non- obstructive oligozoospermia. Obstructive oligozoospermia is a frequent condition caused by partial obstruction of seminal path. A quantitative analysis of the testicular biopsy is the only method of diagnosis.      

International trends in pedestrian injury mortality

Trends in pedestrian injury mortality for children aged 0-4 and 5-14 for England and Wales, Denmark, Sweden, the USA, and New Zealand were examined from 1968 onwards. While there has been a reduction in the pedestrian mortality in all these countries, there are striking international differences in the extent of these reductions. Denmark has achieved the greatest fall in mortality with the smallest decrease seen in New Zealand. Countries which have experienced major decreases in pedestrian mortality are distinguished by having placed greater emphasis on environmentally based prevention strategies rather than pedestrian skills education.