Evaluating Function and Health Related Quality of Life in Patients Treated for Extremity Soft Tissue Sarcoma

Objective To evaluate how functional disability impacts on health related quality of life (HRQOL) of patients with extremity soft tissue sarcoma (STS) at 1 year post-surgery.Design and setting Survey of extremity STS patients pre-surgery and one-year post-treatment.Participants: 100 participants who were treated for extremity STS between 2001 and 2003 at four Canadian hospitals. Patients were over 16 years, non-metastatic at diagnosis, and had limb salvage surgery.Outcome measures Musculoskeletal Tumor Society Rating Scale (MSTS), a measure of impairment; Toronto Extremity Salvage Score (TESS), a measure of activity limitations; Reintegration to Normal Living Index (RNL), a measure of participation restrictions; and EQ-VAS, a measure of HRQOL.Results After adjusting for demographic and clinical variables, impairment explained 54%, activity limitations explained 48%, and participation restrictions explained 61% of the variation in HRQOL. After adjustment, when all three functional measures were included in the model, only participation restrictions had a significant impact on HRQOL explaining 63% of the variation.Conclusion Impairment and activity limitations affect the daily activities a patient can perform, but it is the restriction in participation of life roles and situations that has the greatest effect on patient’s HRQOL.     

Percutaneous treatmerit of heterogertous predorninantly solid echopattern echinococcal cysts of the liver

Purpose: We report our technique for and results of percutaneous treatment of heterogenous, predominantly solid echopattern hepatic hydatid cysts (HHC), i.e., complex type IV cysts according to Gharbi's sonographic classification of HHC. Methods: Eight patients with nine complex type IV HHC were treated by percutaneous aspiration followed by hypertonic saline ablation, using a 14 Fr van Sonnenberg sump drainage catheter under sonographic and fluoroscopic guidance. Results: Successful drainage of cysts contents was achieved in all eight patients. No major complications, such as anaphylaxis, abdominal dissemination, cyst recurrence, or death, occurred. Minor complications including pain (n = 4), mild fever (n = 5), right reactive pleural effusion (n = 4), and transient hypernatremia (n = 2) were observed and managed conservatively. Follow-up imaging studies for an average period of 15 months (range 1–48 months) showed either complete healing (n = 3) or significant reduction in the size of the cyst with solidification (n = 6). Conclusion: Nine complex type IV HHC were effectively treated by suction of the membranes and hypertonic saline ablation using a 14 Fr sump drainage catheter, without major complications.     

Cadmium hepatotoxicity and alterations of the mitochondrial function

OBJECTIVE: To examine the effect of low concentrations of cadmium on isolated liver mitochondrial function as related to hepatotoxicity. METHODS: Tetraphenyl phosphonium ion uptake and retention, estimated with a tetraphenyl phosphonium-sensitive electrode, was used to monitor changes in liver inner mitochondrial membrane potential. Ca2+ efflux was measured spectrophotometrically with the Ca2+ indicator Arsenazo III. Mitochondrial swelling was measured spectrophotometrically at 540 nm. Oxygen consumption was measured with a Clark-type oxygen microelectrode. RESULTS: Incubation of isolated liver mitochondria with cadmium (5-30 microM) altered mitochondrial function as indicated by swelling, inhibition of respiration, loss of inner mitochondrial membrane potential, and loss of preaccumulated Ca2+. The presence of dithiothreitol (2 mM) in the incubation medium restored mitochondrial function to almost the control level. Cyclosporin A (1 microM), however, did not provide any protection against cadmium toxicity. CONCLUSIONS: The findings point to a direct effect of cadmium on liver mitochondrial function. Cadmium toxicity may be due to loss of reduced glutathione rather than to increased mitochondrial inner membrane permeability. The effect of cadmium on liver mitochondria seems to be an early event in cadmium-induced hepatotoxicity.     

Pathological study on the relationship between C4d, CD59 and C5b-9 in acute renal allograft rejection

Abstract:  In order to evaluate the activation or inhibition of the later phases of classical complement cascade in renal allograft presenting with acute rejection, particularly with C4d deposition on the peritubular capillary (PTC), we observed the expression of CD59 and C5b-9 on the PTC. Subjective cases were divided into two groups, an acute rejection group, of 4 males and 6 females, and a normal donor group, of 5 males and 5 females. Renal biopsies were performed at the onset of acute rejection and at the transplant operation, before reperfusion. C4d deposition on PTC was found in three of 10 cases (30%) with biopsy proven acute rejection, whereas CD59 on PTC was positively expressed in all of the rejection cases. Although C5b-9 was not observed on PTC in the acute rejection group, it was intensively deposited on the tubular basement membrane (TBM) in five cases, including the three with positive C4d on PTC. In the normal donor group, CD59 on PTC was intensively observed, whereas C5b-9 was weakly expressed on TBM. CD59, a complement regulatory factor, works as an inhibitory factor against the formation of C5b-9, a membrane attack complex. From our data, we noted the dissociation between the depositions of C4d and C5b-9 on PTC. The substantially expressed CD59 on PTC may affect this dissociation between C4d and C5b-9 on PTC. The intensive deposition of C5b-9 on TBM in acute rejection cases may suggest an independent immunological injury attacking tubular cells.     

Effect of body size and malnutrition on renal size in childhood

SUMMARY: Malnutrition is associated with multi-organ manifestations including urinary concentrating defects. the purpose of our study was to prospectively determine the effect of body size and malnutrition on kidney size in children. the length and width of both kidneys were assessed in 525 children with no renal disease (289 male: 236 female; age: newborn–12 years) by real time ultrasonography. the nutritional status was assessed using the Indian Academy of Pediatrics classification, where the expected weight (EW) for age is the 50th percentile for Harvard statistics. Thus, Grade 0: 80–100% of EW; Grade I: 70–80% of EW; Grade II: 60–70% of EW; Grade III: 50–60% of EW; Grade IV: <50% of EW. There was no difference in renal size between males and females, or between right and left kidneys. the relationship between kidney area and age and grade of malnutrition was as follows: kidney area (mm²) = 13.74 age (months)—110.9 grade + 1265 ( P < 0.001). the partial r for grade and age were—0.318 ( P < 0.001) and 0.849 ( P < 0.001), respectively. Normal Indian children (Grade 0) had smaller kidneys than those obtained in age matched children in the Western world. We conclude that severe malnutrition (Grade IV) reduces kidney size independent of age. Furthermore, we attribute the smaller kidney size in normal (grade 0) children, to the smaller body habitus of Indian children. Age based data alone, which are widely used currently to determine if kidney size is appropriate, may not be sufficient in geographic regions where malnutrition is prevalent and/or the growth curves of the population vary from Western derived standards.     

A novel type of encephalopathy associated with mushroom Sugihiratake ingestion in patients with chronic kidney diseases

BACKGROUND: The etiology of encephalopathy in uremic patients is multiple. We recently encountered a novel type of encephalopathy which occurred exclusively in patients with chronic kidney diseases after ingestion of a mushroom called Sugihiratake. While the exact etiology of this encephalopathy remained mysterious, we aimed to describe its clinical features. METHODS: A total of 32 patients with chronic kidney diseases who had presented with encephalopathy following ingestion of Sugihiratake were enrolled from seven prefectures in Japan., with 24 of the 32 patients undergoing regular hemodialysis. The patient's clinical data were from surveillance by The Japanese Society of Nephrology. RESULTS: There was a significant association between Sugihiratake ingestion and the occurrence of encephalopathy in 524 hemodialysis patients questioned for a recent ingestion of this mushroom (P= 0.0006). The latent asymptomatic period before the onset of symptoms varied from 1 to 31 days (mean 9.1 +/- 7.3) days. The patient's symptoms consisted of disturbed consciousness in 30 patients (93.8%), convulsions in 25 (78.1%), myoclonus in 15 (46.9%), dysarthria in ten (31.3%), ataxia in eight (25.0%), paresis or paralysis in seven (21.9%), and skin parasthesia in two patients (6.3%). Nine (27.2%) patients died, mostly due to respiratory failure. The other patients were either discharged or still in hospitals with various degrees of clinical improvement. CONCLUSION: Patients with chronic kidney diseases are at risk of having serious encephalopathy following Sugihiratake ingestion and must refrain from eating it. Physicians, in those parts of the world, where this mushroom harvesting is common, should be aware of this complication.     

Drug-resistant Escherichia coli, Rural Idaho

Stool carriage of drug-resistant Escherichia coli in home-living residents of a rural community was examined. Carriage of nalidixic acid-resistant E. coli was associated with recent use of antimicrobial agents in the household. Household clustering of drug-resistant E. coli was observed. Most carriers of drug-resistant E. coli lacked conventional risk factors.     

Existence and anatomic distribution of double parathyroid adenoma

BACKGROUND: Double parathyroid adenomas occur in 2% to 15% of primary hyperparathyroidism cases, but the very existence of double adenomas has been controversial. This study was conducted to evaluate the clinical significance and anatomic distribution of parathyroid double adenomas. STUDY DESIGN: Mono-institutional retrospective study of the medical records of 183 unselected consecutive patients who underwent intervention for primary hyperparathyroidism between 1996 and 2003. RESULTS: A total of 14 (7.65%) patients were found to have double parathyroid adenomas. Intraoperative parathyroid hormone (PTH) levels were measured in every case. Two enlarged parathyroid glands were identified in four possible configurations: two both superior, one both inferior, two both right, three both left, two right superior and left inferior, and three left superior and right inferior. There was a preferential crossed bilateral distribution of double adenomas. In all patients, intraoperative PTH levels dropped by at least 50% from baseline after removal of both abnormal parathyroid glands. In this series, no patient developed persistent hypoparathyroidism or had recurrent laryngeal nerve injuries or neck hematoma. All patients remained normocalcemic 9 to 96 months postoperatively. One patient had persistently elevated PTH values with normal serum calcium levels. CONCLUSION: The drop in intraoperative PTH levels and maintenance of normocalcemia postoperatively confirm previous reports that double adenomas do exist and are not simply missed cases of four-gland hyperplasia. There was a preferential crossed bilateral distribution of double adenomas in this series.