DISSEMINATED AMERICAN CUTANEOUS LEISHMANIASIS

Background. While studying cutaneous leishmaniasis in the central part of western Venezuela, we found four cases of disseminated American cutaneous leishmaniasis, three from the Lara State and one from Portuguese State. Methods. A clinical history was taken for each of these patients, followed by microscopic examination of the Giemsa-stained smears from their cutaneous lesions and by a Montenegro skin test. Serum from a skin lesion were grown in Novy-MacNeal-Nicolle medium (nnn). Hamsters were inoculated with suspension of tissues taken from the patient's lesions. Biopsies were taken for histopathologic examination. Isolates from cultures on nnn medium and from hamsters were subcultured in Schneider's medium for parasite identification, using molecular techniques. Treatment with injections of N-methyl glucamine antimonate, 25 mg/kg/day was precribed for each patient for 20 consecutive days and, after a week of rest, a second course of injections was administered. Results. Patients had disseminated papular, ulcerous, nodular, and ulceronodular lesions on the skin. Smears of the skin lesions from all of the patients showed abundant amastigotes within histiocytes or free in the tissues. The skin test was negative in two patients. On histopathologic examination of skin lesions, mainly numerous vacuolated histiocytes filled with amastigotes were observed. Isolates from all the patients were identified as Leishmania venezuelensis. One of the patients healed after treatment with N-methyl glucamine antimonate. The others were resistant to this therapy. Conclusions. Diffuse cutaneous leishmaniasis can be caused also by Leishmania venezuelensis. Patients with nodular lesions who presented a negative Montenegro skin test were more resistant to treatment with specific pentavalent antimonials.     

Urological complications in 980 consecutive patients with renal transplantation

Aim: To present the urological complications of renal transplantations performed in the last 14 years at one center and to briefly explain a modified method of Lich–Gregoir ureteroneocystostomy.
Methods: The data of 980 patients receiving kidney transplants at the authors' institution from April 1991 to February 2004 were reviewed in a retrospective prospective study. In particular, surgical techniques and urological complications were noted.
Results: A total of 980 patients had received kidney transplantation. Extravesical ureteroneocystostomy (Lich–Gregoir method) was used in the first 480 patients (group A). In the subsequent 500 patients, the authors' modified method of extravesical ureteroneocystostomy, using single layer anastomosis and small feeding tubes as stent, was used (group B). Overall urological complication rate was 2.8% (28 patients), including leakage (13 patients, 1.3%), stenosis (seven, 0.7%), obstruction (one, 0.1%), distal ureter necrosis (four, 0.4%), pelvocalyceal fistula (two, 0.2%) and implantation of ureter into the peritoneum (one, 0.1%). Urological complications were significantly more common in group A compared to group B (16, 3.3% and 9, 1.8%, respectively; P  < 0.05).
Conclusions: Preserving the adventitia, fat and blood supply of the ureter by delicate dissection of the ureter during donor nephrectomy, short ureters, and fixation of the adventitia, fat and blood supply of the ureter to the bladder wall, to prevent kinking or twisting, are important factors in decreasing urological complications. Additionally, the authors' method of ureteroneocystostomy is also effective in decreasing the incidence of ureteric complications.     

Angiotensin-converting enzyme gene polymorphism and the progression rate of focal segmental glomerulosclerosis in Iranian children

Aim: Focal segmental glomerulosclerosis (FSGS) is one of the most common forms of glomerulonephritis leading to end-stage renal disease (ESRD). A few clinical and paraclinical factors are considered as contributing factors in progression rate. However, there are controversial reports on the relationship between ACE gene polymorphism and rapidity of progression of FSGS to ESRD in different populations. To elucidate this issue, we investigated the relationship between the insertion (I) and deletion (D) ACE gene polymorphism and rapidity of progression of FSGS to ESRD in Iranian children. Methods: Forty-one children aged 1–18 years admitted to St AlZahra Hospital, Isfahan, and St Ali Asghar Hospital, Tehran, Iran, with idiopathic FSGS were enrolled. Renal death was defined as a glomerular filtration rate (GFR) of less than 50 mL/min per 1.73 m² or a decreased GFR to less than 50% compare to baseline. Reaching renal death in less or more than 2 years were labelled as rapid progressors (RP) or slow progressors (SP), respectively. Intron 16 of the ACE gene was amplified by the polymerase chain reaction technique. Results: Twenty-eight patients were male and 13 were female. In 15 RP patients, the genotype distribution was 26.6% DD, 6.7% II and 66.7% ID. In 26 SP patients, the genotype was similar (38.6% DD, 7.6% II and 53.8% ID, P > 0.05). There were no statistically significant differences for ACE I/D gene polymorphism between the two groups of patients (P > 0.05). Conclusion: Our study revealed no correlation between ACE I/D gene polymorphism and rapidity of progression of FSGS to ESRD in Iranian children.     

General practitioner prescribing and community pharmacist recommendation for the sale of aciclovir topical cream

A questionnaire survey of 50 general medical practitioners (GPs) and 50 community pharmacists in Bristol was undertaken to compare GPs' prescribing behaviour and the recommendations of community pharmacists for the sale of aciclovir topical cream. The participants' stated advice about prescribing or recommending the sale of aciclovir topical cream for a series of case studies illustrated by colour photographs was examined. In only one of the nine cases was a significant difference found between prescribing/recommendation of aciclovir cream, with pharmacists being more prepared than the GPs to recommend the cream for a cold sore at the scabbing stage. Pharmacists reported receiving a greater amount of information about the drug from the manufacturer than did the GPs. Some GPs were shown to be confused about the licensing laws regulating the over-the-counter sale of aciclovir cream. This is likely to lead to inappropriate advice from GPs for patients to visit community pharmacists for the purchase of the cream.     

Early results of a new open surgical technique for treatment of uretero-pelvic junction obstruction

OBJECTIVE: Here we report our initial experience with a new open surgical technique for treating uretero-pelvic junction obstruction (UPJO). METHODS: One centimeter distal to the site of the uretero-pelvic junction (UPJ) stenosis, a longitudinal incision of about 15 mm was made over the lateral side of the ureter. The renal pelvis was evacuated. Simultaneously, an oblique incision was made over the posterior and anterior walls of the renal pelvis. The most dependent point over the renal pelvis was sutured to the distal end of the ureterotomy incision. The anterior edge of the pyelotomy incision was anastomosed to the anterior edge of the ureterotomy incision and the posterior edge was anastomosed to the posterior edge of the ureterotomy incision. When the pyeloplasty was completed, the UPJ, accompanied by the proximal 1 cm of the ureter and excessive parts of the renal pelvis, was excised. RESULTS: In 21 (92%) out of 23 patients, the surgical technique was successful. Conclusions: This technique results in predictably good outcomes and has the advantages of the dismembered method. It seems to be a valuable alternative treatment for UPJO.