Idiopathic membranous glomerulonephritis is a frequent cause of nephrotic syndrome and may have a variable course, from spontaneous remission to progression on renal failure. The therapy is based on ...alternating steroids and chlorambucil or cyclophosphamide (Ponticelli protocol) for six months. In absence of complete or partial remission after protocol, cyclosporine, adrenocorticotropic hormone, mycophenolate mofetil, rituximab can be used for potential therapy. We report here the case of a woman with idiopathic membranous glomerulonephritis unresponsive to the Ponticelli regimen and treated with adrenocorticotropic hormone in association with azathioprine, showing a dramatic decrease of proteinuria and beneficial effects on lipid profile. After 36 months, no relapse of disease has occurred. Although larger cohorts of patients are needed to evaluate the long-term effects, adrenocorticotropic hormone plus azathioprine in association could be a possible therapeutic option for unresponsive idiopathic membranous glomerulonephritis.
...to skeletal muscles, cardiac myofibrils contain actin and myosin, and mitochondria are largely represented in the heart . ...cachexia and heart failure may evolve concurrently during disease . ...Patients unable to give informed consent, with gastrointestinal obstruction or dysphagia, with acute or chronic heart failure, or with history of high blood pressure were excluded. F) 13:1 Age (years) 58.0 ± 20.4 Body weight (kg) 48.6 ± 12.2 BMI 18.7 ± 3.6 Albumin (g/dL) 3.7 ± 0.51 Blood protein level (g/dL) 6.0 ± 1.0 Body weight loss in the previous 6 months (kg) 7.6 ± 8 Handgrip strength (kg) 19.4 ± 7.5 Advanced cancer/chronic renal failure/pneumonia (n) 10/3/1 Correlation between LVM and LBM Our preliminary study shows that in cachectic patients, LVM correlates with LBM and serum creatinine, a recognized maker of muscularity .
Bonatti et al report the recovery of 140-Myr-old "Maiolica"-type pelagic limestones from the centre of the Atlantic Ocean basin. These old deposits within younger crust can be explained by repeated ...ridge jumping.
OBJECTIVES--To examine, by ultrasonography the prevalence of thyroid nodules in a cross sectional study of male medical workers occupationally exposed to chi radiation at the Pisa hospital, in ...comparison with controls matched for age and sex. METHODS--50 male medical workers exposed to radiation were randomly matched for age (+/- 2 years) with 100 male workers not occupationally exposed to ionising radiation who lived in a slightly iodine deficient area of Tuscany (Lunigiana) (control group 1), and with 100 male workers not exposed to radiation who lived in the same area (Pisa) (control group 2). RESULTS--Of the occupationally exposed subjects, thyroid nodules were detected in 19/50 (38.0%). Among controls, thyroid nodules were detected in 19/100 subjects of control group 1 and in 13/100 of control group 2. Comparison of exposed and control groups, stratified into 30-39, 40-49, and 50-59 year old age subgroups, showed a higher significant relative risk for thyroid nodules in the exposed subjects. CONCLUSION--The results suggest that occupational exposure to radiation may be a risk factor for thyroid nodules.
The Romanche transverse ridge (equatorial Atlantic) is located in the northern flank of the fracture zone, opposite the eastern ridge-transform intersection (RTI). It constitutes a major positive ...topographic anomaly that reaches a height of over 4 km above the level predicted by the thermal subsidence curve. A series of E–W aligned peaks, located on the crest of the transverse ridge, were at sea level during early and middle Miocene times; they are presently capped by a ~300 m thick, shallow-water carbonate platform that grew on a subsiding oceanic crust basement surface flattened by erosion at sea level. These structures are now about 1 km below sea level. High resolution seismic reflection surveys and multibeam morphobathymetry as well as study of samples recovered from the carbonate platform allowed a reconstruction of the paleoenvironment and of the vertical movements of the peaks starting from the lower Miocene. Ages derived from microfossils suggest that the base of the carbonate platform dates from 17–25 m.y. ago and the sinking of the platform started between 18 and 13 m.y. ago. These data were included in a numerical simulation model that takes into account thermal and tectonic subsidence, growth potential of the carbonates, subaerial and submarine erosion rates and Mio-Pliocene absolute sea level fluctuations. The results outline the subsidence history of the Romanche transverse ridge and suggest post-Miocene subsidence faster than that predicted by the thermal cooling model.
Fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic vascular disease that has been reported in renal and internal carotid arteries and in almost every arterial bed, primarily ...affecting young to middle-aged people, mainly female individuals. These patients may be asymptomatic or may present with hypertension. A 29 year-old hypertensive woman was referred for a renal color Doppler ultrasound (CDU) scan because of a suspicion of renovascular hypertension and we revealed the presence of three separate stenosis on the right renal artery. Digital selective angiography (DSA) and percutaneous transluminal angioplasty (PTA) were performed but an incomplete dilation of the vessel was obtained. Because of the suboptimal result, it was decided to stent the lesions during two different procedures. Percutaneous transluminal renal angioplasty is the primary treatment of renal FMD, but should not be excluded primary stent implantation as an alternative technique to surgical revascularization.
Abstract Objective Systemic sclerosis (SSc) is a multisystemic chronic disease that is complicated by protein–energy malnutrition (PEM). Considering that PEM also may influence left ventricular mass ...(LVM), the aim of this study was to evaluate whether LVM is related to patients’ nutritional status and to determine clinically relevant features of SSc. Methods Adult patients referring to our institution were considered. Body weight, height, body mass index (BMI), involuntary weight loss, and the presence of gastrointestinal symptoms were recorded. Echocardiography was performed to assess LVM, using the Devereux regression formula. Results were then normalized by body surface area. Pattern, skin thickening, disease activity and severity, and duration were assessed to characterize SSc. Results Ninety-four patents with SSc (81 women and 13 men; median duration of disease 7 y) were studied. The prevalence of PEM as assessed by BMI < 20 kg/m2 was 19%, whereas 15% of patients reported involuntary weight loss of any degree. Patients who lost weight reported gastrointestinal symptoms more frequently ( P < 0.05). PEM was not associated with disease activity. LVM (g/m2 ) correlated with patients’ BMI ( r = 0.32; P < 0.01), and the vascular domain of disease severity (DDS; r = 0.21; P < 0.05), but it showed a negative correlation with skin thickening ( r = –0.21 P = 0.01). Patients with ulcers had a significantly greater LVM than patients without skin lesions. Conclusions Our study shows that LVM correlates with patients’ BMI, skin thickening, and the vascular domain of DSS. Therefore, LVM could serve as a marker of nutritional status and fibrosis in patients with SSc.
PDF
