Serum immunoglobulin E in primary IgA nephropathy.

The biosynthesis of human immunoglobulin E (IgE) is regulated by a complex network involving T and B lymphocytes. Diseases associated with high serum IgE (sIgE) levels are usually characterized by T cell disorders. Total sIgE level has been found to be of clinical relevance in minimal change nephrotic syndrome. However, the clinical significance has rarely been studied in primary IgA nephropathy (IgA N). We retrospectively studied 99 cases of primary IgA N. There were 59 males and 40 females with a mean age of 30.0 +/- 12.1 years. The mean follow-up duration was 45.9 +/- 31.1 months. Pathological grading was done according to the criteria of Meadow et al. Median sIgE for the entire group was 122.0 IU/ml (range: 2.8-5805 IU/ml) which was significantly higher than the healthy control group (median: 43,7 IU/ml, range: 5.0-1003 IU/ml, p < 0.001). However, when the IgA N cases were stratified into grades, only grade I (median: 514 IU/ml, range: 72.1-5805.0 IU/ml) and grade II (median: 229 IU/ml, range: 5.0-5464 IU/ml) patients had significantly higher sIgE than the control group (p < 0.0005 and p < 0.001 respectively). Patients with nephrotic ranged proteinuria (32 cases) were further classified into "stable" and "progressive" groups. The "stable" group had a significantly higher sIgE level (median: 922.0 IU/ml, range: 2.8-5805 IU/ml), compared to that of the "progressive" group (median: 55.3 IU/ml, range: 5.0-1600 IU/ml, p < 0.02). The effect of aggressive treatment (including corticosteroid and/or cyclophosphamide, cyclosporine) was also assessed.(ABSTRACT TRUNCATED AT 250 WORDS)

Glomerular diseases in human renal allograft.

A total of 64 renal graft biopsies performed on 44 transplant patients from among 116 transplants (12 from living donors, 104 from cadavers) were analyzed during the period from July 1983 to December 1990. The frequency of allograft glomerular disease was 22.7% (10/44). Membranous glomerulonephritis (MGN) was detected in five patients; focal segmental glomerulosclerosis (FSGS), in two; transplant glomerulopathy, in two; and IgA nephropathy, in one. Nephrotic syndrome occurred in nine of the ten patients. Progressive deterioration of graft function developed in four patients associated with chronic rejection, and two of them later lost the graft. The remaining six patients had no chronic rejection and retained a stable renal condition with one exception, a patient who suffered from acute total occlusion of the right internal iliac artery and who eventually lost the graft. It is concluded that MGN is the most common allograft glomerular disease, but the outcome of the graft is probably related to the coexistent chronic rejection.

Undergraduate medical education: comparison of problem-based learning and conventional teaching.

OBJECTIVE: To review the literature on studies comparing all aspects of problem-based learning with the conventional mode of teaching. DATA SOURCES: Medline literature search (1980 through 1999) and the references cited in retrieved articles. DATA SELECTION: Studies and meta-analyses that compared the newer problem-based learning curriculum and the conventional lecture-based mode of teaching undergraduate medical students. Areas of comparison included the academic process; programme evaluation; academic achievement; graduates' performance, specialty choices, and practice characteristics; and the attitude of students and teachers towards the programmes. DATA EXTRACTION: Data were extracted independently by multiple authors. DATA SYNTHESIS: Students of the problem-based learning curriculum found learning to be "more stimulating and more humane" and "engaging, difficult, and useful", whereas students of the conventional curriculum found learning to be "non-relevant, passive, and boring". Students who used the problem-based learning method showed better interpersonal skills and psychosocial knowledge, as well as a better attitude towards patients. Students using the conventional model, however, performed better in basic science examinations. Teachers tended to enjoy teaching the newer curriculum. Although the two curricula encourage different ways of learning, there is no convincing evidence of improved learning using the problem-based learning curriculum. CONCLUSION: A combination of both the conventional and newer curricula may provide the most effective training for undergraduate medical students.

Hearing loss and hearing aids: the Singapore School for the Deaf experience.

This is a retrospective study of the population of 180 students in the Singapore School for the Deaf between September 1989 to June 1990. It was found that the average age at which the hearing loss was diagnosed was four years. Rubella accounted for 13 cases (7.2%), hereditary factors for nine cases (5.0%), ototoxicity for two cases (1.1%), trauma for two cases (1.1%) and the other 154 cases (85.6%) were of unknown causes. The average hearing loss at 500 Hz, 1 and 2 kHz is 98 dBHL. The students use either the body-worn type or the behind-the-ear type of hearing aids for amplification. There was little motivation to use the aids because some of them were non or malfunctioning, thereby giving little benefit or they were improperly adjusted for the child, resulting in uncomfortably loud amplification. Also, poorly fitting earmoulds give rise to feedback problems. Although early detection of hearing loss is important, it would be of little value if there is no provision of a good intervention programme with ongoing support.

Routine abdominal and pelvic ultrasound examinations: an audit comparing radiographers and radiologists.

An audit of 202 routine abdominal and pelvic ultrasound examinations was carried out to evaluate the clinical performance and interpretation of these scans by radiographers and compare them with radiologists, and to investigate the extended role of radiographers in performing these scans. Each scan was first performed by a radiographer and then repeated by the radiologist. The findings were subsequently compared and any discrepancy resolved by re-scanning the patient with or without the involvement of an independent radiologist, or by follow-up of the patient by other imaging studies. In 158 (78.2%) scans, there was complete agreement between the radiographer's and radiologist's findings. In 44 scans (21.8%), there was incomplete agreement--there were 108 abnormal findings in these scans with incomplete agreement/discrepancy in 53 abnormalities. Overall, the accuracy of radiographers was 92.0% and radiologists was 91.7%; however, the accuracy rates were 94.0% and 96.4%, respectively, when minor abnormal findings without significant influence on the patient's clinical outcome were excluded.

Acute renal colic: value of unenhanced spiral computed tomography compared with intravenous urography.

OBJECTIVE: The objective of this study was to compare the efficacy of plain spiral computed tomographic (CT) scan with intravenous urography (IVU) in the evaluation of patients with suspected urinary calculi/obstruction. MATERIALS AND METHODS: Twenty consecutive patients with acute signs of renal colic were prospectively examined with unenhanced spiral CT followed by an IVU within the same day. The CT scans were reviewed jointly by 2 radiologists blinded to the IVU and a consensus was reached for each finding. The IVU was similarly reviewed by another 2 separate radiologists. RESULTS: Eleven of the 20 patients had signs of urinary obstruction on CT and IVU. Of these 11 patients, 7 had a ureteric calculus that was demonstrated on CT and IVU and 4 had a calculus that was demonstrated on CT only. Two patients had a urinary calculus seen on CT and IVU with no signs of urinary obstruction. One patient had a calculus seen on CT alone with no urinary obstruction. Two patients only had signs of urinary obstruction on CT. The remaining 4 cases had normal findings on CT and IVU. CONCLUSION: Unenhanced CT is more effective than IVU in identifying ureteric calculi and is equally effective in detecting urinary obstruction. CT is also useful in detecting secondary signs of obstruction even in the absence of any calculus.

Diagnosis of prostatic intraepithelial neoplasia in whole mount sections of prostates.

Dysplasia of prostate or prostatic intraepithelial neoplasia (PIN) is associated with prostatic adenocarcinoma, which is quite common in elderly males. The presence of high grade PIN in biopsy of patients with clinically suspicious tumors is an indication of further search for malignancy. Whole mount sections of 48 prostates were studied. PIN was sought and graded. The morphology of other lesions including atrophy, adenosis and basal cell hyperplasia, and also seminal vesicle epithelium was studied. All 36 prostates resected for treatment of prostatic adenocarcinoma contained foci of PIN. The differential diagnosis of PIN, atrophy, adenosis, basal cell hyperplasia and seminal vesicle epithelium is quite easy when whole mount sections are studied. Whole mount sections of prostates are valuable teaching material for pathologists.

Myofibroblastoma of the breast: a case report.

A tumor in the breast of a 67-year-old male was resected. It was grossly circumscribed and unencapsulated. Histologically, it was composed of plump and long bipolar, spindle cells arranged in fascicular clusters with intervening broad collagen bands. The cells lacked pleomorphism, and no mitotic figures were found. The margin was that of pushing border type. No epithelial component was seen in the tumor. Immunohistochemically, the tumor cells expressed variable reactivity to vimentin, desmin and smooth muscle actin and were negative for S-100 protein and keratin. Electron microscopy showed cell differentiation between fibroblast and smooth muscle cells.

Possible role of gadolinium in nephrogenic systemic fibrosis: report of two cases and review of the literature.

Nephrogenic systemic fibrosis/nephrogenic fibrosing dermopathy (NSF/NFD) is a rare fibrosing disorder that occurs in patients with renal failure. It is associated with significant mortality and morbidity. Patients typically present with painful or pruritic indurated plaques involving the limbs and trunk, with sparing of the face. Severity and rapidity of cutaneous progression correlate with poorer prognosis. To date, the management of NSF/NFD remains anecdotal. The aetiological link in NSF/NFD is also yet to be confirmed, but renal dysfunction seems a common feature. Following recent reports of a possible causative role of gadolinium, we present two patients with histologically confirmed NSF/NFD, who had exposure to gadolinium-containing contrast agents 1-2 months before onset of disease. Severity of renal impairment, lack of immediate dialysis after exposure and cumulative dose of gadolinium are possible factors influencing the development of NSF/NFD. The process of transmetallation of gadolinium chelates may occur in patients with renal impairment, leading to precipitation of free gadolinium in the dermis or other organs, causing tissue injury that ultimately leads to the clinical manifestations of NSF/NFD. Although the causative role is not proven, gadolinium-containing contrast agents should be used only if clearly necessary in patients with renal failure.