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Chronic interstitial nephritis and mixed cryoglobulinemia associated with drug abuse.

Two cases of chronic interstitial nephritis with renal insufficiency were associated with mixed cryoglobulinemia and parenteral drug abuse. Previously recognized causes of interstitial nephritis were not present in either case. Despite extensive interstitial inflammatory infiltrates, no substantial glomerular abnormalities or immune deposits were present in either patient. One patient had a history of intravenous injection of suspended methadone tablets containing talc crystals, and there was evidence of talc embolization in biopsy specimens of liver, spleen, and kidney. Interstitial nephritis associated with drug abuse has not been previously described to our knowledge, but the association in these cases seems not to have been fortuitous and warrants consideration in the evaluation of both parenteral drug abusers and patients with unexplained interstitial nephritis.

Adult↗

[Pulmonary fibrosis and inorganic particles].

Biological data acquired in recent years has thrown new light on the pathogenesis of pulmonary fibrosis. The key element in the genesis of fibrosis may be the alveolar macrophage which, under the influence of different stimuli, secretes numerous factors, attracting polymorphonuclear leukocytes and eosinophils, stimulating fibroblasts and activating lymphocytes. Pulmonary fibrosis induced by inhalation of inorganic particles seems to proceed by identical mechanisms, with certain differences relating to the nature of each mineral. The morphological, cytological and immunological characteristics which defend the lung from silicosis and asbestosis are particularly discussed. The in vitro reactivity of several cell types (alveolar macrophages, mesothelial cells in culture, fibroblasts) equally has revealed differences between quartz and chrysotile. Nevertheless this in vitro response is difficult to interpret compared to an in vivo response: they vary according to the cellular system used and the physico-chemical state of the particular mineral (chrysotile and leached chrysotile by oxalic acid for example). The fibrosing action of other particles (talc, metals) is also reviewed. As opposed to an inflammatory granuloma secondary to the stimulation of alveolar macrophages which represents the usual response to mineral particles, there is also an immunological granuloma of the sarcoid type which may lead to secondary fibrosis: beryllium and talc in certain circumstances may act by this mechanism.

Animals↗

Changes in serum total creatine phosphokinase (CPK) and its isoenzymes caused by experimental ligation of the superior mesenteric artery.

The changes in serum total CPK and its isoenzymes have not been delineated in acute mesenteric infarction. As measurement of serum CPK levels could conceivably be a useful diagnostic test for bowel infarction, this experiment was performed to assess changes in serum CPK levels in bowel infarction in dogs, using sham operation and talc peritonitis as controls. Laparotomies were performed in 20 dogs, and each was as signed randomly to one of three groups: those having laparotomy (LAP), talc peritonitis (PER), and superior mesenteric artery infarction (MAI). Mixed venous blood samples were obtained from all subjects for 30 hours after surgery. All animals were killed, and complete autopsies were performed. Confirmation of infarction and determination of its extent were obtained through both gross and microscopic examination of the gut in canines subjected to arterial infarction. Total serum CPK levels were determined by spectrophotometric analysis. Agarose gel electrophoresis was used to determine the levels of each of the isoenzymes. Significant elevations of CPK and CPK-MM occurred nine hours after injury. CPK-BB reached maximum elevation by six hours, while CPK-MB did not reach its maximum until 24 hours after injury. From data in the study we conclude that total CPK and its isoenzymes become elevated in the serum of canines subjected to experimental superior mesenteric artery infarction. That CPK-BB elevations peak in the first 12 hours after injury and CPK-MB in the second 12 hours after injury may be of particular diagnostic significance.

Animals↗

An in vitro study of the interaction between diazepam and some antacid or excipients.

The adsorption of diazepam on magnesium trisilicate, magnesium oxide, aluminium hydroxide, calcium carbonate, magnesium carbonate, bismuth oxycarbonate bismuth subsalicylate, talc, dibasic calcium phosphate, magnesium stearate, kaolin and charcoal was studied at 37 degrees C. With the exception of charcoal, magnesium trisilicate exhibited the highest adsorptive capacity for the drug. Talc and dibasic calcium phosphate had the lowest adsorptive power while the other materials tested had intermediate adsorption properties. In general, low elution values were obtained with both acidic and alkaline solutions. The presence of a specific interaction between diazepam and surface sites of the adsorbing materials was suggested. The Langmuir relationship was obeyed in case of bismuth oxycarbonate. The dissolution of the drug in absence and presence of magnesium trisilicate, which had a very high retention ability, was also studied. The antacid decreased obviously the dissolution of the tranquilizer. The implication of diazepam interaction with antacids and excipients on its bioavailability is to be further confirmed by in vivo testing.

Adsorption↗

[Current indications for thoracoscopy].

Thoracoscopy is performed at best with a rigid apparatus and a cold light source using a single or double site of entry into the chest. Biopsy under direct vision requires a double-spoon biopsy forceps that can be connected to diathermy to insure haemostasis and prevent any air leak age. Some authors prefer a local anaesthesia but a light general anaesthesia with or without intubation allows a safe and painless examination. Numerous biopsies can be obtained for subsequent examinations, like light or electron microscopy, immunofluorescence, bacteriology and mineral studies as well as search for hormonal receptors sites on tumours. Complications are rare and fatalities exceptional (4 cases in a review of the literature covering 3.384 cases. 2 of which occurred in a small series of 150 cases). In chronic pleurisies secondary to cancer, a diagnosis was made in 92% of cases. In suspected pleural mesothelioma, thoracoscopy allows both diagnosis and staging. In pleural tuberculosis, a diagnosis is obtained in 93% of cases. Talc pleurodesis in the treatment of chronic recurrent malignant pleural effusions is successful in 80%. In the treatment of spontaneous pneumothorax with a mean follow up of 10 years, only 6.6% recurred after talc poudrage, and functional sequelae were minimal; no talcomas induced mesotheliomas were seen in a review of 151 cases. Thoracoscopic lung biopsy has an 87 to 94% success rate depending on series, and is thus comparable to surgical biopsy with a markedly smaller morbidity and mortality. It should thus be used more widely by pneumologists.

Biopsy↗

Pleuroscopy in clinical evaluation and staging of lung cancer.

The use of pleuroscopy in patients with bronchogenic carcinoma has not been reported previously. We performed this procedure in 45 lung cancer patients in whom pleural involvement was suspected. Pleural fluid or mestastases were found in 37 patients, 5 of whom had also major atelectasis due to bronchial obstruction by tumor. Neoplasm penetrating vital structures (aorta, brachial plexus) was found in 3 patients, tumor confining to resectable structures in 3; no pleural abnormalities were disclosed in 2. Based on these findings, 43 tumors were assigned stage III. Only on two occasions pleuroscopy did not aid staging. In 20 patients with massive pleural effusion causing dyspnea we insufflated talc in order to produce pleurodesis. This was fully successful in 16 patients, while in 2 the pleural cavity became only partially obliterated, with symptomatic relief. In 2 patients pleurodesis could not be evaluated because of early death caused by progression of cancer. Pleuroscopy is a highly informative procedure, applicable when involvement of pleura by lung cancer is suspected. It is helpful in clinical staging of the tumor and in assessment of its resectability, particularly in elderly, poor-risk patients. It provides the best way for talc insufflation when pleurodesis is indicated. Pleuroscopy should have an established place in the clinical evaluation and staging of lung cancer.

Adult↗

In vitro antidiabetics-antacid interactions.

The adsorption of the oral antidiabetics metformin hydrochloride, glibenclamide, acetohexamide, tolbutamide, carbutamide, tolazamide and glymidine on various antacids or adsorbents was studied at 37 degrees C. The antacids or adsorbents used were magnesium trisilicate, aluminium hydroxide, calcium carbonate, magnesium oxide, bismuth oxycarbonate, talc, kaolin as well as charcoal. None of the substances tested, with the exception of charcoal, exhibited superior adsorptive properties for all the drugs. Magnesium trisilicate and calcium carbonate were the best adsorbents for metformin hydrochloride. Acetohexamide and glibenclamide were adsorbed to an appreciable extent on most antacids. Tolbutamide showed an adsorption tendency towards talc. Most antacids slightly adsorbed carbutamide, while magnesium trisilicate showed a higher adsorption capacity for tolazamide and glymidine. The dissolution rate of acetohexamide in magnesium oxide suspension (5:400) increased about 40-fold after 10 min, whle in magnesium trisilicate suspension (5:400) it increased about 7-fold. On the other hand, magnesium trisilicate did not influence the dissolution rate of metformin hydrochloride. The probable variation in the bioavailability of orally administered antidiabetics when coadministered with antacids was discussed. However, further in vivo studies are needed before a final assessment for such drug-antacid interaction can be confirmed.

Adsorption↗

[Effectiveness of the resorptive treatment of leptomeningitis (experimental study)].

An introduction into the major cistern of the cranial ground of sterile talc to 134 rabbits artificially created a model of leptomeningitis. The talc evoked proliferative reactions of fiber and cellular structures adjacent to the area of pia mater. Treatment by 1 or 2 sessions of lydase, pyrogenal, bijochinol, bijochinol in combination with radiation therapy led to a significant decrease of the fibroplastic changes in the pia mater and liquordynamic pyrogenal. Bijochinol therapy did not exert any special effect. The convened studies confirm the effectiveness of resorptive therapy, thus permitting to recommend this form of therapy for the treatment of patients with arachnoiditis (leptomeningitis).

Animals↗

The etiology and treatment of spontaneous pneumothorax.

In the past year, studies on spontaneous pneumothorax have focused on etiology and treatment. Chronic obstructive pulmonary disease remains the most common cause of secondary spontaneous pneumothorax. However, Pneumocystis carinii infections in patients who have AIDS have become the leading cause of spontaneous pneumothorax in a population where its prevalence is high. One of the treatment modalities of spontaneous pneumothorax is tube thoracostomy with the instillation of tetracycline as the sclerosing agent. Tetracycline is no longer available. Fortunately, its derivatives doxycycline and minocycline are equally effective. Talc in slurry or insufflated appears to be more effective than tetracycline derivatives. Experience with talc in slurry for the treatment of spontaneous pneumothorax is still limited. Another treatment modality for spontaneous pneumothorax is thoracoscopy, more recently termed video-assisted thoracic surgery, and it has warranted renewed interest due to the advent of improved endoscopic technology. In the treatment of spontaneous pneumothorax, video-assisted thoracic surgery is nearly as effective as thoracotomy.

AIDS-Related Opportunistic Infections↗

[The role of thoracoscopy in the diagnosis and management of pleural effusion].

To assess the value of thoracoscopy in the diagnosis and management of pleural effusion, 146 patients with pleural effusion of unknown causes had this examination by using fiberoptic bronchoscope the rigid cold light thoracoscope. 127 of these cases were histopathologically diagnosed. 109 had malignant diseases and 18 benign specific diseases. The histologic diagnoses following thoracoscopic biopsy in all the patients were compared with the clinical findings at follow-up, the results showed that the sensitivity was 92.7%, specificity 100.0% and diagnostic accuracy 93.2%. 72 patients with more than moderate volume of pleural effusion were treated with intrapleural talcum powder suspensions (3% 100 ml) under thoracoscopic control, 63 of them obtained complete pleurodesis. The success rates of talc poudrage pleurodesis were 88.1% in 67 cases with malignant effusion (59/67) and 80.0% in 5 cases with benign pleural effusion (4/5). There were only minor postoperative complications: transient fever in 54 cases, local subcutaneous emphysema in 6 and thoracoscopy site tumor seeding in 2. It was shown that thoracoscopy is simple, safe, reliable and practical in the diagnosis of pleural effusion and that talc pleurodesis is a very effective method for controlling refractory pleural effusion transendoscopically.

Adult↗

[Pleural effusion: what next?].

This article gives an overview of the aetiology, diagnostic evaluation and treatment of pleural effusions. A systematic approach including radiological and sonographic examinations and pleural fluid analysis is proposed with a view to selecting the most appropriate therapy. Common forms of exudative pleural effusions are explained in detail. For complicated parapneumonic effusions, new therapeutic options such as the use of fibrinolytics or thoracoscopic debridement are discussed. Talc slurry and thoracoscopic talc poudrage provide effective methods for pleurodesis in case of malignant effusions.

Diagnosis, Differential↗

Cellular basis of inflammation-induced osteopenia in growing rats.

Local nonosseous inflammation provoked by four subcutaneous talc powder injections induced a marked trabecular bone loss in rats within 7 days. The disturbance included suppression of bone elongation, inefficiency and decreased number of trabecular osteoblasts, decreased osteoprogenitor cell number in tibial metaphyses, and bone marrow expansion. Neither the appearance and function of osteoblasts in the vicinity of the cortical bone nor the number of osteoclasts in the metaphysis were found to be altered. The loss of trabecular bone in granulomatosis was based on a suppression of bone elongation and a failure of osteoblasts to form normal secondary spongiosa.

Animals↗

Evaluation of joint effusion in rabbits by color Doppler, power Doppler, and contrast-enhanced power Doppler ultrasonography.

PURPOSE: The aim of this prospective study was to evaluate the diagnostic value of power Doppler ultrasonography (PDUS) and contrast-enhanced PDUS (CEPDUS) in the depiction and characterization of experimentally induced arthritis in the rabbit. MATERIALS AND METHODS: Thirty rabbits were divided into three groups consisting of one control group (saline injection group) and two experimental groups: a suppurative arthritis group and a chemically induced synovitis group. The same amount (1 ml) of each agent was directly injected into the right hip joint. Serial color Doppler ultrasound (CDUS), PDUS, and CEPDUS images were obtained before and after injection. RESULTS: We observed that all of the infected knees in the suppurative arthritis group with Staphylococcus aureus demonstrated an increased signal on PDUS after inoculation. A minimal power Doppler signal was presented in the chemically induced synovitis group with talc injection, but none of the control knees demonstrated any increased signals. CEPDUS was the most sensitive imaging modality for evaluating the increase of blood flows in suppurative arthritis and was subsequently followed by PDUS and CDUS. CONCLUSION: The increased signals obtained with PDUS represent increased local blood flows; therefore, this technique can be used for evaluating the degree of inflammation. Furthermore, using the contrast agent enhances the sensitivity of PDUS, and it can even be useful for differentiating borderline cases.

Animals↗

Drug permeation through membranes V: interaction of diazepam with common excipients.

The effects of common tablet excipients on the permeation of diazepam through polydimethylsiloxane membranes and on the turnover time of goldfish were studied. The permeability coefficient decreased and the turnover time increased in the presence of talc, polysorbate 80, and, possibly, fumed silicon dioxide, but these parameters were unaffected by lactose, microcrystalline cellulose, and starch.

Animals↗

Comparative evaluation of tablet lubricants: effect of application method on tablet hardness and ejectability after compression.

The effect of four lubricants (stearic acid, magnesium stearate, calcium stearate, and talc) on the ejectability and hardness of statically compressed tablets of a lactose granulation was examined. Two methods of application of these lubricants, incorporation into the granulation and mixing with the granulation, were compared. In both methods, the energy consumption curves during ejection and the hardness curves with lubricant concentration were similar and showed complicated behavior at a lower concentration. The mixing method gave better results for ejectability and hardness than the incorporation method.

Drug Compounding↗

Toxic and lethal effects of T-2 toxin upon intracerebral administration to rats.

T-2 toxin was given to rats in three ways: Subcutaneous or intracerebral injection of a solution in dimethyl sulfoxide (DMSO) and by implantation of toxin, adsorbed on talc, into various regions of diencephalon and brain stem. The latter method proved to be most effective. Within a few hours after administration of 10-20 micrograms toxin, the animals became restless, ataxic and dyspneic. These early symptoms were followed by depression and immobility. Prior to death, tachypnea and/or convulsions developed. The rats succumbed to implantation of toxin within 1 - 7 days; no fatalities occurred at later dates. Histologically, the toxin pellets caused necrosis a few days after implantation; at a later stage, the necrotic areas were surrounded by inflammatory infiltrates around small blood vessels. These morphological changes were limited to the application site and were insufficient to explain the lethal effect of intracerebral administration. After intracerebral injections of toxin solutions, the animals died within 24 h. No marked histological changes could be seen after such rapid fatalities.

Animals↗

Influence of inflammation-mediated osteopenia on the regional acceleratory phenomenon and the systemic acceleratory phenomenon during healing of a bone defect in the rat.

We have previously shown that restoration of a local bone defect in the rat not only leads to a regional acceleratory phenomenon (RAP), but also to a systemic acceleration of osteogenesis (SAP) at distant sites of the skeleton. In this study, we investigated whether specific inhibition of osteoblasts would affect the local RAP and the systemic acceleratory phenomenon (SAP) healing sites. Systemic inhibition of osteoblasts was induced by inflammation-mediated osteopenia (IMO), a nonspecific type of inflammation initiated by s.c. injections of sterile talc. A drill hole defect 1.2 mm in diameter was performed at the midshaft of the left tibia of female rats. On day 7, during the formation phase of the local healing process, IMO did not influence the number of osteoblasts or the bone volume in the marrow cavity of the local healing site, whereas it did lead to a significant reduction of osteoblast number and bone volume at the systemic site (subepiphyseal spongiosa of the tibia). By contrast, on days 14 and 21, during the resorption phase of bone healing. IMO led to a significant reduction in both osteoblast number and bone volume in the marrow cavity of the local healing site. At the same time, however, it did not influence the cortical area of the bone defect where newly formed bone is needed to ensure mechanical stability. In summary, our model of bone healing reveals that a humoral noxious osteoblast stimulus such as IMO is able to inhibit systemically osteoblasts stimulated by SAP, whereas it is not able to inhibit osteoblasts either from producing woven bone during a RAP or from producing bone that is needed to mechanically stabilize a defect.

Absorptiometry, Photon↗

Usefulness of video thoracoscopy in the management of spontaneous and postoperation chylothorax.

BACKGROUND: The aim of this study was to evaluate indications and results of video thoracoscopy (VATS) in the management of nine chylothorax cases. METHODS: Four spontaneous chylothorax cases were treated by VATS and talc pleurodesis with immediate positive results. Among five postoperation chylothorax cases, two were treated early by VATS and selective lymphatic clipping (VATS group), and three had medical treatment (MT group). RESULTS: Duration of drainage was 4 days for the VATS group versus 15.3 days for MT group. Amount of collected chyle was 2.4 l versus 5.7 l, respectively. CONCLUSIONS: We suggest that VATS should be considered the treatment of choice for spontaneous chylothorax and could be indicated earlier in postoperation chylothorax.

Adult↗