Posterior urethral valves: preliminary observations on the significance of plasma Renin activity as a prognostic marker

PURPOSE: A significant number of children with posterior urethral valves (PUVs) have chronic renal failure due to tubulointerstitial damage. Activation of the renin-angiotensin system is known to inflict this injury. We investigated the role of plasma renin activity (PRA) in patients with PUVs and sought to establish a relationship between renal damage and PRA. MATERIALS AND METHODS: The records of patients with PUVs were reviewed regarding the time of valve ablation, serum creatinine, scars, grade of reflux and glomerular filtration rate (GFR). PRA was measured before and after valve ablation. RESULTS: A total of 25 patients had PUVs (mean age 3.2 +/- 2.4 years, mean period of observation 4.5 +/- 1.2 years). Mean PRA was increased before valve ablation in all patients irrespective of age, and decreased after ablation. Of 25 patients 14 (56%) had renal damage, with a mean PRA of 36 +/- 4.5 ng/ml per hour compared to 26 +/- 8.2 ng/ml per hour in patients with normal renal function (chi-square 4.2 p = 0.01). Of the 14 patients with renal damage 9 (64%) had normal GFR at age 1 year but increased PRA. Of these 14 patients the accepted criteria for renal damage of increased serum creatinine, high grade reflux, scars and decreasing GFR were present in only 6 (43%), 3 (21%), 2 (14%) and 4 (29%), respectively. PRA was increased in all 14 cases. CONCLUSIONS: PRA was increased before valve ablation and decreased after ablation. It is increased in patients with early renal damage. Our preliminary observations indicate that PRA may be helpful in identifying patients with early renal damage.     

Silent blast in oral cavity: is the car battery innocuous?

Low voltage energy source is not free from danger. An exceptionally rare and peculiar mode of facial blast injury is reported. The blast took place silently in the mouth of a 15-year-old boy, due to short-circuiting of wires connected to a12-volt car battery while peeling off insulation with the intent of running a musical instrument. Airway compromise due to soft tissue injury produced further problem during tracheostomy. Emergent airway management is discussed. Post-healing sequel resulted in loss of voice and prevented normal oral feeding. The case report emphasizes need for education to public in handling low voltage energy source.     

Neuropathological spectrum of Rasmussen encephalitis

BACKGROUND: Rasmussen encephalitis (RE) is a chronic epileptic disorder of unknown etiology, and is clinically characterized by progressive neurological deterioration, focal seizures often progressing to intractable epilepsy, cognitive decline and hemispheric atrophy. AIMS: We report the spectrum of neuropathological changes seen in RE, and discuss the evolutionary mechanisms of this disease. MATERIALS AND METHODS: Surgically obtained specimens from RE patients diagnosed during 2002-2004 at this institute were evaluated for the presence and extent of different histopathological features of RE. The H&E and immunohistochemistry stained slides were also evaluated for the type and distribution pattern of inflammatory infiltrates, along with a semiquantitative evaluation for the severity of inflammation. RESULTS: Four cases of RE were admitted during the study period, all of which presented with partial seizures with successive deterioration to intractable epilepsy. The age at onset varied between 5 and 10 years (mean 7.8 years), with three male and one female patients. Subsequently, all four patients underwent hemispherotomy. Histopathological features of perivascular lymphocytic infiltrate, neuronal loss, microglial nodules, and reactive astrocytosis, with or without evidence of neuronophagia confirmed a diagnosis of RE. These cases also had varying degrees of T-cell-rich (CD3-positive) inflammatory infiltrates and CD68-immunopositive microglial proliferation. It was observed that the severity of inflammation had a trend to inversely correlate with the duration of symptoms. CONCLUSION: It is proposed that an accurate evaluation and histopathological grading of these lesions may possibly have a role in patient prognostication.     

Technetium-99m-L,L-ethylenedicysteine renal scan as a single-modality investigation for the evaluation of renal morphology and function: a comparative study with technetium-99m-dimercaptosuccinic acid

AIM: To evaluate whether cortical scars can be detected using the summed images of technetium-99m-L,L-ethylenedicysteine (99mTc-L,L-EC) renal dynamic scan, and to compare the results with technetium-99m-dimercaptosuccinic acid (99mTc-DMSA) scan. To evaluate the inter-observer variability for 99mTc-L,L-EC and 99mTc-DMSA scan reporting. METHODS: One hundred and three patients were initially included in the study; 21 were excluded, five due to a single functioning kidney and 16 due to impaired renal function (serum creatinine>2.5 mg.dl(-1)). Eighty-two patients (39 females, 43 males), including 31 children, with a mean age of 33.4+/-11.3 years (range, 4 months to 74 years), underwent both 99mTc-DMSA and 99mTc-L,L-EC scintigraphy within a period of 14 days. 99mTc-L,L-EC images were regrouped into 2 min image sets, and the initial 2 min summed image (cortical phase) was used for the evaluation of scars. Three independent observers analysed both images separately on different days without being aware of the identity and clinical details of the patients. Their 99mTc-L,L-EC findings were compared with the consensus 99mTc-DMSA scan findings taken as reference. RESULTS: The overall sensitivity of 99mTc-L,L-EC scans was 93% and the specificity was 96%. The inter-observer variability was 0.91 for 99mTc-L,L-EC and 0.94 for 99mTc-DMSA scan reporting, using the weighted kappa analysis at P<0.05. CONCLUSIONS: 99mTc-L,L-EC is an excellent single-modality comprehensive investigational agent for renal morphology, function and outflow tract evaluation with the added advantages of lower cost, convenience and low radiation exposure to the patient.     

Immunostimulatory role of tryptic digest of Abrus agglutinin

Many bioactive peptides are in therapeutic use as immunomodulators at present. The origin of these bioactive peptides is diverse. Such bioactive peptides are reported to be present in enzymatic digest of food and milk proteins. In our previous work we have reported that Abrus agglutinin retains its bioactivity even after heat denaturation but loses its haemagglutination properties. This leads to the supposition that immunostimulatory regions in the protein might be responsible for its in vivo and in vitro stimulatory properties. Thus the bioactivity of tryptic digest of Abrus agglutinin (TDA) was checked in vitro to ascertain the presence of some bioactive region in the protein, which will lead to the discovery of certain immunostimulatory peptides which might be of use in nonspecific immunotherapy. In this study it is observed that TDA stimulates macrophage increasing the phagocytic and bactericidal activity as well as hydrogen peroxide production. TDA also proliferates splenocytes leading to Th1 response and NK cell activation.