Interaction of cis-diamminedichloroplatinum and renal irradiation on renal function in the young and adult rat

The interaction between single low doses of cis-diamminedichloroplatinum(II) (c-DDP) and renal irradiation (7.5, 10, 12.5 Gy) on renal function and systolic blood pressure (SBP) was investigated in young (3-4 weeks old, BW 45-65 g) and adult rats (over 12 weeks old, BW 230-290 g). The glomerular filtration rate (GFR) and effective renal plasma flow (ERPF), plasma creatinine, urea and SBP were measured over 24 weeks. Changes in ERPF, plasma creatinine and urea concentrations paralleled GFR changes, but tended to be less pronounced. In young rats, BW and GFR were 10-20% below control values after c-DDP administration (5 mg/kg BW). Irradiation caused a dose-dependent drop in GFR, starting 4 weeks after irradiation in young rats. When c-DDP was given immediately after irradiation to the young rats, the loss of renal function was more pronounced than after either treatment modality alone. Dose-effect curves for a greater than 25% reduction of the GFR relative to controls (ml/min) after 24 weeks gave an ED50 of 9.8 Gy for irradiation alone and 4.6 Gy for irradiation followed by c-DDP. After correction for the drug effect, dose-effect curves were similar for renal irradiation given alone or followed by c-DDP administration in young rats. In adult rats, c-DDP (2.5 mg/kg BW) or irradiation alone did not significantly alter renal function during the follow-up period. Only 12.5 Gy in combination with c-DDP, caused a significant reduction in GFR after 16 weeks in adult rats. In adult rats data were too limited for probit analysis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Intussusception in a tropical country: comparison among patient populations in Jakarta, Jogyakarta, and Amsterdam.

BACKGROUND: Intussusception is the most common cause of intestinal obstruction in young children, and high mortality rates remain a problem in developing countries. The purpose of this study was to describe and elucidate the differences in outcome between groups of children with intussusception in Indonesia, a developing country, and The Netherlands, a developed country. METHODS: In this retrospective review, 176 patients were studied in three types of hospitals. A comparison was made among children treated at a primary care rural hospital in Indonesia, at a secondary care urban hospital in Indonesia, and at a tertiary care urban hospital in The Netherlands. RESULTS: Children in the rural community hospital in Indonesia were more severely ill at arrival and had a significantly longer duration of symptoms, an increased incidence of nonviable bowel, and a mortality rate of 20%, in contrast to a mortality rate of 3% in the urban hospital in Indonesia and no deaths in the Dutch hospital. CONCLUSIONS: The mortality of children with intussusception in rural Indonesia is much higher than in urban Indonesia or in The Netherlands, probably because of delayed treatment, which results in more patients undergoing surgery in worse physical condition.     

Disturbed defecation after colectomy for aganglionosis investigated with monoclonal antineurofilament antibody

Experience with 108 neonates treated for aganglionosis at the Sophia Children's Hospital, Rotterdam, between 1975 and 1983 has been reviewed. Twenty two of them suffered from disturbed defecation postoperatively, involving 16 cases of classical Hirschsprung's, 4 long-segment aganglionosis, 1 case of aganglionosis up to the cecum, and 1 total aganglionosis. The monoclonal antineurofilament antibody NF2F11 was used to investigate ganglionated as well as aganglionic bowel specimens of these patients as well as 17 patients from the remainder without postoperative constipation serving as controls. The original diagnosis was confirmed in all cases. Proximal ganglionated bowel of all 17 controls appeared normal, while the antibody revealed normal bowel in only 4 out of the 22 patients with postoperative constipation. In 18 cases this new staining technique revealed the picture of pseudo-obstruction. Early recognition of pseudo-obstruction in proximal ganglionated bowel would provide early warning of postoperative complications.     

Developmental aspects of gastroschisis

The development of gastroschisis was studied experimentally as well as clinically, particularly concerning the characteristic fibrous coating of the protruding bowel loops, associated intestinal atresia, and postoperative hypoperistalsis without intestinal obstruction. Experimental investigation was carried out in the chicken embryo. The clinical study was a joint one, involving a total of 50 patients with gastroschisis seen at the Sophia Children's Hospital, Rotterdam, and the Royal Hospital for Sick Children, Glasgow, between 1972 and 1985. Some patients were followed antenatally. The results, correlating with previous experiments, were compared with data from the literature. The fibrous coating of the protruding bowel loops appeared to be a late occurrence and directly related to changes of the amniotic fluid secondary to the onset of renal function. Associated intestinal atresia and postoperative hypoperistalsis in the absence of an obstruction both appeared to be due to another late gestational event, consisting of ischemic changes of the bowel wall secondary to the compression of bowel loops and mesentery in the small abdominal wall defect.     

A non-immunogenic myasthenia gravis model and its application in a study of transsynaptic regulation at the neuromuscular junction

A non-immunological model for myasthenia gravis was developed in rats: 'toxin-induced myasthenia gravis'. Rats were injected once every 48 h with 3-5 micrograms alpha-bungarotoxin for periods of up to 5 weeks. This treatment caused weakness, especially of facial muscles. Respiration, however, was unaffected. Miniature endplate potentials and 125I-alpha-bungarotoxin binding in the extensor digitorum longus muscles were severely reduced. Acetylcholine release evoked by electrical and chemical (50 mM KCl) stimulation was higher in diaphragms from alpha-bungarotoxin-treated rats than in those from control animals. Histological investigation of the tibialis anterior muscle provided no evidence that the endplates were enlarged. It is concluded that the activity of acetylcholine receptors influences the rate of transmitter release in the neuromuscular junction and it is suggested that a transsynaptic regulation process may be active in myasthenia gravis. The present animal model for myasthenia gravis seems very suitable for studying such a regulation of transmitter release.     

Rejection and survival of auxiliary partial liver grafts in non-tissue-typed pigs

A technique for auxiliary heterotopic transplantation of 60% of the liver has been developed in the pig to study acute and chronic rejection. Transplantations were performed in 13 non-tissue-typed donor-recipient combinations without immunosuppressive medication. Three pigs died in the 1st postoperative week from technical problems. In the remaining 10 animals acute rejection of the graft was not found, but signs of chronic rejection developed in 6 animals. It is concluded that auxiliary partial liver transplantation is technically feasible in the pig. Although the auxiliary liver graft is subject to immune attack, long-term graft survival without immunosuppressive medication can be achieved.     

Simultaneous Epstein Barr Virus and Cytomegalovirus Infection Accompanied by Leiomyomatous Change in a Well-Differentiated Liposarcoma in a Patient With Long-Term Corticosteroid Treatment

Patient. A 59-year-old woman presented with a large tumour of the abdominal wall. She had been taking corticosteroids for severe chronic obstructive pulmonary disease for 15 years. On CT scan the tumour had the characteristics of lipomatous tissue with a dense core.Results. Histology showed a well-differentiated liposarcoma with a core of benign fibroleiomyomatous differentiation. Within the core, a third component was observed, characterized by more pleomorphism and the presence of an inflammatory infiltrate. In this component, immunoperoxidase stains and in situ hybridization demonstrated cytomegalovirus (CMV) and Epstein Barr virus (EBV) infection in large and small cells, respectively.Discussion. Long-term corticosteroid use for pulmonary disease may extend the list of immunosuppressed states associated with the development of leiomyomatous tumours with EBV infection, previously described in AIDS patients and liver transplant recipients. The role of CMV is uncertain.     

Diagnostic value of sural nerve biopsy in chronic inflammatory demyelinating polyneuropathy

OBJECTIVE—To investigate the additional diagnosticvalue of sural nerve biopsy of 64 patients in whom chronic inflammatorydemyelinating polyneuropathy (CIDP) was considered, as sural nervebiopsy is recommended in the research criteria of an ad hocsubcommittee to diagnose CIDP.
METHODS—Firstly, the additional diagnostic valueof sural nerve biopsy was analysed with multivariate logistic re-gression. Six clinical features (remitting course, symmetricsensorimotor neuropathy in arms and legs, areflexia, raised CSF proteinconcentration, nerve conduction studies consistent with demyelination,and absence of comorbidity or relevant laboratory abnormalities) wereentered into a logistic model. Afterwards, all significant featuresidentified from this model, as well as the results of sural nervebiopsy were forced into a second logistic model. Secondly, thediagnostic performance of a neurologist experienced in diagnosis ofperipheral nerve disorders was studied by receiver operatingcharacteristics (ROC) curve analysis.
RESULTS—The results of the first logistic analysisshowed that CSF protein concentration >1 g/l (odds ratio (OR)=38.5)and neurophysiological studies consistent with demyelination (OR=51.7)were strong predictors of CIDP. When forcing the significant featuresand the sural nerve biopsy data into the model, an independentpredictive value of sural nerve biopsy could not be found. Theneurologist was able to discriminate patients with and without CIDP(area under the curve (AUC)=0.95). His diagnostic performance did notimprove significantly by offering him the results of sural nerve biopsy.
CONCLUSION—Any additional diagnostic value ofsural nerve biopsy in the diagnosis of CIDP could not be shown.