Granulomatous glomerulonephritis in intravenous drug users: a report of three cases in oxycodone addicts

Various well-documented renal lesions are associated with intravenous drug use; however, intraglomerular mesangial granulomas have not been previously described. We report three patients who developed an unusual granulomatous glomerulonephritis and interstitial nephritis after intravenous injection of oxycodone, derived from suppositories. Granulomas were seen in an intraglomerular mesangial and also interstitial location. In both sites, the granulomas were associated with filamentous material, presumably derived from a component of the suppositories. This material was periodic acid-Schiff-positive, but negative with Congo red and silver stains. Ultrastructurally, the filamentous material was seen within the mesangial granulomas and also in a subendothelial location, suggesting derivation from the circulation with subsequent transport across the basement membrane and accumulation in the mesangium, where a granulomatous reaction was elicited. All patients developed a degree of renal failure; two of the patients require hemodialysis 20 and 30 months after presentation.     

Genetic and population perspectives on life events and depression

Population comparisons of epidemiological surveys using the same investigator-based measures suggest that large differences are possible in the experience of clinically relevant depression and of life events capable of provoking such episodes. It is argued that, given the great majority of onsets in the various populations were provoked by a life event, the differences in the experience of depression are likely to have been largely the result of psychosocial factors. Moreover, this interpretation would still be likely to hold even if heritability (h2) coefficients for depression within the component populations were substantial. The same argument would hold for the interpretation of the across-population differences in the experience of life events. New material concerning the differing experience across populations of humiliation/entrapment events, known to be particularly depressogenic, is also presented and the implications of the findings for future aetiological research discussed.     

MRI in the assessment of a newborn with cervical teratoma

Routine anaerobic culture of urine identified the urinary tract as the primary focus of sepsis in a postoperative patient with Bacteroides fragilis septicaemia. Specimens of urine from six other symptomatic patients grew > 10(8) cfu/litre of a Bacteroides species in pure growth. The significance of these isolates is discussed. Multipoint technology and the availability of anaerobic work stations have facilitated anaerobic culture and reduced its cost. The incorporation of anaerobic culture of urine into routine laboratory practice may be clinically valuable and should be considered.     

Myelodysplastic syndromes (MDS): prognostic factors and scoring systems

OBJECTIVE: To evaluate the score systems of Cassano and Sanz and suggest a new one. DESIGN: Case series. LOCATION: Teaching hospitals: EPM UNIFESP and Faculdade de Medicina de Botucatu. PARTICIPANTS: 59 patients diagnosed from 1979 to 1992. INTERVENTION: Evaluation of clinical-laboratorial data. MEASUREMENT: Statistical comparison, uni and multivariate analysis and actuarial survival curves. RESULTS: Cassano's system divided the patients into high and low risk (p = 0.0966) while Sanz's gave high, intermediate and low risk (p = 0.0108). The univariate analysis showed hemoglobin, WBC count, E/M ratio, liver size and blast percentage in BM as statistically significant. The multivariate analysis showed blast percentage in BM (p = 0.004) and Hb (p = 0.050) as significant. Our system, considering the multivariate analysis data, divided the patients into high, intermediate and low risk (p = 0.0038). CONCLUSIONS: Sanz's system was more functional than Cassano's, while ours showed predictive survival value and ease of use in clinical practice.     

CGRP-beta unlike CGRP-alpha has no osteogenic stimulatory effect in vitro

The purpose of this study is to test whether CGRP-beta has an osteogenic stimulating effect, as does CGRP-alpha, on rat bone marrow cells in vitro. CGRP-beta in different doses was added daily to bone marrow white cells, which were harvested from rats, then seeded onto a previously prepared layer of fibroblasts. CGRP-alpha in different doses was used as a positive control. Fourteen days after the start of the experiment, there was no statistical difference in the number of bone colonies between the control and CGRP-beta dishes. The CGRP-alpha dishes demonstrated an increase in the number of colonies with an increase of peptide dose.     

Bond strengths of the adhesive resin-amalgam interface

Generalized (diffuse) plane xanthoma (GPX) is a normolipaemic xanthomatosis that is very frequently associated with a haematological disorder, and especially with monoclonal gammapathies, which it may precede by several months or years. Here, we report a case of GPX associated with idiopathic Bence-Jones proteinuria, a very rare type of monoclonal gammopathy of undetermined significance. To our knowledge, this association has not been previously described.