Lupus nephropathy: clinical, immunohistochemistry and quantitative morphometric analysis studies

Lupus nephritis includes a wide range of parenchymal injuries and severity. Better predictors to outcome are needed for patients newly diagnosed with lupus nephritis, so that an appropriate management strategy may be selected. This study aimed to determine whether the ratio of hepatocyte growth factor [HGF] to transforming growth factor beta 1 [TGF beta1] in lupus nephritis could be a prognostic factor for response to therapy with cyclophosphamide and steroids at six months. Also, to determine whether a simple automated system for objective scoring of biopsies of lupus nephritis could be a prognostic factor for response to therapy with cyclophosphamide and steroids at 6 months. Consequently, renal biopsy findings and clinical parameters of thirty parasites-free patients with new onset lupus nephritis were recorded. Histopathologic, clinical, immune-histochemical and morphometric data at baseline served to define the predictive value for outcome after 6 months of therapy. The results showed a significant positive relationship between response to therapy and HGF IS [P= 0.007], HGF ES [P= 0.026], HGF IS/ TGFbeta1 IS ratio [P= 0.022] and HGF ES/ TGFbeta1 ES ratio [P= 0.001]. A significant inverse relationship was proved between response to therapy and TGFbeta1 IS [P= 0.025] as well as TGFbeta1 ES [P= 0.017]. Also, a significant inverse relationship was present between response to therapy and nuclear index, tubular index and matrix index [P = 0.03, 0.03 and 0.029 respectively]

Patient risk factors responsible for early ventriculoperitoneal shunt failures in children

Background: shunt failure is by far the most frequent problem in children with shunts, and most of them will experience this condition at some point in their lives

Objectives: we did the study in order to identify patient-related causes that could be responsible for early shunt failure in children and its significance to help reduce the risk of this failure

Methods: we reviewed and analyzed retrospectively the records of 200 hydrocephalic children operated with V-P shunts in the period between March, 2002, to April, 2004. These patients were regularly followed up according to standard follow-up protocol. The preoperative radiological evaluation included computerized tomography scanning, and/or magnetic resonance imaging. Preoperatively, as well as 1, 3, and 6 months postoperatively, patients were interviewed and examined using the standard protocol in which common symptoms and signs were described. Patients were grouped according to the expected factors that could be responsible for shunt failure

Results: there were a total of 76 patients [38%] with new shunt failures in the first 6 months post-insertion. The significance of each particular factor that could be responsible for shunt failure was tested and illustrated

Conclusion: the incidence of early shunt failure is unexpectedly higher in certain groups of shunted children. There are many patient factors that could be relevant to this problem increasing the possibility of shunt failure. This study inters that better outcome in shunted children could be achieved by correcting avoidable factors and taking the utmost care when these factors are unavoidable

Improved outcome of carotid endarterectomy: role of preoperative cardiac assessment

Thirty-five patients indicated for carotid enderterectomy CEA were exposed to a battery of noninvasive cardiac assessment including clinical history and examination [CE], treadmill exercise testing [TET], and myoview nuclear scanning [MS]. As' a gold standard reference technique, coronary arteriography was' per/armed for each patient after noninvasive evaluation. The sensitivity of CE was low [6/%], Treadmill exercise testing proved to be more sensitive [69%] and highly .specific [89%] but feasible only in [63%] with total accuracy of [77%]. Myoview .scanning demonstrated higher .sensitivity [87%] and less specificity [82%] with high feasibility [94%] and diagnostic accuracy [85%]. Thirteen patients [37%] required coronary revascularization prior to CEA; two of them were clinically classified at moderate risk with false negative TET and MS. There was no postoperative [one month] cardiac death and overall survival after 3 years' was 85.7%. Combined modality approach for cardiac risk assessment is reliable for identification of patients who will benefit from coronary revascularization prior to carotid endarterectomy, and may thus improve the perioperative outcome