Talectomy for the clubfeet treatment in children with myelomeningocoele]

Talectomy, despite its palliative character, seems to be a treatment of choice in many cases of severe neurogenic clubfeet. The aim of our study was to determine the value of talectomy in the treatment of equinovarus deformity in children with myelomeningocoele. MATERIAL AND METHOD: The material consists of 12 children with myelomeningocele (21 neurogenic clubfeet), treated by talectomy. The results of two post-operative follow-up examinations were included--first after 15 months (follow-up I, second after 30 months (follow-up II). The material was divided into two groups: I--consist of feet after talectomy combined with wedge resection of calcaneo-cuboid joint, and II--the feet which underwent "only" talectomy. The calcaneo-cuboid wedge osteotomy was performed to improve the forefoot position for the correction of the more severe deformity. The clinical and X-ray records concerning preoperative period were reviewed. At the follow-up the clinical, radiological and functional evaluation were performed with the special affiliation on modified Magone scale. RESULTS: Satisfactory clinical results were achieved in all feet except one which required reoperation. Walking ability in orthopaedic fit was present in 5 cases before surgery, and increased to 9 at follow-up. There were no radiological signs of the tibio-calcaneal fusion at the time of observation. During follow-up, on the basis of radiograms made in lateral position, gradual limitation of ROM in so called "tibio-calcaneal" joint was observed. At follow-up I according to modified Magone scale good clinical result was observed in 3 feet, satisfactory in 10, and unsatisfactory in the remaining 3 feet. At follow-up II 3 were defined as good, 4 were defined as satisfactory and the remaining 8 as pour results (only patients who underwent two postoperative examinations). The clinical deterioration does not correlate with the lost of feet shape correction--but mainly with the lost of the ROM in the new "tibio-calcaneal" joint. There were no statistically significant differences between the clinical outcome of feet from group I and II. The authors concluded that the additional wedge resection of calcaneo-cuboid joint improved the forefoot position and, by this way, makes the surgery correction easier.     

Capillary electrophoretic determination of thiamphenicol in turkeys serum and its pharmacokinetic application

The pharmacokinetics of thiamphenicol were investigated in 12 healthy turkeys of both sexes, following intravenous (i.v.) and intragastric (p.o.) administration of a single dose of 30 mg/kg body weight (bw). Serum drug concentrations were determined by capillary electrophoresis technique on blood samples collected over 24 h following treatment. The method was statistically validated for its linearity, accuracy, precision and selectivity. The linear range was from 0.2 to 500 microg/ml with correlation coefficients greater than 0.999. The limit of detection of drug was 70 ng/ml, while the quantitative limit was 200 ng/ml, using 0.5 ml sample size. Pharmacokinetic variables of the drug were calculated after both administration routes.     

Microalbuminuria predicts overt proteinuria among patients with HIV infection

Background

This study examines the association between microalbuminuria and the development of proteinuria among HIV‐infected persons.

Methods

A total of 948 subjects provided urine samples for albumin, protein and creatinine measurements semiannually. Microalbuminuria was defined as an albumin‐to‐creatinine ratio of >30 mg/g. Proteinuria was defined as a protein‐to‐creatinine ratio of ≥0.350 mg/mg. The progression from microalbuminuria to proteinuria was described.

Results

At baseline, 69.4% of the subjects had no detectable proteinuria, 20.2% had microalbuminuria, and 10.4% had proteinuria. Subjects with microalbuminuria and proteinuria were more likely to be black (P=0.02), have lower CD4 cell counts (P=0.02 comparing subjects without abnormal urine protein excretion to subjects with microalbuminuria; P=0.0001 comparing subjects with microalbuminuria to subjects with proteinuria), and have a higher HIV RNA level (P=0.08 and 0.04, respectively). Among 658 subjects with normal urine protein, 82.7% continued to have no abnormality, 14.3% developed microalbuminuria, and 3.0% developed proteinuria. Subjects without baseline proteinuria (i.e. either normal protein excretion or microalbuminuria) who developed proteinuria were more likely to have microalbuminuria (P=0.001), a lower CD4 cell count (P=0.06), and a higher plasma HIV RNA (P=0.03) than those who did not progress to proteinuria. In multivariate analysis, only microalbuminuria remained associated with the development of proteinuria (odds ratio 2.9; 95% confidence interval 1.5, 5.5; P=0.001).

Conclusion

Microalbuminuria predicts the development of proteinuria among HIV‐infected persons. Because proteinuria has been linked to poorer outcomes, strategies to affect microalbuminuria should be tested.

     

The concentration of uric acid in patients with metabolic syndrome and cardiovascular diseases

The association of elevated serum uric acid (hyperuricemia, gout) with the presence of classical coronary risk factors and coronary artery disease (CAD) or myocardial infarction (MI) has been analysed in many epidemiological studies. Numerous studies have revealed that hypertension, high body mass index (BMI), lipid disorders (especially raised triglyceride (TG) levels and low high dense lipoprotein cholesterol (HDL-C) level), and increased creatinine or insulin levels have caused hyperuricemia. Gout has often occurred with typical disorders for the metabolic syndrome X. Significant correlation of the serum uric level and the CAD presence and severity of coronary atherosclerosis confirmed by coronary angiography has been observed in women. Hyperuricemia has also indirect influence on progress of CAD by physical activity restriction, what causes sedentary mode of life and lead to obesity. Therefore, we conducted our study in order to estimate uric acid levels in patients with metabolic syndrome and coexisting cardiovascular system diseases.     

Blocking neuropilin-1 function has an additive effect with anti-VEGF to inhibit tumor growth

Neuropilin-1 (NRP1) guides the development of the nervous and vascular systems. Binding to either semaphorins or VEGF, NRP1 acts with plexins to regulate neuronal guidance, or with VEGFR2 to mediate vascular development. We have generated two monoclonal antibodies that bind to the Sema- and VEGF-binding domains of NRP1, respectively. Both antibodies reduce angiogenesis and vascular remodeling, while having little effect on other VEGFR2-mediated events. Importantly, anti-NRP1 antibodies have an additive effect with anti-VEGF therapy in reducing tumor growth. Vessels from tumors treated with anti-VEGF show a close association with pericytes, while tumors treated with both anti-NRP1 and anti-VEGF lack this organization. We propose that blocking NRP1 function inhibits vascular remodeling, rendering vessels more susceptible to anti-VEGF therapy.     

Plasma exchange in Goodpasture syndrome associated with Turner's syndrome: A case report

Background

Good pasture syndrome (GPS) has been paid much attention recently for the dangerous illnessand high mortality.

Objective

To investigate the efficiency of plasma exchange (PE) to treat Goodpasture syndrome (GPS) in children associated with Turner''s syndrome.

Method

We report a case of a 15 year old female with GPS and Turner''s syndrome. The patient has intermittent fever and cough for 45 days and oliguria for 6 days. Turner''s syndrome was determined through blood karyotype analysis, and GPS was diagnosed because the patient was negative for antinuclear antibodies and antineutrophil cytoplasmic antibodies (ANCA), but positive for anti-glomerular basement membrane (anti-GBM) antibodies (200 RU/ml). PE was carried out in combination with immunosuppression therapy.

Results

The results show PE treatment can efficiently decrease the levels of anti-GBM antibodies. The antibody levels were >200 RU/ml and 184 RU/ml before and after the first PE treatment, respectively. The removal efficiency were 40%, 47%, 42%, 54%, 52% for the fifth, sixth, seventh, eighth and ninth PE procedures, respectively.

Conclusion

The therapy with PE, hemodialysis, pulse methylprednisolone followed by oral prednisone and cyclophosphamide greatly contributed to improvement of this patient''s condition, and resolved the patient''s pulmonary haemorrhage. All these results demonstrate that PE contributed efficiently to the treatment for GPS in children.