Search

To identify the efficacy of early cerebral MR, performed in the first month of birth, in the detection of brain lesions in high risk preterm infants, compared with conventional US, we recruited into the study a group of 30 preterm infants born at or below a gestational age of 30 weeks, who had a pathologic scan. The findings on US were compared with those of the early MR scan, performed in the same days, the results of which were considered as the final diagnosis. The value of cranial US as a predictor of MR signal intensity was assessed by calculating sensitivity, specificity, positive and negative predictive values. Agreement between two investigations was evaluated by calculating the K coefficient. US showed 33 haemorrhagic lesions in 25 preterms; MR showed 27 haemorrhagic lesions in 22 infants: in 16 cases MR gave the same results of US. Cranial US was reliable in detecting lesions such as GLH and IVH, but less sensitive in the definition of their size and distribution. Sensitivity of US for haemorrhagic lesions was 96.3%, PPV 78.8%, K coefficient 0.55 (p0.001). About the White Matter, cranial US demonstrated 20 lesions in 20 preterms; MR showed 16 lesions in 16 infants: in 3 cases MR was agree to US. US showed high reliability in the detection of cystic lesions, but significant limitations in the demonstration of non-cystic injury. We founded that normal WM echogenicity on US is not a good predictor of normal WM signal intensity on MR (30%). Sensitivity of US for WM lesions was 81.3%, PPV 65%, K coefficient 0.23 (p = 0.04). Finally US showed 4 lesions in other brain locations, MR confirmed 3 of them and discovered other 10. Sensitivity of US for these lesions was 23.1%, PPV 75%, K coefficient 0.21 (p = 0.11). We founded that cranial US is a good method for detecting GLH, IVH, HPI and severe WM lesions (cystic PVL), but it can miss non-cystic PVL, punctate haemorrhages, WMD and lesions in other brain locations, that, on the other hand, MR detects clearly.

The hypothesis that abnormalities of immune function might occur in healthy first degree relatives of two patients with a familial IgA nephropathy was tested. After 7 days of culture, pokeweed mitogen stimulated peripheral blood mononuclear cells from the two affected members with IgA nephropathy (father and older son), as well as two other healthy sons, produced significantly more polymeric IgA than the controls. The fact that only the two patients with IgA nephropathy presented high serum levels of polymeric IgA favours the idea that a defect in the clearance of this immunoglobulin might be an important step in the appearance of this nephropathy. All the healthy members of the family had a normal OKT4+/OKT8+ cell ratio and a normal concanavalin A generated IgA suppressor cell function in contrast with the abnormalities observed in the two affected members and the previous results in a large number of patients with IgA nephropathy. These data suggest that the primary cellular abnormality might reside in B cells, being the T cell alterations observed in patients a secondary or subsequent phenomenon. These results further support the existence of genetic bases for the susceptibility to this disease.

Sixteen patients on regular hemodialysis were treated with clofibrate, 500 mg three times a week for six weeks. A sustained and significant reduction of serum triglycerides occurred in thirteen patients. Serum cholesterol was also significantly reduced, although to a lesser degree. Predialysis levels of blood urea nitrogen, creatinine, and uric acid were significantly elevated during the treatment period and returned to previous levels after withdrawal of the drug. The incidence of side-effects was elevated. Five patients complained of nausea and upper abdominal discomfort, while four patients had muscle pain. Several muscle enzymes were elevated in a high percentage of patients, returning to basal values after discontinuation of the drug. It is concluded that clofibrate, although it is effective in lowering serum triglycerides in patients on hemodialysis, should not be used in such patients.