Oral cyclosporine but not tacrolimus reduces renal transplant blood flow

BACKGROUND: Calcineurin inhibitors are important immunosuppressive agents, but cause nephrotoxicity. METHODS: Instantaneous intra-renal transplant hemodynamics were assessed in 22 patients using quantitative cineloop color Doppler imaging after dosing with microemulsion cyclosporine (CSA) or tacrolimus (TAC). RESULTS: CSA dosing resulted in renal hypoperfusion, with a mean relative reduction of 43%+/-20% (range 22-76%) in maximal fractional area (MFA) of color pixels to nadir, compared to baseline. The mean effect occurred 1.1+/-0.9 hr (median 1 hr) after CSA dosing and was abrogated by calcium channel blockers (P <0.05). The main renal artery velocities, resistive index and small vessel perfusion were unchanged, suggestive of medium-sized arteries mediated vasoconstriction. In contrast, TAC did not alter renal vascularity (2.3+/-4.0% absolute reduction of MFA color pixels vs. 10.7+/-6.5% with CSA, P <0.01). CONCLUSION: CSA, but not TAC, induces phasic hypoperfusion of variable severity within small to medium sized intra-renal arteries soon after dosing, mitigated by calcium channel blockade.     

In vivo effect of the lipido-sterolic extract of <Emphasis Type="Italic">Serenoa repens</Emphasis> (Permixon) on mast cell accumulation and glandular epithelium trophism in the rat prostate

The Serenoa repens lipido-sterolic extract (SRLSE, Permixon, Pierre Fabre Medicament, Castres, France) is used to treat benign prostate hyperplasia. We studied the in vivo effect of SRLSE on mast cell accumulation and the histological characteristics of the rat ventral prostate. Adult Wistar rats received either tocopherol or SRLSE (50 and 100 mg/kg body weight, respectively) every second day for 90 days. Histological features were studied in hematoxylin-eosin stained tissue sections while mean mast cell numbers were determined in Giemsa-stained sections. The central region of the ventral prostate in treated animals showed significant changes with acinar epithelium becoming flat or low cuboidal. In the same region, mean mast cell number per optical field in the control, low-dose and high-dose groups were, respectively, 4.7+/-0.7, 3.4+/-1.0 and 2.4+/-0.6, showing a dose-dependent, statistically significant decrease. Administering SRLSE significantly reduces mast cell accumulation and provokes epithelium atrophy within the central area of the rat ventral prostate. These phenomena may participate in the clinical activity of the drug.     

Shockwave lithotripsy for urinary stones in patients with urinary diversion after radical cystectomy

BACKGROUND AND PURPOSE: During recent years, survival of patients with invasive bladder cancer has been improved by early diagnosis and radical treatment. Urinary lithiasis is not rare in patients who have been submitted to radical cystectomy and urinary diversion. We have demonstrated the effectiveness and safety of SWL for these patients. PATIENTS AND METHODS: We studied 11 patients who presented to our lithotripsy department suffering from urinary lithiasis after radical cystectomy. They were all cancer free at the time of treatment, and all underwent SWL on the Dornier HM-3 lithotripter as a first-line treatment. The mean stone burden was 1.85 cm(2), and the stone-to-patient ratio was 1:1. RESULTS: The stone-free rate 1 month after SWL was 63.7%. Patients who were not stone free underwent a second SWL, and the stone-free rate after the second SWL session was 81.8%. We performed percutaneous nephrolithotripsy in one patient after the second SWL session because of the large stone burden remaining (3.2 cm(2)). The remaining patient was submitted to ureterolithotomy. CONCLUSION: Application of SWL gives very good results in the treatment of urinary lithiasis in patients with a urinary diversion. Indeed, the results are equivalent to those achieved in patients without urinary diversion.     

Mercury exposure: current concepts, controversies, and a clinic's experience

In the context of controversies surrounding fish consumption, amalgams, and commercial hair testing, we reviewed all cases from an occupational and environmental medicine clinic that had undergone mercury testing. Sixty-nine of 71 (97%) patients had no known mercury exposures other than diet or amalgams. Of these 69, 48 had blood mercury tested and 58 had urine testing. Regular-to-heavy fish consumption explained 10 of 11 cases with blood mercury concentrations > 15 micrograms/L (19 to 53 micrograms/L). Six of these 10 individuals reported regular swordfish consumption. For the 31 patients with adequate dietary history, there was a significant relationship between fish consumption and blood mercury concentration (P < 0.001). Higher blood mercury concentrations were, however, not associated with specific patterns of health complaints. Ninety-eight percent (57 of 58) of urine values were < 10 micrograms/L. Fourteen patients were evaluated because they were labeled as mercury toxic by other practitioners after unconventional commercial testing. Using standard tests of blood and urine, we could not document evidence of mercury toxicity in any of these 14 cases. We conclude that consumption of commercially available fish can lead to elevated blood mercury concentrations. A recognized exposure source is a better predictor of significant mercury concentrations in biologic media than any particular symptom constellation. Unconventional commercial panels that test hair or urine for multiple metals have questionable validity. Clinicians should use standard blood and urine tests to evaluate mercury exposure.     

Lipid profile of firefighters over time: opportunities for prevention

Heart disease is the primary cause of on-duty deaths in firefighters, but little is known about their lipid profile. We evaluated the lipid profile in relation to other cardiovascular disease risk factors in 321 firefighters at a baseline examination. Prospective comparisons were performed for 285 firefighters, who were enrolled in a statewide medical surveillance program, and had complete follow-up data for 4 years. The average cholesterol level in firefighters declined from 224 mg/dL at baseline (1996-1997) to 214 mg/dL at the follow-up examination (P < 0.0001). Conversely, both obesity (body mass index > or = 30; 34% versus 40%, P = 0.008) and triglycerides (> or = 200 mg/dL; 27% versus 35%, P = 0.047) increased over time. The proportion of firefighters taking lipid-lowering medications increased from 3% at baseline to 12% at follow-up (P < 0.0001). Cholesterol levels declined significantly, and treatment rates for elevated cholesterol increased over time. Despite repeated examinations, a considerable number of firefighters had persistently elevated cholesterol, and only a minority were receiving adequate treatment.     

Multifocal choroiditis and panuveitis: immunomodulatory therapy

PURPOSE: To report our analysis of the efficacy of immunomodulatory therapy on the course of 19 patients with multifocal choroiditis and panuveitis (MCP). DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Nineteen patients with multifocal choroiditis with panuveitis evaluated on the Ocular Immunology and Uveitis Service of the Massachusetts Eye and Ear Infirmary from 1978 to 2000. METHODS: Fifteen patients were treated with systemic immunomodulatory therapy; 4 patients (who refused therapy) were treated with systemic steroids. All patients were analyzed for control of inflammation, visual acuity outcome, and tolerance of immunomodulatory therapy. MAIN OUTCOME MEASURES: Control of inflammation and visual acuity. RESULTS: Nineteen patients with bilateral MCP with a mean follow-up of 72.7 months were studied. Fifteen were treated with immunomodulatory agents, whereas 4 patients received only systemic steroids; these 4 developed serious systemic steroid-related complications, and 12 others had cataract and/or glaucoma related to chronic topical, regional, or systemic steroid use before immunomodulatory therapy. Two patients who refused immunomodulatory therapy lost considerable vision in three of their four eyes. Of the 15 patients treated with immunomodulatory drugs, 7 patients lost considerable vision in one eye on steroid therapy but maintained good vision in the other eye once immunomodulatory therapy was instituted. No patient lost vision in any eye once he or she was treated with immunomodulatory treatment. CONCLUSIONS: Immunomodulatory therapy controls inflammation and preserves vision in patients with multifocal choroiditis and panuveitis.     

Acute comitant esotropia after cataract surgery

A 52-year-old woman developed comitant esotropia after cataract surgery. The ocular history was significant for accommodative esotropia; preoperatively, she manifested peripheral fusion with central suppression. Immediately postoperatively, the patient was diplopic with comitant esotropia and was treated with extraocular muscle surgery. The appearance of horizontal strabismus after cataract surgery in patients with a history of accommodative esotropia, especially those with subnormal binocularity, is a possible complication that should be discussed with the patient.     

Quality assured trusted third parties for deploying secure internet-based healthcare applications

In this paper we present a complete reference framework for the provision of quality assured Trusted Third Party (TTP) services within a medical environment. The main objective is to provide all the basic guidelines towards the development of a quality system for a TTP as an organisation, which could be mapped directly to the requirements of ISO-9000 standards. The important results of the implementation of a quality system, are the enhanced trustworthiness of the TTP and the confidence of the medical society in the provided services. Furthermore, the value added certification services conform to customer requirements and are characterised by efficiency, reliability, security, credibility and trust. The internal organisation acquires a clear and strict structure and maximises its effectiveness by establishing quality management, committed to control, assure and improve quality. The TTP requirements for quality are identified and the various elements of the quality system are described illustratively.     

CuZn and ZnO Nanoflowers as Nano-Fungicides against Botrytis cinerea and Sclerotinia sclerotiorum: Phytoprotection,Translocation, and Impact after Foliar Application

Inorganic nanoparticles (INPs) have dynamically emerged in plant protection. The uptake of INPs by plants mostly depends on the size, chemical composition, morphology, and the type of coating on their surface. Herein, hybrid ensembles of glycol-coated bimetallic CuZn and ZnO nanoparticles (NPs) have been solvothermally synthesized in the presence of DEG and PEG, physicochemically characterized, and tested as nano-fungicides. Particularly, nanoflowers (NFs) of CuZn@DEG and ZnO@PEG have been isolated with crystallite sizes 40 and 15 nm, respectively. Organic coating DEG and PEG (23% and 63%, respectively) was found to protect the NFs formation effectively. The CuZn@DEG and ZnO@PEG NFs revealed a growth inhibition of phytopathogenic fungi Botrytis cinerea and Sclerotinia sclerotiorum in a dose-dependent manner with CuZn@DEG NFs being more efficient against both fungi with EC₅₀ values of 418 and 311 μg/mL respectively. Lettuce (Lactuca sativa) plants inoculated with S. sclerotiorum were treated with the NFs, and their antifungal effect was evaluated based on a disease index. Plants sprayed with ZnO@PEG NFs showed a relatively higher net photosynthetic (4.70 μmol CO₂ m⁻²s⁻¹) and quantum yield rate (0.72) than with CuZn@DEG NFs (3.00 μmol CO₂ m⁻²s⁻¹ and 0.68). Furthermore, the penetration of Alizarin Red S-labeled NFs in plants was investigated. The translocation from leaves to roots through the stem was evident, while ZnO@PEG NFs were mainly trapped on the leaves. In all cases, no phytotoxicity was observed in the lettuce plants after treatment with the NFs.