Polyoma virus nephropathy, first reported case in Saudi Arabia.

Polyoma virus nephropathy (BK virus) is being recognized as an important cause of graft failure. It is usually confused with acute rejection. No cases have been reported from the kingdom of Saudi Arabia. We report a case of a Saudi gentleman, who was transplanted outside the country, with persistently elevated creatinine and urethral stenosis. He was treated for acute rejection on more than one occasion with no significant improvement in his renal function. Polyoma virus nephropathy was diagnosed by detecting the virus DNA by the Poly chain reaction technique (PCR). The patient's renal function stabilized after the calcineurin inhibitors were discontinued.

Assessment of a neuropathic factor in HIV-1 associated impotence: penile electrodiagnosis.

The value of bulbocavernosus reflex latency verses nerve conduction velocity of the dorsal nerve of penis and penile brachial index was evaluated in 50 impotent individuals infected with the human immunodeficiency virus, type 1 (both symptomatic and asymptomatic) and in 50 aged matched HIV-1 sero-negative impotent men serving as controls. All the subjects were neurologically asymptomatic and non demented. Both HIV-1 infected asymptomatic and symptomatic impotent patients exhibited a significant decrease (P < 0.0005) in the nerve conduction velocity of the dorsal nerve of penis as well as penile branchial index from the controls of the same age group. The latency of bulbocavernosus showed no significant difference between the groups and was within the normal limits. A non-significant association in the study parameters between HIV-1 infected asymptomatic and AIDS positive impotent men was also observed. These findings suggest that impotence and altered erectile electrodiagnostic responses are likely to be associated with an increased frequency to neuropathy in these patients irrespective of their disease state.

Effects of hydroxyapatite and alumina sheaths on postoperative peritendinous adhesions in chickens.

Two experimental methods for restoring flexor tendon sheath integrity and preventing adhesions around traumatized flexor tendons utilizing artificial tendon sheaths made of either hydroxyapatite (HAp) or alumina were studied in a flexor tendon-trauma model and compared to a standard tendon sheath repair and a control. Eighty toes were divided equally into a control group, a sheath repair group, an HAp group, and an alumina group. Profundus tendons in zone II were divided and repaired after sublimis excision in all groups. In the sheath repair group, the flexor sheath was also repaired after suturing the tendon. In artificial sheath groups, sheaths made of HAp and alumina were placed over the repair sites to protect them from the surrounding tissues. In the control group, after repairing the tendon, the flexor sheath was excised and no artificial sheaths were used. Each toe was immobilized in a plaster cast for 3 weeks. After three weeks, the plaster cast was removed followed by the removal of the sheaths in the artificial sheath groups through a small incision in the skin in zone II. Active mobilization was encouraged in each group. Postoperative adhesions were examined at 3, 6, 9, and 12 week intervals by using light microscopic techniques. To further explore the effects of artificial sheaths on tendon healing, transmission electron microscopy was done for the HAp and alumina groups at 3, 6, and 12 week intervals. Results demonstrated decreased severity of postoperative adhesions in the HAp as well as in the alumina groups in comparison with the sheath repair and controls. A space resembling the fibro-osseous canal was formed around the tendon after removing the sheaths. This space remained patent until 12 weeks, 9 weeks after removing the sheaths, and a newly formed tendon sheath-like structure lined by synovial cells and with a peritenon-like structure over the tendon surface was observed. In the sheath repair and control groups, the severity of adhesions was decreased with the passage of time, to some extent due to unrestricted mobility. However, a newly formed tendon sheath or peritenon-like structure was not observed. Electron microscopic studies confirmed good healing at the suture in the HAp and alumina groups with no evidence of necrosis. These results are qualitative in nature as no statistical tests were performed. From these results we conclude that if the tendon is separated from the surrounding granulation tissue by a barrier with good biocompatibility, the tendon can heal with fewer adhesions.(ABSTRACT TRUNCATED AT 400 WORDS)

A computer-aided walking rehabilitation robot.

Even with recent techniques, a significant number of patients with multiple injuries cannot be mobilized at an early stage despite the fixation of all fractures. Conventional mobilization aids are not able to provide the prescribed weight bearing needed in fractures, especially those involving both the lower limbs. Robotics is a current technology aimed at improving the quality of medical care. To this end, Takatoshi Ide developed the mobility rehabilitation robot, the REHABOT. This apparatus facilitates rehabilitation by providing secure postural support and prescribed weight bearing during ambulation. The REHABOT has been used for early mobilization and gait training of severely disabled patients at different hospitals in Japan during the last 6 years. In most of the cases, this training has resulted in earlier improvement of ambulatory capability. In this paper we report the use of this device for early ambulation in two patients with multiple fractures involving the extremities and the spine. Early mobilization was achieved by initially reducing the weight bearing to 30% of body weight followed by a gradual increase governed by patient tolerance. The average length of training for these two patients was 18 days. The average total distance was 5.5 km and total walking duration was 4.5 h. After the completion of the training both patients were able to walk independently.

Comparative studies of the induction of erectile response to film and fantasy in diabetic men with and without neuropathy.

The present study deals with the diabetic neuropathies prevailing in men. In this investigation 100 insulin-dependent diabetes mellitus (IDDM) and 314 non-insulin-dependent diabetes mellitus (NIDDM) patients with and without an objective evidence of neuropathy, having an age span in between 15 and 60 years and a duration of diabetes distributed over 1-33 years, were included along with their age-matched nondiabetic controls. The diabetic subjects were evaluated for the induction of erectile responses. Investigation of induction of erectile responses to erotic stimulation by film and fantasy revealed striking results in diabetic patients with established neuropathy. Both IDDM and NIDDM patients with neuropathy exhibited a highly significant decrease (P < .0005) in penile diameter and length, penile arterial pulse amplitude, both systolic and diastolic blood pressures, and heart rate compared to controls of the same age group. However, both IDDM and NIDDM patients without neuropathy showed a nonsignificant difference in the above-mentioned parameters compared to control subjects. A nonsignificant association of induction of erectile responses to erotic stimulations among IDDM and NIDDM patients with and without neuropathy was also observed, suggesting that impotence and altered erectile responses are likely to be associated with an increased frequency to autonomic neuropathy in these patients irrespective of their type of diabetes.

Semen analysis in insulin-dependent/non-insulin-dependent diabetic men with/without neuropathy.

The present study deals with the diabetic neuropathies prevailing in the male population. In this investigation 100 insulin-dependent diabetes mellitus (IDDM) and 314 non-insulin-dependent diabetes mellitus (NIDDM) patients with and without an objective evidence of neuropathy, having an age span of 15 to 80 years and the duration of diabetes distributed over 1-33 years were included along with age-matched nondiabetic controls. The diabetic subjects were evaluated for semen analysis. Results of semen analysis showed a highly significant increase (p > .0005) in total sperm output and sperm concentration in both IDDM and NIDDM neuropathic diabetic men. On the other hand, sperm motility and semen volume were found to be about 30 and 60% less, respectively, in IDDM and NIDDM patients, where as sperm morphology and quality of sperm motility remained unaffected. A comparison between IDDM and NIDDM neuropathic and non-neuropathic diabetic groups further indicated a nonsignificant difference in the parameters of semen analysis, thus suggesting an endocrine basis for the sexual disturbances of diabetic neuropathy. A significant rise in total sperm output in both IDDM and NIDDM neuropathic diabetic patients and a significant decrease in semen volume in both types of diabetic patients thus suggests some kind of Leydig cell hyperplasia, which in turn may stimulate spermatogenesis and atonia of the bladder and urethra, resulting in retrograde ejaculation.

The healing of flexor tendons in chickens.

The healing of flexor tendons was studied in chickens using transmission electron microscopy. After resecting the flexor sheath between the proximal and distal pulleys in zone II, the profundus tendon was severed and sutured. Intermittent passive motion was carried out 35 times daily immediately afterwards. The chickens were sacrificed at 3, 6 and 9 weeks. In vivo healing was shown to be much more rapid than in in vitro studies. There was marked proliferation of endoplasmic reticulum and phagocytosis at 3 weeks, collagen synthesis at 6 weeks and remodelling at 9 weeks. Healing was by a combination of extrinsic and intrinsic mechanisms.

Osteofibrous dysplasia of the tibia treated by bracing.

Osteofibrous dysplasia of the tibia in children will commonly recur after surgical resection. The use of a leg brace until puberty offers a useful method of conservative management. Seven female patients, age three months to nine years at the time of brace treatment, have been followed for 3.5 to 18 years, an average of nine years, with evidence of satisfactory healing of the lesions in all. Three of the cases had recurred after surgery, two with fibular grafts and one required leg lengthening. The use of a brace to control bowing of the tibia while awaiting spontaneous regression is advised until epiphyseal closure.

An experimental study on the application of a hydroxyapatite artificial tendon sheath to prevent adhesions after tendon repair (Part 1).

The formation of adhesions around the lacerated flexor tendons in zone II was studied in chickens after using an artificial tendon sheath made of hydroxyapatite (HAp). The flexor sheath was excised between the proximal and distal pulleys in zone II to create a window in the fibro-osseous tunnel. After suturing the severed profundus tendon, an HAp sheath was placed around the suture site followed by 3 weeks of immobilization. The results were compared with controls in which no HAp sheaths were used after the operation. Adhesion formation was assessed both biomechanically and histologically. The mobility of the tendons was better in the HAp group at all the periods studied. HAp sheath was not firmly adherent to either the granulation tissue or the surface of the tendon. Histology at 3 as well as 6 weeks in HAp groups revealed epitenon-like structure on the tendon surface including the tenorrhaphy site and a wide space around the tendon after the HAp sheath was removed. The outer margins of this space was lined by a layer of fibrocyte-like cells and collagen fibers thereby resembling new formed tendon sheath. In the cases of control, marked peritendinous adhesions were observed.