Background
To clarify the therapeutic impact of tonsillectomy and combined therapies of tonsillectomy plus steroid on the long-term prognosis of immunoglobulin A nephropathy (IgAN).
Methods
A ...retrospective study was conducted on 208 patients with IgAN between 1986 and 2009. According to the strategies for treatments, patients were divided into four groups: tonsillectomy and steroid pulse (TSP,
n
= 47), tonsillectomy and oral steroid (TOS,
n
= 33), tonsillectomy alone (T,
n
= 56), and N group (no particular therapy,
n
= 72). Multivariate analysis based on the Cox’s regression model was used to assess the relative risk of reaching the outcome of doubling creatinine based on the influence of baseline prognostic factors.
Results
The mean observation periods were 53.8 months in the TSP group, 122.0 months in the TOS group, 102.9 months in the T group, and 84.6 months in the N group. During an observation period, serum creatinine levels doubled as follows: one in the TSP group (2.1 %), two in the TOS group (6.1 %), five in the T group (8.9 %), histological severity, and 22 in the N group (30.6 %). The Cox’s regression proportional hazard model showed that gender, age, histological activity, dialysis induction risk and therapy were associated with doubling creatinine levels. Hazard ratios (95 % CI) and (
P
value) in T, TOS, and TSP groups versus N were 0.314 (0.11–0.93,
P
= 0.037), 0.213 (0.04–1.10,
P
= 0.065), and 0.032 (0.00–0.28,
P
= 0.002), respectively.
Conclusion
A combination therapy of tonsillectomy and steroid pulse had the most significant therapeutic impact compared to other therapies.
Ovid's Metamorphoses can, as announced in its opening lines (1.1-4), be characterized as an epic which is one continuous song composed of variegated stories of metamorphoses. According to B. Otis, ...this characteristic consists of three elements: continuity, variety and unity. Furthermore in some cases Metamorphoses shows a structure in which a story is told in yet another story. The aim of this paper is to demonstrate the importance of this characteristic in connection with Orpheus' song (10. 148-739). In book ten Orpheus sings seven stories, and they are connected with each other to be one unified song. This paper examines the first two stories ('Ganymede' and 'Hyacinthus') and the last two ('Adonis' and 'Atalanta') in his song. We shall discuss the interrelation among these stories in respect of the common elements, 'gravity', 'lightness', 'earth' and 'sky', which can be found in them. First, in the stories of 'Ganymede' and 'Hyacinthus' we find that the elements of 'gravity and lightness' and 'earth and sky' are emphasized. These two stories are connected by these elements which point to the contrast between Ganymede and Hyacinthus. For instance, Ganymede was loved by Jupiter and snatched away into the ether, whereas Hyacinthus, who was loved by Apollo on earth, became flower on the ground after his death. Moreover, in the scene of death and transformation of Hyacinthus these elements are important in that they underline the contrast between mortals and immortals. Mortals have the attribute symbolized as 'earth and gravity'. On the other hand, immortals including Ganymede after he was brought up to heaven, have the attribute of 'sky and lightness'. This shows that these elements create not only the narrative continuity but also the correspondences between the stories. These elements play a vital role in unifying the stories. Second, we shall discuss the interrelation between the stories of 'Adonis' and 'Atalanta'. Adonis, who is described as having the attribute of 'gravity' in the first part of story, obtains the 'lightness' when he is transformed into an anemone. In contrast, Atalanta, who has the 'lightness' in the first part, obtains the 'gravity' when she is transformed into a lioness. Even though their metamorphoses show a striking contrast, they resemble each other in that they both relate to the 'earth'. This resemblance becomes clearer when we compare them with the elements of 'lightness and sky' of Venus and notice the contrast between mortals and immortals. By focusing our attention on the 'gravity and lightness' and 'earth and sky', we perceive the interrelation between these stories. The first two stories and last two, which form the outer frame of Orpheus' song, depict love and sorrow of humans and gods. These stories draw the contrast between mortals who have the attribute of 'gravity and earth' and immortals characterized by the nature of 'lightness and sky'. We conclude that these elements create interrelation among stories and the unity of Orpheus' song.
Maxacalcitol therapy was applyed for treatment of secondary hyperparathyroidism associated with an intact parathyroid hormone (intact-PTH) level higher than 500pg/mL in three patients on peritoneal ...dialysis. The patients were one male and two females aged 51.3 years on average. The mean duration of dialysis was 5.7 years and all patients had been maintained on CAPD alone. Intravenous administration of maxacalcitol was initiated with a single dose of 10μg weekly. When the intact-PTH level failed to decrease, the dose was increased gradually to a maximum dose of 30μg by 10μg per week, and then was adjusted to maintain the intact-PTH level between 100pg/mL and 250pg/mL. The intact-PTH level decreased in all patients. Levels of osteocalcin and bone alkaline phosphatase, a bone formation marker, also decreased. However, maxacalcitol therapy was discontinued in one patient who showed an increased intact-PTH level after the dose of the drug was reduced due to hypercalcemia, and in another patient who developed an increase of CPK in association with neurological symptoms of numbness. As reported above, treatment with maxacalcitol was effective in controlling secondary hyperparathyroidism in CAPD patients, but it is necessary to pay careful attention to adverse reactions such as an increase in CPK especially after reduction of dose.
Reticulocyte hemoglobin content (CHr), percentage of hypochromic red blood cells (%HRC, level of serum transferrin receptor (sTfR), and STIR/serum iron ratio (sTfR/Fe) were measured in 132 ...hemodialysis patients. On univariate analysis, CHr was positively correlated with serum amyloid A (SAA) and negatively correlated with Kt/V. %HRC showed a positive correlation with the recombinant human erythropoietin (rHuEPO) dosage. The dependency of each iron-status index on 5 variables, SAA, sFt, TS, KtN, and dose of rHuEPO administered, was determined by stepwise multiple regression analysis. CHr was influenced only by TS, while %HRC, sTfR and sTfR/Fe were influenced by both logrHuEPO dosage and TS. Patients whose hemoglobin concentration increased by more than 1 g/dl following iron supplementa-tion were defined as Iron-Responders, and the remaining patients were defined as Iron-Nonresponders. Fifteen out of 20 patients responded to 10 consecutive intravenous administrations of 80 mg of saccharated ferric oxide at each dialysis session, while five did not. The baseline CHr was significantly lower in Iron-Responders than Iron-Nonresponders. The baseline %HRC, sTfR, and sTfR/Fe were significantly higher in Iron-Responders than Iron-Nonresponders. The baseline CHr, %HRC, and sTIR/Fe were correlated with the degree of change in Hb concentra-tion at 4 weeks of iron supplementation. The absolute change in CHr at 2 weeks of iron supplementation was positively correlated with the absolute change in Hb concentration over the first 4 weeks. Conclusion:(1) In assessing the iron metabolic status of dialysis patients, CHr, %HRC, and sTfR/ Fe were unique indices compared with the ordinary indices, particularly in diagnosing the functional iron deficiency state. (2) CHr was a valuable marker of iron deficiency anemia and could predict the degree of increase in Hb level following iron supplementation. (3) The %HRC and sTfR/Fe seemed to reflect both erythropoiesis induced by rHuEPO and the iron supply to erythropoietic cells.
Diffuse hyperpigmentation is common in patients with chronic renal failure undergoing hemodialysis (HD) or peritoneal dialysis (PD). We previously reported that serum levels of 5-S-cysteinyldopa ...(5SCD, a pheomelanin precursor) and pheomelanin were significantly elevated in HD patients.
Skin color was assessed using a Mexameter that measures the melanin index (MI) and the erythema index (EI). The upper inner arms (non-sun-exposed site) and the foreheads (sun-exposed site) of HD and PD patients and control subjects were analyzed.
MI values on the upper inner arms and on the foreheads of HD and PD patients were significantly higher than in controls. In HD patients, significant correlations were found for serum 5SCD levels with MI and EI on the upper inner arm, and for EI on the forehead. In PD patients, no such correlations were found.
Hyperpigmentation in HD patients results partly from accumulation of pheomelanin in the skin.
This study was designed to clarify if high performance membranes are effective in removing Di-(2-ethylhexyl) phthalate (DEHP) by measuring DEHP, which is an endocrine disrupter. During in vitro ...experiments, we circulated albumin solution in blood tubes and measured DEHP concentrations. Also, we circulated albumin solution in blood tubes connected to regenerated cellulose membranes (CU) or cellulose triacetate membranes (CTA). DEHP eluted from the tubes was 0.95mg. It consisted of 0.72mg from a CU membrane (AMFP 110), and 0.17mg from a CTA membrane (FB 90 U). Furthermore, we compared two different models of CTA dialyzers (FB-E (55Å) and FB-F (75Å)) to observe the influence of different pore sizes on DEHP removal. The quantity of DEHP was 0.47mg in FB 50 E, and 0.29mg in FB 50 F, the lower value found in the membrane with a larger pore size. During in vivo experiments, we measured DEHP in arterial blood before and after hemodialysis sessions. DEHP was not detected in the serum of any patients dialyzed with CU, CTA, or PS membranes over a long period. However, DEHP was detected in the serum of post-hemodialysis patients, and its concentration was 0.69±0.31mg/l in CU, while it was 0.41±0.07mg/l in CTA, and 0.25±0.21mg/l in PS. It was significantly lower in CTA and PS membranes, compared to CU. In conclusion, we can state that high-performance membranes are useful in the removal of DEHP eluted from blood circulating tubes.
Dietary zinc intake was examined by using a check list for estimating dietary habits in 48 non-diabetic patients on maintenance hemodialysis, to determine if zinc metabolism has a role in the ...development of renal osteodystrophy. A significant correlation between the zinc intake score (zinc score), an increase in the serum parathyroid hormone level (PTH-c ng/ml/year; ΔPTH) and a decrease in bone density (ΣGS/D/year; Δbone density) was documented by multiple linear regression analysis using a mathematical model. The following regression equation was obtained: Δbone density=-0.070+0.016 zinc score -0.014 ΔPTH (r2=0.48, p=0.02). The probability and accuracy of this model was confirmed by the one-way analysis of variance method. These results suggest that adequate dietary zinc intake may prevent the development of renal osteodystrophy in patients on maintenance hemodialysis.
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