Pituitary abscess in an eight-year-old girl - diagnostic difficulties.

Not required for Clinical Vignette.

Ultrastructural examination of renal tubular epithelial cells and hepatocytes in the course of chronic cyclosporin A treatment--a possible link to oxidative stress.

Cyclosporin A is an immunosuppressant drug used to prevent graft rejection in organ transplantation. Side effects include toxicity to the kidney and liver. Recently, many experimental and clinical data have demonstrated that CsA-induced toxicity is associated with increased production of reactive oxygen species (ROS) and lipid peroxidation in the kidney and liver. The aim of the study was ultrastructural examination of renal and liver epithelial cells in the course of chronic experimental CsA treatment. Rats were treated with CsA in a dose of 25 mg/kg/day. Animals developed failure of the kidney and the liver functions manifested by an increase in serum levels of creatinine, urea, uric acid, bilirubin, AST, and ALT and a decrease in total proteins. Ultrastructural examination of tubular epithelial cells and hepatocytes revealed dilatation of endoplasmic reticulum and injury to mitochondria, formation of autolysosomes, and presence of single apoptotic cells. On the basis of a review of the literature the authors suggest that mitochondrial and cell membrane system changes are, at least in part, a result of oxidative damage to the liver and renal tubular epithelial cells.

[Bronchial obstruction reversibility test in the assessment of COPD severity--controversies]. / Próba rozkurczowa w klasyfikacji stopnia zaawansowania przewleklej obturacyjnej choroby pluc--kontrowersje.

UNLABELLED: The GOLD and ERS/ATS guidelines recommend the post-bronchodilator FEV1 (% predicted) to define the severity of chronic obstructive pulmonary disease (COPD). Yet in various publications authors analyze the pre-bronchodilator value or do not clearly state which value was used when the bronchial reversibility test was performed. The guidelines established by the Polish Respiratory Society (PRS) do not specify if performing the reversibility test is necessary to estimate the COPD severity and suggest a reversibility test evaluation which differs from that in the ERS/ ATS and GOLD recommendations. AIM: to assess the changes in the degree of severity of COPD in the classification based upon the pre- and post-bronchodilator FEV1 and to compare the interpretation of the reversibility test as suggested by GOLD and ATS/ ERS and the PRS. METHODS: 145 COPD patients (67F, 78M, mean age 67.5+/-8.9 yrs) with a negative bronchial obstruction reversibility test (salbutamol 400 microg) were enrolled to the study. For each patient the degree of COPD severity using the pre- and postbronchodilator FEV1 was established. The pre- and post-bronchodilator classifications were compared. Differences in the interpretation of the reversibility test according to the GOLD and ATS/ ERS and the Polish guidelines were analyzed. RESULTS: In 22 subjects (15.2%) the degree of disease severity changed after salbutamol. The changes were most frequent in the group of severe and very severe COPD (77.3% of changes). In 1 patient (0.7%) post-bronchodilator severity was greater than before salbutamol intake. In 7 patients (4.8%) the post-bronchodilator FEV1/FVC exceeded 70%, thus excluding the diagnosis of COPD. Of all the 145 negative (according to the ATS/ ERS and GOLD criteria) reversibility tests in 24 cases (16.6%) the test was positive when the criteria recommended by PRS were applied. CONCLUSIONS: the bronchial obstruction reversibility test is essential in the diagnosis and assessment of severity of COPD. Despite poor obstruction reversibility in this disease the use of pre-bronchodilator FEV1 in the assessment of COPD severity may be misleading and is an obstacle in the comparative analysis of studies in the domain of this disease. Differences in the guidelines for the management of COPD may also hinder comparative studies and influence epidemiologic data.