Factors affecting growth after pediatric liver transplantation.
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Biomedical subjects
Publications and source records attributed to J Laine.
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Congenital nephrotic syndrome of the Finnish type (CNF) is an autosomal recessively inherited disease manifesting as massive proteinuria, edema and ascites in the neonatal period. The disease is believed to be limited to the kidneys and recurrences after renal transplantation have not been reported. At our center 29 transplantations have been performed on 28 CNF patients. One to 33 months after transplantation, seven grafts (24%) of six patients have developed a steroid-resistant nephrotic syndrome. The clinical data and renal histology of these patients were analyzed in order to elucidate the cause of the proteinuria. At the onset of six of the seven episodes of nephrosis, the patient had evidence of a preceding CMV- or EBV-infection and the remaining patient had sinusitis. Upon light and electron microscopy examination, endothelial swelling of the glomerular capillaries resembling transplant glomerulopathy (TG) was seen, but unlike TG, the glomerular basement membranes were normal. The response of proteinuria to steroid or cyclophosphamide therapy was poor, with total remission in only two patients and partial remission in one patient, all treated with methylprednisolone and cyclophosphamide immediately after the diagnosis. Four grafts have been lost. Our data show that CNF patients have an increased tendency for post-transplantation nephrosis.
The periodontal status and treatment of three teenagers in a Finnish family with familial neutropenia is described. The mother was also diagnosed with neutropenia. At initial examination, the 15-year-old male and the 10-year-old female had severe periodontitis, whereas the 13-year-old male had oral ulcerations but no significant periodontal disease. The two siblings with periodontitis were treated and followed approximately 5 years. It was concluded that periodontal therapy including scaling, surgery, and use of antimicrobial agents can be successful in patients with familial neutropenia, and that such patients are not necessarily candidates for full mouth extraction. The role of granulocyte colony-stimulating factor in which was used in the treatment of these patients remains to be established.
The significance of contact allergy in patients with various oral symptoms was studied. Positive patch-test reactions to mercury compounds were found in 21/91 patients. Of these, 18 had lichenoid lesions in oral mucosa in close contact to amalgam fillings, and three patients with contact allergy had neither amalgam fillings in their teeth nor visible oral lesions. Amalgam replacement was carried out in 15/18 symptomatic patients. The fillings were replaced with gold in three cases, composite resin fillings in six, glass ionomer in three and both gold and composite materials in three cases. In 10 patients there was complete replacement and in five it was restricted to the fillings adjacent to the mucosal lesions. After a mean follow-up period of 3.2 years a complete cure was seen in seven patients, each of whom had had all their fillings changed. A marked improvement occurred in six patients, and there was no change in two.
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As part of a prospective study of children with bacterial meningitis we analyzed in 36 patients of our hospital the fluid balance on admission and during the first three days of treatment. On admission 10 of them (28%) had inappropriate antidiuretic hormone secretion SIADH, 10 (28%) hypo-osmolal and 10 (28%) iso-osmolal contraction. Six patients (17%) had no clear fluid disorder. The patients with SIADH had significantly lower mean serum NA+ (127 vs. 132 mEq/l, p less than 0.01) and higher mean urine Na+ (111 vs. 26 mEq/l, p less than 0.01) concentration as well as higher mean urinary Na+/K+ ratio (2.23 vs. 0.365, p less than 0.005) than the patients with hypo-osmolal contraction. They also tended to be younger and have a shorter history of fever. The patients with SIADH had a less strict fluid restriction than the patients with hypo-osmolal contraction, and their fluid balance normalized more slowly. Our findings support initial water restriction for all children with bacterial meningitis.
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BACKGROUND: Evaluation of nuclear DNA staining intensity from histological breast cancer sections has not always been accepted, because of the difficulties in interpreting the histograms. One reason for this is the lack of evidence based interpretation guidelines. MATERIALS AND METHODS: The DNA staining intensity of 140 breast cancer samples was measured with flow cytometry (FCM) and image cytometry (ICM). The methods were compared by using grading efficiency (GE). RESULT: First, the ICM histograms were evaluated with a computer assisted image cytometry system using different cut off points for aneuploidy. The GE results varied from 67.9-76.4%. Subjective interpretation and evaluation according two previously published interpretation methods did not improve the GE. Secondly, we excluded histograms which showed clearly different cell clones in FCM and ICM. The GE of remaining histograms was 77.9%. Comparison of these histograms allowed formulation of interpretation guidelines which improved the GE to 85.3%. CONCLUSIONS: This study suggests that efficient interpretation guidelines of section-based DNA histograms can be created.
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Clonidine efficacy was evaluated in 24 manic inpatients, hospitalised in a locked ward. This is a double blind and randomized study. The duration of the trial was 14 days, and the daily dose of clonidine was 0.225 mg/day during the first week, increased to 0.450 mg/day during the second week, in the case of incomplete improvement. There was a trend for a better efficacy of clonidine over placebo, but this did not reach significant, due to an important amelioration of many patients under placebo. The effects of the hospitalisation in a locked ward are discussed.