A case of IgA nephritis showing diffuse podocytic detachment from the glomerular basement membrane.

We report the case of a 15-year-old Japanese female with severe mesangial proliferative IgA glomerulonephritis who showed a dramatic response to cocktail therapy for nephrotic syndrome. She had suddenly developed massive proteinuria and microscopic hematuria. The first renal biopsy at one month after onset revealed severe mesangial hypercellularity and podocytic detachment from the glomerular basement membrane (GBM). The cocktail therapy resulted in a decrease of proteinuria clinically, and a second biopsy demonstrated repair of the podocytic detachment. We suggest that the massive proteinuria in this case was due to destruction of the size barrier by detachment of podocytes from the GBM, and the repair of the podocytic covering on the GBM was accelerated by the cocktail therapy.     

Aphakic retinal detachment.

An analysis of 54 cases of ARD, and a PRD control group, revealed that retraction of the posterior vitreous hyaloid was more severe in the aphakic eyes. On the basis of retinal break morphology, the ARD cases could be divided into two groups: (1) detachments that had resulted from small tears situated along the posterior slope of a peripheral retinal traction ridge and (2) detachments that had resulted from breaks that resembled those encountered in the PRD group. The yearly incidence of retinal detachment, in the 38 and over age group, was calculated to be 12 times greater for an aphakic eye. That increase in risk was thought to be due to the changes in vitreous morphology which follow cataract extraction.     

Management of detachment of Descemet's membrane caused by injection of hyaluronic acid

We report a case in which, in an attempt to reform a flat anterior chamber, hyaluronic acid inadvertently was injected between Descemet's membrane and the corneal stroma. The surgical repair is described and a way to prevent this complication is recommended.     

Sodium hyaluronate (Healon) in the surgical repair of Descemet's membrane detachment

Two cases of Descemet's membrane detachment are presented. In both cases, sodium hyaluronate (Healon) was successfully used to repair the detachment surgically. The viscoelastic property of sodium hyaluronate allows it to move Descemet's membrane easily into proper position and maintain it there post-operatively. Sodium hyaluronate left in the anterior chamber can cause an increase in intraocular pressure and prophylactic measures, such as diamox and timoptic should be used in these cases.     

Static progressive splinting.

Static progressive splinting is the use of inelastic components to apply torque to a joint in order to statically position it as close to end range as possible. It maximizes total end-range time, thus increasing passive range of motion. As tissue lengthens in response to this carefully applied stress, the clinician or wearer adjusts the joint position to progress tissue at the new maximum tolerable length. Static progressive splinting combines precision in joint position and torque application with patient-controlled stress to create an approach powerful enough to succeed when no other treatment approach does. This article discusses static progressive splinting indications, contraindications, and advantages as well as guidelines for a splinting regimen. It offers many examples of static progressive splinting and makes clear that this approach can be used with any mobilizing splint design. The unique mechanics of this splinting approach are described, and the various methods of achieving static progressive splinting are compared. Offering high levels of patient satisfaction and compliance, static progressive splinting has come to the forefront of clinical practice.     

Idiopathic progressive pulmonary fibrosis.

Five patients with progressive fibrotic lung disease are described. The dominant symptom was slowly increasing dyspnoea, and cough and sputum were not prominent. Marked weight loss was also a feature. There was severe restrictive impairment of ventilation with normal arterial gas tensions. The changes were confined to the upper parts of the lung in some but others had more generalized disease. The duration has varied so far from two to 17 years. The lung changes are considered to be due to dense progressive fibrosis. Necropsy in two confirmed this. Histologically there was monotonous fibrosis with lymphoid collections and secondary bronchiectasis, a picture similar to that found in association with ankylosing spondylitis. None of these patients had joint disease. Tuberculosis was excluded as a cause by exhaustive bacteriological tests and the failure of chemotherapy to stop deterioration. All other recognized types of infective and non-infective progressive lung fibrosis were also excluded, and this is not considered to be a variant of cryptogenic fibrosing alveolitis. Though these patients have many features in common they do not necessarily have the same pathogenesis. They are presented as an encouragement to further study.     

Familial progressive renal tubulopathy.

We report herein data on 6 male patients with progressive tubulopathy. These patients belonged to two families: the propositus, his father, a paternal first cousin, two paternal uncles, and a maternal uncle. A 7-year-old proband had mild proteinuria (1 g/day), consisting of beta 2-microglobulin, alpha 1-microglobulin and lysozyme, and aminoaciduria. Glycosuria and acidosis were absent. A 38-year-old father had mild proteinuria (2 g/day), including low-molecular-weight protein. Hypokalemia, hypophosphatemia, glucosuria, phosphaturia, aminoaciduria, and reduced urinary concentrating ability were also present. The other 4 affected family members also had low-molecular-weight proteinuria, detected by screening for beta 2-microglobulin. In addition, there were several abnormalities; aminoaciduria in all 6, phosphaturia in 4 of 6, hypercalciuria in all 6 and glycosuria in 2 of 6 patients. Tubular dysfunction was more severe in the older subjects, hence, the disease seems to progress with age. Familial low-molecular-weight proteinuria is apparently a progressive disease linked to a X-linked or to an autosomal dominant inheritance.     

Treatment of progressive, local, advanced cancer of the prostate

Summary Due to the lack of randomized and controlled trials comparing treatment options for locally advanced prostate cancer no clear cut therapeutical advise can be given. Currently, external beam radiotherapy is the form of treatment most often applied to which other therapeutic modalities have to be compared. Radical prostatectomy alone does not improve survival at this stage. The combination of local treatment modalities with neoadjuvant androgen deprivation seems to be a promising approach which has to be evaluated in prospectiv clinical trials.      

Macular pucker after retinal detachment surgery.

To better understand postsurgical macular pucker in rhegmatogenous retinal detachment, we reviewed a consecutive series of 277 eyes in 268 patients in whom retinal detachment had spared the macular area and in whom no preretinal membrane with distortion of the retinal vessels had been present preoperatively. Postoperatively, 17 eyes (6.1%) developed obvious macular pucker; 260 eyes (93.9%) did not. Using the Mantel-Haenszel chi-square test, we found that patient age, preoperative vitreous hemorrhage, large retinal breaks of more than three disc diameters, and cryoapplication were significant precipitating factors of postoperative macular pucker. These findings are consistent with the view that dispersion of retinal pigment epithelial cells through the retinal break into the vitreous cavity is the major cause of this disorder. Minimal use of cryotherapy is recommended in treating elderly patients who have a large retinal break or a preoperative vitreous hemorrhage.     

Macular vision following retinal detachment surgery.

We studied 100 retinal detachment patients with macular involvement who had successful scleral buckling procedures using encircling fascia lata. Aphakic patients and patients with pre-existing ocular pathology in addition to the detachment were not excluded from the series. Follow-ups of one year or more (average 26.1 months) were available for 77 of the patients. Forty-four of these patients (56.5%) achieved acuities of 20/60 or better. The duration of the detachment was an important prognostic factor; one month was the critical period for the duration of the detachment. The existence of preoperative ocular pathology in addition to the detachment was also an important prognostic indicator. There was no significant difference in the visual acuities of phakic versus aphakic patients. Half of the patients studied with respect to refractive error became more myopic with an average change of -1.01 diopters.     

Aldosterone in progressive renal disease.

Blockade of the renin-angiotensin-aldosterone system has proven effective in retarding progression of renal disease in the remnant kidney model, as well as other experimental diseases, and, most importantly, in a range of progressive human renal diseases. Attention has focused on the role of angiotensin II (Ang II) in propagating progression both by its hemodynamic and nonhemodynamic actions. Recent evidence, predominately in the remnant kidney model, indicates that the drugs used to block this hormone system, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, also lower aldosterone levels. Thus, aldosterone, as well as angiotensin II, appears to be instrumental in sustaining the hypertension and fibroproliferative destruction of the residual kidney.     

Rat supraspinatus muscle atrophy after tendon detachment.

Rotator cuff tears are one of the most common tendon disorders found in the healthy population. Tendon tears not only affect the biomechanical properties of the tendon, but can also lead to debilitation of the muscles attached to the damaged tendons. The changes that occur in the muscle after tendon detachment are not well understood. A rat rotator cuff model was utilized to determine the time course of changes that occur in the supraspinatus muscle after tendon detachment. It was hypothesized that the lack of load on the supraspinatus muscle would cause a significant decrease in muscle mass and a conversion of muscle fiber properties toward those of fast fiber types. Tendons were detached at the insertion on the humerus without repair. Muscle mass, morphology and fiber properties were measured at one, two, four, eight, and 16 weeks after detachment. Tendon detachment resulted in a rapid loss of muscle mass, an increase in the proportion of fast muscle fibers, and an increase in the fibrotic content of the muscle bed, concomitant with the appearance of adhesions of the tendon to surrounding surfaces. At 16 weeks post-detachment, muscle mass and the fiber properties in the deep muscle layers returned to normal levels. However, the fiber shifts observed in the superficial layers persisted throughout the experiment. These results suggest that load returned to the muscle via adhesions to surrounding surfaces, which may be sufficient to reverse changes in muscle mass.     

Sudden vision loss following retinal detachment surgery.

A 22-year-old man with Eales' disease with secondary rhegmatogenous retinal detachment with a break five disc diameters from the disc underwent radial scleral buckling using a silicone sponge episcleral explant with local cryopexy. Five hours after surgery the patient had no light perception. There was no intraoperative or postoperative rise of intraocular pressure or central retinal artery ischemia. Immediate removal of the explant brought a return of light perception and postoperative visual acuity improvement. The episcleral explant may have caused the direct optic nerve trauma that resulted in loss of vision.     

Hemorrhagic choroidal detachment with anterior vitreoretinal adhesions.

We present three cases of large intraoperative or postoperative hemorrhagic choroidal detachment with subsequent adherence of the retina to anterior segment structures. Surgical management involved bimanual vitrectomy through anterior sclerotomy sites and dissection within the anterior segment. Successful retinal reattachment was achieved in two of these cases (18-months' follow up). In the third case, the retina remained attached for 4 months but then redetached.