HMGB-1 and TGFß-1 highlight immuno-inflammatory and fibrotic processes before proteinuria onset in pediatric patients with Alport syndrome.

INTRODUCTION: Alport syndrome (ALP) is a rare genetic condition characterized by progressive involvement of the basal membranes and renal dysfunction. The purpose of the study was to evaluate urinary (u) and serum (s) levels of tumor growth factor (TGF)-beta(ß) and high mobility group box (HMGB)-1 in ALP patients with normal renal function, albuminuria and proteinuria. METHODS: A prospective, single-center study was performed with a follow-up period of 12 months, enrolling 11 pediatric ALP patients and 10 healthy subjects (HS). Normal values of serum creatinine, albuminuria and proteinuria, as well as unaltered estimated glomerular filtration rate (eGFR) were required at enrollment. RESULTS: ALP patients had significantly higher levels of serum and urinary HMGB1 compared to HS. The same trend was observed for TGF-ß1, with higher values in ALP patients than in HS. HMGB1 and TGF-ß1 correlated with each other and with markers of renal function and damage. Urinary biomarkers did not correlate with eGFR, whereas sHMGB1 and sTGF-ß1 were negatively related to filtration rate (r: - 0.66; p = 0.02, r: - 0.96; p < 0.0001, respectively). Using proteinuria as a dependent variable in a multiple regression model, only the association with sTGF-ß1 (ß = 0.91, p < 0.0001) remained significant. CONCLUSIONS: High levels of HMGB1 and TGF-ß1 characterized ALP patients with normal renal function, highlighting the subclinical pro-fibrotic and inflammatory mechanisms triggered before the onset of proteinuria. Further studies are needed to evaluate the role of HMGB1 and TGFß-1 in ALP patients.

Cicatriz miocárdica arritmogénica localizada mediante el uso combinado de la SPECT con 123I-MIBG y la RMN cardíaca / Arrhythmogenic myocardial scar localized through the combined use of 123I-MIBG SPECT and cardiac MRI

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Effect of including carob pulp in the diet of fattening pigs on the fatty acid composition and oxidative stability of pork.

The effect of feeding pigs with carob pulp on meat quality was investigated. Nine pigs were finished on a conventional concentrate-based diet (control), while two groups received a diet comprising of the same ingredients with the inclusion of 8% or 15% carob pulp (Carob 8% and Carob 15%, respectively). Feeding carob-containing diets reduced the concentration of saturated fatty acids in the muscle, increased the concentration of monounsaturated fatty acids in meat (P < 0.01) and of n-3 polyunsaturated fatty acids (PUFAs) and reduced the n-6/n-3 PUFA ratio (P < 0.001). The meat underwent slow oxidative deterioration over 9 days of storage. However, the Carob 15% treatment increased meat susceptibility to lipid oxidation across storage (P = 0.03), while the dietary treatment did not affect meat colour stability. In conclusion, feeding pigs with carob pulp could represent a strategy,in the Mediterranean areas, to naturally improve meat nutritional value and to promote the exploitation of this local feed resource.

Proximal oesophageal pH-metry in children with respiratory symptoms.

Twenty-six children (mean age: 16.3 months) with vomiting and/or respiratory symptoms and 28 children (mean age 10.5 months) with vomiting and/or regurgitation underwent dual-site 24-hour oesophageal pH recording. Thirty-nine children had gastro-oesophageal reflux and in all of them, irrespective of respiratory symptoms, distal oesophageal acid exposure was significantly (p < 0.01) longer than proximal exposure. Furthermore, data from the proximal pH electrode were not significantly different between children with and without respiratory symptoms for any of the variables studied. In conclusion, no single features of reflux pattern, as determined by 24-hours pH-metry, account for respiratory symptoms in children with documented gastro-oesophageal reflux.

[Primary percutaneous approach in staghorn kidney calculus]. / Abord per-cutané premier dans la lithiase rénale coralliforme.

36 staghorn calculi were treated percutaneously under ultrasound guidance between 1983 and 1992. Each stone had a renal pelvic element and at least two caliceal branches. The area of each stone was measured on the plain abdominal x-ray (mean: 1,020 mm2) and the total length of the various caliceal branches was measured from the pelvic element (mean: 50.2 mm). These 36 procedures represented 8.2% of the 438 percutaneous nephrolithotomies performed over the same period. The stone was able to be entirely removed by nephrolithotomy in 12 patients. Of the 24 residual stones after percutaneous nephrolithotomy, 16 were treated by extracorporeal shock-wave lithotripsy, which eliminated all stones in 12 of these patients. Eight of the remaining 12 patients were lost to follow-up and treatment was not completed, and 4 present a residual stone (11% of failures). These results are compared with those of other series and are comparable to those of surgery which gives a similar residual stone rate of 16% in the AFU 1982 report [6]. The primary percutaneous approach to staghorn calculi therefore represents an effective therapeutic modality, whose use and results must be weighed up with those of surgery.

Long-term follow-up of children with chronic idiopathic constipation.

To determine the outcome of chronic idiopathic constipation, we followed 62 children with chronic idiopathic constipation (mean age: 5.2 +/- 2.8 years) for a period of five years. Each child received the same initial treatment over a 12-week period and was then followed every three months. After five years from diagnosis, chronic idiopathic constipation persisted in 52% of the children; 47% who remained symptomatic were > 10 years old at the time of the five-year evaluation. Of the 27 who were constipated in the first year of life, 63% remained constipated after five years. Children who recovered within the five-year interval were significantly different from those that remained symptomatic in age of onset of constipation (P < 0.05) and family history of constipation (P < 0.05). After five years, both severity of abdominal pain and degree of soiling significantly decreased in both the recovered and unrecovered groups (P < 0.05). This study suggests that chronic idiopathic constipation persists for > or = 5 years in at least half of children. Early age of onset and family history of constipation are predictive of persistence. Abdominal pain and soiling improve in long-term follow-up irrespective of constipation outcome.

Panmetatarsal head resection. A viable alternative to the transmetatarsal amputation.

While the transmetatarsal amputation has resulted in the salvage of numerous diabetic limbs, it remains an ablative procedure with both short- and long-term complications. The authors reviewed their experience with the panmetatarsal head resection as an alternative to the transmetatarsal amputation. A retrospective review was performed of all patients having undergone this procedure between May 1986 and November 1991. Thirty-seven procedures were performed; of these, 34 were evaluated. The average follow-up period was 20.9 months. Thirty-two feet showed primary healing while one showed delayed healing. One patient had local recurrence of the original ulceration. Primary healing was 94% while overall success was 97%. No patient required amputation of any kind. The authors conclude that the panmetatarsal head resection is a viable alternative to the transmetatarsal amputation in properly selected patients because it avoids many of the structural and biomechanical pitfalls of the transmetatarsal amputation.

Salvaging the ischemic transmetatarsal amputation through distal arterial reconstruction.

From 1982 to 1991, 17 patients underwent a lower extremity arterial bypass to salvage an ischemic transmetatarsal amputation at the New England Deaconess Hospital. Eleven patients were male, and 16 had diabetes for an average of 29 years. The mean age was 71 years. Twelve patients presented with an ischemic ulcer, one had rest pain, and four underwent bypass for failure to heal a transmetatarsal amputation. Twelve patients presented with findings of secondary infection. All 17 patients underwent successful lower extremity bypass procedures to a variety of outflow vessels. Thirteen bypasses were to infrapopliteal arteries, including four to the dorsalis pedis artery. There were no perioperative deaths and all patients were discharged with patent grafts and healing limbs. Actuarial graft patency of the 14 vein grafts was 90% at 2 years. Actuarial limb salvage for the entire group was 93% at 2 years. Thirteen of the 14 patients who maintained patent grafts and healed their transmetatarsal amputations were ambulatory at their last known follow-up examination. Ischemic complications of previously created transmetatarsal amputations are uncommon. However, limb salvage attempts by lower extremity arterial bypass have a high likelihood of success. Major amputation in these patients should not be done without having first undergone a comprehensive vascular evaluation.

[Brachial plexus block by the axillary route. Cannulation of the neurovascular sheath with a G22 spinal needle. Our experience with 100 cases]. / Il blocco del plesso brachiale per via ascellare. Incannulamento della guaina del fascio neuro-vascolare mediante ago da spinale G22. Nostra esperienza su 100 casi.

The aim of this study was to evaluate the utility of the brachial plexus block using an axillary route employing the technique in which the needle is inserted into the sheath at an angle parallel to the neuro-vascular bundle with a sole modification: using a G22 spinal needle and without evoking paresthesia. The results obtained show that this method ensures an improved and more widespread analgesia. The flexibility and small size of the G22 spinal needle allow traumas to the axillary guaina and brachial plexus to be reduced to a minimum. In addition its length enables the anesthetic solution to be diffused around the first rib, including the axillary and musculo-cutaneous nerves, thus ensuring e total sensory and motor block of the upper limb.

[Propofol in gynecologic ambulatory minor surgery]. / Il propofol nella piccola chirurgia ambulatoriale ginecologica.

We have reported the results of 700 general anesthesia induced and maintained by Propofol in women who have undergone IVG operation. The anesthesia-method used has guaranteed an adequate level of anesthesia with the characteristics of a quick induction, non significant variations of the cardiovascular parameters, a quick recovery of consciousness, low incidence of side effects, the abolition of the azote-peroxide and the halogen-anesthetics, a quick discharge of the patients.

[An anaphylactic reaction to succinylcholine. A clinical case]. / Reazione anafilattica da succinilcolina. Caso clinico.

A case of severe anaphylactic reaction provoked by suxamethonium during the induction of general anaesthesia is reported. Diagnosis of reaction and the trigger effect of suxamethonium was identified by intradermal testing. Diagnosis of anaphylactic reaction was confirmed on serial blood estimations of IgE and C3-C4 of complement fractions.

Esophageal aperistalsis due to reflux esophagitis: a report of two cases.

Two small infants with gastroesophageal reflux disease and esophagitis are reported. Esophageal manometry revealed in both patients severe abnormalities consisting of aperistalsis and simultaneous low-amplitude motor waves. In one of the patients, defective relaxation of lower esophageal sphincter was also noted. Short-term intensive treatment with H2 antagonists resulted in symptomatic and endoscopic improvement as well as in manometric normalization. It is suggested that severe esophagitis may affect control mechanisms of esophageal motility, resulting in loss of coordination and decreased amplitude of contractions.

Isolation of beta-hemolytic streptococci from the respiratory tract: distribution and clinical significance.

Isolates of beta-hemolytic streptococci obtained from respiratory tract specimens were studied for determination of their serogroup, and Patients' charts were reviewed for the clinical significance of these respiratory isolates. Fifteen of 69 patients were considered to have definite respiratory infection. Thirteen of these 15 patients had Group B beta-hemolytic streptococci. Staphylococcus aureus was isolated concomitantly with Group B streptococci (GBS) in 34% of cases, but rarely was it isolated with other beta-hemolytic streptococci. Sero-groups of beta-hemolytic streptococci were compared with respect to the patient's underlying disease, age, and clinical outcome. Patients who had GBS isolated from sputum were elderly (mean age, 68.1 years) and were older than patients with other beta-hemolytic isolates (mean age, 56 years). Patients with Group B streptococci were more likely to have cerebrovascular disease, whereas patients with Group C, G, and F were more likely to have malignancy, particularly of the head and neck.

[Etiological diagnosis of hepatic masses by percutaneous puncture guided by ultrasonics. Study carried out in patients without known neoplasms]. / Diagnostic étiologique des masses hépatiques par la ponction percutanée guidée par les ultra-sons. Etude réalisée chez des malades sans néoplasie connue.

Ultrasonically guided liver puncture was carried out in 26 patients without overt carcinoma, who presented with a small intrahepatic mass giving an ultrasonographic image of primary or secondary tumour. Puncture was performed with a lumbar or a Chiba needle under local anaesthesia, and a real-time ultrasound apparatus with guide was used. The specimens collected were fixed on slides for histological examination. An aetiological diagnosis was made in 73% of the cases (16 carcinomas and 3 liver abscesses). No abnormal cells were detected and further investigations were conducted in 15%. The failure rate was 12% (2 punctures without specimens and 1 false-negative result). No infectious or haemorrhagic complication was observed.

Differential exposure of components of cytochrome b-c1 region in beef heart mitochondria and electron transport particles.

The reduction of cyctochromes c + c1 by durohydroquinone and ferrocyanide in electron transport particles (ETP) and intact cytochrome c-depleted beef heart mitochondria has been studied. At least 94% of the ETP are in an inverted orientation. Durohydroquinone reduces 80% of c + c1 in ETP but less than 20% in mitochondria; sonication of mitochondria allows reduction of cytochromes c + c1 (80%). Addition of ferrocyanide (effective redox potential +245 mV) to electron transport particles results in 30% reduction of cytochromes c + c1. Addition of ferrocyanide to intact cytochrome c-depleted mitochondria does not reduce cytochrome c1; treatment with N,N,N',N'-tetramethylphenylenediamine, Triton X-100, or sonic oscillation results in 30% reduction of cytochromes c + c1. The Km value of ferrocyanide oxidase for K-ferrocyanide is pH-dependent in ETP only, increasing with increasing pH. The extent of reduction of cytochrome c1 is also pH-dependent in ETP only, the extent of reduction increasing with decreasing pH. On the basis of these data cytochrome c1 is exposed to the matrix face and cytochrome c is exposed to the cytoplasmic face. No redox center other than cytochrome c in the segment between the antimycin site and cytochrome c is exposed on the C-side.