Fluid flow shear stress over podocytes is increased in the solitary kidney.

BACKGROUND: Glomerular hyperfiltration is emerging as the key risk factor for progression of chronic kidney disease (CKD). Podocytes are exposed to fluid flow shear stress (FFSS) caused by the flow of ultrafiltrate within Bowman's space. The mechanism of hyperfiltration-induced podocyte injury is not clear. We postulated that glomerular hyperfiltration in solitary kidney increases FFSS over podocytes. METHODS: Infant Sprague-Dawley rats at 5 days of age and C57BL/6J 14-week-old adult mice underwent unilateral nephrectomy. Micropuncture and morphological studies were then performed on 20- and 60-day-old rats. FFSS over podocytes in uninephrectomized rats and mice was calculated using the recently published equation by Friedrich et al. which includes the variables-single nephron glomerular filtration rate (SNGFR), filtration fraction (f), glomerular tuft diameter (2RT) and width of Bowman's space (s). RESULTS: Glomerular hypertrophy was observed in uninephrectomized rats and mice. Uninephrectomized rats on Day 20 showed a 2.0-fold increase in SNGFR, 1.0-fold increase in 2RT and 2.1-fold increase in FFSS, and on Day 60 showed a 1.9-fold increase in SNGFR, 1.3-fold increase in 2RT and 1.5-fold increase in FFSS, at all values of modeled 's'. Similarly, uninephrectomized mice showed a 2- to 3-fold increase in FFSS at all values of modeled SNGFR. CONCLUSIONS: FFSS over podocytes is increased in solitary kidneys in both infant rats and adult mice. This increase is a consequence of increased SNGFR. We speculate that increased FFSS caused by reduced nephron number contributes to podocyte injury and promotes the progression of CKD.

Pneumocystis jiroveci pneumonia prophylaxis is not required with a CD4+ T-cell count < 200 cells/microl when viral replication is suppressed.

OBJECTIVE: To determine the safety of discontinuing Pneumocystis jiroveci pneumonia (PCP) prophylaxis, in patients on effective antiretroviral therapy with CD4+ T-cell counts that have plateaued at < 200 cells/microl. METHODS: We prospectively evaluated a cohort of HIV infected patients at a multidisciplinary HIV clinic with sustained HIV RNA levels < 50 copies/ml and CD4+ T-cell counts that have plateaued at < 200 cells/microl and who have discontinued PCP prophylaxis. RESULTS: Nineteen patients fulfilled the above criteria. Eleven had been taking daily trimethoprim-sulfamethoxazole, seven were receiving monthly aerosolized pentamidine, and one patient never received any prophylaxis. The median CD4+ T-cell count at the time of discontinuation and at the most recent determination were 120 (range, 34-184) and 138 (range, 6-201) cells/microl, respectively. To date, patients have been off PCP prophylaxis for a mean of 13.7 +/- 10.6 months and a median of 9.0 (range 3-39) months for a total of 261 patient-months. To date, no patient has developed PCP. This is significantly different from the risk of developing PCP with a CD4+ T-cell count of < 200 cells/microl in untreated HIV infection (rate difference 9.2%; 95% confidence interval, 5.7 to 12.8%; P < 0.05). CONCLUSION: With sustained suppression of viral replication, PCP prophylaxis may not be necessary, regardless of CD4+ T-cell count. This illustrates a degree of immune recovery that occurs with virologic suppression that is not reflected in absolute CD4+ T-cell count or percentage and suggests that guidelines for P. jiroveci pneumonia prophylaxis may need to be re-evaluated.

Benign cephalic histiocytosis.

Benign cephalic histiocytosis is a self-healing non-X, nonlipid cutaneous histiocytosis of children, characterized by a papular eruption on the head. Mucous membranes and viscera are always spared. In the 13 cases reported herein, the children were otherwise in good general health. The disease appeared during the first three years of life, and spontaneous regression was complete by the age of nine years in the four cases healed to date. The histiocytic infiltrate was localized in the upper and middle dermis and contained no lipids at any stage of evolution. All the histiocytes contained coated vesicles, and 5% to 30% also contained comma-shaped bodies in their cytoplasm.

Anterior cruciate ligament reconstruction and augmentation with PDS graft.

The article briefly explains the biomechanical properties of the PDS and the most important ways of its use in anterior cruciate ligament (ACL) reconstruction. The different techniques of ACL reconstruction with gracilis and semitendinosus tendons are outlined. The authors explain their technique of ACL reconstruction with gracilis and semitendinosus plus PDS-band. The possible variations and pitfalls are pointed out. The results of this surgery are expounded.

[Acute postintervention cholecystitis]. / La colecistite acuta post-aggressiva.

A case of postoperative cholecystitis in a 64 years old man is reported. This is a nosological entity characterized by gallbladder distension without any patent obstacle in the cystic duct and constancy of necrosis involving all the parietal layers. Clinical signs and symptoms are aspecific. Mortality rate is high and diagnosis has to be done quickly because the gallbladder necrosis makes cholecystectomy compulsory on such patients.

[Hamartomatous polyps of Brunner's gland. Presentation of 2 cases. Review of the literature]. / I polipi amartomatosi delle ghiandole di Brunner. Presentazione di due casi. Review della letteratura.

Two uncommon cases of Brunner gland hyperplasia are reported. Both presented clinical symptoms simulating gastrointestinal disease caused by hyperacidity. In conjunction with clinical statistics, diagnosis based on aetiology was only formulated after a double-contrast radiological exam of the g-i tract. After treatment with antiacid and antisecretory drugs, remission of the clinical symptoms was obtained, and regression of the hamartomatous polypoid duodenal neoformation, thus confirming the hypothesis which states that hyperacidic gastric secretion is the main cause of Brunner gland hyperplasia.

[Infantile sclero-atrophic lichen and infection caused by Borrelia burgdorferi]. / Lichen sclero-atrofico infantile e infezione da Borrelia burgdorferi.

The authors describe a study of 8 girls suffering from genital and perianal lichen sclerosus et atrophicus. Following the most recent reports in literature, antibodies against Borrelia burgdorferi have been looked for, and the patients have been treated with propicillin. The results are discussed.

[Topics and considerations on reducing hospital admission: from evidence to practice]. / Tópicos y reflexiones sobre la reducción de ingresos hospitalarios: de la evidencia a la práctica.

Demographic changes and the economic situation of the recent years have conditioned a turning point in health policies, which have decided to progressively prioritize chronicity care programs. Given that hospital costs were concentrated in attention to patients with chronic diseases, reduction on admissions is now a priority target. Meanwhile, we state that among the obviously community handling paradigmatic aim for those patients and the current care situation, there is a long way to do that should be done gradually. According to the current scientific evidence: Is it sensible to assume that there is a proper level of admissions or is it better for the patients to reduce the number of admissions? Is it possible to operationally and reliably define which hospital admissions are avoidable? Is it harmful to a patient and to the health care system to admit a patient with multiple chronic disease? Maybe are hospital admissions are avoidable and readmissions are indicators of a fragmented health care system? Given that situation, a reasonable approach requires firstly a critical analysis of the various realities of care (microsystems) and a systematic review of the scientific evidence-breaking, and rejecting some topics if necessary. Secondly, we should bring all this knowledge to clinical practice, conciliating «what¼ and the know-how, individual and population view, sole disease and multimorbidity, and finally clinical approach and health planning.