Soluble interleukine-2 recptor and MDR1 gene expression levels as inflammatory biomarkers for prediction of steroid response in children with nephrotic syndrome

Upregulation of interleukin-2 may be involved, not only in the pathophysiology of nephrotic syndrome, but also in steroid resistance treatment, by increasing expression of multidrug resistant gene-1 [MDR1] gene on lymphocytes and its product P-glycoprotein effluxing corticosteroid. Our aim was to assess the relation of serum soluble interleukin-2 receptor [sIL2R] levels and MDR1 gene expression on lymphocytes with nephrotic syndrome and its corticosteroids therapy. We examined 40 children with nephrotic syndrome [15 cases of recent onset and 25 known cases with relapse] and 20 healthy children as a control group. We examined every patient twice at the time of disease activity and within 1 week of remission. A significant increase was found in sIL2R level and MDR1 gene in the patients in comparison with the control group whether in activity or remission, and they were significantly higher in activity than in remission. Levels of sIL2R and MDR1 gene expression in different subgroups were higher in known cases with relapse than in new onsets, both in activity and remission, and relatively higher in steroid-resistant than in steroid-sensitive ones. We propose sIL2R and MDR1 gene expression levels as early predictors of steroid resistance in nephrotic syndrome for early control of disease by immediate introduction of cytotoxic drugs. This is the first report providing new insight into the use of sIL2R as a predictor of steroid resistance. Thus, wide-scale studies are needed to determine a cutoff level of sIL2R above which cytotoxic drugs are introduced

Clinical impacts of oral gastrografin follow through in adhesive small bowel obstruction [ASBO]. [a prospective randomized study]

Many studies have shown that Gastrografin can be used for diagnosis of adhesive small bowel obstruction [ASBO] and for assessing the need for surgical intervention .However; several the studies have reported conflicting results. Therefore the aim of this study is to assess the diagnostic and therapeutic effect of Gastrografin in ASBO. Altogether 110 patients with ASBO were randomized into control and Gastrografin groups. In the Gastrografin group, 100 ml of the dye was administered through a nasogastric tube. Obstruction was considered complete if the contrast failed to reach the colon on the 24-hour film. Patients with Gastrografin in the colon within 24 hours after dye administration were considered as partially obstructed and were submitted to non operative treatment. The patients were operated on if they developed signs of strangulation or failed to improve within 48 hours. The overall operative rate 14.5% in Gastrografin group versus 34.5% in control group: P = 0.04 .The time from admission to resolution of symptoms was significantly lower in Gastrografin group [19.5 vs. 42.6 hours: P = 0.001] and the length of hospital stay shorter in Gastrografin group [3.8 vs. 6.9 days 0.002] and in non operative patients [3.1 vs. 5.1 days]. Sensitivity, specificity, positive predictive value and negative predictive value for Gastrogrqfin follow-through as an indicator for operative treatment of ASBO were 87.5%, 100%, 100%, and 97.9% respectively. Oral Gastrografin helps in the management of ASBO. Oral Gastrografin is safe and reduces the operative rate and time of resolution as well as hospital stay

Early oral feeding in patients undergoing elective colonic anastomosis

Recent evidence seems to indicate that immediate postoperative feeding if feasible is safe after either laparoscopic surgery or laparotomy. This study is done to assess the safety, outcome of early oral feeding and shows factors affecting early postoperative feeding after colorectal procedures. Between June 2005 and April 2008, 120 consecutive patients underwent elective colonic anastomosis were then randomized into 2 groups. Early feeding group began fluid on the first postoperative day and regular feeding group were managed in the traditional way- nothing by mouth until the resolution of the ileus. The majority of patients [75%] tolerated the early feeding. The time to first passage of flatus [3.3 +/- 0.9 d vs. 4.2 +/- 1.2 d] and stool [4.1 +/- 1.2 d vs 4.9 +/- 1.2 d] were significantly sooner in group 1. Hospital stay is significantly shorter in early feeding group [4.2 +/- 0.2 d vs. 6.9 +/- 0.5 d]. Operative time and amount of blood loss had a significant impact on tolerability of early feeding while age, gender, type of operation, and previous abdominal operation had no significant impact. Early oral feeding after colorectal surgery is safe, tolerated by the majority of patients. Operative time and amount of blood loss has impact on the tolerability of early feeding

Clinical impacts of oral gastrografin follow through in adhesive small bowel obstruction [SBO]

Many published studies have shown that Gastrografin can be used for diagnosis post operative acute small bowel obstruction [ASBO] and assessing the need for surgical intervention. However, the studies have reported conflicting results hence the aim of our study to test this hypothesis. Altogather 100 patients with 117 episodes of ASBO were randomized into control and gastrografin groups in a double blinded fashion. Eight episodes in eight patients were excluded due to protocol violation. In Gastrografin group, 100 ml of the dye administered through a nasogastric tube and complete-obstruction has been considered if the contrast failed to reach the colon on the 24-hour film .Patients were operated on only if they developed signs of strangulation or failed to improve within 48 hours. Gasrografin group showed a significant decrease of both the time between admission and operation [P = 0.001] and that of hospital stay [P = 0.000]. The need for surgery was reduced but statistically insignificant [P = 0.225]. Oral Gastrografin helps in the management of ASBO

Efeito das condiçöes de preparaçäo e sinterizaçäo sobre a porosidade da hidroxiapatita / Effect of preparing and sintering conditions on hydroxyapatite porosity

Este estudo foi realizado para verificar o efeito das condiçöes de preparaçäo e sinterizaçäo sobre a porosidade de amostras de hidroxiapatita, calculada como procentagem da densidade teórica da hidroxiapatita. Foram verificados o efeito da carga utilizada para obter as amostras, o tamanho inicial das partículas de hidroxiapatita, a temperatura de sinterizaçäo e porosidade, mas nenhuma correlaçäo entre tempo de sinterizaçäo e porosidade. Amostras fabricadas com partículas de tamanho maior apresentaram maior porosidade. Foi concluído que para a fabricaçäo de amostras de hidroxiapatita, a combinaçäo entre a carga utilizada para a compactaçäo das partículas e a temperatura de sinterizaçäo resulta na produçäo de amostras com uma ampla variaçäo de porcentagens de porosidade