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The aetiology of chronic renal failure in adult Sudanese patients.

One hundred adult Sudanese patients who presented to Soba University Hospital (SUH) with established chronic renal failure (CRF) were studied to determine the aetiology. Thirty-eight had chronic glomerulonephritis, 12 renal calculi, nine diabetic renal disease, seven chronic pyelonephritis, five sequelae of acute renal failure (ARF), four renal vascular disease, three polycystic disease of the kidneys, and two obstructive uropathy. In 20 patients the aetiology was not determined because of late presentation to hospital. The results were compared with those of the developed countries, which differ greatly from Sudan in climate, diet, race, culture and social habits. The main differences were in the prevalence of renal calculi which, although being the second commonest cause of CRF in the Sudan, were rare in European countries. Also, diabetes mellitus was a much commoner cause of CRF in Sudan than Europe. Other aetiological factors were similar.

Acute Kidney Injury↗

Platelet serotonin 5-HT2A receptor binding in patients with carcinoid tumor.

BACKGROUND: As carcinoid tumors produce and secrete serotonin, various serotonin markers in blood, plasma and urine have been used as diagnostic tools, and quantification of the urinary excretion of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) is the method most frequently used. METHODS: [3H]lysergic acid diethylamide ([3H]LSD) binding to the platelet serotonin 5-HT2A receptor was investigated in nine patients with carcinoid tumors. The possible effect of serotonin-rich food on the receptor binding was also investigated. RESULTS: B(max) for [3H]LSD binding was significantly lower in the carcinoid group than in the control group (mean +/- SD: 17.6 +/- 1.3 vs. 23.9 +/- 5.2 fmol/mg protein; p = 0.007). Kd for [3H]LSD binding was significantly higher in the carcinoid group than in the control group (median: 1.14 vs. 0.71 nmol/L; p = 0.03). B(max) was inversely related to the urinary 5-HIAA excretion, but the correlation did not reach statistical significance (r(s) = -0.57; p = 0.14). Intake of five bananas per day for one week had no effect on B(max) or Kd in healthy volunteers. CONCLUSIONS: The results are consistent with a down-regulation of the 5-HT2A receptor as a response to the high serotonin levels found in patients with carcinoid tumors. Intake of serotonin-rich food does not affect the receptor characteristics. Further studies are needed to determine whether the platelet 5-HT2A receptor status can be used as a supplement to urinary 5-HIAA and other biochemical variables in carcinoid tumors.

Aged↗

Safety assessment and risk-benefit analysis of the use of azodicarbonamide in baby food jar closure technology: putting trace levels of semicarbazide exposure into perspective--a review.

The discovery of trace levels of semicarbazide (SEM) in bottled foods (especially baby foods) led to a consideration of the safety of this hydrazine compound by regulatory agencies worldwide. Azodicarbonamide, which is used in the jar-sealing technology known as Press On-Twist Off (or Push-Twist/PT) closures for the formation of a hermetic, plastisol seal, partially degrades with the heat of processing to form trace amounts of SEM. This review has evaluated the potential toxicological risks of resulting exposure to SEM and also the benefit of the PT technology (with azodicarbonamide) in the context of possible microbial contamination. It also considers the potential impact on infant nutrition if parents come to the conclusion that commercial baby foods are unsafe. SEM shows limited genotoxicity in vitro that is largely prevented by the presence of mammalian metabolic enzymes. Negative results were found in vivo in DNA alkaline elution, unscheduled DNA synthesis and micronucleus assays. This pattern is in contrast to the genotoxic hydrazines that also have been shown to cause tumours. Carcinogenicity studies of SEM are of limited quality, show a questionable weak effect in mice at high doses, which are not relevant to human exposure at trace levels, and show no effect in the rat. The IARC has assigned SEM as Group 3, 'Not classifiable as to its carcinogenicity to humans'. Based on estimates of exposure to infants consuming baby foods (with the assumption of SEM levels at the 95th percentile of 20 ng g(-1) in all of the consumed 'ready-to-eat' foods) compared with a no observed adverse effect level (NOAEL) in developmental toxicity studies, the margin of safety is more than 21 000. Since the risk of an adverse effect is negligible, it is clear that any theoretical risk is outweighed by the benefits of continuing use of the PT closure (with azodicarbonamide blowing agent) to ensure both the microbial integrity and availability of commercial baby foods as a valuable source of infant nutrition.

Azo Compounds↗

Intracranial meningiomas following irradiation--a growing problem?

We present 10 cases of meningiomas occurring after high-dose irradiation for other brain tumours. These constitute 3.7% of 272 patients with meningiomas treated in our unit over 10 years. The clinical and pathological features of the 10 cases were added to those of 69 previous cases documented in the literature and compared with the features of our 262 spontaneous meningiomas. The literature on 119 cases of low-dose radiation-induced meningiomas was also reviewed. Malignant histological features and multiplicity were more common in the radiation-induced meningiomas (p < 0.01). Increasing long-term survival rates following radiotherapy for primary intracranial tumours, particularly in childhood, may lead to an increased incidence of postirradiation meningiomas.

Adolescent↗

Recurrent self-inflicted craniocerebral injury: case report and review of the literature.

Self-inflicted craniocerebral injuries have been reported exclusively in mentally disturbed patients and criminals. We report a 28-year-old man with a severe mental disorder who initially hammered a nail into his brain and subsequently repeatedly inserted foreign objects into his brain. The literature is reviewed and the surgical and psychiatric management discussed.

Adult↗

Hepatotoxicity of high dose salicylate therapy in acute rheumatic fever.

Liver function tests, including serum alanine aminotransferase (ALT) activity, serum bilirubin, alkaline phosphatase, serum proteins, blood ammonia levels and intravenous glucose utilization, were monitored in 50 children with acute rheumatic fever receiving anti-rheumatic doses of aspirin. There was a significant increase in blood ammonia levels and serum ALT after aspirin therapy. A significant fall in glucose utilization coefficient was also recorded. Serum alkaline phosphatase, bilirubin and total proteins did not change significantly. Twenty-two of the 50 children recorded a rise in serum ALT; in 12, the rise was five- to tenfold. These 12 children developed adverse symptoms to aspirin. Also, all had a marked rise in blood ammonia levels. The children improved clinically and biochemically on withdrawal of aspirin. There was no constant relationship between hepatocellular function and serum salicylate levels.

Acute Disease↗

Management of accidental kerosene ingestion.

Accidental kerosene ingestion is still a common problem in Libya. It causes considerable morbidity and occasionally mortality. The role and choice of antibacterial agents in its management remain unsettled. Pulmonary damage has been reported as resulting from aspiration. In aspiration pneumonia, anaerobic organisms may be important pathogens and metronidazole may have a place in therapy. The present randomized trial in 100 children with accidental kerosene ingestion assesses the role of ampicillin, carbenicillin and metronidazole in its management. The results are not conclusive but chemoprophylaxis appears to decrease morbidity. Of the various regimens used, the ampicillin/metronidazole combination was found to be slightly better than the others. Further study is recommended.

Accidents↗

Juvenile offences among hospitalized adolescent inhalant users in Istanbul: a comparison regarding place of residence.

In this research, juvenile offenses and associated behaviors among adolescent inhalant users in Istanbul were investigated and inhalant users living in the street were compared to inhalant users living with their families. An interview questionnaire developed by the researchers was administered to 200 male adolescent inhalant users who were hospitalized during 2002-2003. More than half of the sample had committed juvenile offenses at least once in their lifetime, 16.3% had entered a house of corrections, 91.5% had friends who committed juvenile offenses, and the majority had been taken to a police station at least once in their lifetime. The rates for juvenile offenses, being taken to the police station, committing crimes to obtain money to buy drugs, and obtaining income through illegal activities were higher among adolescents living in the street than adolescents living with their families. Although the juvenile offense rate was higher among adolescents living in the street, it can be suggested that both groups live in subcultures that have a tendency towards crime, and inhalant use is part of these subcultures. Juvenile offense interventions can be useful for all inhalant users.

Adolescent↗

The use of banana in MRCP.

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Cholangiopancreatography, Magnetic Resonance↗

Gluteal V-Y advancement fasciocutaneous flap for treatment of chronic pilonidal sinus disease.

Although pilonidal disease is quite common, controversy still exists about the treatment. The procedure should cure the patient, and allow speedy resumption of normal activities by reducing pain and disability. This retrospective study was conducted to evaluate our experience with the V-Y fasciocutaneous advancement flap and to review current publications about flap surgery for the treatment of sacrococcygeal pilonidal sinus. We describe the application of the fasciocutaneous V-Y advancement flap for reconstruction of defects after radical excision of recurrent pilonidal sinus in 11 cases. Primary and uneventful wound healing was achieved in all patients but two who developed minor wound breakdown. Large defects after excision can easily be closed using the V-Y advancement flap. This type of flap closure in selected cases offers tension-free, recurrence-free, and reliable skin coverage while flattening the natal cleft that predisposes to recurrences. Reliable flap closure reduces hospital stay, costs, as well as disability and time spent off work.

Adult↗

Reconstruction of soft tissue defects of the hand using the shape-modified radial forearm flap.

We have reconstructed soft tissue defects in 121 hands with radial forearm flaps. So that the flap perfectly fitted the defect, and to minimise the size of the donor site, we divided the flap into two or three components in each case. We call this the shape-modified radial forearm flap. Of the 118 patients, 113 had complete survival of the flap. The follow-up time was 1 to 15 years. The donor sites were closed primarily in all patients, giving good aesthetic results. The shape-modified radial forearm flap seems to be reliable, and makes it possible to adjust the flap according to the defect. The donor area can be closed primarily in all cases.

Adolescent↗

An association between inflammatory state and left ventricular hypertrophy in hemodialysis patients.

This study was performed to investigate the potential relationship between left ventricular hypertrophy (LVH) and proinflammatory cytokines in hemodialysis (HD) patients and the effect of HD on cytokine production. Serum interleukin 1 beta (IL-1 beta), interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) measurements and echocardiographic studies were performed in 35 stable HD patients. A variety of probable risk factors for LVH including age, HD duration, blood pressure (BP), body mass index, lipid profile, hemoglobin, albumin, parathormone and homocysteine levels were also investigated. Additionally, the effect of HD procedure on cytokine levels was evaluated. Predialysis serum levels of IL-1beta, IL-6, TNF-alpha, and homocysteine in HD patients were compared with 12 healthy subjects. Left ventricular hypertrophy was demonstrated in 20 (57%) of HD patients by echocardiography. Left ventricular mass index (LVMI) was correlated positively with systolic BP (r=0.556, p=0.001), diastolic BP (r=0.474, p=0.004), and serum levels of TNF-alpha (r=0.446, p=0.009). Multiple regression analysis showed that systolic BP and TNF-alpha levels were significant independent predictors of LVH. No relationship was observed between LVH and other parameters. The mean predialysis serum level of IL-6 was significantly higher in HD patients compared to healthy controls (15.7 +/- 8.7 vs. 7.3 +/- 0.7 pg/ mL, p=0.001). Predialysis serum levels of TNF-alpha in HD patients were higher when compared to healthy subjects, but the difference was not statistically significant (8.3 +/- 3 vs. 7 +/- 1.45 pg/mL, respectively, p>0.05). However, serum levels of IL-6 and TNF-alpha significantly elevated after HD, when compared to predialysis levels (from 15.7 +/- 8.7 to 17.8 +/- 9.5 pg/mL, p=0.001 and from 8.3 +/- 3.0 to 9.9 +/- 3.5 pg/mL p=0.004, respectively). As a conclusion, in addition to BP, proinflammatory cytokines, TNF-alpha in particular, seem to be associated with LVH in ESRD patients.

Adolescent↗

The importance of nucleolar organizer regions in pediatric acute lymphoblastic leukemia.

The silver-staining of the nucleolar organizer regions (AgNORs) was performed in patients with acute lymphoblastic leukemia (ALL) to verify the role of cell proliferation in predicting complete remission and survival. Bone-marrow aspiration smears of 20 pediatric cases with ALL, were stained with argyrophilic method during the diagnosis, remission, and 3rd, 6th, 9th, and 12th months after remission. The mean NORs count (NORsc) and the mean of (nucleolar organizer regions surface/total nuclear surface x 100) value (NORss/TNs) for each case were calculated. At diagnosis, the NORsc and NORss/TNs value for the whole series were 3.30+/-0.86 and 4.77+/-1.15, respectively. In complete remission, NORsc and NORss/TNs values were 1.23+/-0.20 and 3.45+/-0.87, respectively, and the differences were statistically highly significant (p < .001). The most important parameters of prognostic factors that effect diagnosis NORss/TNs and NORsc values were found to be FAB morphology and leukocyte count according to the multivariant analysis test. AgNORs analysis is a suitable method to assess cell proliferation in bone marrow aspirate and can predict complete remission, remission duration, and survival in pediatric ALL patients.

Adolescent↗

Role of protein kinase C in hydroxyapatite- induced phagocytosis by a murine macrophage cell line (RAW264.7).

The role of protein kinase C (PKC) in hydroxyapatite (HA)-induced phagocytosis by RAW 264.7 cells was investigated. The cells were incubated with HA particles at various incubation time and the levels of PKC activity were determined from the cell lysate. To determine the role of PKC, particles were incubated with the cells pretreated with the various concentrations of bisindolylmaleimide, a PKC inhibitor, and phagocytosis was then assessed at 60 min. Latex beads were used as a control. Our results showed that following incubation with HA particles, the levels of PKC activity in RAW264.7 cells was highest at 7 min and then decreased to reach the baseline levels of the controls at 30 min. Pretreatment of the cells with bisindolylmaleimide significantly reduced phagocytosis of HA particles in a dose-dependent pattern. The results of our present study suggest therefore that ingestion of HA by RAW264.7 cells may depend on PKC activity that may act in the early stages of phagocytosis.

Animals↗

The effect of aminoguanidine on blood and tissue lipid peroxidation in jaundiced rats with endotoxemia induced with LPS.

Obstructive jaundice (OJ) is a severe condition that leads to several complications. One of the important problems in OJ is the increased incidence of endotoxemia, which is the result of bacterial translocation (BT) and defective host immune response. Lipid peroxidation (LP) is an important problem in OJ and sepsis in which nitric oxide (NO) production and inducible nitric oxide synthase (iNOS) activity are increased and antioxidative activity is decreased. Formation of peroxynitrite (ONOO(-)) anion leads to cellular damage and apoptosis. In this experimental study, we explore the effect of specific iNOS inhibitor aminoguanidine (AG) on blood and tissue (liver and renal) LP and iNOS levels in jaundiced rats with endotoxemia induced with lipopolysaccharide (LPS). Rats were randomized into six groups; group A, sham; group B, obstructive jaundice (OJ); group C, OJ + LPS; group D, OJ + AG; group E, OJ + LPS + AG; group F, OJ + AG + LPS. Serum malondialdehyde (MDA) and serum myeloperoxidase (MPO) activity and liver and renal tissue MDA, MPO, and Na(+)/K(+)-ATPase activity levels were detected in biochemical methods. Liver and renal tissue iNOS levels were examined immunohistopathologically. Serum and tissue MDA and MPO levels and tissue iNOS expression were increased significantly in groups B, C, and E, while tissue ATPase levels were decreased significantly in the same groups. In the group treated with AG (group D), serum and tissue MDA and MPO levels and tissue iNOS expression were decreased while tissue ATPase levels were increased significantly. In group F, if AG was administrated before LPS, we observed that serum and tissue MDA and MPO levels and tissue iNOS expression were decreased while tissue ATPase levels were increased significantly. Thus, our study showed that AG had a protective effect when it was administrated before LPS, but it failed to prevent tissue iNOS expression and LP if there was established endotoxemia in OJ.

Adenosine Triphosphatases↗

Effect of N-acetylcysteine on blood and tissue lipid peroxidation in lipopolysaccharide-induced obstructive jaundice.

In obstructive jaundice, free radical production is increased and antioxidative activity is reduced. N-Acetylcysteine (NAC) has a beneficial effect with anti-inflammatory and antioxidant activity, acting as a free radical scavenger. NAC inhibits inducible nitric oxide synthase, suppresses cytokine expression/release, and inhibits adhesion molecule expression and nuclear factor kappa B. The aim of this study was to investigate the effects of NAC on liver/renal tissue and serum lipid peroxidation in lipopolysaccharide (LPS)-induced obstructive jaundice. We randomized 60 rats into 6 groups: group 1, Sham; group 2, obstructive jaundice (OJ) induced after bile-duct ligation; group 3, OJ + NAC (100 mg kg- 1 subcutaneously); group 4, OJ + LPS (10 mg kg-1); group 5, OJ + NAC + LPS; and group 6, OJ + LPS + NAC. For each group, the biochemical markers of lipid peroxidation and the antioxidant products were measured in serum and liver/renal tissue after sacrifice. Almost all lipid peroxidation products levels were increased and antioxidant products levels were decreased in groups who received LPS (groups 4, 5, and 6), but the effect was less remarkable when NAC was administered before LPS (group 5). The same trend was seen for groups with OJ +/- LPS who did not received NAC or received it after induced toxemia (groups 2, 4, and 6) as compared to groups 1 and 3. Moreover, in the case of OJ + LPS, rats treated with NAC before LPS (group 5) had lower lipid peroxidation products levels and higher antioxidant products levels as compared to those who did not received NAC (group 4). This phenomenon was not reproducible with NAC administered after LPS (group 6). Thus, results of this study showed that NAC prevents the deleterious effects of LPS in obstructive jaundice by reducing lipid peroxidation in serum and liver/renal tissue if administered before LPS. Nonetheless, NAC failed to prevent the lipid peroxidation in the case of established endotoxemia in obstructive jaundice.

Acetylcysteine↗