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Extrahepatic duplication of the common bile duct (CBD) is an extremely rare anatomic variation seen in the biliary tract. It represents failure of regression of the primitive duplicated biliary ductal system, resulting in five different subtypes of the duplicated CBD as described by Choi et al. To date, only few such cases have been reported in the literature. Associated variation in branching of intrahepatic bile ducts presenting as combined dual ductal anomaly is even rarer phenomena to be seen. We report a case of a 67-year-old man with chronic kidney disease and obstructive jaundice resulting from choledocholithiasis. Evaluation revealed type IIIa branching of intrahepatic bile ducts with type Va duplication of the CBD.

Background There is limited current knowledge on feasibility and safety of kidney transplantation in COVID-19 survivors. Methods We present a retrospective cohort study of 75 kidney transplants in patients who recovered from polymerase chain reaction (PCR) confirmed COVID-19 performed across 22 transplant centers in India from July 3, 2020 to January 31, 2021. We detail demographics, clinical manifestations, immunosuppression regimen, laboratory findings, treatment and outcomes. Patients with a previous diagnosis of COVID-19 were accepted after documenting 2 negative SARS-CoV-2 PCR tests, normal chest imaging with complete resolution of symptom for at least 28 days and significant social distancing for 14 days prior to surgery. Results Clinical severity in patients ranged from asymptomatic (n=17, 22.7%), mild(n=36,48%), moderate(n=15,20%) and severe(n=7,9.3%) disease. Median duration between PCR positive to transplant was 60 days (overall) and, increased significantly from asymptomatic, mild, moderate and severe disease (49,57,83,94 days, P-value 0.019) respectively. All recipients and donors were asymptomatic with normal creatinine after surgery at a median (interquartile range) follow up of 81 (56-117) days without any complications relating to surgery or COVID-19. Patient and graft survival was 100%, and acute rejection was reported in 6.6%. Conclusions Prospective kidney transplant recipients post-COVID-19 can be considered for transplantation after comprehensive donor and recipient screening before surgery using a combination of clinical, radiologic, and laboratory criteria, careful pre-transplant evaluation, and individualized risk-benefit analysis. Further large-scale prospective studies with longer follow-up will better clarify our initial findings. Till date, this remains the first largest study of kidney transplantation in COVID-19 survivors.Supplemental Visual Abstract; http://links.lww.com/TP/C180.

Background: Corona Virus Disease (COVID-19) was declared as Global Pandemic by W.H.O. on 11th March 2020. As nationwide lockdown was imposed from 21st March 2020 in India, teleconsultation project known as eSanjeevani: Stay Home OPD” was launched by Honourable Union Health Minister. This facility was also started by the Department of Health & Family Welfare, Govt. of Himachal Pradesh at our center; Dr. Rajendra Prasad Govt. Medical College (Dr. RPGMC), Kangra at Tanda from 20th April 2020 onwards. Aim & Objective: To analyse the parameters influencing teleconsultation service from the perspective of patients during Covid-19 pandemic. Materials and Methods: This cross-sectional descriptive study was conducted through a semi-structured 10-point feedback questionnaire. The feedback was collected telephonically. A total of 131 responses were noted and analysed accordingly. Results: Out of 131 patients, 71 (54%) were males and 60 (46%) were females. All of them 131 (100%) accepted the legibility of e-prescription, and the majority (91%) of them were comfortable in procuring (downloading) the same. (83%) respondents preferred teleconsultation services over conventional OPD based services and (98%) patients also recommended teleconsultation platform to others. Conclusion: Mean rating score was 8.9±1.04 out of 10 which clearly shows that majority of patients were satisfied with teleconsultation services availed by them through Dr. RPGMC Tanda hub. Keywords: COVID- 19, Pandemics, Remote Consultation, Patient Satisfaction, Electronic Prescribing, eSanjeevni OPD.

Objectives: To analyse the utilization of outpatient eSanjeevani Telemedicine Service during COVID pandemic in a public healthcare institution in North India by profiling the attributes of patients availing online video consultation in terms of gender, age, urban-rural, organ-system involvement, speciality of OPD service given and prescription analysis. Materials and Methods: This is a descriptive, cross sectional study done at Dr. Rajendra Prasad Govt. Medical College which served as a hub in a hub & spoke type model for rendering online OPD consultations; on a software platform “eSanjeevani” developed by Centre for Development of Advanced Computing (C-DAC) Mohali. Data from 206 audio+video based online tele-OPD consultations & their prescriptions were analysed. Results: Out of a total 206, 114 (55%) were males and 92 (45%) were females. Mean ± S.D. age of patients was 42 ±19.6 years. 146 (71%) connected from rural area and 60 (29%) from urban area. 38 (18%) patients required to be referred to the health-care centre and 46 (22%) patients required a review after blood biochemistry investigations. 76 (37%) were from district Kangra of Himachal Pradesh. The most common organ system involved was musculoskeletal system (19%) followed by skin (18.4%) and gastrointestinal system (16%). The most commonly prescribed class of drugs were NSAIDs & analgesics (36%) antimicrobials (23%) and antihistaminics (18%). Conclusion: Telemedicine is an innovative solution to many of the challenges posed by COVID-19 pandemic. It can help substantially in decreasing the OPD workload in hospitals & decreasing infection chances for both patients & hospital staff. Keywords: COVID- 19, Remote Consultation, Teleconsultation, Telemedicine.

In December 2019, novel coronavirus (SARS-CoV-2) infection started in Wuhan and resulted in a pandemic within a few weeks' time. Organ transplant recipients being at a risk for more severe COVID-19 if they get SARS CoV-2 viral infection, COVID-19 vaccine has a significant role in these patients. The vaccine is a safer way to help build protection and would either prevent COVID-19 infection or at least diminish the severity of the disease. It would also reduce the risk of the continuing transmission and enhance herd immunity. Immuno-compromised patients should not receive live vaccines as they can cause vaccine-related disease and hence the guidelines suggest that all transplant recipients should receive age-appropriate 'inactivated vaccine' as recommended for general population. Though trials have not been undertaken on transplant recipients, efficacy and safety of COVID-19 vaccine have been scientifically documented for few vaccines among the general population.

Alcohol use and alcohol use disorders (AUDs) are an increasing concern among veterans, particularly those from recent conflicts in Iraq and Afghanistan. The study of biomarkers in alcohol use and AUD has moved to enhancing the understanding of the development and maintenance of AUDs, as well as investigating its association with clinical severity and potential predictors of treatment response. Cortisol, a glucocorticoid known as a stress hormone, has been linked with both stress and trauma, as well as increased alcohol suppression effects. The present review summarizes existing literature and presents suggestions for future research to evaluate whether cortisol may be a possible biomarker of alcohol use disorder risk in combat veterans. Specifically, aspects of combat deployments and high levels of PTSD, coupled with the stress of reintegration may dysregulate cortisol and increase risk to AUD. There may also be bidirectional impacts, such that alcohol is used as a coping mechanism and can dysregulate hypothalamic pituitary adrenal (HPA) axis functioning and cortisol. In the context of this framework, cortisol may serve as a biomarker for the development of AUD, as well as a biomarker of risk or relapse. This review ends with both theoretical and clinical implications, as well as directions for future research.

Posttraumatic stress disorder (PTSD) is a common psychiatric disorder for military Veterans, characterized by hyperarousal, intrusive thoughts, flashbacks, hypervigilance, and distress after experiencing traumatic events. Some of the known physiological effects of PTSD include hypothalamic-pituitary-adrenal (HPA)-axis imbalance, a cortical function resulting in neuronal deficit and changes in behavior. Moreover, excessive discharge of inflammatory molecules and a dysregulated immune system are implicated in the pathophysiology of PTSD. Due to complex nature of this disorder, the biological underpinnings of PTSD remain inexplicable. Investigating novel biomarkers to understanding the pathogenesis of PTSD may reflect the underlying molecular network for therapeutic use and treatment. Circulatory microRNAs (miRNAs) and exosomes are evolving biomarkers that have shown a key role in psychiatric and neurological disorders including PTSD. Given the unique nature of combat trauma, as well as evidence that a large portion of Veterans do not benefit from frontline treatments, focus on veterans specifically is warranted. In the present review, we delineate the identification and role of several miRNAs in PTSD among veterans. An association of miRNA with HPA-axis regulation through FKBP5, a key modulator in PTSD is discussed as an emerging molecule in psychiatric diseases. We conclude that miRNAs may be used as circulatory biomarker detection in Veterans with PTSD.

Kidney Disease: Improving Global Outcomes (KDIGO) engaged an evidence review team and convened a work group to produce a guideline to evaluate and manage candidates for living kidney donation. The evidence for most guideline recommendations is sparse and many “ungraded” expert consensus recommendations were made to guide the donor candidate evaluation and care before, during, and after donation. The guideline advocates for replacing decisions based on assessments of single risk factors in isolation with a comprehensive approach to risk assessment using the best available evidence. The approach to simultaneous consideration of each candidate’s profile of demographic and health characteristics advances a new framework for assessing donor candidate risk and for defensible shared decision making., One of the most important tasks we have to undertake is to evaluate and then care for living donors. This paper provides a summary of the KDIGO Guidelines and encapsulates what you will find in the guidelines themselves, which are published in full in a separate supplement. Care of our living kidney donors is not an evidence free void for personal opinion and practice to fill–there are data.

The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a “proof-in-concept” risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided. In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1–S109.

Background Cardiac fibrosis occurs because of disruption of the extracellular matrix network leading to myocardial dysfunction. Angiotensin II (Ang II ) has been implicated in the development of cardiac fibrosis. Recently, micro RNA s have been identified as an attractive target for therapeutic intervention in cardiac pathologies; however, the underlying mechanism of micro RNA s in cardiac fibrosis remains unclear. Next‐generation sequencing analysis identified a novel characterized microRNA, miR‐1954, that was significantly reduced in AngII‐infused mice. The finding led us to hypothesize that deficiency of miR‐1954 triggers cardiac fibrosis. Methods and Results A transgenic mouse was created using α‐MHC (α‐myosin heavy chain) promoter and was challenged with AngII infusion. AngII induced cardiac hypertrophy and remodeling. The in vivo overexpression of miR‐1954 showed significant reduction in cardiac mass and blood pressure in AngII‐infused mice. Further analysis showed significant reduction in cardiac fibrotic genes, hypertrophy marker genes, and an inflammatory gene and restoration of a calcium‐regulated gene (Atp2a2 [ATPase sarcoplasmic/endoplasmic reticulum Ca2+ transporting 2]; also known as SERCA 2), but no changes were observed in apoptotic genes. THBS 1 (thrombospondin 1) is indicated as a target gene for miR‐1954. Conclusions Our findings provide evidence, for the first time, that miR‐1954 plays a critical role in cardiac fibrosis by targeting THBS 1. We conclude that promoting the level of miR‐1954 would be a promising strategy for the treatment of cardiac fibrosis.

Pneumocephalus is a rare condition characterized by the presence of gas within the cranial cavity. This gas arises either from a trauma, tumor, surgical procedure, or occasionally from infection. Pneumocephalus secondary to chronic otitis media is an extremely rare phenomenon. We describe here a 70-year-old male, a known case of chronic suppurative otitis media who presented with sudden onset severe thunderclap headache and was eventually diagnosed as pneumocephalus.

Diabetic cardiomyopathy (DCM), a significant contributor to morbidity and mortality in diabetic patients, is characterized by ventricular dysfunction, in the absence of coronary atherosclerosis and hypertension. There is no specific therapeutic strategy to effectively treat patients with DCM, due to a lack of a mechanistic understanding of the disease process. Retinoic acid, the active metabolite of vitamin A, is involved in a wide range of biological processes, through binding and activation of nuclear receptors: retinoic acid receptors (RAR) and retinoid X receptors (RXR). RAR/RXR-mediated signaling has been implicated in the regulation of glucose and lipid metabolism. Recently, it has been reported that activation of RAR/RXR has an important role in preventing the development of diabetic cardiomyopathy, through improving cardiac insulin resistance, inhibition of intracellular oxidative stress, NF-κB-mediated inflammatory responses and the renin-angiotensin system. Moreover, downregulated RAR/RXR signaling has been demonstrated in diabetic myocardium, suggesting that impaired RAR/RXR signaling may be a trigger to accelerate diabetes-induced development of DCM. Understanding the molecular mechanisms of retinoid receptors in the regulation of cardiac metabolism and remodeling under diabetic conditions is important in providing the impetus for generating novel therapeutic approaches for the prevention and treatment of diabetes-induced cardiac complications and heart failure.

It is well recognized by orthopedic surgeons that fractures of alcoholics are more difficult to heal successfully and have a higher incidence of non-union, but the mechanism of alcohol's effect on fracture healing is unknown. In order to give direction for the study of the effects of alcohol on fracture healing, we propose to identify gene expression and microRNA changes during the early stages of fracture healing that might be attributable to alcohol consumption. As the inflammatory stage appears to be the most critical for successful fracture healing, this paper focuses on the events at day three following fracture or the stage of inflammation. Sprague–Dawley rats were placed on an ethanol-containing or pair-fed Lieber and DeCarli diet for four weeks prior to surgical fracture. Following insertion of a medullary pin, a closed mid-diaphyseal fracture was induced using a Bonnarens and Einhorn fracture device. At three days' post-fracture, the region of the fracture calluses was harvested from the right hind-limb. RNA was extracted and microarray analysis was conducted against the entire rat genome. There were 35 genes that demonstrated significant increased expression due to alcohol consumption and 20 that decreased due to alcohol. In addition, the expression of 20 microRNAs was increased and six decreased. In summary, while it is recognized that mRNA levels may or may not represent protein levels successfully produced by the cell, these studies reveal changes in gene expression that support the hypothesis that alcohol consumption affects events involved with inflammation. MicroRNAs are known to modulate mRNA and these findings were consistent with much of what was seen with mRNA microarray analysis, especially the involvement of smad4 which was demonstrated by mRNA microarray, microRNA and polymerase chain reaction.

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a drug reaction commonly occurring in association with aromatic anticonvulsants and allopurinol. It is characterized by triad of fever, skin eruption, and systemic involvement. DRESS is rare with beta-lactam antibiotics and even rarer with ceftriaxone. We describe a case of pneumonia who developed ceftriaxone-induced rash, bicytopenia, eosinophilia, transaminitis and was eventually diagnosed and managed successfully as a case of DRESS.

Catastrophic antiphospholipid antibody syndrome (CAPS) resembles severe sepsis in its acute presentation, with features of systemic inflammatory response syndrome (SIRS) leading to multiple organ dysfunction. Infections are the best known triggers of CAPS. This emphasizes the need for early diagnosis and aggressive treatment as the mortality is as high as 50%. We present a 42-year-old woman who developed SIRS postoperatively and was eventually diagnosed as CAPS.

Shrinking lung syndrome (SLS) is a infrequently reported manifestation of systemic lupus erythematosus (SLE). Reported prevalence of SLS is about 0.5% in SLE patients. Pathogenesis is not fully understood and different therapeutic modalities have been employed with variable results, as only 77 cases of SLS have been documented in literature. SLS in SLE-Scleroderma overlap has not been reported yet. We report a patient of SLE - scleroderma overlap presenting with dyspnea, intermittent orthopnea and pleuritic chest pain. Evaluation revealed elevated hemidiaphragms and severe restrictive defect. She was eventually diagnosed as a case of SLS. This case report is a reminder to the medical fraternity that SLS although a rare complication must be thought of in the special subset of patients of SLE having respiratory symptoms.

Deep vein thrombosis (DVT) is a rare but potentially serious complication of coronary angiography (CAG), incidence being just 0.05%. Only a few clinical cases of DVT after diagnostic transfemoral catheterization have been reported. Here, we describe the case of a 54-year-old woman who developed significant DVT after CAG without venous thromboembolism (VTE) and, which was treated with anticoagulants.

The urological complications of renal transplantation are well documented. In 1990, our experience of 507 consecutive renal transplants using the Leadbetter-Politano technique, which was unsplinted in the vast majority of patients, had a ureteric complication rate of 7.7%. Here, we report the long-term incidence and management of our ureteric complications in 1186 consecutive renal transplants done over the following 11 years using an extravesical onlay stented ureteroneocystostomy. We report a considerable reduction in the urological complications of renal transplantation to 3.8%. Furthermore, we were able to use percutaneous radiological techniques to salvage the majority (84.7%) of ureteric complications. Recourse to surgery was required rarely but enabled salvage of all treatment failures.

Background. High dose interleukin-2 (IL-2) has been found to produce durable antitumor responses in some patients, benefiting most greatly those patients with melanoma and renal cell carcinoma. In this paper, the hematologic toxicity and changes resulting from high dose IL-2 alone administered by intravenous bolus are discussed. Methods. One hundred ninety-nine consecutive patients treated with high dose IL-2 alone from January 1, 1988 to December 31, 1992 were included in this study. All patients had a diagnosis of metastatic melanoma or metastatic renal cell carcinoma and were treated at the National Cancer Institute (Bethesda, MD). Results. Anemia, requiring erythrocyte transfusions, occurred in 14% of all treatment courses, with a median of two units of erythrocytes transfused. Severe leukopenia (

Background Women with positive screening mammograms but negative at assessment (false-positive) are referred back to routine screening assuming that they have an average risk of breast cancer. However in a long-term follow-up of women with false-positive screening mammography we found that these women had in fact an excess risk of breast cancer later in life; RR=1.67(von Euler-Chelpin et al, JNCI 2012). This finding has later been supported by Castells et al.(Cancer Epidemiol, 2013). Furthermore, we studied the breast cancer cases in false-positive women and found that 26% of the cases were misclassified and were in fact true positives. However, even correction for misclassification, the false-positive women in our study remained at an excess breast cancer risk. At the same time, it was clear that, in the later periods of our study, when more modern techniques were used, the rate of misclassification decreased (von Euler-Chelpin et al, Cancer Epidemiol., 2014). Over time there have been changes both in the imaging and biopsy techniques. We used data from an organised screening programme in Denmark. Since its start in 1991, needle biopsies have been performed on all palpable solid lesions and on all uncertain, suspicious or malignant findings. In the very beginning fine needle aspiration cytology (FNAC) was used, later to be replaced by needle core biopsies in the majority of cases. Since 2002, suspicious micro-calcifications and impalpable mammographic findings not found by ultrasound have been examined using stereotactic needle core biopsy and later with vacuum-assisted breast biopsy as a replacement for surgical biopsy. To have a needle breast biopsy taken is a psychological burden on the woman. To minimize the harms and maximize the benefits is at the core of developing medical care. We therefore mapped the use of needle biopsies over time in a long-standing, organised screening programme. Method: We used data from the population-based screening mammography program in Copenhagen, Denmark. The programme has a database including personal records on demographic data, date of invitation, data of screening, and test results,1998-2013. Data from the Mammography Register were linked to the Danish Pathology Register (for biopsy procedures). Results: A total of 208 500 screens were included in the study. The rate of recall for assessment ranged between 1.7-3.2% of screened women with a mean of 2.4. The false-positive rate ranged between 1.0-2.5% with a mean of 1.6%. In 1998, 56% of all recalled women had a biopsy taken, which by 2013 had risen to 74% (using two-year smoothing). In proportion of all screens, the biopsy rate was 1.9% in 1998/99 which then fell to 0.7% in 2005/06 and the rose again 2.0% in 2012/13. In 1998, 59% of the biopsies were fine-needle aspiration cytology (FNAC) which by 2013 was only used in 11% of the cases, and replaced by core biopsies, ultrasound or stereotactic guided. Conclusion While the recall rate, as well as the false-positive rate, has been fairly stable during the study period the use of needle core biopsies has had a u-shaped development and has intensified in the later years. Citation Format: von Euler-Chelpin M, Vejborg I, Lænkholm A-V, Guleria S, Peterkin A, Lynge E. When needles are needed. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-02-11.

Partial rhombencephalosynapsis in the presence of Chiari II malformation has been proposed as a “new abnormality of the hindbrain and spine“. We describe a case of Chiari II malformation with imaging features mimicking partial rhombencephalosynapsis. Our case demonstrates how the imaging findings of Chiari II malformation can be confused with the above entity and highlights the differentiating features to help radiologists make an accurate diagnosis.

PURPOSE To describe the incidence and management of renal dysfunction associated with the use of high-dose interleukin-2 (IL-2) (as is currently approved) in the treatment of cancer patients. PATIENTS AND METHODS One hundred ninety-nine consecutive patients with metastatic renal carcinoma or melanoma were treated with intravenous bolus infusions of IL-2 alone (720,000 IU/kg) every 8 hours. RESULTS Patients received 310 courses (589 cycles) of therapy and most experienced oliguria, hypotension, and weight gain; 13% of cycles were discontinued due to increased serum creatinine levels. Creatinine values (mean pretherapy, 1.2 mg/dL) increased during therapy and peaked (mean, 2.7 mg/dL) approximately 1 day after discontinuation of the second cycle of IL-2. Off therapy, toxicities reversed promptly and creatinine values returned to baseline. Higher peak creatinine values occurred in patients with renal carcinoma (v melanoma), older patients, males (v females), and those who had undergone prior nephrectomy. These same patient subsets received fewer doses of IL-2, but clinical responses were not associated with creatinine values or number of IL-2 doses administered. Urinalyses showed the appearance of protein, bilirubin, RBCs, WBCs, and granular casts during therapy, which cleared completely on follow-up evaluation. CONCLUSION High-dose IL-2 can be safely administered to cancer patients. The associated renal dysfunction is transient and without evidence of intrinsic long-term renal damage. Practical guidelines for patient management have been identified.

Schistosomiasis involving the urinary tract has only occasionally been reported in North American literature and rarely from American hospital experience. Chronic infection may result in numerous abnormalities of the urinary tract which may interfere with the function of a transplanted kidney. Our institution has performed a number of renal transplants in patients who are from countries where schistosomiasis is endemic. Six patients in our group had evidence of schistosomal disease during their pretransplant evaluation and were appropriately treated. None of these patients had postoperative complications attributable to the schistosomal disease. We recommend that all patients who are from areas where urinary schistosomiasis is endemic undergo a cystoscopic examination and bladder biopsies in addition to the routine pretransplant urologic evaluation.

Carbamazepine, is well known to cause Stevens–Johnson syndrome and toxic epidermal necrolysis(TEN). Oxcarbazepine, a 10-keto analog of carbamazepine, is an anticholinergic, anticonvulsant and mood stabilizing drug, used primarily in the treatment of epilepsy. Its efficacy is similar to carbamazepine but allergic reactions and enzyme induction is low. We describe a case of oxcarbazepine induced TEN, who presented with erythematous ulcerative maculopapular rash.

Immune hemolytic anemia is a rare adverse effect of ceftriaxone, a third-generation cephalosporin, which is a commonly used antibiotic. We describe a 60-years-old lady, a case of community-acquired pneumonia, who developed severe hemolysis after the first dose of ceftriaxone. Her hemoglobin dropped from 9.6 g /dl to 5.5 g /dl. However, she improved after discontinuation of the drug and blood transfusion. This report serves as a reminder to medical fraternity that life-threatening hemolysis can rarely follow administration of ceftriaxone.

Glucocorticoid receptor (GR) content was measured in bronchoalveolar lavage fluid (BALF) cells of 20 untreated patients with sarcoidosis. A significantly higher (p

The efficacy of radio-aerosol and perfusion lung imaging in the early detection of chronic obstructive lung disease was evaluated in 38 subjects. The subjects included 5 non-smokers, 21 smokers with minimal or no respiratory symptoms and 12 patients with chronic obstructive lung disease. Each subject consented to a respiratory questionnaire, detailed physical examination, chest X-ray examinations, detailed pulmonary function tests and 99mTc-radio aerosol-inhalation lung imaging. Perfusion lung imaging with 99mTc-labelled macroaggregated albumin was performed in 22 subjects. A significant correlation (P less than 0.001) was observed between the degree of abnormalities on radio-aerosol imaging and pulmonary function tests (PFTs) including forced expiratory volume in 1 s, maximum mid-expiratory flow rate and mean transit time analysis. Abnormal radio-aerosol patterns and deranged PFTs were observed in 21 subjects each. Of 21 subjects with abnormal radioaerosol pattern 8 had normal PFTs. Of 21 subjects with abnormal PFTs 8 had normal aerosol images. Aerosol lung images and PFTs were abnormal more frequently than perfusion lung images. The results suggest that radio-aerosol lung imaging is as sensitive an indicator as PFTs for early detection of chronic obstructive lung disease and can be usefully combined with PFTs for early detection of alteration in pulmonary physiology in smokers.

Nonspecific aortoarteritis is a major cause of renovascular hypertension in children. Stenosis of the renal artery is usually long and begins at the origin of that artery. We retrospectively studied the midterm results of angioplasty during treatment and defined the predictors of restenosis in 40 stenoses in 24 children.All patients had clinically inactive disease and hemodynamically significant stenosis causing hypertension. Midterm results were analyzed by the life table method. The effect of clinical, angiographic, and technical factors on the restenosis rate was tested by the Kaplan-Meir survival method.Technical success was obtained without complications in 38 (95%) of the lesions in 22 (92%) of the patients. The stenosis decreased from 89 +/- 7% to 11 +/- 12%, the pressure gradient fell from 97 +/- 27 to 10 +/- 10 mm Hg, and blood pressure decreased from 174 +/- 14/112 +/- 11 to 141 +/- 13/88 +/- 11 mm Hg (p.001). Clinical benefit was seen in all patients with technically successful angioplasty. During the follow-up period (33 +/- 22 months), restenosis was seen in eight lesions (20%). The predicted cumulative patency rate at 5 years was 71%. Adverse effects on the rate of restenosis were associated with male sex (p = .04), stenosis beginning at the origin of the renal artery (p = .01), and more than 20% residual stenosis after angioplasty (p = .02).Our results show that hypertension in children with renal artery stenosis caused by nonspecific aortoateritis can be safely treated by renal angioplasty with excellent midterm results. A long stenosis beginning at the origin of the artery predisposes to restenosis, but repeat dilatation often produces lasting benefit.