Alternative treatment to corticosteroids in steroid sensitive idiopathic nephrotic syndrome

A review was undertaken of the use of alternative immunosuppressive treatment in addition to corticosteroids in a cohort of 429 children with steroid sensitive nephrotic syndrome (SSNS) treated between 1980 and 1994. Two hundred and twenty two children (52%) received at least one course of alternative treatment, 98 (23%) two, and 43 (10%) three. Cyclophosphamide was administered to 196 children (46%); in 181 it was the first course of alternative treatment and in 104 (57%) of those it was also the last ('final course'). Levamisole was given to 56 children (13%) and cyclosporin to 53 (12%). Fifteen children in whom cyclosporin failed were treated with chlorambucil. A few patients received azathioprine or vincristine. Ten children developed secondary steroid resistance, of whom five progressed to chronic renal failure. Acute complications included reversible renal failure, septicaemia, peritonitis, convulsions, and cerebral thrombosis. There were three deaths. It is concluded that half of the referred children with SSNS were deemed to require at least one course of alternative immunosuppressive treatment, and that side effects of the treatment and complications of SSNS are infrequent but occasionally fatal.     

Cross-over trial of superovulation protocols from two major in vitro fertilization centers

A study was undertaken as a controlled comparison of two different superovulation induction protocols currently in use in major Australian in vitro fertilization (IVF) clinics. Thirty patients each from the Monash University and the Royal Women's Hospital (RWH) IVF programs were stimulated for ovulation induction by the other program. Once timing for oocyte retrieval was scheduled, all care reverted to the program from which the patient first came. Results given as pregnancies per patient commencing stimulation were: RWH patients on Monash protocol, 27%; RWH control patients, 15%; Monash patients on RWH protocol, 7%; Monash control patients, 13%. In the year preceding the trial pregnancy rates were 16.9% at Monash and 10.6% at RWH. Stimulation protocols were also compared with respect to each of administration, cost, and patient stress. The results of this cross-over trial demonstrated major differences between the two ovulation induction protocols studied, although it was not possible to conclude that differences in pregnancy rate were due to stimulation alone.     

Ovulation induction in clomiphene nonresponsive patients: the place of pulsatile gonadotropin-releasing hormone in clinical practice

Seventy-three treatment courses of pulsatile gonadotropin-releasing hormone (GnRH) were given to 19 patients with clomiphene nonresponsive anovulatory infertility. Fifty cycles were given by the subcutaneous route, and 23 were given intravenously. Doses varied between 1 and 40 micrograms per pulse given at 60- or 90-minute intervals. Luteal support was either by continuation of the pulsatile GnRH or by human chorionic gonadotropin injections. In 16 cycles, potentially fertile ovulation occurred, and three pregnancies resulted, of which one continues normally. Only one of the three pregnancies occurred during intravenous GnRH treatment, and it is likely that this patient would have responded to subcutaneous treatment. The optimum dosage to induce ovulation ranged between 10 and 20 micrograms per pulse at a frequency of 60 to 90 minutes. Those patients who responded to treatment were all of normal or low body weight for their age and frame. Conversely, those who failed to respond to pulsatile GnRH with ovulation were obese except for one patient with the polycystic ovary syndrome. Because pulsatile GnRH treatment is simple and potentially safe to administer, a therapeutic trial is indicated in patients of low to normal body weight who fail to respond to clomiphene. Where patients are responsive to pulsatile GnRH, the ovulations produced are likely to be fertile, possibly because of the endogenous nature of the ovulatory luteinizing hormone surge.     

Experimental radiation injury: combined MR imaging and spectroscopy

A model of radiation injury to the brain was developed in the cat. Definite radiation changes were demonstrated at magnetic resonance (MR) imaging in four of six cats. These changes consisted of high-intensity abnormalities on images obtained with a long repetition time (TR) and a long echo time (TE), which were initially noted 208-285 days after irradiation. These changes were associated with gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) enhancement on short TR and inversion-recovery (IR) pulse sequences. Gd-DTPA enhancement and the high intensity on the long TR/TE images were identified at the same time and became more prominent throughout the study. Chemical-shift imaging and phosphorus spectroscopy demonstrated no notable changes despite clear-cut MR evidence of abnormalities. Sodium imaging was positive in one case. Correlation of MR and pathologic findings revealed areas of radiation necrosis and wallerian degeneration that corresponded to areas of Gd-DTPA enhancement on short TR and IR images and to areas of high intensity on long TR/TE images. Peripheral to the areas of Gd-DTPA enhancement were nonenhanced zones of high-signal-intensity abnormality on long TR/TE images, which represented regions of demyelination without necrosis. Gd-DTPA-enhanced proton imaging was the most sensitive method for detecting radiation damage in this animal model.     

Proton nuclear magnetic resonance imaging of regionally ischemic canine hearts: effect of paramagnetic proton signal enhancement

In a study to evaluate the potential of proton nuclear magnetic resonance (NMR) imaging with and without manganese contrast with and without manganese contrast enhancement for detecting acute myocardial infarction, 12 dogs underwent 90-minute occlusion of the left circumflex coronary artery. Transverse-section NMR images of the excised, nonbeating heart were obtained at 1-cm intervals using the steady-state-free-precession (SSFP) technique. All NMR images revealed detailed structure of the heart. The three hearts without manganese showed no difference in intensity between the normal and the ischemic posterior regions, whereas those with manganese demonstrated a clearly demarcated zone of reduced signal intensity consistent with the ischemic zone. It is concluded that high-resolution tomograms of the excised canine myocardium can be obtained using proton NMR imaging. With the SSFP imaging technique, proton signal enhancement with manganese infusion is necessary to differentiate between ischemic and nonischemic myocardium after 90 minutes of coronary occlusion.     

Inferior joint space arthrography of normal temporomandibular joints: reassessment of diagnostic criteria

Inferior joint space arthrograms of the temporomandibular joints of 31 healthy volunteers (62 joints) were obtained to determine normal arthrographic findings. The superior margin of the anterior recess was smooth and flat in 68% of the joints and concave in 32% with the subjects' mouths closed. The concavity was the result of the anterior ridge of the meniscus impinging on the contrast material. The concave impression could be distinguished easily from an anteriorly displaced meniscus on videotaped studies, which demonstrated a smooth transition of contrast material from the anterior to the posterior recess during opening of a subject's mouth. With the mouth open, the anterior recess decreased in size, appearing as a small, crescent-shaped collection of contrast material anterior to the head of the condyle in 52 joints (84%); it remained large in ten joints (16%) at maximal mouth opening. The configuration of the posterior recess was identical to that described previously; however, with the subjects' mouths closed, it was larger than the anterior recess, contrary to most previously reported results.