Introduction and Review of Literature. Diagnosis of Wegener?s granulomatosis
in the early stage is difficult because nonspecific symptoms of the disease
mimic other disorders. Our Experience. A ...retrospective review of case records
of 37 patients with Wegener?s granulomatosis referred to the Institute for
Lung Diseases in Belgrade to be diagnosed and treated over a 15-year period
was carried out. There were 37 patients (20 males and 17 females), ranging in
age from 18 to 73 years (mean age 46.2 years). The mean period from the onset
of first symptoms to diagnosis of Wegener?s granulomatosis was 4.59?6.15
months. The American College of Rheumatology criteria were fulfilled in all
patients. Twenty-five of 37 patients had evidence of systemic, generalized
form of Wegener?s granulomatosis and a limited involvement of the upper and
lower respiratory system occurred in 12 cases. The frequency of different
system involvement expressed in percents was as follows: the upper
respiratory tract 64.8%, the lower respiratory tract 100%, the kidneys 67.5%,
the musculoskeletal system 40.5%, the skin 27.2%, the eyes 8.1%, the nervous
system in two patients. Anti-neutrophil cytoplasmic antibodies test was
positive in 32 (6.5%) patients, and negative in 5 (13.5%). All patients were
antinuclear antibodies negative. Histological evidence of granulomatous
vasculitis was obtained in 34 (91.9%), whereas in three patients the
diagnosis was based on clinical manifestations and positive c-anti-neutrophil
cytoplasmic antibodies test.
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Purpose To compare the treatment outcome of two urotherapy programs in children with dysfunctional voiding (DV) through analysing the clinical manifestations and uroflowmetry parameters. Material and ...Methods Eighty-six children, mean age 7.1±2.5 years, unimproved by previous therapies, were randomly divided into two groups (group A and group B). Children in both groups were educated about the importance of regular voiding and hydratation, and about the apropriate posture during voiding. Simple voiding instructions were provided. In group A pelvic floor muscle rehabilitation was additionally assigned to children. Constipation and recurrent urinary tract infections (UTIs) were treated in both groups. Selected children from both groups received pharmacotherapy (anticholinergics or desmopressin). Uroflowmetry with electromyography of the pelvic floor and ultrasound residual urine volumes were obtained before and at the end of the 12-month treatment period. Results After one year of therapy urinary incontinence and nocturnal enuresis were cured in a significantly larger number of children in group A than in group B (P<0.001; P<0.05). Although more children with UTIs were cured in group A, the difference was not statistically significant compared to group B. There was a significant recovery constipation-wise in both groups. Post-treatment uroflowmetry parameters such as average flow rate, peak flow rate, flow time, residual urine and curve pattern were markedly improved only in group A. Conclusions Pelvic floor rehabilitation is necessary in the majority of children with DV for the purpose of curing urinary incontinence, nocturnal enuresis, constipation and UTIs. Furthermore, regularly controlled program including pelvic floor exercises leads to normalization of uroflowmetry parameters and curve type.
Purpose To compare the treatment outcome of two urotherapy programs in children with dysfunctional voiding (DV) through analysing the clinical manifestations and uroflowmetry parameters. Material and ...Methods Eighty-six children, mean age 7.1±2.5 years, unimproved by previous therapies, were randomly divided into two groups (group A and group B). Children in both groups were educated about the importance of regular voiding and hydratation, and about the apropriate posture during voiding. Simple voiding instructions were provided. In group A pelvic floor muscle rehabilitation was additionally assigned to children. Constipation and recurrent urinary tract infections (UTIs) were treated in both groups. Selected children from both groups received pharmacotherapy (anticholinergics or desmopressin). Uroflowmetry with electromyography of the pelvic floor and ultrasound residual urine volumes were obtained before and at the end of the 12-month treatment period. Results After one year of therapy urinary incontinence and nocturnal enuresis were cured in a significantly larger number of children in group A than in group B (P<0.001; P<0.05). Although more children with UTIs were cured in group A, the difference was not statistically significant compared to group B. There was a significant recovery constipation-wise in both groups. Post-treatment uroflowmetry parameters such as average flow rate, peak flow rate, flow time, residual urine and curve pattern were markedly improved only in group A. Conclusions Pelvic floor rehabilitation is necessary in the majority of children with DV for the purpose of curing urinary incontinence, nocturnal enuresis, constipation and UTIs. Furthermore, regularly controlled program including pelvic floor exercises leads to normalization of uroflowmetry parameters and curve type.
Glucocorticoids and classic immunosuppressive drugs can improve disease activity in primary glomerulonephritis (GN). However, these drugs have serious toxicity and patients frequently experience ...inadequate response or relapse, so there is a need for alternative agents. This multicenter uncontrolled study analyzed the efficacy and safety of mycophenolate mofetil (MMF) in high-risk patients with primary GN.
A total of 51 patients with biopsy-proven membranous (n = 12), membranoproliferative (n = 15), mesangioproliferative (n = 10), focal segmental glomerulosclerosis (n = 13) and minimal change disease (n = 1) received MMF with low-dose corticosteroids for 1 year. The primary outcome included the number of patients with complete/partial remission.
Proteinuria significantly decreased, from its median value of 4.9 g/day (IQR 2.9-8.4) to 1.28 g/day (IQR 0.5-2.9), p < 0.001. The urine protein/creatinine ratio significantly improved, from a median of 3.72 (IQR 2.13-6.48) to 0.84 (IQR 0.42-2.01), p < 0.001. The mean area under the curve for proteinuria significantly decreased, from 4.99 +/- 3.46 to 2.16 +/- 2.46, between the first (visits 1-2) and last (vists 4-5) treatment periods (p < 0.001). The change was similar for every type of GN, without difference between groups. eGFR slightly increased (62.1 +/- 31.8 to 65.3 +/- 31.8 ml/min, p = n.s.) and ESR, total proteins, albumins, total- and HDL-cholesterol parameters improved significantly. Systolic, diastolic and mean blood pressure decreased (p < 0.02 for systolic blood pressure). The age of patients was the only independent predictor of complete or partial remission.
MMF proved to be efficient in 70% of high-risk patients with primary GN, who reached either complete or partial remission without safety concern after 12 months of treatment. Favorable effects of MMF therapy have to be confirmed in the long term and particularly after discontinuation of the drug.
HIV-infected patients may be faced with a variety of renal problem patterns. HIV-associated nephropathy is a unique pattern of sclerosing glomerulopathy and represents the most rapidly progressive ...form of focal segmental glomerulosclerosis. This study involved the examination of 32 renal biopsies: by light, immunofluorescence, and electron microscopy, in order to determine the most accurate and reliable diagnostic procedure. The findings show that the most sensitive and accurate procedure is electron microscopy, capable of detecting specific EM changes very early on, which is sufficient for the diagnosis of HIV-associated nephropathy.
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