Homohemodialysis: A technique of dialysis for the uremic animal

As an alternative to kidney transplantation in conditions of renal failure, an in situ kidney of a healthy individual may be used. The present study utilizes the kidney of a healthy rabbit as a hemoperfusion unit for another, uremic, animal. The study comprised 17 experimental models, each of which consisted of 2 adult Newzealand rabbits. One animal of each model was rendered uremic by means of bilateral nephrectomy. The blood chemistry (urea, creatinine, sodium, potassium, pH and base deficit) was examined pre- and 4-houriy post-operation. When, after 48 hours post-nephrectomy, the blood chemistry had reached a sufficient level to endanger the animal's life, homohemodialysis was performed. The anticoagulated blood was circulated from the uremic animal to the normal one and then back to the uremic animal through the femoral vessels using a tube system. The blood chemistry was determined every 10 minutes and pH and base deficit every 30 minutes. All animals died or were sacrificed within 21 hours after shunting was started, and autopsy was done. Serum sodium was the first to normalize within the first 10 minutes post-shunting, followed by serum potassium and pH in 30 minutes. Blood urea and creatinine reached normal levels in 40 minutes and base deficit in 60 minutes post-shunting. The pathologic examination of specimens from the vital organs of both the normal and uremic animals showed different degrees of cellular damage probably due to hypotension or acute effects of the unbalanced animal homeostasis. In conclusion, homohemodialysis proved to be effective in normalizing the concentrations of the different substances retained in the blood of uremic animals within only 60 minutes of dialysis.

Outcome of preemptive renal transplantation and pretransplantation dialysis in children

The present study compares the outcome of 40 children (39%) transplanted without prior dialysis, i.e., preemptive transplantation (PET), with 63 children (61%) transplanted after a variable duration of dialysis, i.e., pretransplantation dialysis (PTD). The two groups were matched for recipient and donor age and for immunological risk factors. There was no statistical difference in the time to first acute rejection episode nor in the number of acute rejection episodes during the 1st year after renal transplantation. In the PET group, 78% of the recipients received blood transfusion versus 92.5% in the PTD group (P < 0.05), and the average number of blood units per patient was 3.2 and 7.8, respectively (P < 0.05). Arterial hypertension was found in 55% of the patients in the PET group versus 73% in the PTD group (P < 0.05). The number of functioning grafts at the end of the study period was 87.5% in the PET group and 73% in the PTD group (NS). The major cause of graft failure was vascular thrombosis in the PET group (3/5) and chronic allograft rejection in the PTD group (10/17). In the PET group, the actuarial graft survival rate was 100%, 84%, 81%, and 76% at 1, 3, 5, and 7 years, which was not statistically different from the PTD group at 1, 3, and 5 years (98%, 91%, and 73%, respectively) but there was a significantly lower graft survival (59%) after 7 years in the PTD (P < 0.05). The 7-year actuarial patient survival rate was 97% in the PET group and 90% in the PTD group (NS). In the PTD group, children on dialysis for less than 1 year (group 1, n = 25) were compared with those on dialysis for more than 1 year (group 2, n = 38). Arterial hypertension was noted in 40% of patients from group 1 and 65% from group 2 (P < 0.05); there was no significant difference in graft loss rate. In conclusion, these results confirm PET as the preferred approach rather than PTD in children who need renal replacement therapy.

Vernix caseosa: an unusual cause of post-cesarean section peritonitis

Surgeons should be aware of a very unusual cause of post-cesarean section peritonitis. This rare form of peritonitis is caused by the spillage of vernix caseosa material into the peritoneal cavity. The exact mechanism of the development of peritonitis in these few cases is unknown. Clinically, vernix caseosa peritonitis should be considered in the post-cesarean section acute abdomen after excluding the more common causes of peritonitis such as appendicitis and perforated viscus. Intraoperatively, the presence of cheese-like yellow patches limited to the serosal layer of visceral organs is the most characteristic feature. Histopathological examination of these serosal patches reveal the desquamated anuclear squamous cells confirming the diagnosis. Postoperative treatment with antibiotics should be continued. The addition of steroids (only after confirming the diagnosis pathologically) has a significant effect on improving the clinical outcome.

Advantage of surgery and adjuvant chemotherapy in the treatment of primary gastrointestinal lymphoma

BACKGROUND

Surgery has been the mainstay of treatment for gastrointestinal (GI) lymphoma. The role of adjuvant chemotherapy to surgery has not been clearly elucidated.

METHODS

The review covered 100 patients who were diagnosed with primary GI lymphoma and treated from 1980 to 1993 at Providence Hospital (Southfield, MI), and Hartford and St. Francis Hospitals (Hartford, CT) with a median follow-up of 5 years. Forty-two patients were treated with surgery alone; 31 patients with surgery and adjuvant chemotherapy; 23 patients with primary chemotherapy, and 4 patients received no treatment.

RESULTS

The 5-year actuarial survival based on the above treatments calculated by life-table analysis were 57%, 76%, 58%, and 0%, respectively. This series showed that surgery with adjuvant chemotherapy significantly improved the 5-year actuarial survival of patients with primary GI Lymphoma and that primary chemotherapy showed comparable survival to surgery alone. There was no difference in prognosis when comparing patients with different stage, grade, or location of disease in the GI tract.

CONCLUSIONS

We recommend surgery when feasible with adjuvant chemotherapy as the mainstay of treatment for primary GI lymphoma. However, if a patient presents with comorbid factors, primary chemotherapy offers an effective alternative.

Advantage of surgery and adjuvant chemotherapy in the treatment of primary gastrointestinal lymphoma

BACKGROUND

Surgery has been the mainstay of treatment for gastrointestinal (GI) lymphoma. The role of adjuvant chemotherapy to surgery has not been clearly elucidated.

METHODS

The review covered 100 patients who were diagnosed with primary GI lymphoma and treated from 1980 to 1993 at Providence Hospital (Southfield, MI), and Hartford and St. Francis Hospitals (Hartford, CT) with a median follow-up of 5 years. Forty-two patients were treated with surgery alone; 31 patients with surgery and adjuvant chemotherapy; 23 patients with primary chemotherapy, and 4 patients received no treatment.

RESULTS

The 5-year actuarial survival based on the above treatments calculated by life-table analysis were 57%, 76%, 58%, and 0%, respectively. This series showed that surgery with adjuvant chemotherapy significantly improved the 5-year actuarial survival of patients with primary GI Lymphoma and that primary chemotherapy showed comparable survival to surgery alone. There was no difference in prognosis when comparing patients with different stage, grade, or location of disease in the GI tract.

CONCLUSIONS

We recommend surgery when feasible with adjuvant chemotherapy as the mainstay of treatment for primary GI lymphoma. However, if a patient presents with comorbid factors, primary chemotherapy offers an effective alternative.

New approaches to the Budd-Chiari syndrome

Recent research has led to an improved understanding of the aetiology of Budd-Chiari syndrome in some patients. Fresh approaches and technical developments within methods of radiological intervention have added more effective options to its treatment. In this editorial we aim to summarize our understanding of the role of new aetiologies and new therapeutic approaches in the Budd-Chiari syndrome.

COFS syndrome with familial 1;16 translocation

We report on an Egyptian girl with phenotypic abnormalities of cerebro-oculofacio-skeletal syndrome. She had microcephaly, bilateral congenital cataract, nystagmus, long ear pinnae, camptodactyly, prominent heels, coxa valga, kyphosis and flexure contracture of the elbows and knees. CT scan showed bilateral symmetrical intracranial calcifications. In addition, she had an apparently balanced translocation: 46,XX,t(1;16)(q23;q13) in all cells transmitted from a phenotypically normal mother with a similar balanced translocation mosaicism. We suggest that genes for COFS syndrome could be located on chromosome 1q23 or 16q13. We recommend chromosomal analysis and DNA studies in cases with COFS manifestations.

Critical evaluation of the effectiveness of different modes of treatment of male infertility

Among cohorts of couples treated for infertility due to a male factor it is the effective cumulative rate of successful deliveries and the cost per delivery that must be considered in assessing the value of different modes of treatment. The 'wait and see', timed coitus, or counselling approach has a low success rate (about 15% in 12 months), and a relatively high cost per delivery because of the cost of control visits and of tests for the prediction of ovulation. The high success rate of varicocele treatment (35% in 12 months, between 60 and 80% after 24 months), and the moderate cost of retrograde venography and embolisation results in a low cost per delivery. This cost is the lowest in anti-oestrogen treatment of idiopathic oligozoospermia, with a 20-30% effective cumulative pregnancy rate in 6 months. Three months of intra-uterine insemination (IUI) of Percoll gradient selected spermatozoa has a higher effective cumulative success rate than conventional in vitro fertilization (IVF) applied in cases with similar sperm characteristics, and the cost per successful delivery of the former is eight times lower than that of the latter. Intracytoplasmic sperm injection can successfully be applied in cases with more severe sperm deficiency; it has a higher success rate than conventional IVF, and is slightly more cost-efficient. However, the effective cumulative pregnancy rate remains relatively low (about 45% in 12 months) because of the high drop-out rate and long time interval between treatment cycles among unsuccessful couples.

Relationship between resazurin reduction test, reactive oxygen species generation, and gamma-glutamyltransferase

The production of reactive oxygen species (ROS) from spermatozoa has been measured by chemiluminescence in the two fractions of a Percoll gradient column (47 and 90%). Chemiluminescent signals were recorded in each fraction after addition of luminol and horse-radish peroxidase (basal state), and after stimulation with formyl-methionyl-leucyl-phenyl-alanine (FMLP) and phorbol ester (PMA). We found an inverse correlation between the reducing capacity of the semen as estimated by the resazurin test, and the production of ROS by the spermatozoa, especially after stimulation with PMA (r = 0.51, P < 0.001). gamma-glutamyltransferase activity of seminal plasma was inversely correlated with ROS (r = -0.47, P < 0.01) and the resazurin test result (r = -0.43, P < 0.001) suggesting a possible role of prostatic secretions in the protection of spermatozoa against oxygen radicals. The resazurin test has a positive predictive value of 92.5% at a criterion value of colour scale 4 to discriminate between normal and excessive ROS production by spermatozoa, with sensitivity 79% and specificity 74%. In addition, at criterion value of colour scale 3, the resazurin test could distinguish between samples with normal or low activity of gamma-glutamyltransferase, with sensitivity 57% and specificity 93%. It is concluded that the result of the resazurin test can be influenced by the oxidative stress of spermatozoa and by prostatic function.

Comparison of different methods for the investigation of antisperm antibodies on spermatozoa, in seminal plasma and in serum

Since there is no gold standard for the diagnosis of immunological infertility, comparison between different methods and of their results with biological tests for the detection of antisperm antibodies must be used in defining the most reliable and clinically relevant method. We have evaluated the results of direct (n = 100) and indirect tests in serum (n = 140) and seminal plasma (n = 100) using the SpermMAR and Immunobead (IB) techniques for the detection of sperm antibodies of the immunoglobulin (Ig) classes G, A and M, and we have compared the results with those of the tray agglutination test and the adenosine triphosphate release cytotoxicity test. Results indicate the higher specificity and sensitivity of the SpermMAR results for IgG and IgA, as compared to the outcome of the IB test. It appears that the IB test for IgA may detect non-specific antibodies in serum. Little information is obtained from the tray agglutination test in seminal plasma, and the indirect SpermMar test for IgG in seminal plasma was the only independent variable associated with the outcome of the former test. Since the SpermMAR tests for IgG and IgA are more accurate and biologically relevant, as well as easier to perform than the respective IB tests, the former must be considered the method of first choice.

Bone mineral density in nonsteroid treated early rheumatoid arthritis

OBJECTIVES

To determine whether significant reduction in bone mass is detectable in early disease in patients with rheumatoid arthritis (RA) and to examine the possible influences of disease activity and physical disability on bone mineral density (BMD) of the lumbar spine (LS) and femoral neck (FN).

METHODS

LS and FN BMD values were measured and Z scores determined in a cross-sectional study of 104 patients with RA of less than five years duration. BMD values were also compared between a subgroup of 64 patients and a normal control group matched for age, sex, menopausal status and body mass. BMD values and Z scores were correlated with disease activity, measured by the Stoke Index, disability, measured by HAQ score, and disease duration.

RESULTS

Premenopausal female patients with RA had significantly reduced mean FN Z scores (-0.62, 95% CI -0.30 to -0.94) which correlated with HAQ scores (Rs 0.358, p = 0.05) and age (Rs 0.397, p = 0.03). There were no significant changes of BMD in males or postmenopausal females. Disease duration and disease activity did not correlate with BMD changes.

CONCLUSION

BMD is reduced in premenopausal female patients with early RA possibly related to the attainment of peak bone mass. No significant reduction of BMD was found in males or postmenopausal females with early disease. Physical disability but not disease activity appears to play a role in the reduction of FN bone mass.

Longitudinal bone mineral density changes in early rheumatoid arthritis

A prospective longitudinal study of patients with early RA was performed to examine the influence of disease duration, disease activity and physical activity on bone loss. Sixty-seven patients with non-steroid treated RA of less than 5 yr duration, including 16 patients with disease duration less than 6 months, had BMD measurements of the femoral neck and the lumbar spine over a 12-month period using dual energy X-ray absorptiometry. The BMD changes were compared with values from 72 control patients and were also correlated with serial measurements of disease activity (measured by the Stoke Index) and disability [measured by the Health Assessment Questionnaire (HAQ) score], at 3-monthly intervals over the 12-month period. No significant differences in BMD changes were found between RA patients and controls overall. Patients with disease duration of less than 6 months had significantly greater loss of BMD at the femoral neck (-3.9%, S.E.M. 1.5) than the remainder of the cohort (-0.2%, S.E.M. 0.7) (P = 0.02) and controls (-0.8%, S.E.M. 0.6). Lumbar spine BMD changes correlated with the initial Stoke Index (Rs-0.373, P = 0.01) but not mean Stoke Indices. There was no correlation of BMD changes with age or HAQ scores. These findings suggest that significant bone loss occurs within the first few months of disease in patients with RA.

Is there a relationship between subclinical myocardial abnormalities, conduction defects and Ro/La antibodies in adults with systemic lupus erythematosus?

Thirty-three adult patients with systemic lupus erythematosus (SLE) were studied to determine whether there was an association between subclinical abnormalities of left ventricular function, conduction defects, and the presence of antibodies to Ro and/or La. Twelve patients had one or both of these antibodies. Conduction defects were present in 2, neither being currently positive for Ro or La antibody. There was no difference in abnormalities of left ventricular function between those with or without antibody. Valvular abnormalities were present in 11, 6 of whom had focal or diffuse thickening of one or more valves. Adults with SLE and anti-Ro and/or La antibody do not appear to be at particular risk of conduction defects. Subclinical left ventricular functional abnormalities were not associated with the presence of these antibodies.

Role of thallium-201 in the diagnosis of solitary bone lesions

Thallium-201 is known to accumulate in malignant tumours. In this work we are evaluating the role of thallium in differentiating benign from malignant solitary bone lesions in 28 patients with solitary bone lesions on 99Tcm-MDP bone scans. Lesions' uptake of 201Tl was evaluated using visual assessment and lesion to background ratio. We found significant uptake with a mean lesion to background ratio of 4.27 in malignant lesions and no or faint uptake with a mean lesion to background ratio of 1.37 in benign lesions.