Effects of azithromycin on cyclosporine-induced gingival hyperplasia in renal transplant patients.

BACKGROUND: Gingival hyperplasia is a well-known complication of cyclosporine therapy, affecting 21% to 35% of renal transplant patients. Metronidazole, clarithromycin, and azithromycin, all azalid antimicrobial agents derived from the macrolide antibiotic erythromycin, have been used for treatment. Marked improvements in gingival hyperplasia have been recorded in particular with azithromycin. The aim of the present study was to investigate histopathological features of cyclosporine-induced gingival hyperplasia and to evaluate the quantitative efficacy of short-term azithromycin therapy. METHODS: Eighteen renal transplant patients with cyclosporine-induced gingival hyperplasia were included in the study. All patients received azithromycin with a dose of 500 mg/d for 3 consecutive days. Changes in gingival hyperplasia were evaluated by measuring the gingival sulcus depth to the cementum-enamel junction of every tooth in each of the four quadrants on days 0, 7, 30, 90, 180. Gum biopsies were obtained on days 0 and 30; the degree of inflammation was classified as "mild," "intermediate," and "severe". RESULTS: Gingival hyperplasia was reduced in all treated patients throughout the study. The degree of improvement was more significant between 0 to 7 and 7 to 30 days than at other times (respectively, P < .0001 and P < .002). Histopathologically, eight patients had severe and one patient moderate chronic inflammation at the beginning of therapy. Three other biopsies were reported as papilloma, mucosal hyperplasia, and normal gingival tissue biopsy. CONCLUSIONS: Azithromycin appears to be useful to treat cyclosporine-induced gingival hyperplasia in renal transplant patients. Treatment is inexpensive and free from known adverse effects.

Intravitreal trovafloxacin against experimental Staphylococcus epidermidis endophthalmitis.

This study was designed to test the effects of intravitreal trovafloxacin on an experimental rabbit model of Staphylococcus epidermidis endophthalmitis. Out of 26 rabbits, 22 were given intravitreal S. epidermidis (100,000 CFU). At 24 h, group 1 (8 rabbits) and, at 48 h, group 2 (8 rabbits) received 100 microg intravitreal trovafloxacin. Group 3 (6 rabbits) was used as inoculated but untreated controls. Four rabbits (group 4) were used as uninfected controls. Clinical scores were calculated at 24, 48 and 72 h. Microbiological and histopathological scorings were made. Microbiological analysis showed that trovafloxacin administered at 24 or 48 h significantly reduced the number of bacteria compared to the untreated group. We conclude that trovafloxacin applied at 24 or 48 h is effective against S. epidermidis endophthalmitis in this experimental rabbit model.

Direct communication between pulmonary artery and left atrium.

In this article an autopsy finding of a rare congenital anomoly is presented. We found only 28 cases in the literature. Four anatomic variations have been defined, and our case was of type II. The morphogenetic mechanism is a matter for discussion. The previous reports include inadequate pathological examinations. Our histologic findings support the arterial nature of the aneurysmal sac.

The chondrogenic potential of free autogenous periosteal and fascial grafts for biological resurfacing of major full-thickness defects in joint surfaces (an experimental investigation in the rabbit).

In the present study, 40 rabbits were used, 30 of them for the experiment and 10 as controls. Full layer defects of 7-14 mm which were produced on knee joint cartilage were repaired with free autogenous periosteal and fascial grafts. The defects were made on the weight bearing areas of the medial condyles of the femurs of rabbits. The full layer periosteal grafts which were taken from the upper parts of the anterior tibia of 15 rabbits were located so that the combium layer faced the joint, and sutured to synovial membrane with 6.0 vicryl. The defects of the other rabbits were covered with fascial grafts obtained from fascia lata and were sutured to synovial membrane with 6.0 vicryl. No grafting was performed on the 10 rabbits in the control group after production of defects. The rabbits were immobilized for two hours postoperatively, and then allowed to be active. The rabbits in the experimental group were sacrificed in the third, sixth and ninth weeks respectively, and the rabbits of the control group were sacrificed in the ninth week. The distal femurs of 40 rabbits were removed and examined both macroscopically and histologically. The collagen phenotype was determined biochemically. When the assessments were made, it was noticed that the joint faces of the rabbits which were repaired with periosteal grafts were smooth, a tissue resembling hyaline joint cartilage had developed, and the synthesis of collagen of type II increased. On the other hand, the joint faces of the rabbits which were repaired with fascial grafts were not smooth, immature cartilage had with fibrous tissue developed, and the synthesis of type II collagen accounted for 50 per cent. The joint faces of the control group were course and covered with fibrous tissue, and the collagen synthesized was type I. According to these findings, we suggest that the biological repair of joint cartilage defects is possible with free autogenous periosteal grafts.

Intradural disc herniations pathogenesis, clinical picture, diagnosis and treatment.

The relatively rare occurrence and uncertainty about pathogenesis of intradurally displaced disc herniations stimulated an anatomico-pathological study into intradural disc herniations. The relation between the ventral dura and posterior longitudinal ligament in the cervical, thoracic, lumbar and sacral regions were examined macroscopically and microscopically, and ventral and dorsal dural thickness was compared in 20 adult autopsies on patients who died from various causes; in addition, 20 late abortions and newborn cadavers were investigated in the same way. In this study, a total of 40 autopsies has shown that the ventral dura is most frequently and firmly attached to the posterior longitudinal ligament at the L4-L5 level and these adhesions may be congenital. In the adult cadavers dorsal dura was found to be thicker than the ventral dura in the lumbar and lower cervical interspaces. Three personal clinical cases of intradurally herniated disc prolapse are shortly described and the diagnosis and management of this pathology discussed.