Membranous nephropathy and multiple sclerosis are believed to be mediated by immune mechanisms. A patient is reported with the first described association of membranous nephropathy and multiple sclerosis. Its significance and possible pathogenetic mechanisms are discussed.

Adolescent↗

PubMedDate not supplied

[Upper lateral cartilage transposition in the surgical management of nasal valve incompetence].

We have operated eight patients with nasal obstruction secondary to internal valvular incompetence. In three of them an alar collapse were associated. Diagnosis was made by anamnesis and clinical exploration. Open rhinoplasty approach was employed. Surgical technique was the transposition of lateral over alar cartilage. In the three patients with alar collapse, a fixation graft of septal cartilage were added to the previous technique. Nasal obstruction and valvular incompetence missapeared in all the patients.

Adult↗

PubMedDate not supplied

Total serum IgE: adult reference values in Valencia (1981-2004). Usefulness in the diagnosis of allergic asthma and rhinitis.

BACKGROUND: The reference values for total serum IgE are accepted to vary according to the geographical area involved. In 1981 we published the reference values for a donor population in the city of Valencia (Spain) and its metropolitan area. Since then, we have noted an increase in the prevalence of asthma and rhinitis in countries with a Western lifestyle, including Spain. AIM: To update the adult reference values for total serum IgE in the city of Valencia and its metropolitan area, and to determine their diagnostic usefulness in asthma and allergic rhinitis. MATERIAL AND METHODS: We studied two groups of 69 and 100 individuals each. One group comprised apparently healthy blood donors, as assessed by a routine blood bank study protocol and the application of a questionnaire to exclude perceived allergic or parasitic diseases, while the other group consisted of individuals with atopic respiratory disease (bronchial asthma and allergic rhinitis) studied in our service in the same time period (spring 2004). Total serum IgE was determined by the UniCAP method developed by Pharmacia. RESULTS: The geometric mean of total serum IgE among blood donors was 46.65 kU/l (95% CI: 15.5-77.8) versus 204.29 kU/l (95% CI: 93.3-515) among allergic subjects. The difference between the two groups was statistically significant. No significant difference was found between our donor sample in 1981 and the sample in the present study. Establishing an arbitrary cut-off point of 1.65 standard deviations (SD)(equivalent to 95 % of the donor population), we obtained a figure of > 183 kU/l whereby 44% of all allergic individuals presented a value below this cut-off point. To practical effects, these allergic patients behaved as low responders (LRs) in relation to total IgE, whereas the remaining individuals were high responders (HRs) in relation to total IgE. CONCLUSIONS: Our data confirm the current validity of the reference values obtained in 1981, which continue to be significantly different from those of the UniCAP method for Swedish donors. The population of allergic subjects can be divided into two subgroups: subjects with total IgE levels similar to those of the donors, which we refer to as LRs, and which represent 44% of all allergic subjects, and a second subgroup with total IgE values above those of the donors (HRs), who would therefore be the only subjects that would be identified by individual serum IgE study.

Adult↗

PubMedDate not supplied

Pathology teach and tell: cellular mesoblastic nephroma.

Explore the source record for details and available documents.

Diseases in Twins↗

PubMedDate not supplied

Hypertension following orthopaedic surgery in children.

Five patients developed hypertension after undergoing orthopaedic surgery. Three of four patients in whom serum renin was assayed had significant elevation, suggesting a possible renal-mediated etiology. Two patients required the addition of an angiotensin-converting enzyme (ACE) inhibitor to control hypertension while continuing the prolonged orthopaedic procedures. The need for careful blood-pressure monitoring of children undergoing orthopaedic surgery is emphasized in this article.

Adolescent↗

PubMedDate not supplied

Therapeutic compliance among asthma patients in an allergy clinic: third evaluation (SEGARIA Project).

OBJECTIVES: To perform a third evaluation of therapeutic compliance in asthma patients managed in our department by using identical methodology to that employed in two prior evaluations (1995 and 1993). To study the possible association between correct inhalation technique and the patient's degree of knowledge about asthma. MATERIAL AND METHODS: A random sample with a fixed rate was obtained, comprising 54 adult patients with asthma (aged more than 18 years old) managed in our department in an outpatient regime. Patients who reported that they habitually failed to comply with the treatment duration, the number of dosage times per day, or the dose at each specific dosage time were classified as noncompliers with the medication in question. The study was performed during October and November, 2003. First visits were excluded. The same categories of medications and procedures as those employed in the 1993 and 1995 studies were used. RESULTS: Of the 54 patients studied, 19% revealed some type of pharmacological noncompliance. The overall percentage of incorrectly used medication was 8%. Among noncompliers, clinical course was poor in 44% and additional visits to specialists or the emergency room were required in 45%. Incorrect use was most frequent with the turbuhaler (32.1%), and faulty technique was also most common with this device (67.9%). CONCLUSIONS: In this evaluation, overall therapeutic compliance was clearly better than that in 1995 (81% compared with 54%), indicating a positive tendency over time. These results were more positive than those reported in the scientific literature on therapeutic compliance. Nevertheless, correct inhalation technique was markedly less frequent than in our previous studies. The most incorrectly used pharmacological groups continue to be the controller medications. A nonsignificant tendency among noncompliers to require more additional visits and to have worse clinical course and less knowledge about their disease than compliers was maintained. This type of evaluation continues to be useful in the clinical monitoring of therapeutic complicance in daily clinical practice.

Administration, Inhalation↗

PubMedDate not supplied

Medical audit on asthma in an emergency department.

BACKGROUND: To determine the management of acute bronchial asthma in an adult emergency department. METHODS: A retrospective medical audit of 46 consecutive adult patients with acute asthma exacerbations was performed. We collected information from 48 episodes of acute asthma over a 5-month period. Using classical audit methodology, four indicators were examined: severity evaluation, diagnostic tests, specific treatment, and discharge treatment plans. RESULTS: The least recorded severity indicators were respiratory rate (27 %), heart rate (50 %) and peak expiratory flow (20 %). Heart and respiratory auscultation were recorded in all patients and oxygen saturation was recorded in 93 %. Laboratory blood test and chest radiograph were performed in all patients. Arterial blood gas was tested in 57 %, electrocardiography in 17 %, and coagulation in 39 %. No treatment was provided in 12 % of patients. Bronchodilator medications were administered in all treated patients and oxygen was prescribed in 60 %. Systemic corticosteroids (methylprednisolone or hydrocortisone) were administered in 80 % of treated patients. Seventeen percent of patients were discharged from hospital with no change to their usual treatment. CONCLUSIONS: The following weak points were identified: 1) Severity assessment is inadequate, 2) use of diagnostic tests is excessive, 3) patients discharged to home with no treatment plan. Opportunities for improvement consisted of: 1) greater availability of peak expiratory flow meters, 2) individualized use of diagnostic tests, and 3) management protocols.

Acute Disease↗

PubMedDate not supplied

Early morphofunctional alterations induced by cisplatin in the cochlea. A quantitative and electrocochleographic study.

The early morphological and functional alterations of the cochlea were studied in guinea pigs treated with cisplatin, administered to two groups of animals as a single dose of 4 or 10 mg/kg body weight. Morphological changes were observed by scanning electron microscopy, and functional alterations were investigated by electrocochleography to record compound action potentials. Statistically significant alterations in neurosensory stereocilia, consisting of partial or total denudation, were observed only after the experimental administration of the higher dose of cisplatin; these changes were consistently associated with distortions in the compound action potential.

Action Potentials↗

PubMedDate not supplied

Diabetic nephropathy in a prepubertal diabetic female.

Diabetic nephropathy is an uncommon finding in the pediatric age group. Previous reports have demonstrated that persistent proteinuria does not occur during the first five years following the diagnosis of insulin dependent diabetes mellitus. We report a prepubertal female child with less than five years duration of diabetes who developed persistent proteinuria and histologic changes diagnostic of diabetic nephropathy. The earlier than expected diabetic nephropathy noted in our patient raises the question regarding the need for earlier surveillance for diabetic nephropathy in children with a family history of chronic diabetic complications.

Child↗

PubMedDate not supplied

The origin of the otoconia in the rat.

The transitional zone of the saccule and the utricle--has been studied by transmission electron microscope in rats, days before birth. A noticeable secretory activity has been observed in their cells as well as the presence of inorganic spicular bodies that have also been observed in the lumen, some of them integrated into the otoconia. These findings were not seen in adult animals. It is assumed that both organic and inorganic components of the otoliths are produced in a critical period of the embryonal development in the transitional cells.

Animals↗

PubMedDate not supplied

Mineralization in the newborn rat statoconia. An EDAX study.

Several types of statoconia, differing in size and shape, have been observed in macula utriculi, the smaller ones in the macular periphery. The larger statoconia seem to be formed by the association of smaller units and calcium presence is comparatively higher: In some parts of the marginal zone there exists a granular material in which the presence of calcium is significant.

Animals↗

PubMedDate not supplied

Otoconial mineralization in post-natal development.

Otoconial mineralization has been studied in the utricle of post-natal rats, i.e. from birth to the 20th day. Calcium microanalytically detected is seen to decrease progressively until, after 20 days, when the level is rather lower than at birth. In the adult animal the calcium value is much higher, which leads us to believe that there is an immediate calcium loss that is later recovered. Calcium in the peripheral areas of the macula is proportionately less than in the central part.

Age Factors↗

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Immunotherapy with a mass unit Parietaria judaica extract: a tolerance study with evidence of immunological changes to the major allergen Par j 1.

Specific immunotherapy with Parietaria judaica pollen extract has been proven to be effective in the treatment of patients with respiratory allergy induced by this pollen. Nevertheless, there is some controversy about its tolerability. We conducted an open uncontrolled study to evaluate the tolerability of an aluminium adsorbed P. judaica pollen extract whose major allergen (Par j 1) content was known. Changes in immunological parameters to a complete P. judaica extract and to a purified Par j 1 preparation were monitored. Twenty-one patients (12 women, 9 men; mean age 30.2 years) suffering from rhinoconjunctivitis and/or asthma due to Parietaria pollen were enrolled. The maximum dose was established at 10 BU/ml (0.6 microgram Par j 1). Skin and conjunctival reactivity as well as serum levels of specific IgE, IgG, IgG1 and IgG4 were evaluated before therapy (T0), when 1 BU was given (T1), 2 weeks after the maintenance dose was reached (T2) and after the pollen season (T3). Four-hundred and fifteen doses were administered during immunotherapy. Only one systemic reaction (0.24% of doses) and two local reactions were registered. Reactions occurred during the administration of the highest concentrated vial. Before immunotherapy, purified Par j 1 accounted for 94.2% of the cutaneous response elicited by the complete extract. A statistically significant decrease in cutaneous response was detected after 8 weeks of treatment. There were no significant changes in conjunctival reactivity throughout the study. Specific IgG, IgG1 and IgG4 showed a pronounced and significant increase during the study, while specific IgE levels initially decreased and increased after the pollen season. The kinetics of specific antibodies to P. judaica complete extract and purified Par j 1 showed a parallel trend. The present study demonstrates that immunotherapy with P. judaica extract is well tolerated in patients suffering from rhinoconjunctivitis and/or asthma due to Parietaria pollen. This therapy induces specific changes in the immunological response to P. judaica and to purified Par j 1. These changes can be detected at very early stages of therapy.

Adolescent↗

PubMedDate not supplied

[Gianturco-Grifka device in the percutaneous closure of patent ductus arteriosus].

We present our early experience with the Gianturco-Grifka device for transcatheter closure of patent ductus arteriosus. Grifka occlusion was attempted in 13 patients (7 female, 6 male), median patient age was 6.5 years. Echocardiographic evaluation showed a mean ductal diameter of 5.47 +/- 1.09 mm, and the morphology was type C in 7 patients, type A in 5 and type E in 1 patient. The angiographic ductal morphology was 6 type A, 5 type C and 2 type E. Mean PDA diameter was 5.69 +/- 1.15 mm. Three patients had pulmonary hypertension. They were given supplemental oxygen (100%), decreasing their pulmonary pressures. A total of 13 devices were implanted, 5 of 7 mm and 8 of 9 mm. Twelve patients had complete ductal occlusion documented by aortic angiography (92%), one patient presented residual shunt (8%). Color echocardiography at 24 hrs documented complete occlusion in 12 cases. One device embolized to the descending aorta 2 hours after closure, and it was successfully retrieved in the catheterization lab. We conclude that the Gianturco-Grifka device is an appropriate alternative for transcatheter closure of the PDA. This technique can be performed in ductus arteriosus type C, D and E, with diameter < 9 mm. More clinical trials are needed to establish the long-term results of this technique.

Cardiac Surgical Procedures↗