Chronic kidney disease–mineral bone disorder: an update on the pathology and cranial manifestations

Chronic kidney disease–mineral bone disorder (CKD‐MBD) is a syndrome encompassing skeletal and extra skeletal changes associated with chronic kidney disease. It progresses silently until an advanced clinical stage when complications impact on the quality of life and survival rates of patients. The maxillofacial manifestations are unique and may play an important role in the early identification of changes which could influence the management of these patients. The goal of this review is to highlight the maxillofacial features, pathology, and principles of management of CKD‐MBD.     

Risk and obligation: Health professionals and the risk of AIDS

Abstract

This essay deals with the question of risk-taking by physicians and other health professionals when confronted with AIDS patients. The duty to take risks, and consequently to treat patients who have AIDS, is examined (a) from a historical perspective; (b) by considering fear and courage in the medical setting; (c) by considering views of community, justice, and the social contract; and (d) in light of notions of professionalism and obligation. It is concluded that health professionals have a historically grounded obligation to assume “reasonable” risks in dealing with such patients, that “reasonable” is defined by the community, and that this modifiable obligation emerges from views of community, justice, and professionalism.     

Plasmablastic lymphomas with light chain restriction – plasmablastic extramedullary plasmacytomas?

J Oral Pathol Med (2010) 39 : 435–439 Background: It is diagnostically difficult to differentiate plasmablastic lymphomas (PBLs) from plasma cell neoplasms with plasmablastic differentiation. Plasmablastic lymphomas are currently classified as ‘PBL of the oral mucosa’ and ‘PBL with plasmacytic differentiation’. Methods: Forty‐five cases of PBL were retrieved from the Departments of Oral Pathology of the Universities of Pretoria and Limpopo, South Africa. Clinical features and HIV status were recorded and each case was classified as ‘PBL of the oral mucosa type’ or as ‘PBL with plasmacytic differentiation’. Immunohistochemistry included: CD45, CD3, CD20, CD79a, CD38, CD138, MUM1, Ki‐67 and kappa and lambda light chains. Positivity was recorded based on the percentage of positive staining cells as focal (5–20%); intermediate (20–70%) or diffuse (>70%). In situ hybridization was performed for Epstein–Barr virus (EBV) and HHV‐8. Results were recorded as positive or negative. Results: All cases showed some degree of plasmacytic differentiation. All were negative for CD20 with reactive T cells detected with CD3. Diffuse and strong positive staining was found with Ki‐67 and MUM1, but variable immunoreactivity was found with CD79a, CD45, CD38 and CD138. Twenty cases (47%) showed light chain restriction. Epstein–Barr virus was detected in 44/45 cases and HHV‐8 in none. Conclusions: The morphological classification of PBLs is not valid as all cases showed some degree of plasmacytic differentiation. We propose that PBLs with light chain restriction be reclassified as ‘plasmablastic extramedullary plasmacytomas’ and managed accordingly. The rest represents true PBLs. The true nature of these neoplasms as an entity should be further investigated with molecular and genetic studies.     

Short and long term adaptation of variability during walking using unstable (Mbt) shoes

BackgroundThe purpose of the study was to compare the variability of biomechanical variables during treadmill walking using unstable shoes (Masai Barefoot Technology, MBT, Roggwil, Switzerland) and conventional shoes, before and after a 10 week (wk) training period.MethodsCycle characteristics, plantar pressure distribution, whole body 3D kinematics, and electromyographic signals of selected leg muscles during ground contact were recorded on 12 Sport Science students while walking on a treadmill with both conventional and unstable shoes before and after a 10 wk training intervention. The intervention consisted of more than 4 h use of unstable shoes during daily activity. The standard deviation of 15 consecutive cycles in each analyzed variable was taken as the measure for variability.FindingsThe main pattern was marked by a 35% (SD 10%) higher variability with the unstable shoes at pretest when compared with the conventional shoes, but decreased 30% (SD 12%) (both P < 0.05) during the training intervention to almost equal variability in between the two shoe situations. This was especially true with regard to variables representing within gait characteristics (peak foot force, joint angles, etc.), whereas in variables describing the overall gait cycle (e.g. cycle rate, impulse of total force, etc.) no difference between MBT and conventional shoes at pre and post tests were found.InterpretationThe current study supports the idea that the unstable shoe serves as a motor constraint applicable during everyday activity, provoking increased variability during walking. In addition, a decrease in movement variability on the MBT shoes during the training intervention to the level of conventional shoes was observed.     

Symptomatic pulmonary embolism and the risk of recurrent venous thromboembolism

BACKGROUND: In patients with a first symptomatic pulmonary embolism (PE), the risk of recurrence is unknown. We therefore investigated the risk of recurrence among patients with spontaneous symptomatic PE and among those with deep vein thrombosis (DVT) without symptoms of PE. METHODS: After discontinuation of secondary thromboprophylaxis for a first venous thromboembolism (VTE), we prospectively observed 436 patients for an average of 30 months. Patients with secondary VTE, natural inhibitor deficiencies, lupus anticoagulant, cancer, long-term antithrombotic therapy, vena cava filters, or pregnancy were excluded. The study outcome was objectively documented recurrent symptomatic VTE. RESULTS: Recurrent VTE was seen among 28 (17.3%) of 162 patients with symptomatic PE and among 26 (9.5%) of 274 patients with DVT without symptoms of PE. Compared with patients with DVT, the relative risk of recurrent VTE among patients with symptomatic PE was 2.2 (95% confidence interval, 1.3-3.7; P =.005). The relative risk was not affected by age, sex, presence of factor V Leiden or prothrombin G20210A, hyperhomocysteinemia, or high factor VIII levels. Compared with patients with DVT without symptoms of PE, patients with symptomatic PE had an adjusted relative risk of PE at recurrence of 4.0 (95% confidence interval, 1.3-12.3; P =.03). CONCLUSION: Patients with a first symptomatic PE not only have a higher risk of recurrent VTE than those with DVT without symptoms of PE, but are also at high risk of symptomatic PE at recurrence.