Progressive tubulointerstitial nephritis and chronic cholestatic liver disease

We report the clinical and morphological features of a distinctive hepatorenal disorder in four patients and review the five similar patients in the literature. The main clinical characteristics were early onset of cholestatic liver disease and progressive tubulointerstitial nephritis leading to renal death in early childhood. Liver histology showed disturbed architecture with nodular and acinar formations and portal fibrosis and bile duct proliferation. Histological abnormalities in the kidney were severe interstitial fibrosis and tubular atrophy and dilatation, while the typical features of nephronophthisis were lacking. These clinical and morphological characteristics distinguish our patients from the majority described, as having nephronophthisis and congenital hepatic fibrosis or any other known syndrome with concomitant hepatorenel involvement. We suggest that the association of cholestatic liver disease and progressive tubulointerstitial nephritis represents a new syndrome.     

多烯脂肪酸对脑血栓伴高脂血症病人降脂作用的疗效观察

目的：研究多烯脂肪酸胶囊对脑血栓伴高脂血症病人的降脂作用。选血脂康作对照。方法：６０例脑血栓伴高脂血症病人随机分为二组：治疗组（ｎ＝３１）及对照组（ｎ＝２９）。服药前及服药后４周,８周查血脂。结果：⑴服药４周后ＴＣ和ＬＤＬ－Ｃ分别降低２１．０２％和２８．９３％（多烯脂肪酸组）。⑵多烯脂肪酸组降低了３４．０６％的血清ＴＧ水平,效果显,结论：多烯脂肪酸胶囊降ＴＧ和ＬＤＬ－Ｃ水平与血脂康作用相近,其降     

P53 overexpression as an indicator of overall survival and response to treatment in osteosarcomas

The p53 gene located at chromosome 17pl3 is found to be altered (allelic loss or other mutation) in multiple human cancers, including osteosarcomas. The mutated gene produces a protein with a prolonged half-life thus rendering it detectable by conventional immunohistochemistry. We examined the correlation between p53 expression and clinical prognosis as well as response to therapy. Twentyone patients with previously untreated and histologically verified highly malignant osteosarcoma were used for this study. Biopsy material taken both prior to the start of COSS 91 protocol and at the time of surgery (ten weeks later) was examined for alterations in p53 protein expression and drug resistance. Two patients who had strong (+++) p53 protein expression and three others who became positive during the chemotherapy had significantly worse prognosis (all of them died within one year) than those who showed no p53 expression both at biopsy and after chemotherapy (all 11 patients are alive, average follow-up time: 3.5 years). All patients who showed any kind of positive p53 protein expression on initial biopsy were non-respon-ders to chemotherapy. In contrast, 69% (9 out of 13) of those who exhibited no p53 expression on initial biopsy were responders or intermediate responders to chemotherapy. We concluded that p53 expression may be a useful prognostic factor in osteosarcomas. The direct correlation between p53 positive expression and resistance to therapy can help in identifying patients who are in need of a more vigorous or different chemotherapeutical protocol.     

Incidence of IDDM during 1988–1992 in Zagreb,Croatia

Summary The objective of this study was to determine the incidence of insulin-dependent diabetes mellitus (IDDM) in the population of Zagreb, Croatia, during 1988–1992. A centralized diabetes registry was the primary source of data, while secondary sources were used to assess ascertainment. A total of 282 new cases of IDDM were diagnosed in the study period, the primary and secondary sources identifying annually 93–100% of the cases. The annual incidence rate ranged from 5.6 per 100,000 to 6.6 per 100,000. Early fatality in persons older than 50 years was the major cause of underascertainment. The incidence peaked in the 10–14 years age group (12.4 per 100,000), and remained stable after age 24 years. Males had a significantly higher incidence in the 5–9 and 24–44 years age groups. In the 45–54 years age group, females had a significantly higher incidence. No seasonality was observed. Despite the war conditions in Croatia, the low overall IDDM incidence rates did not change significantly during the study period.Abbreviations IDDM Insulin-dependent diabetes mellitus - DKA diabetic ketoacidosis     

Urinary excretion of adenosine deaminase binding protein in neonates treated with tobramycin

The potential tubulotoxicity of tobramycin and cefotaxim were assessed in neonates by measuring the urinary level of adenosine deaminase binding protein (ABP) and urinary ₁-microglobulin and ₂-microglobulin. In a prospective study, 33 neonates who received tobramycin and cefotaxim for suspected neonatal sepsis were compared with 48 untreated newborns during the first 10 days of life. The urinary concentrations of ABP and its excretion rates, corrected for body weight and body surface area, were significantly increased from the 1st day of treatment. Urinary ₁-microglobulin and ₂-microglobulin were not elevated under tobramycin and cefotaxim during the first 2 days of treatment. We conclude that ABP may be a sensitive marker for the detection of proximal renal tubular injury during tobramycin and cefotaxim treatments of neonates. The increase in urinary ABP which occurs before an elevation of urinary ₁-microglobulin and ₂-microglobulin may reflect earlier structural than functional alterations. However, since none of the treated infants had signs of electrolyte disorders or glomerular dysfunction, the clinical relevance of ABP measurement should be reevaluated.     

Idiopathic interstitial pneumonitis presenting with Wells grade III. Can imaging methods help predict further progression of disease?

PURPOSE: Three different grades of idiopathic pulmonary fibrosis can be identified by HRCT pattern. Patients with predominant ground-glass opacity (grade I) usually improve after treatment and may have a better prognosis. The subjects with a predominant reticular pattern and honeycombing (grade III) have irreversible fibrosis and usually do not improve after immunosuppressive therapy. Nevertheless, these patients may worsen even in the absence of HRCT features of the so-called alveolitis. We investigated the predictive role of some noninvasive imaging methods (HRCT with visual score of disease extent; Gallium scintigraphy; DTPA scintigraphy) in patients with idiopathic fibrosis and a prevalent macroscopic fibrosis at HRCT study. MATERIAL AND METHODS: Fourteen former smokers with grade III idiopathic fibrosis were examined. None of the patients had been treated. They were all submitted to HRCT, lung function studies, Gallium and DTPA scintigraphy, both at presentation (T0) and follow-up sessions (T1: mean one year post-diagnosis). The HRCT extent of disease was evaluated by means of the visual score as the fraction of the total lung volume. The patients were divided into two groups, using a cut-off value of 50%. All the patients underwent a Gallium scintiscan (using a fixation index of 160 as cut-off) and a ventilatory scintigraphy with DTPA-aerosol, with radionuclide clearance assessment. The lung function tests considered were vital capacity (VC), arterial blood oxygen partial pressure (PaO2) and the diffusing lung capacity for carbon monoxide (DLCO). RESULTS: After one year of follow-up, the HRCT extent score increased (from 46.6% to 50%) and lung function worsened (VC from 66.8% to 63.4% of predicted; DLCO from 37.6% to 27.1%; PaO2 from 77 to 71 mmHg). The patients presenting with HRCT extension score > 50% had a worse lung function at T0 and showed a significant deterioration of PaO2 and HRCT at T1. On the other hand, VC and DLCO significantly worsened in the subjects with HRCT score < 50% at presentation. The patients with a Gallium fixation index > 160 significantly deteriorated in HRCT score, VC and DLCO. Those with Gallium index < 160 had major worsening only for diffusing lung capacity for carbon monoxide. Thirteen of 14 patients had an abnormal value of DTPA clearance at presentation. No variation was observed at T1. DISCUSSION AND CONCLUSIONS: The majority of patients with idiopathic fibrosis are grade III at presentation. They can further deteriorate both in HRCT extent of disease and lung function impairment. After one year of follow-up HRCT extent score increased in 64% of the patients, with a mean increase of 5%. HRCT worsening was more apparent in the patients with a HRCT score > 50% at presentation. In the remaining patients, the worsening of lung function tests was more apparent than the anatomoradiological changes. DTPA clearance had no predictive value in this series. Gallium scintigraphy was a useful prognostic index. The patients with Gallium fixation index > 160 had better lung function and lower HRCT extent score at T0 but significantly deteriorated at T1. A positive Gallium scan at presentation could be considered a useful index of persisting active "alveolitis" in patients with grade III disease, not visible at HRCT study, due to overwhelming fibrosis. These patients, who were untreated, exhibit quicker radiological and functional worsening.     

The concordance and discordance of cardiovascular risk factors in a group of twin children

The cross-sectional study of epidemiological screening type has permitted to evaluate some cardiovascular risk factors in two groups of monozygotic (MZ) and dizygotic (DZ) twins born between 1975-1990, in the town of Ia?i. In the 89 MZ pairs and 112 DZ pairs, certain constitutional and behavioural cardiovascular risk factors have presented values of prevalence with statistical signification (p < 0.05) in terms of their age, sex, the urbanisation time and the educational level of their parents. In risk factors existence or absence to both of the twins have put into evidence, to the MZ, most enhanced values of concordance as regards: overweight (66.6%), excessive consumption of salt (56.9%), food with atherogenic risk (50.9%). The concordance values have been less in DZ compared to MZ concerning all the risk factors excepting compartmental type A (77.7%). By analysing the concordance variants, an preponderant influence of the environment has been noted in the studied MZ and heredity and environment influence in DZ. By measuring the arterial blood pressure values at the twins and the twins parents, a prevalence of the essential arterial hypertension is noticed to both of the twins, 6.2% in MZ pairs and 6.9% in DZ ones.     

Increased muscle stiffness after anterior cruciate ligament reconstruction – memory on injury?

Residual impairment of knee function was tested in 25 patients 6 to 12 months after successful unilateral reconstruction of the anterior cruciate ligament. The control group comprised 25 healthy individuals. Jumping onto one foot from a height of 20 cm was taken as a prototype of similar everyday activities. We measured maximum flexion of the knee during the landing phase of the jump, and the degree of knee flexion at the time of maximum deceleration of the knee against gravity during jumping using the three-dimensional optical motion analysis system-ELITE. In the group of patients, measured parametres were significantly smaller on the operated side than on the unaffected side. These two measured values were significantly smaller on both legs in group of patients as compared to the values in the control group. The results of our study indicate that functional disturbance persisted for 6 to 12 months after anterior cruciate reconstruction. This may be due to the changed muscle activation pattern of the knee causing increased stiffness of knee muscles. It seems that re-programming of the central nervous system occurred in order to protect the injured lower extremities from another injury.     

The prognostic significance of DNA cytophotometry and proliferation index (Ki-67) in giant cell tumors of bone

We studied DNA ploidy by smear cytophotometry and proliferation activity by Ki-67 MIB immunohistochemistry in 69 primary and recurrent giant cell tumors (GCT) from 50 randomly selected patients. The obtained results were evaluated with comparisons made to the available clinical data. From the 46 primary tumors 63% showed diploidy and 37% aneuploidy. A significantly (P=0.026) higher recurrence rate (64%) was observed in aneuploid than in diploid tumors (31%). In the course of the recurrences, both the ratio of aneuploid tumors as well as the proliferation index of the tumors increased, though the degree of the latter was non-significant. Aneuploidy did not mean an unambiguous tendency towards malignant transformation; however, a close follow-up of recurrent aneuploid tumors, and wide excision of the recurrence instead of intralesional curettage are the recommended procedures. The DNA cytophotometry and proliferation index of GCTs – as compared to other histologic examinations – are of prognostic value in the evaluation of the recurrence potential of the GCTs.

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Résumé  Les auteurs ont examiné 1’anomalie chromosomique de DNA á 1’aide de cytophotometrie de frottis; et 1’activité de proliferation par le moyen de 1’immuno- histochimie Ki-67 MIB dans 69 tumeurs de cellules géantes de 50 patients choisis accidentellement. lls ont évalué les résultats en les comparant aux données cliniques disponibles. Parmi les 46 tumeurs primaires 63% ont manifesté un caractère diploide et 37% un caractère aneuploide. On a observé une proportion de recidive significativement plus élevée (P=0.026) dans les tumeurs aneuploides (64%) que dans les tumeurs diploides (31%). Au cours des récidives on a remarquè une augmentation tant dans la proportion des tumeurs aneuploides que dans 1’indice de proliferation mais en ce dernier 1’augmentation n’était pas significative. Le caractère aneuploide ne signifie pas forcément une tendance univoque á la transformation maligne cependant dans les tumeurs aneuploides récidivantes il est nécessaire de suivre la maladie avec beaucoup de soin et comme intervention chirurgicale on conseille une excision large au lieu du curettage intralésionel.

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Accepted: 20 October1999