Acute renal allograft rejection. Comparative value of ultrasound versus magnetic resonance imaging.

Both magnetic resonance imaging (MRI) and ultrasound (US) have been reported to be useful in differentiating between acute allograft rejection and other causes of graft dysfunction in renal transplantation. The aim of this study was to evaluate the comparative usefulness of these techniques in the assessment of patients with acutely rising serum creatinine levels. Seventeen patients with 19 episodes of acute serum creatinine elevations were evaluated for the presence of acute rejection. The ultimate diagnoses of acute rejection were based on either renal pathological findings, or the response to standard antirejection therapy. Clinical, US and MRI diagnoses were assessed independently, without knowledge of the results of the other evaluation techniques. We found that US alone was useful in diagnosing acute rejection (x2 = 4.95, P less than 0.05), and when taken in the clinical setting was an added advantage (x2 = 6.68, P less than 0.01). MRI did not increase the diagnostic accuracy significantly.

Plasma exchange for recurrent nephrotic syndrome following renal transplantation.

Patients with steroid-resistant nephrotic syndrome and focal segmental glomerulosclerosis (FGS) who develop end-stage renal disease are at risk for recurrence of the disease following renal transplantation. Recurrence of the nephrotic syndrome in renal allografts of two children with primary FGS was successfully controlled by plasma exchange. This report suggests that plasma exchange instituted early in the course of recurrent nephrotic syndrome may be beneficial in some patients with steroid-resistant nephrotic syndrome and FGS.

Luteinized unruptured follicle syndrome: a subtle cause of infertility.

A clinical description of luteinized unruptured follicles is presented. This abnormality in ovulation is characterized by normal endocrinologic presumptive signs of ovulation: biphasic basal body temperature curves, secretory endometrium, and laboratory evidence of progesterone production by elevated urinary pregnanediol or plasma progesterone levels. In a group of 102 such infertile women, laparoscopy performed 3 to 5 days after apparent ovulation revealed the absence of a corpus hemorrhagicum in 30 women, and the absence of a sigma on a corpus hemorrhagicum in an additional 32 women. These findings were evidence that a follicle had not ruptured and an ovum had not escaped. Of 28 patients undergoing follicular stimulation with clomiphene citrate or human menopausal gonadotropin after this diagnosis, 15 conceived.

A test for the practical evaluation of male fertility by acridine orange (AO) fluorescence.

A new and practical test for evaluating the fertility of a male subject has been developed. Twenty-eight donors whose semen had induced at least one pregnancy resulting in a normal delivery and 61 patients attending our infertility clinic were studied. Semen smears stained with acridine orange were read on a fluorescence microscope; sperm heads appeared either green (fertile) or red ( nonfertile ). We introduce the concept of an "effective sperm count" which is obtained by multiplying the percentage of green-fluorescing sperm by the actual sperm count. Of our fertile subjects, 27 of 28 (96.4%) exhibited an effective sperm count of greater than or equal to 50 million/ml, while 60 of 61 (98.3%) infertile patients fell below this value. The percent green correlates with neither actual sperm count nor motility, indicating that this test measures a new parameter of male fertility.

A simple technique of laparoscopic tubal sterilization.

In the last several years the use of laparoscopy in gynecological practice has become very popular. It is indicated for a number of conditions. However, sterilization of the female has been the main indication for laparoscopy and will remain so until more efficient and reversible techniques are developed. A simple technique of laparoscopic tubal sterilization is presented. In the opinion of the authors it offers several advantages over other methods. Only one instrument is used and only one type of electrical current applied. A small portion of the fallopian tube is removed and the surrounding tissue--the tube and mesosalpinx-- is sufficiently cauterized to secure hemostasis. The histological quality of the removed specimen is excellent. Finally, less than 2 cm of fallopian tube is destroyed, providing an excellent opportunity for reanastomosis.

[Clinical and genetic characteristics of the Klippel-Trenaunay syndrome]. / Klinická a genetická charakteristika syndromu Klippel-Trenaunay.

The authors examined comprehensively a group of 23 patients with angiodysplastic changes of the type of Klippel-Trenaunay's syndrome. It is a longitudinal investigation, incl. a paediatric and genetic examination. The authors recorded the main phenotypical characteristics of the disease with emphasis on biomechanical aspects. The genealogical examination revealed microsymptoms in the family in a total of 52.2%, such as varicose veins and crural ulcers, haemangiomas and congenital heart disease. The genetic examination proves the assumed polygenic type of heredity with a low risk for grade 1 relatives, i.e. children and siblings of the affected subjects, who are isolated cases in the pedigree. In rare instances the authors recorded complete transmission in two generations. The clinical picture of the disease involves above all hemihypertrophy or asymmetry ensuing from trophic changes, mainly of the extremities and adequate part of the trunk. These changes were recorded in 100% of the investigated patients. Usually the lower half of the body is affected--52.2%, a lateral predilection was not observed. The authors mention also other facultative characteristics of the syndrome.

[The effect of reduced doses of BCG vaccine on the occurrence of osseous complications after vaccination]. / Vliv snízené dávky BCG vakcíny na výskyt kostních komplikací po kalmetizaci.

The authors present a review on the incidence of osseous complications after calmettization with the Soviet BCG vaccine during the period from February 1, 1980 and June 30, 1985 when the total dose of the vaccine was used, as compared with the period from July 1, 1985 to December 31, 1989 when the dose of the vaccine was reduced to half. During the first period 28 cases of the disease were recorded (on average 5 cases in every year of birth) which was an incidence of 3.71/100,000 vaccinated children. After reduction of the vaccine dose to half another 11 cases of the disease were recorded, i.e. a reduction of the incidence to 2.30/100,000 vaccinated children. During the last two years of this period only one case in each vaccinated birth year was notified. A major part of the children with bone complications after calmettization was vaccinated with a batch of vaccine which contained a higher number of germs, close to the upper range of normal values. In the development of these complications thus, no doubt, among other factors also the dose of vaccine participates. As bone complications occur after calmettization even after reduction of the dose of vaccine to half, though the incidence was lower, is should be considered whether the hitherto used dose used for vaccination of neonates is not too high.