Clinical, radiological, and physiological differences between obliterative bronchiolitis and problematic severe asthma in adolescents and young adults: the early origins of the overlap syndrome?

PURPOSE: Few reports have compared chronic obstructive lung diseases (OLDs) starting in childhood. AIMS: To describe functional, radiological, and biological features of obliterative bronchiolitis (OB) and further discriminate to problematic severe asthma (PSA) or to diagnose a group with overlapping features. RESULTS: Patients with OB showed a greater degree of obstructive lung defect and higher hyperinflation (P < 0.001). The most frequent high-resolution computed tomography (HRCT) features (increased lung volume, inspiratory decreased attenuation, mosaic pattern, and expiratory air trapping) showed significantly greater scores in OB patients. Patients with PSA have shown a higher frequency of atopy (P < 0.05). ROC curve analysis demonstrated discriminative power for the LF variables, HRCT findings and for atopy between diagnoses. Further analysis released five final variables more accurate for the identification of a third diagnostic group (FVC%t, post-bronchodilator ΔFEV(1) in ml, HRCT mosaic pattern, SPT, and D. pteronyssinus-specific IgE). CONCLUSIONS: We found that OB and PSA possess identifiable characteristic features but overlapping values may turn them undistinguishable.

Faecal and serum levels of eosinophil cationic protein in a healthy paediatric population.

BACKGROUND: Eosinophil cationic protein (ECP) has been regarded as an excellent marker of eosinophil activation in various diseases where eosinophil-mediated inflammation plays a role. Recently, it has been suggested as a faecal marker of intestinal inflammation in several immune-mediated diseases with gastrointestinal expression. Owing to the scarcity of information at paediatric age, the establishment of reference values is necessary before further clinical studies. OBJECTIVE: To determine faecal and serum ECP levels in healthy children and their association with other biological parameters, thereby providing background additional validation data for this age group. METHODS: Faecal and serum ECP levels were available from healthy Caucasian children recruited at a regular outpatient clinic. Exclusion criteria were: chronic illnesses, acute illness, mucosal bleeding and recent pharmacological medication. Faecal and serum ECP levels and faecal a1AT were determined by commercial radioimmunoassay and serum IgE by fluoroenzyme immunoassay Uni-CAP. RESULTS: Mean and median faecal ECP levels were 1.93 microg/g and 1.20 microg/g, respectively (range 0.41-22.20),while the corresponding serum ECP levels were 13.50 microg/L and 9.54 microg/L, respectively (range 0.20-74.8). The cut-offs found were 2.80 microg/g and 16.89 microg/L for faecal and serum ECP, respectively. A significant (p=0.001) increase in serum, but not in faecal, ECP levels was found among patients with high peripheral eosinophil blood count. Neither faecal nor serum ECP levels were influenced by serum IgE levels. CONCLUSIONS: Faecal and serum ECP levels, as determined in the present study, add background information concerning reference levels at paediatric age for further studies indifferent clinical settings.

IgG subclasses serum concentrations in a population of children with Down syndrome: comparative study with siblings and general population.

Serum total IgG and subclasses were determined in three different groups of children: with Down syndrome, their siblings and general pediatric population. Several cases of IgG2 and IgG4 deficiency were identified, predominantly in children with Down syndrome. The differences, considering three age groups, were statistically significant for both groups in relation to the general population group, with an increase of IgG1 and IgG3 and a decrease in serum concentrations of IgG2 and IgG4. Down syndrome children and their siblings tend o have a similar variation of the IgG4 serum concentration levels (P < 0.05). The mechanisms of this concordance are not well understood. The results point out that an adequate strategy to improve the immune status of Down syndrome children could have a positive manifestation in the immune profile of their brothers.

[A comparative study of ultrasonography, computed tomography and magnetic resonance imaging in the staging and invasiveness of adjacent structures by renal tumors]. / Estudo comparativo dos métodos de ultra-sonografia, tomografia computadorizada e ressonância magnética no estadiamento e invasão das estruturas adjacentes por tumores renais.

BACKGROUND: Ultrasonography (US), Computed Tomography (CT), and Magnetic Resonance imaging (MR) were compared for the staging of renal tumors. The differences between these imaging techniques were also studied for their ability to detect adenopathies, vascular invasion, distant intra-abdominal metastases, and particularly adjacent organ invasion. METHODS: Thirty-one patients with solid or complex renal masses were prospectively studied using US, CT, and MR. Differences between the results obtained were studied using the COCHRAN G test and the McNEMAR test. The sensitivity and specificity of each diagnostic technique were compared against a "gold standard" of the surgical and histopathological findings. RESULTS: The following sensitivities were obtained: For the detection of adenopathy, US 63.6%, CT and MR 90.9%. For vascular invasion, US 42.8%, CT and MR 85.7%. For the adjacent organ invasion, US 28.5%, CT 85.7%, and MR 71.4%. Some of the criteria that suggest invasion of adjacent structures include: the envelopment of the adjacent structures by the tumor, tumor extension into the adjacent structures with an irregular appearance, and alterations in shape, size, and density of adjacent structures. Loss of fat planes between the tumor and adjacent structures is not a sign of tumor invasion. CONCLUSIONS: Significant differences were found in the detection capacity of US in relation to CT and MR, which were similar. All three techniques were highly sensitive and specific only in the detection of distant abdominal metastases. In addition to the accuracy of these diagnostic modalities for the detection and staging of tumors, invasiveness, risks and cost should be considered in relation to relative costs and benefits.

Single-cell gel (comet) assay detects primary DNA damage in nonneoplastic urothelial cells of smokers and ex-smokers.

A protocol for DNA damage assessment by the single-cell gel (SCG)/comet assay in human urinary bladder washing cells was established. Modifications of the standard alkaline protocol included an increase to 2% of sodium sarcosinate in the lysis solution, a reduction in the glass-slide area for comet analysis, and a cutoff value for comet head diameter of at least 30 microm, to exclude contaminating leukocytes. Distinguishing cell populations is crucial, because significant differential migration was demonstrated for transitional and nontransitional cells, phenomena that may confound the results. When applying the modified protocol to urinary bladder cells from smokers without urinary bladder neoplasia, it was possible to detect a significant (P = 0.03) increase in DNA damage as depicted by the tail moment (6.39 +/- 3.23; mean +/- 95% confidence interval; n = 18) when compared with nonsmokers (1.94 +/- 1.41; n = 12). No significant differences were observed between ex-smokers and current smokers regarding comet parameters. Inflammation was not a confounding factor, but DNA migration increased significantly with age in nonsmokers (r = 0.68; P = 0.014). Thus, age matching should be a concern when transitional cells are analyzed in the SCG assay. As it is well known, DNA damage may trigger genomic instability, a crucial step in carcinogenesis. Therefore, the present data directly support the classification of individuals with smoking history as patients at high risk for urinary bladder cancer.

[Immunoglobin subclasses and determination of specific antibodies. What role in the study of children with recurrent pneumonias?]. / Subclasses de imunoglobinas e doseamento de anticorpos específicos. Que papel no estudo das crianças com pneumonias recorrentes?

BACKGROUND: Recurrent pyogenic infections, including pneumonia, are known to occur in children with a defective immune system. Until recently, diagnosis was made by measuring major immunoglobulin isotypes and IgG subclasses. Recent reports show that in some cases all these measurements are normal, but that there is a defect in the production of specific protein or polysaccharide antibodies. OBJECTIVE: To study immune function in children with recurrent pneumonia to determine the most appropriate immunologic studies for the evaluation of recurrent infections in children. METHODS: Forty-three children (ages 2 to 12 years; mean 5.3 years, 29 male) who were referred to our pulmonology clinic because of recurrent lower respiratory tract infections. Major causes of recurrent infections were excluded by clinical, radiological or laboratory studies. Immunologic studies included serum immunoglobulins, IgG subclasses, IgA subclasses, isohemagglutinins and antibody responsiveness to vaccination with tetanus, rubella, H. influenza b conjugate and pneumococcal polysaccharide. RESULTS: The majority of children had normal or elevated serum immunoglobulin and subclass levels. Three patients had low levels of IgG2 and IgA, alone or simultaneously. Eleven patients failed to respond to Hib or rubella vaccination and one failed to respond to pneumococcal immunisation. CONCLUSIONS: Our preliminary results seem to indicate that a high proportion of children with recurrent pneumonia have a demonstrable immunologic abnormality. There is no direct relationship between low levels of IgG subclass and the child's capacity to form antibodies to several antigens. Defects in antibody production are very specific and an extended panel is necessary. Examination of the antibody-forming capacity seems important in the initial evaluation of children with recurrent pneumonia.

[Treatment of hemangioma of the glans penis using Nd:Yag laser. Apropos of a case]. / Traitement de l'hémangiome du gland par laser Nd:Yag. A propos d'un cas.

Hemangioma of urinary tract are unusual, being about 2% of all hemangiomas. We present a case of a glans penis hemangioma. There is controversy concerning their treatment and outcome. Our patient was treated with a Neodymium: Yag laser irradiation, with complete morphological recuperation.

[Urinary flow in children: correlation with age, body height and body surface area]. / Débitmétrie dans l'enfance: corrélation avec l'âge, la taille et la surface corporelle.

Peak flow rate data (Qmax) are important for diagnosis of lower urinary tract obstruction. However, the lack of uroflowmetry studies in children, makes their interpretation difficult. With this aim, we studied 167 boys classified in four groups according to their age (G1: n = 48, 6-7 years; G2: n = 43, 8-9 years; G3: n = 37, 10-11 years; G4: n = 39, 12-14 years). We studied in all children, weight, height, body surface area, peak flow rate (Qmax) and the correspondant urinary volume (Vol). Means and standard deviations of Qmax (ml/sec) were: 15 +/- 5 (G1), 15 +/- 5 (G2), 17 +/- 5 (G3) and 22 +/- 7 (G4) respectively. Corresponding urinary volumes (Vol) (mean standard deviation-in ml) were: G1 = 123 +/- 75; G2 = 122 +/- 79; G3 = 158 +/- 96 and G4 = 162 +/- 101. We found a significant correlation (p < 0,01) between Qmax and Vol in groups G2, G3 and G4; and between Qmax and height in groups G1 and G4. The authors demonstrated a positive correlation between maximum flow and voided volume, and an increase of Qmax with age.

End-to-side neurorrhaphy with removal of the epineurial sheath: an experimental study in rats.

Terminolateral neurorrhaphies were used up to the beginning of this century. After that, they were no longer reported. We tested the efficacy of a new type of end-to-side neurorrhaphy. A group of 20 rats had the peroneal nerve sectioned, and the distal ending was sutured to the lateral face of the tibial nerve after removing a small epineural window. All experiments were made on the right side, the left one remaining untouched in half the animals of each group. The other half was denervated by sectioning and inverting the endings of the peroneal nerves. In this way, tibial cranial muscles were either normal or denervated on the left side and reinnervated through end-to-side neurorrhaphies on the right side. After 7.8 months, the animals were subjected to electrophysiologic tests, sacrificed, and the nerves and muscles were taken for histologic examination. A response of the tibial cranial muscle was obtained in 90 percent of the animals. The distal ending of the peroneal nerve showed an average of 861 nerve fibers. The average areas of the reinnervated tibial cranial muscles were (microns 2) 1617.81 for M2n (when the contralateral side was normal) and 1579.19 for M2d (when the contralateral was denervated). We conclude that the terminolateral neurorrhaphy is functional, conducting electrical stimuli and allowing the passage of axons from the lateral surface of a healthy nerve, to reconstitute the distal segment of a sectioned nerve. The absence of an incision on the axons of the donor nerve was no impediment to axonal regeneration or to the passage of electrical stimuli. The results demonstrate the possibility of using end-to-side and terminolateral neurorrhaphies for reconstituting neural lesions when only a distal end is available; the reinnervation can be obtained from the lateral face of a healthy nerve.

Two end-to-side neurorrhaphies and nerve graft with removal of the epineural sheath: experimental study in rats.

We have studied a new type of end-to-side nerve repair in rats. The healthy (donor) nerve was not divided but an epineural window was created. In our experiment, a nerve graft bridged the tibial nerve to the distal end of the divided peroneal nerve. Electrophysiological studies showed electrical impulses conducted through both end-to-side nerve junctions. Histological studies demonstrated axons leaving the lateral surface of the healthy (donor) nerve. Based on these observations, we suggest that end-to-side neurorrhaphy from a healthy nerve may bridge a neural deficit.

[Leiomyoma of the bladder. Apropos of a case and review of the literature]. / Le léiomyome de la vessie. A propos d'un cas et revue de la littérature.

Mesodermal tumors of the urinary tract are unusual, being leiomyoma the most frequent tumor type. We present a case of leiomyoma of the urinary bladder in a 29 year old woman and review the literature. Clinical features, diagnosis and treatment are discussed.

Specific immunotherapy 3 years follow-up in asthmatic children.

Seventy seven children, aged 4-10 years with bronchial asthma and sensibilization to D.pt were included in this study, divided in two groups: group A included 42 children submitted during 3 years to Sl; group B included 35 children followed during the same time period but not submitted to Sl. This group was regarded as the control group. The clinical evolution was evaluated every three months by clinical assessment, medication scores and DEMI. Total IgE, RAST, D.pt and IgG4 have been determined every year. The obtained results showed a clear improvement of the clinical score and reduction of medication use in the group submitted to Sl. In this group there was a total absence of medication during the last 6 months of Sl in 45.2% of the patients, while in the control group only 5.7% of the patients went completely without symptomatic and prophilactic therapy during the same time period. None of the children presented acute systemic reactions that could constitute a risk for their lives. 4 children presented systemic reactions, 3 of them with a bronchial asthma crisis, reversible with bronchodilating therapy and a child presented a rash reaction; two of them abandoned Sl. 13 children presented grade IV local reactions and one of them abandoned Sl; the others continued Sl with a reduction of the maintenance dose. Sl proved to be a safe and efficient ethiopathogenic therapy for child bronchial asthma treatment, when based on a clear selection of the cases and fulfillment of the safety rules established by the Allergology and Clinical Immunology European Academy.

Latero-terminal neurorrhaphy without removal of the epineural sheath. Experimental study in rats.

Termino-lateral neurorrhaphies have been used up to the beginning of this century. After this period, they have no longer been reported. We tested the efficacy of a new type of latero-terminal neurorrhaphy and evaluated the role of the epineural sheath. A group of 10 rats had the fibular nerve sectioned and the distal ending was sutured to the lateral face of the tibial nerve without removing the epineurium. All experiments were made on the right side, the left one remaining untouched in half of the animals of each group. The other half were denervated by sectioning and inverting the endings of the fibular nerves. In this way, tibial cranial muscles were either normal or denervated in the left side and reinnervated through latero-terminal neurorrhaphy in the right side. After 7.7 months, the animals were subjected to electrophysiological tests, sacrificed, and the nerves and muscles were taken for histological exams. A response of the tibial cranial muscle was obtained in 75% of the animals. The distal ending of the fibular nerve showed an average of 498 nerve fibers. The average areas of the reinnervated tibial cranial muscles were (mu 2):841.30 for M2n and 1798.33 for M2d. We concluded that the termino-lateral neurorrhaphy was functional, conducting electrical stimuli and allowing the passage of axons from the lateral surface of a healthy nerve, to reconstitute the distal segment of a sectioned nerve. The presence of the epineurium was no impediment to axonal regeneration or to the passage of electrical stimuli.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of nephrectomy on the growth of a murine Wilms tumor: a study using parabiotic rats.

It has been reported that unilateral nephrectomy causes acceleration of the growth of a Wistar/Furth rat Wilms tumor. We studied this phenomenon in parabiotic rats by measuring tumor growth after either sham nephrectomy, or excision of 1, 2 or 3 kidneys. We observed no stimulation of tumor growth in the experimental groups. Renal function was significantly decreased after removal of 2 or 3 kidneys. Serum creatinine levels were significantly different between right and left members of parabiotic pairs in these 2 groups. The effect of unilateral and bilateral nephrectomy on tumor growth in single rats also was examined. In these rats progressive increases in tumor growth were observed after unilateral and bilateral nephrectomy. Our inability to demonstrate a tumor-stimulating factor in the parabiotic model may be due partly to incomplete sharing of humoral factors between parabionts. Serum transfer studies in vitro may prove more fruitful in demonstrating such a factor.

Cyclophosphamide and inhibition of renal compensatory hypertrophy.

The objective of the present study was to determine whether cyclophosphamide inhibits nephrectomy-induced compensatory renal hypertrophy directly or indirectly owing to the reduced food intake caused by the drug. We measured kidney weight and renal water, protein, deoxyribonucleic acid (DNA), and ribonucleic acid (RNA) content and the renal RNA/DNA ratio in 72 rats distributed into groups as follows: left nephrectomized/cyclophosphamide-treated rats; left nephrectomized/saline treated rats; left nephrectomized rats submitted to food restriction and treated with saline; and left sham-nephrectomized rats treated with saline. An additional group of 12 rats was studied to obtain the initial values of the parameters. The parameters were also measured 1, 2 and 3 weeks after left nephrectomy or sham-operation. Cyclophosphamide was given once a week intraperitoneally at the dosage of 60 mg/kg body weight in saline. Corresponding volumes of saline were given to control animals. At the end of the 1st week all nephrectomized groups of rats showed some degree of renal compensatory growth. However, no significant differences in kidney weight, protein or RNA content were detected between controls, cyclophosphamide-treated rats, and animals submitted to food restriction at the end of the 2nd and 3rd week. We conclude that cyclophosphamide inhibits but does not abolish compensatory renal hypertrophy after uninephrectomy in the young rat and this inhibition is mediated primarily through the reduced food intake caused by the drug.

Resseccao transuretral (RTU) de prostata no cao estudo das repercussoes na funcao renal e no fluxo e composicao da linfa. / Transurethral resection of the prostate in the dog study of the repercussions on the renal function and on the flow and composition of the lymph

Com o objetivo de avaliar as repercussoes imediatas da RTU da prostata em funcao renal e no fluxo e composicao da linfa, empregaram-se o modelo de RTU no cao (Trindade e col., 1974) e o manitol a 5% como liquido de irrigacao. Para estudar separadamente as repercussoes dependentes exclusivamente da RTU nao complicada e aquelas decorrentes da perfuracao da capsula prostatica, com extravasamento do liquido de irrigacao, os animais foram distribuidos em 3 grupos experimentais: (1) controle, (2) ressecado e (3) perfurado. A RTU com e sem perfuracao causou elevacao do potassio da linfa, que foi atribuida a hiponatremia acentuada e ao trauma cirurgico provocado nesses animais. Nao foi possivel demonstrar repercussoes em parametros de funcao renal dependentes da RTU com ou sem perfuracao da capsula prostatica