The gingival inflammatory infiltrate in cardiac patients treated with calcium antagonists.

OBJECTIVES: To analyse the periodontal inflammatory infiltrates in patients with cardiac disease, some of these patients were treated with calcium antagonists (nifedipine and diltiazem) and some were not, to compare them with a healthy control group, and to evaluate the changes in the inflammatory infiltrate after periodontal treatment. MATERIAL AND METHODS: A "healthy group" (HG, n=12), a "cardiac group" (CG, n=12) without treatment with calcium antagonists, a "nifedipine group" (NG, n=18) and a "diltiazem group" (DG, n=13) were analysed. Biopsies were taken from a zone 2-3 mm below the upper part of the interproximal papillae 12-13 and 33-32 before causal periodontal treatment and after 1 year. Using haematoxylin-eosin staining, the plasma cells (P), lymphocytes (L), histiocytes (H) and polymorphonuclear cells (PMN) were counted. T and B lymphocytes were evaluated using the monoclonal antibodies anti-CD20 and anti-CD45RO. Statistical tests used: chi2 for study of the sample composition; ANOVA for comparison between groups; Student t-test and Wilcoxon test for comparison between visits; post-hoc test Bonferroni. RESULTS: When the cells were compared statistically, differences were established for L at the first visit (p<0.00001) and at the last visit (p<0.02), for the B lymphocytes (first visit p<0.0021, last visit p<0.022) and for the T lymphocytes (first visit p<0.0042, last visit p<0.0021). Between the 2 visits, HG showed significant reductions for P (p<0.01), L (p<0.045) and H (p<0.033); and the NG for L (p<0.0001). Lymphocytes showed differences in the NG with respect to the B lymphocytes (p<0.008). CONCLUSIONS: Nifedipine affects the inflammatory infiltrate with a greater number of lymphocytes (especially B) and these cells fell significantly in number after periodontal treatment.

[Aluminum and uremic bone disease. Diagnostic utility of serum aluminum and the deferoxamine (DFO) test ]. / Aluminio y enfermedad ósea urémica. Utilidad diagnóstica del aluminio sérico y del test de la deferoxamina (DFO).

The optimal control of aluminium content in dialysis fluids has resulted in a decrease in the incidence of aluminium related bone disease (ARBD) and in the risk for aluminium toxicity. Nevertheless the problem has not disappeared. Bone biopsy with specific staining for Al remains the only reliable method for the diagnosis of ARBD. Currently there is not a total agreement on the reliability of serum Al levels and of the DFO test in the identification of patients with Al overload or toxicity. In a series of patients (mean age 48 +/- 14 years old) from our hemodialysis units we carried out bone biopsy and we studied the prevalence of bone aluminium overload and of ARBD and the usefulness of serum aluminium and of DFO test in their diagnosis. Seventy- three bone biopsies were evaluated by histomorphometric analysis and aluminium staining (Aluminon). Al overload was diagnosed when the Aluminon staining was positive independent of the bone surface covered with Al and of the bone formation rate (BFR). Patients were consider to have ARBD when aluminium covered > 25% of bone surface and BFR was < 0.031 micron 3/micron 2/day. Fifteen patients had aluminium overload while 7 patients were considered to have ARBD. Positive Aluminon staining appeared in all histopathological forms of renal osteodystrophy although it appeared mainly in patients with mixed lesion and osteomalacia. Most of the patients with adynamic bone disease had negative Aluminon staining. Patients with aluminium overload showed lower bone formation and mineralization rates. Serum aluminium levels below 40 micrograms/l were useful to exclude bone aluminium overload. Serum aluminium levels and DFO test were not specific in diagnosing aluminium overload or ARBD. A DFO test with an increment in serum aluminium over 100 micrograms/l in combination with a serum PTH below 200 pg/ml was useful to diagnose ARBD.

[Study of renal osteodystrophy by bone biopsy. Age as an independent factor. Diagnostic value of bone remodeling markers]. / Estudio de la osteodistrofia renal mediante biopsia ósea. La edad como factor independiente. Utilidad diagnóstica de los marcadores del remodelado óseo.

The spectrum of bone disease in uremic patients on hemodialysis has changed in the last years. Undecalcified bone biopsy with histomorphometric measurements and tetracycline labelling remains the gold standard for diagnosis of the different forms of renal osteodystrophy. But because of its invasive nature and complicated laboratory processing a number of non-invasive biochemical parameters have been proposed. The aim of our study was to determine the prevalence of the different forms of renal osteodystrophy in our patients in hemodialysis. Moreover we analyse the correlation between several biochemical parameters and the histological findings and evaluate their diagnostic and predictive value. Transiliac bone biopsies were performed in seventy three uremic patients (31 males) on chronic hemodialysis and static and dynamic parameters were measured. Serum levels of intact parathyroid hormone (iPTH), osteocalcin (OC), total alkaline phosphatase (FAT) and bone alkaline phosphatase (FAO) were determined. High-bone remodelling (50 pts, 68.5%) predominates over low-bone remodelling (23 pts, 31.5%). The distribution of the different types of bone disease was: Mild hyperparathyroidism 8 pts, Osteitis fibrosa 37 pts, Mixed lesions 5 pts, Adynamic bone disease 21 pts and Osteomalacia 2 pts. Six of our 73 patients were diabetics and they had adynamic bone disease (4 pts), osteomalacia (1 pt) and osteitis fibrosa (1 pt). Patients older than 50 years presented lower cellular activity (osteoblast surface, ObS/BS) and lower bone formation rate (BFR/BS). iPTH showed different correlation with these parameters of bone formation in patients above and below 50 years old suggesting that older patients need higher levels of PTH to obtain a determined level of bone formation. iPTH, OC, FAT and FAO correlated with the majority of histomorphometric indices of bone formation and resorption, though the best correlations were those with iPTH. The diagnostic and predictive value of these bone markers is better with high-bone remodelling. Serum levels of FAT > 300 U/l, OC > 150 ng/ml, FAO > 40 ng/ml and iPTH > 200 pg/ml showed a positive predictive value of 1 (with a specificity of 1, but sensibility below 0.78 except for iPTH that is 0.95) in the diagnosis of high-bone remodelling. After an analysis with ROC curves the cut-off value to differentiate high from low-bone remodelling was obtained. iPTH level > 200 pg/ml combined with one of the other markers (FAT > 150 U/l, FAO > 30 ng/ml or OC > 100 ng/ml) are predictive of high-bone remodelling, while values below those figures are predictive of low-bone remodelling.

Estudio de la osteodistrofia renal mediante biopsia ósea. La edad como factor independiente. Utilidad diagnóstica de los marcadores del remodelado óseo / Study of renal osteodystrophy by bone biopsy. Age as an independent factor. Diagnostic value of bone remodelling markers

La biopsia ósea sin decalcificar y su estudio histomorfométrico son esenciales para el diagnóstico exacto de las alteraciones óseas en el paciente urémico. Actualmente disponemos de una serie de marcadores bioquímicos del remodelado óseo que pueden ser de utilidad en el estudio y seguimiento de la osteodistrofia renal. Nos propusimos estudiar mediante biopsia ósea la prevalencia de los diferentes tipos histológicos, buscar factores relacionados con su desarrollo, relacionar los marcadores bioquímicos con los diferentes parámetros histomorfométricos y analizar su capacidad diagnóstica. Se biopsiaron 73 pacientes. Se realizó estudio histomorfométrico estático y dinámico. Se determinó PTHi, osteocalcina, fosfatasa alcalina total y la fracción ósea. Hubo un predominio de alto remodelado (enfermedad leve 10,9 por ciento, osteítis fibrosa 50,6 por ciento y enfermedad mixta 6,8 por ciento) sobre el bajo remodelado (enfermedad adinámica 28 por ciento y osteomalacia 2,7 por ciento). Los enfermos con enfermedad leve y adinámica fueron más frecuentemente mujeres. La mayoría de los enfermos diabéticos presentaron enfermedad adinámica. Los pacientes de mayor edad presentaron menor actividad celular y tasa de remodelado óseo. La PTHi, osteocalcina, fosfatasa alcalina total y ósea se mostraron como buenos marcadores del remodelado óseo presentando buenas correlaciones con la mayoría de los parámetros tanto de formación como de resorción. La PTHi fue el índice que mejores correlaciones presentó y mejor diferenció los grupos histológicos entre sí. Con un nivel de corte de PTHi en 200 pg/ml más otro marcador (fosfatasa alcalina total 150 U/l; fosfatasa alcalina ósea 30 nglml; osteocalcina 100 ng/ml) se consiguió diferenciar el alto del bajo remodelado (AU)

Bone alkaline phosphatase isoenzyme in renal osteodystrophy.

Serum total alkaline phosphatase is the most commonly used biochemical marker of bone disease in renal patients, but alkaline phosphatase originates from different organs and sometimes lacks specificity. Bone isoenzyme measurement is considered superior to total alkaline phosphatase for the assessment of bone metabolism. We have studied the value of bone isoenzyme, determined by a new. IRMA (Tandem-R-Ostase), in haemodialysis patients with secondary hyperparathyroidism and renal osteodystrophy. Fifty-six haemodialysis patients were studied. Intact parathyroid hormone (PTH), osteocalcin, total alkaline phosphatase and bone alkaline phosphatase were determined. A transiliac bone biopsy was performed in 20 of the 56 patients after double tetracycline labelling. There was a significant correlation between bone alkaline phosphatase and PTH (r = 0.79, P < 0.001) and between bone and total alkaline phosphatase (r = 0.84, P < 0.001) in all patients. The patients who underwent a bone biopsy showed osteitis fibrosa in 17, mixed lesion in one, adynamic bone disease in one and normal bone in one. Bone alkaline phosphatase showed a significant correlation with static and dynamic histomorphometric indices similar to that obtained with PTH and better than those of total alkaline phosphatase and osteocalcin. It is concluded that bone alkaline phosphatase (ostase) seems to be a useful non-invasive marker of bone metabolism in patients on haemodialysis with high turnover bone disease. More studies are necessary to know its value in low turnover bone disease.

The effect of HeNe laser radiation on the thyroid gland of the rat.

Although laser irradiation is becoming common practice in medicine, there is not always a clear understanding of the possible side-effects. The present report is a light and electron microscopic study of the effects of fixed low intensity doses of soft HeNe laser on the thyroid of Wistar rats. The immediate effects are mild multifocal degenerative changes; these lesions recover in less than 3 months. Long-term lesions are identified only by electron microscopy; they consist of an increased number of peroxisomes and free or intramitochondrial crystalline structures. We discuss the laser's hypothetical functions.

Progressive systemic sclerosis and nephrotic syndrome. An unusual association resulting in postpartum acute renal failure.

A 27-year-old, full-term pregnant woman with progressive systemic sclerosis (PSS) came to the hospital with marked proteinuria and edema. Two days later, she gave birth to a normal baby. After delivery and during the next 48 hours, renal failure developed. A renal biopsy specimen disclosed findings characteristic of PSS, and immunofluorescence studies displayed nonspecific deposits of fibrinogen and complement. The patient's general condition deteriorated, with development of pericarditis and pulmonary failure; after several peritoneal dialysis treatments, a peritoneal infection developed, and the patient died of Gram-negative sepsis. The association of PSS and nephrotic syndrome is unusual.

[Renal biopsy in the hemolytic-uremic syndrome in infancy. A study of three cases (author's transl)]. / La biopsia renal en el síndrome hemolítico-urémico de la infancia: a propósito de tres casos.

The hemolytic-uremic syndrome, although clearly described from the clinical and morphological points of view, has uncertain etilogy and pathogenesis for which various hypotheses have been advanced. In the immunohistochemical study of three recent infantile cases, whose clinical description and analysis follow those described in the literature, we found fibrinogen deposits, C3 and immunoglobulins in the walls and glomerular capillary vessels in two from which biopsies were taken early; while in the third case, in which the biopsy was taken a month after the process had begun, only fibrinogen was found. These findings suggest a pathogenesis of lesions involving an immunocomplex reaction with ulterior development of secondary intravascular coagulation. On the other hand, the presence or absence of C3 and immunoglobulins could be related to the timing of the biopsy, disappearing in the more developed cases. In the ultrastructural study performed in one of the case, besides other lesions habitually referred to, the presence of virus-like particles in the glomerular capillary endothelium was observed. Although having been seen in multiple locations and circumstances, this has not previously been described in the hemolytic-uremic syndrome, and it probably represents the morphological expression of degenerative glomerular processes.

[Urothelial tumor of the renal pelvis in horseshoe kidney]. / Tumor urotelial de pelvis renal sobre riñón en herradura.

The authors describe a case of tumour of transitional cells in patient with a horseshoe-shaped kidney, the suspected diagnosis of which was reached with the aid of a selective cinearteriography. They stress the low incidence of the same in the literature consulted which reveals the importance of studying the patients with this malformation in an attempt to prevent complications and in particular, to make an early diagnosis of a possible malignant transformation.