Marked functional improvement in a pediatric patient treated with hemodialysis for scleroderma related renal failure

Systemic sclerosis (SSc) is a rare autoimmune disease characterized by fibrosis and vasculopathy of the skin and visceral organs. Scleroderma renal crisis (SRC), the most acute and life threatening complication, occurs in 10–20% of adult patients with SSc and has not been reported in children. A 10‐year‐old girl was diagnosed with SSc when she presented with weakness and skin thickening. She had positive ANA and anti‐Scl 70. Renal function, urinalysis, and blood pressure were normal. She was treated with steroids, penicillamin and methotrexate as well as amlodipine for Raynaud's phenomenon, but her diffuse skin thickening and contractures progressed and she became wheelchair bound and had poor growth despite nutrition through a G‐tube. At age 15 (weight 28 kg), when evaluated for abdominal pain, she was found to have acute renal failure (BUN 54 mg/dl, creatinine 2.2 mg/dl) and hypertension. Despite therapy with enalapril, serum creatinine continued to rise and she became oligoanuric, requiring initiation of hemodialysis. BP was controlled with enalapril and dialysis but she remained dialysis dependent. Steroid therapy was discontinued and replaced by low dose cyclosporine. Enalapril was replaced by losartan because of leukopenia and BP remained normal. Over the next 2 years, she was treated with hemodialysis and did not experience any complications. She progressively had an outstanding overall clinical improvement, marked skin softening, and was able to walk independently. Renal function did not improve. 28 months after the SRC, she received LRD renal transplant. Immunosuppression included cyclosporine, mycophenolate and prednisone. Creatinine 2 months post‐transplant is 0.7 mg/dl. SRC in children may progress to end‐stage renal disease but can be treated successfully with dialysis and transplantation without significant complications.     

Targeted imaging using ultrasound contrast agents

The applications of ultrasound contrast agents have recently expanded from blood pool enhancement to include passive targeting of physiological systems (in particular, the lymphatic and reticuloendothelial systems) and molecular imaging of factors expressed in angiogenesis, atherosclerosis, and inflammation. This article summarizes the progress made in targeted imaging using ultrasound with an emphasis on the opportunities this research provides for both clinical and research applications. We begin with a summary of current ultrasound contrast technology and then review the latest research in the use of targeted ultrasound contrast agents.     

“Key” sectors in final energy consumption: an input–output application to the Spanish case

In this paper we analyze the determination of “key” sectors in the final energy consumption. We approach this issue from an input–output perspective and we design a methodology based on the elasticities of the demands of final energy consumption. As an exercise, we apply the proposed methodology to the Spanish economy. The analysis allows us to indicate the greater or lesser relevance of the different sectors in the consumption of final energy, pointing out which sectors deserve greater attention in the Spanish case and showing the implications for energy policy.     

Total body irradiation and acute graft-versus-host disease: the role of gastrointestinal damage and inflammatory cytokines

The influence of bone marrow transplantation (BMT) conditioning regimens on the incidence and severity of graft-versus-host disease (GVHD) has been suggested in clinical BMT. Using murine BMT models, we show here an increase in GVHD severity in several donor-recipient strain combinations after intensification of the conditioning regimen by increasing the total body irradiation (TBI) dose from 900 cGy to 1,300 cGy. Increased GVHD was mediated by systemic increases in tumor necrosis factor alpha (TNF alpha). Histologic analysis of gastrointestinal tracts showed synergistic damage by increased TBI and allogeneic donor cells that permitted increased translocation of lipopolysacharide (LPS) into the systemic circulation. In vitro, LPS triggered excess TNF alpha from macrophages primed by the GVH reaction. In addition, macrophages isolated within 4 hours of conditioning were primed in proportion to the TBI dose itself to secrete TNF alpha. Thus, the higher TBI dose increased macrophage priming and increased gut damage after allogeneic BMT, causing higher systemic levels of inflammatory cytokines and subsequent severe GVHD. These data highlight the importance of conditioning in GVHD pathophysiology and suggest that interventions to prevent LPS stimulation of primed macrophages may limit the severity of GVHD after intensive conditioning for allogeneic BMT.     

A spectral approach for the determination of the reverberatingchamber quality factor

A simple and effective approach for the evaluation of the chamber quality factor is presented. It is based on the averaged periodogram and permits a complete spectral characterization of the efficiency of reverberating chambers. A meaningful set of experiments is performed and discussed     

Subband decomposition strategies for object‐based image coding

In order to attain perfect reconstruction, subband decomposition of arbitrarily shaped objects requires special strategies to deal with the decimation problem. One of the two strategies described in this paper (scheme 1) inserts pixels with amplitudes equal to the mean values of the neighboring ones belonging to the object. The requirement of transmitting (coding) these pixels reduces the coding gain and is avoided by the second strategy (scheme 2) examined in this paper. This strategy determines specific values of the pixels added to the object in such a way that they result in predefined amplitudes after decimation. For this reason, this method outperforms scheme 1. PSNR versus bit rate are presented for two objects. © 2003 Wiley Periodicals, Inc. Int J Imaging Syst Technol 13, 179–187, 2003; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/ima.10054     

Preparation of High - Purity Tl(1223) Ceramics

The influence of changes in the nominal composition and preparation conditions on the formation of Tl(1223) under a high isostatic gas pressure was studied. Optimization of the cation substitution allowed to increase the phase purity, whereas substitution of small amounts of oxygen by fluorine decreased the formation temperature of the Tl(1223) phase and extended the temperature range favorable for grain growth. A two-step reaction involving substantial melting produced well shaped, plate-like grains.     

Reverberating chambers as sources of stochastic electromagneticfields

Reverberating chambers are of recognized relevance in many EMC applications since they allow us to generate a reference electromagnetic statistical field. This paper investigates the electromagnetic field in reverberating chambers. Reverberating chambers are large overmoded cavities wherein a nonstationary electromagnetic field is present. This electromagnetic field is stochastic in nature; therefore, proper analytical tools need to be considered in order to characterize it. We deal with the theoretical aspects related to the characterization of the electromagnetic field inside the chamber and with the application to the case of the reverberating chamber of the Istituto Universitario Navale     

Incremental doses of diltiazem in patients with coronary artery disease in end-stage renal failure maintained on hemodialysis: which is the optimal dose?

End-stage renal disease patients on maintenance hemodialysis suffering from coronary artery disease probably receive too low doses of calcium-antagonists, because the attempt to avoid adverse effects prevails the well-documented antianginal activity of the drug. The aim of our study was to assess the safety and efficacy of incremental doses of diltiazem in treating angina pectoris in hemodialyzed patients with coronary artery disease, to identify the optimal dose. Ninety-four chronic hemodialyzed patients (59 males and 35 females; mean age 55.2 +/- 3.3 years; on periodic dialysis for 80.3 +/- 25.6 months) with coronary artery disease and more than 5 min of transient myocardial ischemia during 48 hours of Holter monitoring were included in the study. A double-blind, randomized, placebo-controlled trial design was used. Incremental doses of diltiazem (from 120 to 240 mg/day) were administered in 4 months. At doses of 120 and 180 mg/day it was observed a statistically significant reduction in the number and duration of total and symptomatic ischemic episodes in 48 hours, compared with baseline (p < 0.001). Instead, the number and the duration of silent ischemic episodes did not significantly change (NS). The efficacy on silent myocardial ischemia was obtained only with the dosage of 240 mg/day (p < 0.001). If this dosage was obtained with a sustained-release formulation (120 mg twice a day), the efficacy was similar to the administration of 4 tablets/day of 60 mg, but the tolerability was better, especially during dialysis. The circadian variations of transient ischemic episodes showed two peaks in the 24 hours, one from 6.00 to 9.00 a.m. and another from 4.00 to 8.00 p.m., just during the dialysis. Both peaks were reduced only with 240 mg/day. In conclusion, this study demonstrates that sustained-release diltiazem (120 mg twice a day) is greatly useful in patients with coronary artery disease on maintenance dialysis because it reduces the frequency of silent ischemic episodes, has a good tolerability, and modifies the circadian pattern of ischemic episodes, reducing both peaks during the day.