Clinical and demographic features of hidradenitis suppurativa: a multicentre study of 1221 patients with an analysis of risk factors associated with disease severity

BACKGROUND

Hidradenitis suppurativa (HS) is a chronic, relapsing and debilitating inflammatory disease associated with profound morbidity.

AIM

In this multicentre study, we investigated the demographic and clinical features of HS, and determined risk factors of disease severity.

METHODS

In total, 1221 patients diagnosed with HS from 29 centres were enrolled, and the medical records of each patient were reviewed.

RESULTS

The mean age of disease onset was 26.2 ± 10.4 years, and almost 70% (n = 849) of patients were current or former smokers. Mean disease duration was 8.9 ± 8.4 years with a delay in diagnosis of 5.8 ± 3.91 years. Just over a fifth (21%; n = 256) of patients had a family history of HS. The axillary, genital and neck regions were more frequently affected in men than in women, and the inframammary region was more frequently affected in women than in men (P < 0.05 for all). Acne (40.8%), pilonidal sinus (23.6%) and diabetes mellitus (12.6%) were the most prevalent associated diseases. Of the various therapies used, antibiotics (76.4%) were most common followed by retinoids (41.7%), surgical interventions (32.0%) and biologic agents (15.4%). Logistic regression analysis revealed that the most important determinants of disease severity were male sex (OR = 2.21) and involvement of the genitals (OR = 3.39) and inguinal region (OR = 2.25). More severe disease was associated with comorbidity, longer disease duration, longer diagnosis delay and a higher number of smoking pack-years.

CONCLUSIONS

Our nationwide cohort study found demographic and clinical variation in HS, which may help broaden the understanding of HS and factors associated with disease severity.

Effect of mitomycin-C on post-operative adhesions in tendon surgery: an experimental study in rats

We investigated the effect of mitomycin-C on the reduction of the formation of peritendinous fibrous adhesions after tendon repair. In 20 Wistar albino rats the tendo Achillis was cut and repaired using a modified Kessler technique. The rats were divided into two equal groups. In group 1, an injection of mitomycin-C was placed between the tendon and skin of the right leg. In group 2, an identical volume of sterile normal saline was injected on the left side in a similar fashion. All the rats received mitomycin-C or saline for four weeks starting from the day of operation. The animals were killed after 30 days. The formation of peritendinous fibrous tissue, the inflammatory reaction and tendon healing were evaluated. The tensile strength of the repaired tendons was measured biomechanically. Microscopic evidence of the formation of adhesions and inflammation was less in group 1. There was no significant difference in the tensile load required to rupture the repaired tendons in the two groups. Mitomycin-C may therefore provide a simple and inexpensive means of preventing of post-operative adhesions.

Effect of obesity and overweight on cyclosporine blood levels and renal functions in renal adolescent recipients

INTRODUCTION

The impact of obesity, a frequent problem after renal transplantation, which has been associated with poor graft and patient survival, was evaluated on renal function and cyclosporine (CsA) blood levels.

PATIENTS

We retrospectively evaluated the data of adolescent renal recipients between 1994 and 2004. Patients with serum creatinine > or = 2.5 mg/dL were excluded. We grouped the data with regard to the body mass index (BMI) percentiles as group I (BMI > 95th), group II (BMI < 95th), group III (BMI > 85th), group IV (BMI < 85th). We compared the clinical and laboratory findings between groups I and II and between groups III and IV.

RESULTS

We evaluated 778 visits of 27 patients (M/F: 19/8). There were 30 visits in the obesity period (group I) and 72 visits after the overweight periods were added (group III). Serum creatinine levels were significantly higher and glomerular filtration rate levels significantly lower among obese and/or overweight than lean periods (P < .05). Proteinuria levels were similar in groups I and II, but significantly higher in group III than group IV (P = .356 and .000, respectively). CsA(mg/bw), CsA(mg/bmi), and CsA(mg/bsa) levels were significantly lower in group I than group II and in group III than group IV (P < .05), while C0 and C2 levels were similar (P > .05).

CONCLUSION

Weight gain is associated with worse renal functions but not greater proteinuria in our patients. Smaller CsA doses were sufficient to maintain C0 and C2 levels similar to the lean patients, results that were parallel to those of adult renal recipients.

The factors affecting blood pressure in pediatric renal transplant recipients

To investigate the parameters affecting systemic blood pressure in pediatric renal transplant recipients, we retrospectively examined the data from 19 adolescent renal transplant recipients including 6 girls overall, mean age of 15,47 +/- 3.56 years. Serum creatinine (Scr), fractional extraction of sodium (FENa), whole blood trough cyclosporine(C0), plasma total cholesterol (TC) and triglyceride levels, and systolic and diastolic blood pressure (SBP and DBP) were monitored during a total of 677 visits. SBP and DBP, classified as <95p (groups 1s and 1d) and >95p (groups 2s and 2d), were correlated with differences between groups 1 and 2. Group 2s Scr and FENa levels were higher than group 1s (P =.002 and P =.048, respectively), whereas C0 and FENa levels were higher in Group 2d than Group 1d (P = 0.028 and P = 0.036, respectively). Among the entire group, SBP and DBP positively correlated with C0; Scr and SBP, with FENa. While there was a positive correlation between SBP and C0 in groups 1s and 2s (r = 0.188, P <.000; and r = 0.145, P =.040), DBP was only associated with C0 in group 1d (P =.03, r = 0.156). In contrast, DBP showed a positive correlation with Scr in group 2d (P =.023, r = 0.132), and SBP with Scr in Group 1s. C0 and Scr levels were correlated in Groups 1s, 1d and 2d. At high BP levels (>95p), SBP is mostly affected by C0; DBP, with Scr. However, in both groups these two parameters positively correlate with each other. Thus, in adolescent renal transplant recipients the cause of high blood pressure does not appear to be solely related to cyclosporine related to induced allograft dysfunction.

Cyclosporine a toxicity in association with reduced renal mass

The long-term effect of cyclosporine A (CsA) in male Wistar rats with reduced renal mass was studied. The aim of the study was to highlight the relationship of CsA effect on rats, simulating patients with two functioning kidneys (eg, heart, liver transplant recipients) and one kidney (renal transplant recipients). The Wistar rats were subjected to unilateral nephrectomy (Unx, n = 14) and to 5/6 nephrectomy (STnx, n = 14). Half of these rats and half of the sham operated ones (control, n = 13) were administered CsA (10 mg/kg/d) for 28 days IP. The serum creatinine (S(CR)), total protein (S(P)), and urine protein (U(P)) values as well as the whole blood CsA levels were determined on the 28th day of the study. The remnant kidneys were evaluated by image analyses and semiquantitative methods after sacrifice on the 28th day. In the three non-CsA-treated groups (Unx, STnx, and control) S(CR) was significantly higher in STnx rats than in Unx rats (P =.011). Percent of renal scarring (PRS) was significantly higher in Unx (P =.02) and in STnx rats (P =.017), compared with the control group. Among CsA-treated three groups S(CR) was significantly higher in STnx rats compared with Unx (P =.017). In addition, segmental sclerosis rate (SSR) was higher in STnx rats, compared with the control group (P =.008), whereas S(P) was higher in the control group (P =.005). When CsA-treated groups were compared with non-CsA-treated ones, U(P) of the Unx rats not receiving CsA were significantly higher than the Unx rats receiving CsA (P =.026). Also, U(P) was higher in non-CsA-treated groups (P =.014), whereas S(CR) (P =.001), S(P) (P =.001), and PRS (P =.001) were higher in CsA-treated rats. In conclusion, we suggest that preserved renal mass is not enough to prevent CsA toxicity and that CsA should be administered to patients with both kidneys (eg, heart, pancreas recipients) as carefully as to patients with one functioning kidney (renal transplant recipients).

Familial arthropathy with camptodactyly: reports of two families

Familial association of congenital camptodactyly and arthropathy without evidence of concurrent inflammation has an autosomal recessive pattern of inheritance. We describe four children born to consanguineous parents in two families with congenital camptodactyly and polyarthropathy which were misdiagnosed and treated as juvenile rheumatoid arthritis (JRA) for some time. The siblings in the second family also had fibrosing pleuritis. Histopathological examination of the synovial tissues of the children in the first family revealed synovial hypertrophy and presence of multinucleated giant cells with minimal inflammation and vasculitis. On the other hand, prominent fibrosis with no inflammation was present in the synovial tissue of the elder boy in the second family. Thus, while the children in the first family had the phenotypic characteristics of congenital familial hypertrophic synovitis, the latter siblings probably represent a form of the familial fibrosing serositis.

Posterior leukoencephalopathy syndrome in poststreptococcal acute glomerulonephritis

Reversible posterior leukoencephalopathy syndrome is an increasingly recognized brain disorder most commonly associated with hypertension, toxemia of pregnancy, or the use of immunosuppressive agents. Its clinical features include headache, decreased alertness, mental abnormalities, such as confusion, diminished spontaneity of speech, changed behavior ranging from drowsiness to stupor, seizures, vomiting, and abnormalities of visual perception like cortical blindness. Magnetic resonance imaging shows edematous lesions primarily involving the posterior supratentorial white matter and corticomedullary junction. We describe a 7-year-old uremic girl who developed neurological symptoms of posterior leukoencephalophaty syndrome during the course of acute poststreptococcal glomerulonephritis. Since the symptoms first appeared 24 h after a hypertensive crisis and the patient was uremic at the time of symptoms, we decided to report this patient to discuss the differential diagnosis of neurological symptoms developing during the course of acute poststreptococcal glomerulonephritis.

The effect of vitamin A on the course of renal ablation nephropathy

Renal scarring due to pyelonephritis was shown to improve in rats given vitamin A. We evaluated the effect of vitamin A in a renal ablation nephropathy model. Four groups, each including 7 rats with 5/6 nephrectomy, were formed: group I (no vitamin A), group II (60 kIU vitamin A), group III (120 kIU vitamin A), and group IV (180 kIU vitamin A). Four sham-operated rats comprised the control group. After 6 weeks of 5/6 nephrectomy, the rats were sacrificed and serum creatinine, vitamin A, and beta-carotene levels were determined in addition to histopathological evaluation of the remnant kidneys. The tubulointerstitial and glomerular changes were graded as "0-3" and "0-5" respectively, in accordance with the severity of the lesions. Tubulointerstitial score (TIS), mean glomerulosclerosis score (MGS, arithmetical mean of the sclerosis scores of 100 glomeruli), and severity of glomerulosclerosis index (SGI, ratio of the number of glomeruli with grade > or = 3 sclerosis to the total number of glomeruli examined) were calculated for each rat. Serum creatinine levels were higher in the study groups than the control rats (P < 0.05), but there was no significant difference between the study groups (although the levels increased as the dose of vitamin A increased). Serum vitamin A levels were significantly higher in the groups given vitamin A than the control rats and group I (P < 0.05). In addition, serum vitamin A levels increased significantly in parallel to increasing doses of vitamin A (P < 0.05). Serum beta-carotene levels did not differ between the groups, except for group II, which had lower levels than controls (P = 0.01). MGS and SGI were significantly higher in the study groups than control rats (P < 0.05), but did not differ between the study groups. Study and control rats were not different with respect to TIS, but there was a difference between the control group and group III (P = 0.04). Group II had the lowest MGS, SGI, and TIS scores among the study groups. When all the rats were considered together, vitamin A levels did not correlate with the MGS and SGI, but correlated positively with the TIS (r = 0.391, P = 0.027). beta-Carotene levels also did not correlate with the MGS, SGI, and TIS. In conclusion, vitamin A administration did not significantly affect the clinical and pathological course of renal ablation nephropathy in rats. Furthermore, higher doses of vitamin A might even damage renal tissue.

Dermatomyositis with membranous nephropathy

Dermatomyositis is the connective tissue disease with the least renal involvement. Although some renal findings like proteinuria, hematuria, pyuria, progressive renal insufficiency, and glomerular and tubular calcium deposits with arteriolar fibrosis have been described, glomerulonephritides have rarely been associated with dermatomyositis, especially in childhood cases. We describe a 10-year old boy with the clinical picture of dermatomyositis who underwent renal biopsy due to microscopic hematuria demonstrating membranous glomerulonephritis with Clq deposition. Children with "full-house" membranous glomerulonephritis with deposition of Clq and the other immunoglobulins have been reported to present in the future with the clinical findings of systemic lupus erythematosus. However, laboratory evaluation of our patient for systemic lupus erythematosus was negative at the present time. Thus, we think this case should be followed up closely with special attention to the possible clinical and laboratory findings of systemic lupus erythematosus.

Neutrophil chemotaxis and random migration in preterm and term infants with sepsis

The aim of this study was to evaluate neutrophil chemotaxis and random migration in healthy newborn infants and septic neonates with similar gestational and postnatal age. Possible relationships between chemotactic activity, random migration, causative microorganisms, and clinical course of septic infants were also investigated. The neutrophil chemotaxis and random migration was evaluated in 24 healthy newborn babies and 34 septic neonates and 20 healthy adults by modified Boyden technique. The mean neutrophil chemotaxis of healthy preterm-term infants and adults were similar (66.6 +/- 18.9, 64.4 +/- 19.9, and 74.7 +/- 17 microm, respectively). The mean neutrophil random migration of healthy term infants was not different than that of adults. But the mean neutrophil random migration of healthy preterm infants was lower than that of adults (36.9 +/- 13.7 and 43.5 +/- 1 1.8 microm, respectively) (p = 0.03). The mean neutrophil chemotaxis and random migration septic term infants were not different from the value of healthy term infants (p > 0.05). Although the mean random migration of septic and preterm infants were similar (p > 0.05), the mean neutrophil chemotaxis of septic preterm infants was lower than the value of healthy preterm infants (p = 0.04). Not only mean neutrophil chemotaxis of septic preterm and term infants were significantly lower than that of adults (p = 0.002 and p = 0.006, respectively), but also neutrophil random migration of septic preterm and term infants were significantly lower than that of adults (p = 0.001 and p = 0.005, respectively). There was no relationship between the nature of causative microorganism and neutrophil random migration or chemotactic activity. Polymorphonuclear leukocytes chemotaxis was significantly lower in preterm with sepsis compared with healthy preterm-term infants and adults. These findings may indicate deterioration in neutrophil functions in premature babies under stress but more detailed studies with larger groups are needed.

Usefulness of pulse-wave Doppler tissue sampling and dobutamine stress echocardiography for identification of false positive inferior wall defects in SPECT

False positive inferior wall perfusion defects restrict the accuracy of SPECT in diagnosis of coronary artery disease (CAD). Pulse-Wave Tissue Doppler (PWTD) has been recently proposed to assess regional wall motion velocities. The objectives of this study were to evaluate the presence of CAD by using PWTD during dobutamine stress echocardiography (DSE) in patients with an inferior perfusion defect detected by SPECT and compare PWTD parameters of normal cases with patients who had inferior perfusion defect and CAD. Sixty-five patients (mean age 58 +/- 8 years, 30 men) with a normal LV systolic function at rest according to echocardiographic evaluation with an inferior ischemia determined by SPECT and a control group (CG) of 34 normal cases (mean age 56 +/- 7 years, 16 men) were included in this study. All patients underwent a standard DSE (up to 40 microg / kg / min with additional atropine during sub-maximum heart rate responses). Pulse-wave Doppler tissue sampling of inferior wall was performed in the apical 2-chamber view at rest and stress. The coronary angiography was performed within 24 hours. The results were evaluated for the prediction of significant right coronary artery (RCA) and / or left circumflex coronary artery (CX) with narrowing (> or = 50% diameter stenosis, assessed by quantitative coronary angiography). It was observed that the peak stress mean E / A ratio was lower in patients with CAD when compared to patients without CAD (0.78 +/- 0.2 versus 1.29 +/- 0.11 p < 0.0001). Also the peak stress E / A ratio of normal cases was significantly higher than patients who had CAD (1.19 +/- 0.3 versus 0.78 +/- 0.2 p < 0.0001). When the cut off point for the E / A ratio was determined as 1, the sensitivity and specificity of dobutamine stress PWTD E / A were 89% and 86 %, respectively. The peak stress E / A ratio was higher than 1 in all patients with a false positive perfusion defect. Systolic S velocity increase during DSE was significantly lower in patients with CAD (54 % +/- 17 versus 99 % +/- 24 p = 0.01). The analysis of S velocity increase yielded 81% sensitivity and 76 % specificity for prediction of CAD when a 70 % increase was accepted as a cut-off value. Pulse-wave Doppler tissue sampling during DSE may help to identify false positive inferior wall defects detected by SPECT.

Effect of socioeconomic status on the blood pressure in children living in a developing country

BACKGROUND

Lower socioeconomic status has been reported to favor higher blood pressure both during childhood and adulthood, because obesity is more prevalent among this population. The aim of the present study was to evaluate the effect of socioeconomic status on blood pressure and prevalence of obesity among children living in a developing country.

METHODS

Prepubertal primary school children (total number 1024, male/female ratio 513/511, mean age 10.32 +/- 0.60 years) living in Izmir, a metropolis of Turkey, were enrolled in the present study. The children were classified into three groups according to the locations of their schools as those from the well-developed (WD; n = 290), moderately developed (MD, n = 356) and underdeveloped (UD, n = 378) areas. Body mass index (BMI), ratio of BMI to the 50th percentile value of BMI for that age (BMI%) and systolic (SBP) and diastolic blood pressures (DBP) were determined in all children. Each socioeconomic group was subdivided into three subgroups with respect to BMI% as those with less than 90% (SG(< 90)), 90-110% (SG(90-110)), and more than 110% (SG(> 110)). Then, mean SBP and DBP in each subgroup of the WD, MD and UD groups were compared with the corresponding blood pressure values of each other to evaluate the effect of socioeconomic status on the blood pressure. In addition, the SBP and DBP of each subgroup were compared with other subgroups within that group to evaluate the effect of BMI on blood pressure.

RESULTS

The BMI and BMI% of the UD group were significantly lower than that of the WD and MD groups (P < 0.05). In addition, the number of children with a BMI of more than 95% for their age was significantly lower in the UD group compared with the WD and MD groups (1.7, 1.9 and 0.5% in the WD, MD and UD groups, respectively, P < 0.05). The SBP and DBP were positively correlated with BMI% in each group and in all of the subjects cumulatively (r = 0.26, P < 0.001 for SBP and r = 0.34, P < 0.001 for DBP). The SBP and DBP were significantly higher in SG(> 110) than in SG(90-110) and were also higher in SG(90-110) than in SG(< 90) in each group. Mean DBP values in all subgroups of the MD and UD groups were significantly lower than the respective subgroups of the WD group. The SBP of SG(< 90) and SG(90-110) of the UD group were significantly lower than those of the corresponding subgroups of the WD and MD groups.

CONCLUSION

Obesity is not more prevalent among the children of lower socioeconomic classes in Turkey as a developing country. In addition, independent of anthropometric structure, DBP and SBP were shown to be related to the socioeconomic status in childhood age groups and both values were determined to decrease in accordance with a decrease in the socioeconomic level.

Renal histomorphometry and resistance index in children with renal disease

PURPOSE

The aim of this study was to examine the relationships between the renal resistance index (RI) and histomorphometric variables measured in children with glomerular or nonglomerular renal disease. Patients and Methods The medical records, sonography reports, and biopsy specimens of 30 children with glomerular or nonglomerular renal disease (mean age, 11.0 +/- 4.7 years; range, 2. 5-17 years) who underwent sonographic evaluation and biopsy of the right kidney were retrospectively studied. Biopsy specimens were evaluated for glomerular surface density, number of glomeruli in the stroma, capillary surface density, number of capillaries within the glomeruli, and the diameters of the afferent arterioles.

RESULTS

The RI was negatively correlated with age in patients 2.5-4.0 years old (rho = -1.0, p < 0.001). The RI was positively correlated with serum creatinine levels (rho = 0.63, p < 0.001), and the RI differed significantly between patients with abnormally high and age-appropriate serum creatinine levels (0.8 +/- 0.1 and 0.6 +/- 0.1, respectively; p = 0.002). No differences in age, histomorphometric variables, RI, or arteriolar diameter were found between patients who had interstitial fibrosis and those who did not, and the RI was not correlated with histomorphometric variables in either group. However, the mean RI was significantly higher in patients with severe fibrosis than in those with mild fibrosis. In those with severe fibrosis, the RI was negatively correlated with number of glomeruli in the stroma (rho = -0.975, p < 0.01), glomerular surface density (rho = -0.931, p < 0.05), number of capillaries within the glomeruli (rho = -0.989, p < 0.01), and arteriolar diameter (rho = -1.00, p < 0.01).

CONCLUSIONS

The RI was correlated with histomorphometric variables in patients with severe interstitial fibrosis and could be useful in the follow-up of these patients.

The role of vitamin A in preventing renal scarring secondary to pyelonephritis

OBJECTIVE

To evaluate the efficiency of exogenously administered vitamin A in preventing renal scarring caused by experimental pyelonephritis in rats.

MATERIALS AND METHODS

Forty Wistar rats were injected with 0.1 mL of solution containing Escherichia coli (1010 /mL) into both renal medullae. Five equal groups were then formed: group 1 was treated only with ciprofloxacin (30 mg/kg per day, twice daily, intraperitoneally) for 5 days, starting 3 days after bacterial inoculation; in group 2, 60 kIU of vitamin A was injected intramuscularly with the bacterial inoculation; in group 3, 60 kIU of vitamin A was injected similarly, but 3 days after bacterial inoculation; in group 4, 60 kIU of vitamin A was given orally with the bacterial inoculation; and group 5 was treated with ciprofloxacin for 5 days and vitamin A intramuscularly from the third day after bacterial inoculation. All the rats were killed 6 weeks after bacterial injection; blood samples were obtained to determine serum vitamin A and beta-carotene levels, and both kidneys were examined pathologically for scarring, graded as 0 (none), 1 (mild), 2 (moderate) and 3 (severe).

RESULTS

Serum vitamin A levels were higher in the rats given vitamin A (group 2-5) than in group 1, being highest in group 4, although only this group had significantly higher levels of vitamin A than group 1 (P<0.05). Histopathologically, the fibrosis was mildest in groups 2 and 4 (two of 16 kidneys grade 1), whereas it was most severe in group 1 (all 16 grade 2-3). Fibrosis was significantly less in groups 2-5 than in group 1 (P<0.05). There was a significant negative correlation between vitamin A levels and the sum of the fibrosis, inflammation and tubular atrophy scores of all rats (r=-0.391, P<0.02). beta-carotene levels were unrelated to renal scarring.

CONCLUSION

The administration of vitamin A could have a role in preventing renal scar formation from pyelonephritis induced experimentally in rats.

Serum vitamin A and beta-carotene concentrations and renal scarring in urinary tract infections

OBJECTIVE

To evaluate the role of vitamin A on renal scarring in recurrent urinary tract infections (UTIs).

DESIGN

Twenty three children with UTIs and renal scarring (mean (SD) age 7.3 (3.9) years) and 91 children without renal scarring (6.4 (3.4) years) were studied. All the children had serum vitamin A and beta-carotene measurements and nutritional evaluation. Renal scarring was assessed by technetium-99m dimercaptosuccinic acid (99mTc DMSA) scanning. Nutritional status of all the patients was within normal limits and not different between the groups.

RESULTS

Mean (SD) serum vitamin A and beta-carotene concentrations were not significantly different between the patients with and without renal scarring (vitamin A 53.2 (22.6)/46.8 (17.0) micrograms/dl and beta-carotene 232.3 (201.3)/272.4 (86.0) micrograms/dl respectively). However, when the patients with renal scarring and with greater than 10% difference among the DMSA uptakes of their kidneys (11 cases) were evaluated, a significant negative correlation was determined between the serum vitamin A concentrations and the magnitude of the difference in uptakes of each kidney. The same relation was not true for serum beta-carotene concentrations.

CONCLUSION

This study demonstrated a relation between serum vitamin A concentrations and magnitude of hypoactivity in 99mTc DMSA scanning in kidneys with advanced scarring.

The effects of L-carnitine on respiratory function tests in children undergoing chronic hemodialysis

Respiratory functions are affected during hemodialysis. Ultrafiltration rate, acid-base balance and the strength of respiratory muscles have been suggested as important factors in adults undergoing chronic hemodialysis. L-carnitine is crucial for energy producing utilization fatty acid and, possible amino acids. Carnitine treatment has been associated with hypertrophy of type I muscle fibers. Carnitine supplementation in nondialysis patients increases exercise tolerance. Eventually, administration of L-carnitine to adult hemodialysis patients improves exercise capacity, energy metabolism and muscle mass. The study was performed to investigate the chronic effects of L-carnitine treatment on respiratory functions in children receiving chronic hemodialysis therapy. Predialytic and postdialytic respiratory function tests were performed in ten children with end-stage renal disease before and after a three-month L-carnitine treatment period. The mean age was 12 +/- 4 years. L-carnitine was administered at a dose of 20 mg/kg intravenously at the end of each hemodialysis session. Mean predialytic serum carnitine value before and after the carnitine treatment period were 21.8 +/- 3 and 132.0 +/- 48.5 mmol/L, respectively, and the increase was significant (p < 0.05). Respiratory function tests performed just before the carnitine treatment period implied bronchospasm that was clinically vague and could only be detected by a significant decrease in FEV1/FVC, PEF and FEF25-75 values (p < 0.05). Nevertheless, at the end of the three-month carnitine therapy period these respiratory function parameters did not show any significant variation. Hence, it is implied that carnitine therapy might have prevented the subclinic bronchospasm that developed in children during hemodialysis.

IgA nephropathy in mice following repeated administration of conjugated Haemophilus influenzae type B vaccine (PRP-T)

OBJECTIVE

In this study, the risk of IgA nephropathy in Swiss albino mice following the subcutaneous administration of conjugated Haemophilus influenzae type b vaccine (PRP-T), containing capsular polysaccharide of the organism (PRP) conjugated to tetanus protein (T), was evaluated.

METHODS

Three treatment and corresponding control groups, each containing mice, were constituted and given 2, 4, 6 injections of 1/4 HD of PRP-T or placebo, respectively, at 2-week intervals. All mice in each treatment group were sacrificed two weeks from the last injection to examine sequential glomerular changes.

RESULTS

The niceoscpic examination of renal tissues revealed mesangial proliferation (6/7; 85%) in the first group given 2 doses of vaccine; mesangial proliferation (5/7; 72%) and increase in matrix (7/7; 100%) in the second group given 4 doses; and mesangial proliferation (7/7; 100%), increase in matrix (7/7; 100%), IgA (7/7; 100%) and C3 (3/7; 42%) deposition within mesangium in the third group given 6 doses. No histopathological changes were detected in the renal tissues of any control mouse. When the experimental groups were compared statistically with their respective controls at the light microscopic level, mesangial proliferation in the first group (p: 0.0047), mesangial proliferation (p: 0.021) and increase in matrix (p: 0.001) in the second group, mesengial proliferation (p: 0.001) and increase in matrix (p: 0.001) in the third group were determined to be significantly different. When study and control groups were compared by immunofluorescence microscopy, only the third group revealed a statistically significant difference with respect to IgA deposition (p: 0.001). C3 deposition was also demonstrated in this group, but it was not significantly different (p: 0.192). However, in no instance was a control mouse found to have any form of immune deposition.

CONCLUSION

We concluded that conjugated Haemophilus influenzae type b vaccine, given at two-week intervals to a total of six doses, caused secondary IgA nephropathy in mice.

Urinary N-acetyl-beta-D-glucosaminidase activity in rabbits with experimental hypercalciuria

Routinely used renal function tests remain normal in uncomplicated hypercalciuria. The aim of this study was to assess the value of N-acetyl-beta-D-glucosaminidase (NAG), a sensitive marker of renal proximal tubular damage, in experimental hypercalciuria. Oral calcium providing 75 mg/kg per day elementary calcium and 20,000 IU/day vitamin D3 was administered for 15 days to 7 rabbits (Orytolagus cuniculus-New Zealand white) and 7 rabbits were given placebo as a control group. Serum calcium, phosphorus, and alkaline phosphatase, daily urinary calcium excretion and NAG/creatinine ratio were measured before and after drug administration. Kidneys were examined macroscopically and microscopically following the study period. Serum calcium, phosphorous and urinary calcium excretion increased, while alkaline phosphatase decreased significantly in response to drug treatment [10.8 +/- 1.5 vs. 12.2 +/- 1.3 mg/dl, 4.6 +/- 0.6 vs. 6.7 +/- 0.7 mg/ dl, 22.3 +/- 8.3 vs. 46.8 +/- 22.5 mg/kg per day, and 138.0 +/- 57.1 vs. 70.1 +/- 33.1 IU/l, respectively (P < 0.05)]. The NAG/creatinine ratio prior to the study (0.5 +/- 0.1 mU/ mg) was significantly different from that after the study (5.4 +/- 1.5 mU/mg, P < 0.01). In the control group, changes in serum and urinary parameters were not significant (P > 0.05). The relationship between the urinary NAG/ creatinine ratio and the daily urinary calcium excretion was statistically significant (r = 0.67, P < 0.05). In the study group, nephrocalcinosis was present in all rabbits except 1 (85.7%), whereas none of the control group rabbits had nephrocalcinosis. In conclusion, in rabbits urinary NAG excretion increases significantly in nephrocalcinosis induced by hypercalciuria.

Evaluation of the resistance induction in enteric flora in children caused by oral ampicillin plus sulbactam

To evaluate the effect on bacterial resistance of a beta-lactamase inhibitor, resistance patterns of predominant bacteria in enteric flora were evaluated before and after a 7-day course of oral ampicillin (100 mg/kg/days, qid, in 16 patients) and ampicillin-sulbactam (50 mg/kg/day of ampicillin, bd, in 32 patients) therapy. Ampicillin and ampicillin-sulbactam MICs for Escherichia coli, the predominant bacteria in all cases, and resistance rates of E. coli species to both antibiotics were 51.20 +/- 13.80 mg/L, 87.5% and 4.84 +/- 2.11 mg/L, 21% before the treatment respectively. Post-treatment MICs and resistance rates were 106.51 +/- 14.05 mg/L, 100% and 15.89 +/- 5.76 mg/L, 37.5% respectively, indicating a significant increase in MICs of both antibiotics (P < 0.05), being more prominent in the case of ampicillin-sulbactam (about four-fold). We concluded that oral ampicillin-sulbactam could also decrease the susceptibility of the enteric flora to ampicillin.

Topical anaesthesia in haemodialysis: evaluation of topical anaesthesia with lidocaine during vascular access in children undergoing long-term haemodialysis for chronic renal failure

Children with chronic renal failure are frequently exposed to painful invasive procedures. Ointments containing lignocaine-prilocaine, when used before intravenous punctures, have been reported to lessen the pain sensation. The aim of this study was to interpret the effectiveness of lidocaine 2.5% ointment in preventing pain when used before venous and arterial punctures in children undergoing a haemodialysis programme for chronic renal failure. Eight children were included in this study. The pain level was identified by the patients using a linear analogue scale. When topical anaesthetic and placebo were compared, there was no statistical difference in interpretation of pain during arterial (P > 0.4), venous (P > 0.375) or both (P > 0.4) procedures. We conclude that lidocaine 2.5% ointment is not effective in preventing pain in children undergoing long-term haemodialysis. In these patients some other factors, like psychological factors, puncture technique and needle size must be taken into consideration for the prevention of pain.

Renal, gastric and thyroidal amyloidosis due to familial Mediterranean fever

Chronic renal failure developed in a 10-year-old girl due to renal amyloidosis secondary to familial Mediterranean fever (FMF). During management of the chronic renal failure by hemodialysis and of FMF with colchicine, goiter and hypothroidism were observed. Thyroid fine-needle aspiration and gastric endoscopical biopsies, performed when recurrent abdominal pain could not be controlled, revealed amyloid deposits in both thyroid and gastric tissues. After 6 months' therapy with colchicine and levothyroxine, there was no significant change in the thyroid volume. This is the first case in which gastric amyloidosis secondary to FMF in childhood has been demonstrated. Patients with amyloidosis secondary to FMF who have thyroid enlargement and unexplained gastrointestinal symptoms despite adequate therapy should be evaluated with imaging studies and biopsy examinations.

Urinary enzyme changes in newborns with unconjugated hyperbilirubinemia

Various changes in renal function caused by unconjugated hyperbilirubinemia in newborns have been suggested in previous reports. Disclosing an injury in renal tubulus epithelium is feasible by measurement of urinary enzymes. Thus, renal function tests and urinary enzymes in 25 terms newborns with unconjugated hyperbilirubinemia were evaluated before and after phototherapy. Ten healthy term newborns without hyperbilirubinemia formed the control group. Mean values of the variables obtained before and after phototherapy in the study group and in the controls were, respectively: urine osmolality (osm/kg H2O): 0.147 +/- 0.009, 0.174 +/- 0.011, and 0.153 +/- 0.018; endogenous creatinine clearance (mL/min per 1.73 m2): 45.7 +/- 2.15, 46.0 +/- 1.6 and 46.7 +/- 3.9; fractional excretion of sodium (%): 1.27 +/- 0.30, 0.79 +/- 0.19 and 1.24 +/- 0.07; tubular phosphorus reabsorption (%): 85.8 +/- 3.3, 87.8 +/- 2.8 and 86.6 +/- 1.7; urinary N-acetyl-beta-D glucosaminidase/creatinine (IU/mg): 0.617 +/- 0.226, 0.574 +/- 0.214 and 0.619 +/- 0.210; fractional excretion of alkaline phosphatase (%): 0.422 +/- 0.103, 1.001 +/- 0.374 and 0.596 +/- 0.201; fractional excretion of lactic dehydrogenase (LDH; %): 0.102 +/- 0.019, 0.121 +/- 0.023 and 0.119 +/- 0.041; fractional excretion of AST (%): 0.433 +/- 0.127, 0.530 +/- 0.113 and 0.502 +/- 0.074; fractional excretion of alanine aminotransferase (ALT; %) 0.856 +/- 0.413, 1.619 +/- 1.076 and 1.066 +/- 0.366. No significant difference was found between these values before and after phototherapy in the study group, or between the values before phototherapy in hyperbilirubinemic neonates and in the control group. In conclusion, unconjugated hyperbilirubinemia up to a serum level of 18.4 mg/dL in term neonates does not seem to result in injury of normal tubulus epithelium as shown by urinary enzyme levels.

Hypercalciuria in renal glucosuria

Primary renal glucosuria is a benign condition in which serum glucose level is normal. Idiopathic hypercalciuria is defined as increased urinary calcium excretion of more than 4 mg/kg/day in normocalcemic individuals in whom all known causes of hypercalciuria have been excluded. In this paper, we report on a case who has both renal glucosuria and hypercalciuria.

Juvenile rheumatoid arthritis and renal amyloidosis (case report)

Clinical renal abnormalities, including haematuria, proteinuria, abnormal urinary sediment, decreased renal functions and hypertension are relatively common in children with juvenile rheumatoid arthritis (JRA). These findings may be due to renal amyloidosis or administration of drugs that are potentially nephrotoxic. The case of an 11 years old boy diagnosed as JRA at 4.5 months of age and treated with steroids for 10 years is presented. In his history he had hypertension for 5 years and cataract for one year. Renal biopsy was done to evaluate the aetiology for proteinuria, which was overlooked before his admission to our Department. Secondary renal amyloidosis due to JRA was found at biopsy. The importance of investigation for amyloidosis during the long-term follow-up of JRA is reemphasized.

The urological manifestations of the tethered spinal cord

The tethered cord is the fixation of the cord resulting in stretching as growth occurs. In this paper, three cases of tethered cord with symptoms related to the urinary tract were presented. In the first case, a 12-year-old girl presenting with abdominal pain and urinary incontinence had bilateral hydronephrosis and neurogenic bladder due to a tethered cord without having any other neuropathological manifestation. In the second case, an eight-year-old girl presented with enuresis and a mass in her back was found to have a lipomyomeningocele, hyperactive tendon reflexes in the lower limbs and pes cavus. Tethered cord associated with lipomyomeningocele caused a neurogenic bladder and bilateral hydronephrosis. In the third case, a seven-month-old girl presented with hydrocephalus as well as bilateral dilation of the renal pelvis, unilateral ureteral duplication and vesicoureteral reflux. A tethered cord was revealed in this patient, who had a meningomyelocele operation in the neonatal period. Renal function test in the first two cases were abnormal.

[Isolated bone tuberculosis of the talus. Case report]

In view of the rarity of isolated bone tuberculosis a case is reported here. Clinical and laboratory findings are also described. The patient was a nine-year-old boy. We were unable to find any other case of isolated tuberculosis reported in the literature.