1Long-term renal outcome in patients with malignant hypertension: a retrospective cohort study

ABSTRACT: BACKGROUND: Malignant hypertension is frequently complicated by renal insufficiency. Although the survival of this hypertensive emergency has improved, recent data on renal outcome and its predictors are lacking. We assessed renal outcome and its predictors in patients with malignant hypertension. METHODS: Retrospective analysis of patients admitted with malignant hypertension in Amsterdam, the Netherlands between August 1992-January 2010. Follow-up data on vital status, renal function and blood pressure (BP) were obtained from the outpatient department and from general practitioners. The primary composite endpoint was end-stage renal disease (ESRD) defined as the start of kidney replacement therapy (KRT) or [greater than or equal to] 50 % decline of estimated glomerular filtration rate (eGFR). The secondary endpoint was all cause mortality. RESULTS: A total of 120 patients admitted with malignant hypertension were included. After a median follow-up period of 67 months (IQR 28 to 108 months) the primary endpoint was reached by 37 (31 %) patients, whereas 18 patients (15 %) reached the secondary endpoint. Twenty-nine (24 %) patients started KRT and 8 patients (7 %) had an eGFR decline [greater than or equal to] 50 %. After the acute phase (> 3 months after admission), initial serum creatinine and follow-up BP were the main predictors of future ESRD with hazard ratios of 6.1 (95 % CI, 2.2-17) for patients with initial serum creatinine [greater than or equal to] 175 mumol /L and 4.3 (95 % CI, 1.4-14) for patients with uncontrolled hypertension. CONCLUSIONS: Progressive renal function decline leading to ESRD remains a major threat to patients with malignant hypertension. BP control during follow-up was an important modifiable predictor of renal outcome.     

MR imaging and computed tomography in patients with rectal tumours clinically judged as locally advanced

AIM: To compare magnetic resonance (MR) imaging and computed tomography (CT) in the local staging of locally advanced rectal tumours. MATERIALS AND METHODS: Sixteen consecutive patients who, after pre-operative radio-chemotherapy (RCT), had surgery for rectal tumours clinically judged as extending into neighbouring tissues in the pelvis, were examined using MR and CT before and after treatment. The examinations were reviewed by four radiologists. The relation of the tumours to 14 different anatomic structures in the pelvis in a total of 50 examinations was studied. The results were compared to surgical and histopathological findings. RESULTS: Seven patients had tumour infiltration of adjacent organs in the pelvis at surgery, the most common being the urinary bladder, prostate, uterus and small bowel. MR predicted involvement of the urinary bladder and the uterus better than CT. However, there were more false positive findings on MR than on CT compared to surgical and histopathological findings. CONCLUSION: For staging of advanced rectal cancers, the overall results were not significantly better for MR than CT. If involvement of the urinary bladder and the uterus cannot be ruled out using CT, MR is advocated due to its higher soft tissue contrast resolution and multi-planar capability.     

Retro-cost-xyphoid hernia and common mesentery: a case diagnosed in an adult

Authors analysed Morgagni's hernia pathogenesis through a new case associated to a common mesentery position and revealed by respiratory distress after delivery.     

The phasing of circadian rhythms in mice kept under normal or short photoperiods

Mammals represent a multi-oscillatory system. Not only different rhythmic function but also a certain rhythmic function may be controlled by several oscillators. Also, the LD cycle, though being the main zeitgeber, may have different effects on different rhythmic functions. The aim of the present study was to investigate putative changes of internal phase relationships between different rhythms and their phase relationship with respect to the light-dark cycle following a gradual lengthening of the dark time. The investigations were carried out on adult female mice (HaZ:ICR). Animals were initially kept in a 12:12 h LD cycle. The dark time was then lengthened once a week by delaying the time of lights-on by 1 h until an L/D=6:18 h was reached. The motor activity was recorded continuously. The daily profiles of food intake, liver glycogen and melatonin in the serum and the pineal gland were estimated as transverse studies under L/D=12:12 h and L/D=6:18 h. Under short-day conditions (L/D=6:18 h), the evening onset of the main maximum of motor activity and food intake was delayed in relation to lights-off and the onset of the secondary maximum in the morning was advanced in relation to lights-on. Similar phase changes were found with respect to the onset of glycogen synthesis and its breakdown. In the case of melatonin, the rise and the fall occurred earlier or later, respectively, and the phase differences with respect to lights-off and lights-on became smaller. If the mid-point between the evening and morning onsets of activity and food intake and between the rises and falls of glycogen and melatonin concentrations are considered, then the changes in all rhythmic functions were similar. Consequently, the phase relationships between different rhythmic functions and with respect to the light-dark cycle, and thus the internal and the external temporal order, were preserved under different light-dark ratios. Also, the results are in good accordance with a modified two-oscillator model where lights-off triggers advances of an evening oscillator and lights-on delays a morning oscillator.     

Cellular disorders induced by high magnetic fields

PURPOSE: To evaluate whether static high magnetic fields (HMFs), in the range of 10-17 T, affect the cytoskeleton and cell organization in different types of mammalian cells, including fibroblasts, epithelial cells, and differentiating neurons. MATERIALS AND METHODS: Cells were exposed to HMF for 30 or 60 minutes and subsequently assessed for viability. Cytoskeleton arrays and focal adhesions were visualized using immunofluorescence microscopy. RESULTS: Cell exposure to HMF over 10 T in the case of cycling cells, and over 15 T in the case of neurons, affected cell viability, apparently because of cell detachment from culture dishes. In the remaining adherent cells, the organization of actin assemblies was perturbed, and both cell adhesion and spreading were impaired. Moreover, in the case of neurons, exposure to HMF induced growth cone retraction and delayed cell differentiation. CONCLUSION: Cell exposure to HMF (over 10T and 15 T in the case of cycling cells and neurons, respectively) affects the cell cytoskeleton, with deleterious effects on cell viability, organization, and differentiation. Further studies are needed to determine whether such perturbations, as observed here in cultured cells, have consequences in whole animals.     

The TAFES multi-family group intervention for Kosovar refugees: a feasibility study

The object of this study was to describe a feasibility study of the Tea and Families Education and Support (TAFES) intervention used in a group of newly resettled adult refugees from Kosova. The subjects were 86 newly resettled Kosovar refugees in Chicago who gave informed consent to participate in an investigation of the TAFES intervention. All subjects received family home visits, and most participated in the TAFES multi-family groups. The instruments were administered to adult participants before and 3 months after the intervention. The TAFES program had contact with 61 Kosovar refugee families, of which 42 families (69%) engaged in TAFES groups, including families with educated and working members. Several characteristics were associated with engaging in TAFES groups and included lower monthly family income and higher age of the first child. The uncontrolled postintervention assessments demonstrated increases in social support and psychiatric service use associated with engagement in the TAFES group. Participants also showed time changes in scale scores assessing trauma mental health knowledge, trauma mental health attitudes, and family hardiness. This study provides preliminary evidence that multi-family support and education groups are a feasible and possibly beneficial intervention for newly resettled refugees and indicates the need for further studies.     

Study of the hypoglycaemic activity of Fraxinus excelsior and Silybum marianum in an animal model of type 1 diabetes mellitus

The hypoglycaemic effect of the aqueous extracts of Fraxinus excelsior (FE) seed and Silybum marianum (SM) aerial part was investigated in normal and streptozotocin (STZ) diabetic rats. After a single dose or 15 daily doses, oral administration of the aqueous extracts (20 mg/kg) produced a significant decrease of blood glucose levels in both normal and STZ diabetic rats (P < 0.001). From the first week, the body weight was increased in normal rats (P < 0.05) and decreased in STZ rats (P < 0.01) after FE administration. In addition, no changes were observed in basal plasma insulin concentrations after both FE and SM treatments in either normal and STZ diabetic rats indicating that these plants exert their pharmacological activity without affecting insulin secretion. We conclude that the aqueous extracts of FE and SM exhibit potent hypoglycaemic and anti-hyperglycaemic activities in normal and STZ rats, respectively, without affecting basal plasma insulin concentrations.     

A case of a retinitis pigmentosa and asteroid hyalosis

Asteroid hyalosis is a rare degenerative condition of the vitreous. No causal relationship between retinitis pigmentosa and asteroid hyalosis has been established. We report a case of a 65-year-old male admitted for progressive hemeralopia. Visual acuities were 2/10e in the right eye and 4/10e in the left eye. Ophthalmic examination revealed a large number of asteroid and refringent bodies, a typical retinitis pigmentosa with a cystoid macular oedema confirmed by fluorescein angiography. Electrodiagnostic testing revealed an altered electroretinogram. Visual fields showed a typical generalized constriction. We discuss the clinical aspects and physiopathogenic mechanisms of this rare association through this case and other cases found in the literature.