Intra-ureteric capsaicin in loin pain haematuria syndrome: efficacy and complications

OBJECTIVE

To evaluate the safety and efficacy of intra-ureteric capsaicin for loin pain haematuria syndrome (LPHS).

PATIENTS AND METHODS

In an open prospective pilot study, four middle-aged patients (three women and one man) with LPHS resistant to therapies such as splanchnic nerve block, psychological treatment or renal autotransplantation (one) were assessed. An intra-ureteric infusion of capsaicin (30 mg/100 mL of 30% alcohol in saline) for 30 min with bladder irrigation was administered under general anaesthesia, with a subsequent intravenous patient-controlled narcotic analgesic pump for pain control. Double-concentration capsaicin was used for second infusions, if necessary when the response to the earlier infusion was inadequate or incomplete.

RESULTS

The first patient had experienced reduced pain levels for the first 3 months only, with no benefit from the subsequent treatments with higher doses of capsaicin (60 mg). The second patient with recurrent pain in an autotransplanted kidney had no benefit from either a 30 or 60 mg capsaicin infusion a month apart, but developed a fibrotic stricture at the transplant pelvi-ureteric junction, requiring pyelocystoplasty. The third patient with concurrent depression had no benefit from a 30-mg infusion of capsaicin. The fourth patient experienced no pain relief from a 30 mg infusion of capsaicin but developed proteinuria secondary to mesangial proliferative glomerulonephritis, ureteric inflammation needing stenting within 7 days of treatment and subsequently nephrectomy for a nonfunctioning kidney at 3 months.

CONCLUSION

Intra-ureteric capsaicin was neither effective nor safe in LPHS; the contribution of the alcohol diluent cannot be excluded.

Hepatic abscess complicating paratyphoid infection

Salmonellosis is ubiquitous and is a world-wide public health concern. Liver abscesses are occasionally reported in Salmonella typhi infections, they are a very rare complication of Salmonella paratyphi infections. A 28 year old male patient without any prior medical history presented with fever, abdominal pain and a tender hepatomegaly. The imaging studies revealed multiple liver abscesses and an ultrasound (US) guided aspiration of the abscess yielded heavy growth of Salmonella paratyphi A. He was treated successfully by percutaneous drainage of the abscesses and appropriate antibiotics.

[Neonatal cutaneous lupus. Necessary interdisciplinary collaboration]

INTRODUCTION

Neonatal lupus erythematosus is a rare syndrome (affecting 5% of the children born of mothers with lupus), characterized essentially by cutaneous lesions and/or congenital auricular-ventricular heart block. It is due to the transplacental passage of maternal antibodies (anti-SSA or anti-SSB, or occasionally anti-U1RNP antibodies) into the fetal circulation.

OBSERVATION

We report a case of neonatal lupus erythematosus, having appeared 4 weeks after birth. The 26 years old mother exhibited systemic lupus erythematosus concomitant to Gougerot-Sjögren's syndrome, with positive antinuclear factors (1/2560), native anti-DNA, anti-SSA and anti-SSB antibodies and anticardiolipin antibodies. During pregnancy, the mother had been treated with aspirin at the dose of 100 mg/day, followed by subcutaneous enoxaparin 0.4 ml/day, and combined with prednisone 10 mg/d and hydroxychloroquine 400 mg/day. Early and regular cardiac monitoring of the foetus was performed. The clinical examination and the electrocardiogram at birth were normal. Four weeks later, the infant presented with erythematous cutaneous lesions with atrophic center. No systemic treatment was initiated and the lesions partially regressed.

CONCLUSION

Cutaneous lesions can also appear after the 4th week of life. It is important that the pediatricians clinically monitor all the children born to mothers exhibiting anti-SSA or anti-SSB antibodies, at least during the first 7 months of life.

Biochemical measures in a population-based study: effect of fasting duration and time of day

BACKGROUND

Epidemiological studies generally aim to make simple but unbiased measurements of individuals. For this reason measurements of metabolic variables (including blood lipids, glucose and insulin) are usually carried out after a period of fasting. Few studies have examined the extent to which the use of a defined protocol for fasting in epidemiological studies abolishes the influence of fasting duration and time of day on biochemical measurements.

METHODS

Cross-sectional survey of British Regional Heart Study participants (4,252 men aged 60-79 years), in which men without diabetes were asked to provide a blood sample after fasting for at least 6 h. Serum total, HDL and LDL cholesterol, triglyceride and insulin, and plasma glucose concentrations were measured between 08:00 h and 18:00 h.

RESULTS

Non-fasting men had lower mean LDL cholesterol and higher glucose, insulin and triglyceride levels than fasting men; these differences were more marked among diabetics. Among fasting men without diabetes, insulin and glucose levels were strongly related to time of day, falling gradually throughout the morning and remaining stable in the afternoon. Because of these relationships and the dependence of fasting duration on time of day, insulin and glucose displayed a periodic relation with fasting duration above 6 h. These associations were largely abolished by adjustment for time of day; associations with time of day were unaffected by adjustment for fasting duration. Triglyceride concentrations fell with increasing fasting duration. This relationship was also mediated through a gradual increase in triglyceride levels throughout the day. Adjustments to compensate for these variations are described.

DISCUSSION

Even after fasting, biochemical measurements may still differ in relation to fasting duration and time of day. In epidemiological studies, it is important to standardize both the period of fasting and the time of day as much as possible, and make adjustments where necessary.

Effects of agonists of peroxisome proliferator-activated receptor gamma on proteoglycan degradation and matrix metalloproteinase production in rat cartilage in vitro

OBJECTIVE

To examine the effects of agonists of peroxisome proliferator-activated receptor (PPAR) gamma on proteoglycan degradation induced by interleukin (IL)-1beta or tumor necrosis factor (TNF)alpha in cartilage in vitro.

DESIGN

Proteoglycan degradation was measured as release of radioactivity from rat cartilage explants previously labeled with (35)SO2-4. Western blots were used to examine tissue levels of aggrecan neoepitopes NITEGE and VDIPEN, generated by aggrecanases and matrix metalloproteinases (MMP), respectively. Production of MMP-2, -3 and -9 by cultured rat chondrocytes was measured by zymography and by fluorimetric assay.

RESULTS

IL-1beta-induced proteoglycan degradation was likely due to aggrecanase, since it was associated with a strong increase of NITEGE signal. MMP-dependent VDIPEN signal increased only after further incubation with pro-MMP activator APMA. PPAR agonists 15d-PGJ(2) and GI262570 (10 microM) inhibited IL-1beta- and TNFalpha-induced proteoglycan degradation measured both before and after addition of APMA. The agonists also inhibited cytokine-induced MMP production by isolated chondrocytes.

CONCLUSION

This study shows that PPARgamma agonists inhibit cytokine-induced proteoglycan degradation mediated by both aggrecanase and MMP. This effect is associated with inhibition of production of MMP-3 and -9. These results support the interest for PPARgamma agonists as candidate inhibitors of pathological cartilage degradation.

A new era of dental education at the University of Sydney, Australia

Dental education is currently under scrutiny in order to most appropriately address community needs for the new millennium. Educational outcomes need to include a commitment to life-long learning, and an emphasis on professional ethics and moral responsibility. These needs are supported by new forms of information delivery with a focus on the electronic media, by student centred and self-directed coursework, and by clinical stimulation. Additionally, at the University of Sydney, selection will follow a first degree. This will allow candidates time for an informed decision to be made for their future professional career and for a period of experience in the tertiary education system.

A novel approach to promoting change in SHO training in a dental teaching hospital

An action research study using a series of staged focus groups with senior house officers (SHOs) and educational supervisors (ES) was used to identify the perceptions of the strengths and challenges in the SHO training programme and to indicate areas for improvement. The basic findings were not entirely surprising, with SHOs wanting more detailed feedback from educational supervisors and educational supervisors challenged (by time constraints and competing clinical and research responsibilities) in meeting the expectations of the SHOs. However the novel approach of using staged focus groups enhanced the educational supervisors' perception of the SHOs' view of their training and the SHOs' perception'of the challenges faced by educational supervisors. Thus a culture of dialogue was created which supported change and innovation. This process was able to directly inform and influence the development of a new induction programme for SHOs and provide valuable insight into the use of the portfolio of learning and the provision of study opportunities. These findings may only be of local interest, however the method employed can be transferred to other contexts to support a grass roots approach to change. Indeed, since this study has been completed, the method has been replicated in a medical setting.

[Taste disorders]

PURPOSE

This review focuses on the present state of the question about taste disorders with reference to their associated factors, diagnostic methods, and potential effects.

CURRENT KNOWLEDGE AND KEY POINTS

Taste disorders may be induced by many drugs and are associated to a number of acute or chronic diseases. Patients may be asked about their taste complaints, and taste thresholds may be determined by electrogustometry or chemical gustometry. Taste impairment may provide a good indicator to the course of some diseases such as diabetes mellitus in which hypogeusia predicts occurrence of degenerative complications. Dysgeusia may induce nutritional disorders and contribute to wasting in chronic liver disease, cancer, or human immunodeficiency virus infected patients. Mechanisms involved in dysgeusia are more than one in a patient. Taste disturbance may be secondary to a variety of causes that include zinc deficiency, lesions of the lingual epithelium, neurological impairment, and a pharmacological effect.

FUTURE PROSPECTS AND PROJECTS

A better understanding of the transduction mechanisms of the gustatory signal and the main pathogenic factors involved in dysgeusia may possibly improve the follow-up of the concerned patients notably in terms of nutritional status.

The Marchetti-Vincenzi humeral nail--a useful device in fresh fractures

Whilst most humeral fractures may be treated by closed methods, humeral nailing has gained popularity where a surgical option is indicated. Concern has been expressed regarding placement of proximal and distal locking screws whilst the efficiency of the ingenious intra-medullary locking device of the Seidel nail has also been questioned. The Marchetti-Vincenzi nail, which "locks" proximally with the spreading of intra-medullary pins and distally with a single screw inserted via the surgical wound, apparently avoids potential neurovascular and tendon injury. Prospectively recorded data was analysed in 19 "fresh" fractures, i.e. within 3 weeks of injury, and in 13 "late" fractures (total of 32 humeral fractures) treated with the Marchetti nail. All fresh fractures thus treated progressed to union, whilst in the late fracture group there were three non-unions all of whom were in osteoprotic females. Whilst we commend the use of the Marchetti humeral nail in fresh fractures, we have reservations about its use in "late" fractures particularly where the patient is female and osteoporotic.

Novel homozygous splice acceptor site GnRH receptor (GnRHR) mutation: human GnRHR "knockout"

Mutations in the GnRH receptor (GnRHR) have been shown to be responsible for a significant number of autosomic recessive and, less commonly, sporadic cases of idiopathic hypogonadotropic hypogonadism. We describe a woman with complete GnRH resistance secondary to a novel homozygous GnRHR gene mutation, transmitted as an autosomal recessive trait. The propositus presented with primary amenorrhea and absent thelarche and pubarche. Dynamic tests demonstrated absent spontaneous gonadotropin pulsatility, and no response to either exogenous pulsatile (10 microg/pulse at 90-min intervals over 6 h) or acute (100 microg) GnRH administration. However, she responded to exogenous gonadotropin administration, with a resulting normal pregnancy. Genomic DNA extracted from peripheral blood was PCR amplified using amplimers spanning intron-exon boundaries for the three exons of GnRHR and revealed a homozygous splice junction mutation (G to A transversion) at the intron 1-exon 2 boundary. Her unaffected sister, with a totally normal phenotype, was heterozygous for this mutation. After lymphocyte Epstein-Barr virus transformation, RNA was extracted and subjected to RT-PCR, using primers located in the first and third exons. Results showed a transcript lacking all of exon 2 (exon 2 skipping), with splicing of exon 1 to exon 3. This created a frame shift, generating a coding sequence for three new amino acids, followed by a stop codon. Although it is not clear whether the mutant receptor is actually expressed, the resultant mRNA sequence was presumed to produce a truncated receptor with no binding or signaling capacity.

Myelopathy from intracranial dural arteriovenous fistula

Dural arteriovenous fistulas arising intracranially are an uncommon cause of progressive myelopathy. This report is of a patient in whom the diagnosis of the condition was confounded by coexisting small vessel cerebrovascular disease.

Ankylosing spondylitis associated with non-Hodgkin's lymphoma

Malignancies have rarely been reported in patients with ankylosing spondylitis either as a complication of therapy or de novo. Here we report a 37 years male with ankylosing spondylitis who developed non-Hodgkin's lymphoma during the course of his illness.

Hematopoietic growth factors in drug-induced agranulocytosis

Drug-induced agranulocytosis (DIA) is a potentially fatal disorder. Hematopoietic growth factors have been used in the treatment of DIA. We report nine cases of DIA treated with granulocyte macrophage - colony stimulating factor (GM-CSF) in a dose of 300 microg/day. All the patients had evidence of systemic infection. Mean time to reach an absolute neutrophil count of 0.5 x 10(9)/L was three days. One patient succumbed to the disease. The cause of death was multiorgan failure. No adverse events were observed with GM-CSF. We conclude that hematopoietic growth factors are useful in shortening the period of neutropenia and reducing morbidity and mortality in these patients.

Airway resistance estimation by best fit analysis in very premature infants

Plethysmographic measurement of airway resistance (R(aw)) has been determined by single-point analysis, usually at 50% of maximum inspiratory flow (MIF). Computer-assisted (best fit) analysis, however, allows R(aw) to be calculated by applying a regression line to any portion of the plethysmograph pressure-flow loop. We determined whether the results of best fit analysis using a computer program, sampling at 200 Hz, were influenced by the portion of the inspiratory loop analysed and if best fit or single-point analysis gave more reproducible results. Twenty infants of median gestational age 26 (range 24-28) weeks, were studied at a median age of 12 (12-14) months corrected for prematurity. R(aw) was calculated by best fit analysis between 0 and 33% MIF, 0 and 50% MIF and 0 and 67% MIF and single-point analysis at 50% of MIF. Similar mean R(aw) values were obtained by best fit analysis between 0 and 33% MIF (2.79 kPa/(l/s)) and 0 and 50% MIF (3.01 kPa/(l/s)) and single-point analysis at 50% MIF (2.86 kPa/(l/s)), but best fit analysis between 0 and 67% gave higher results (3.60 kPa/(l/s)), p < 0.0001. Within the linear portion of the inspiratory loop, the mean intrasubject coefficient of variation was lowest for best fit analysis between 0 and 50% MIF. Best fit computerized analysis between 0 and 50% MIF is recommended as the analysis of choice.

[Pseudotumoral enterocolic phlebitis of the cecum and rutoside. A case report]

INTRODUCTION

Enterocolic phlebitis is an entity characterized by ischemic injury of the gastrointestinal tract caused by thrombophlebitis of the mesenteric veins without arterial involvement or systemic disease.

EXEGESIS

We report a case of enterocolic phlebitis in a 57-year-old female treated by rutoside, revealed by intestinal obstruction related to a pseudotumoral lesion of the caecum.

CONCLUSION

This case adds to the four cases of enterocolic phlebitis under rutoside already reported in the literature, suggesting a possible involvement of this drug in this rare disease.