Methylprednisolone in Patients with Membranous Nephropathy and Declining Renal Function

Fifteen consecutive patients aged 24 to 70 years, with membranousnephropathy and a progressive decline in renal function, weretreated with methy prednisolone, 1 g intravenously daily forfive days, followed immediately by a tapering dose of oral prednisolone.Plasma creatinine levels fell by a mean of 46 per cent (range21–65). In 10 patients the beneficial effect was sustained,but in three it had reversed by six months. In the other twopatients the progressive decline of renal function was not influenced. These observations suggest that many patients with membranousnephropathy and declining renal function could benefit fromintervention with high dose steroids.     

The complex-type oligosaccharide binding lectin Datura stramonium agglutinin detects type II A muscle fibres in the brachial biceps from man and cat

Complex-type oligosaccharides were detected in the sarcoplasm of muscle fibres from cat and human biceps using lectins and anticarbohydrate antibodies. The lectin Datura stramonium agglutinin strongly stained type II A fibres as identified by myosin ATPase activity after alkaline and acid preincubation. In contrast, all muscle fibres showed a moderate coarse granular staining after incubation with Tetracarpidum conophorum agglutinin and Telfairia occidentalis agglutinin which recognize tri-antennary complex glycans poorly bound by D. stramonium agglutinin. Strong sarcoplasmic staining in all muscle fibres was obtained after incubation with an antibody against branched N-acetyllactosamine structure while an antibody against binary 2←3 sialyllactosamine glycans failed to detect the muscle fibres. Treatment of the muscle sections with sialidase prior to incubation with D. stramonium agglutinin did not influence the lectin staining pattern. Staining of blots from electrophoretically separated muscle proteins obtained byhomogenization, solubilization and centrifugation of small muscle pieces showed D. stramonium agglutinin binding to a number of bands ranging from 200 kDa to 30 kDa. No D. stramonium agglutinin positive bands were observed in blots from separated mitochondrial proteins while blots from sarcoplasmic reticulum separated by electrophoresis stained many bands in the range from 200 kDa to 30 kDA. It may be concluded that all muscle fibres inhuman and cat biceps hold intracellular non-sialylated complex-type oligosaccharides and further, that a specific tri-antennary complex-type glycoform is strongly expressed in type II A fibres as recognized by D. stramonium agglutinin. These results indicate a differential glycosylation of certain myofibrillar-associated proteins in muscle fibre types This revised version was published online in July 2006 with corrections to the Cover Date.     

Respiratory Allergies in Industry: A Review of Recent Advances and Current Clinical Practice

In the last decade significant advances have been made in ourunderstanding of allergy. Many new industrial allergens causingrespiratory disease have been discovered. This paper reviewsthe present understanding of the types of allergy commonly encounteredin industry and examines methods of detection, diagnosis andcontrol, necessary within a factory environment. A programmeof screening procedures to exclude those most likely to be affectedand to discover subjects with acute or chronic disease is discussed. The necessity for detecting long-term trends is considered,and statistical methods of analysing data from screening proceduresare outlined. Dr C. P. Juniper, Medical Adviser, Lever Brothers Ltd, Port Sunlight, Wirral, Cheshire, L62 4XN     

A Customized Spoon for a Patient with Arthritis

Patients with arthritis frequently experience difficulty with self feeding due to deformity of the hands. This article describes the fabrication of a customized feeding aid for such a patient. The technique uses dental wax to create a form fitting pattern which will suit individual needs. The pattern is then cast in strong acrylic by a simple and non-costly process. The spoon constructed proved to be effective by allowing the patient to feed herself independently.     

CARDIOVASCULAR RESPONSES IN HYPERTHYROIDISM BEFORE AND DURING 0-ADRENOCEPTOR BLOCKADE: EVIDENCE AGAINST ADRENERGIC HYPERSENSITIVITY

The relationship between the sympathetic nervous system and cardiovascular responses has been studied indirectly in ten hyperthyroid patients and age matched euthyroid controls. Nyctohemeral variations in heart rate, and heart rate and blood pressure responses to exercise were measured before and during β-blockade with slow-release propranolol. Both groups showed a parallel variation in heart rate over 24 h, with an increase in heart rate in the hyperthyroid group that was the same during the day (27·9 ± 0·95 beats/min) and during the night (26·7 ± 0·75 beats/min). Similarly, the increase in resting heart rate (32·7 ± 4·4 beats/min) in the hyperthyroid group was close to the increase in peak exercise-induced heart rate (25·0 ± 4·7 beats/min). Adequate β-blockade was achieved in all subjects as evidenced by a percentage reduction in peak exercise heart rate of 25–45%. Propranolol caused a greater reduction in daytime than night-time heart rate in both groups and blunted the response to exercise. Following β-3-blockade, the mean percentage reduction in heart rate and systolic blood pressure during exercise, and heart rate responses over 24 h were similar in hyperthyroid and euthyroid groups. The closest correlation between thyroid hormone levels and heart rate was that of serum total tri-iodothyronine (T3) and nocturnal heart rate during β-bockade (r = 0.92; P < 0·001). It is concluded that excess circulating thyroid hormones exert a direct effect on the cardiovascular system additive to the sympathetic nervous system and that there is no evidence of adrenergic hypersensitivity in hyperthyroidism.     

Carcinogen Activation and the Biological Detection of Activated Metabolites

The general principles of how organic chemical carcinogens arethought to act are detailed and a unifying hypothesis of theirmode of action is presented. Using this unifying principle,several short term assays in which chemicals can be screenedfor their carcinogenic potential are set out as well as therole of these assays in any testing programme to try and predictcarcinogenic hazard to man Requests for reprints should be addressed to: Dr R.C. Garner, Cancer Research Unit, University of York, Heslington, York YO1 5DD     

Minimally Ablative Erbium:YAG Laser Resurfacing of Facial Atrophic Acne Scars in Asian Skin: A Pilot Study

BACKGROUND Atrophic scars are dermal depressions caused by collagen damage most commonly occurring after inflammatory acne vulgaris. There are little published data regarding the effectiveness and safety of minimally invasive lasers in the treatment of atrophic acne scars in darker skin types.
OBJECTIVE The purpose was to evaluate the efficacy and safety of a low-fluence 2,940-nm erbium:YAG laser in the treatment of atrophic acne scars in Asian patients.
MATERIALS AND METHODS Nine patients aged 19 to 45 years with mild to moderate atrophic facial scars and Skin Types IV and V were treated with topical anesthesia and one to two passes with an erbium:YAG laser two times at 1-month intervals. Treatment parameters were 6-mm spot size, fluence of 400 mJ, pulse duration of 300 μs, and repetition rate of 2 Hz.
RESULTS At 2 months after the last treatment, mild to moderate clinical improvement was noted in all patients compared to baseline. Treatment was well tolerated. Side effects consisted of posttreatment erythema, peeling, and crusting, which resolved within 1 to 2 weeks. There was no postinflammatory hyper- or hypopigmentation, blistering, or hypertrophic scarring.
CONCLUSION Low-fluence erbium:YAG facial resurfacing was effective and safe in patients with mild to moderately severe atrophic acne scarring.     

Sleep architecture changes during a trek from 1400 to 5000 m in the Nepal Himalaya

The aim of this study was to examine sleep architecture at high altitude and its relationship to periodic breathing during incremental increases in altitude. Nineteen normal, sea level-dwelling volunteers were studied at sea level and five altitudes in the Nepal Himalaya. Morning arterial blood gases and overnight polysomnography were performed in 14 subjects at altitudes: 0, 1400, 3500, 3900, 4200 and 5000 m above sea level. Subjects became progressively more hypoxic, hypocapnic and alkalinic with increasing altitude. As expected, sleep architecture was affected by increasing altitude. While time spent in Stage 1 non-rapid eye movement sleep increased at 3500 m and higher ( P  <   0.001), time spent in slow-wave sleep (SWS) decreased as altitude increased. Time spent in rapid eye movement (REM) sleep was well preserved. In subjects who developed periodic breathing during sleep at one or more altitudes (16 of 19), arousals because of periodic breathing predominated, contributing to an increase in the total arousal index. However, there were no differences in sleep architecture or sleeping oxyhaemoglobin saturation between subjects who developed periodic breathing and those who did not. As altitude increased, sleep architecture became progressively more disturbed, with Stage 1 and SWS being affected from 3500 m, while REM sleep was well preserved. Periodic breathing was commonplace at all altitudes, and while associated with increases in arousal indices, did not have any apparent effect on sleep architecture.