The pathogenetic mechanism of focal segmental glomerulosclerosis (FSGS) is not known. Some authors suggest glomerular hypertrophy may precede the development of FSGS in patients with minimal lesion. It was recently reported that the size of nonsclerotic glomeruli in adults with FSGS is significantly larger than that of cases with minimal lesion. It is not clear whether glomerular hypertrophy observed in adults with FSGS is also seen in children with FSGS. Thus, we have analyzed 37 renal biopsies from children with FSGS by morphometry and the data were compared with 37 renal biopsies from age- and sex-matched patients with minimal lesion. The number of glomeruli submitted for morphometric analysis was 22.6+/-14.2 in cases with FSGS and 30.9+/-11.4 in cases with minimal lesion. Mean glomerular volume (MGV) in FSGS group was significantly larger than that of minimal lesion [(13.1+/-3.9) x10(5) microm3 vs. (10.1+/-1.9) x10(5) microm3, p<0.001]. The relative interstitial volume of renal cortex in patients with FSGS was significantly larger than that of minimal lesion [(0.106+/-0.051) microm3/microm3 vs. (0.029+/-0.012) microm3/microm3, p<0.0001]. In FSGS, the percentage of glomeruli with FSGS was significantly correlated with relative interstitial volume of renal cortex (r=0.79, p<0.0001). As is the case for adult FSGS, MGV of children with FSGS is significantly larger than that of minimal lesion. Thus, the presence of glomerular hypertrophy observed in biopsies with minimal lesion nephropathy seems to be an indication that the coexistent FSGS lesions are undetected due to sampling problems.
Child ; Adult ; Male ; Female ; Humans ; Biopsy

To evaluate the structural characteristics that might be related to the clinical features noted in preeclamptic patients with focal segmental glomerulosclerosis(FSGS), we analyzed post-partum renal biopsies of 8 preeclamptic patients with FSGS (group 1) by morphometry and glomerular studied the structural-functional relationships. These findings were also compared with those from three postpartum cases with minimal change lesion(group 2) and normal age-matched women(group 3). Mean glomerular volume (MGV) in group 1 and group 2 was (2.64 +/- 0.49) x 10(6) micrometer3 and (2.56+/-0.25)x 10(6) micrometer3, respectively. MGV in both groups was significantly increased compared with that of the control group [(1.11+/-0.22)x10(6) micrometer3](p<0.0005). The volume density of the mesangium/glomerulus [Vv(mes/glom)] in the group 1 patients was significantly increased (p<0.0001) when compared with that of the group 2 and the control group patients. The increment of Vv(mes/glom) was related to both the mesangial cell proliferation and expansion of mesangial matrix. The volume density of the capillary lumen/glomerulus [Vv(cap/glom)] in group I was significantly decreased(p<0.0001) when compared with that of group 2 and the control group. Vv(cap/glom) was directly related to Ccr in group l(r=0.70, p=0.05). These results suggest that reduced capillary luminal area caused by mesangial interposition is related to the decreased glomerular filtration rate in preeclamptic FSGS.
Pregnancy ; Female ; Humans ; Biopsy

Pathogenetic mechanisms of progressive glomerulosclerosis are not clear. We studied the long-term(10 weeks) effects of puromycin aminonucleoside(PAN) in Sprague-Dawley rats with or without uninephrectomy(UN). Compared to rats with PAN injections only, rats with uninephrectomy and PAN injections showed significantly higher serum levels of urea nitrogen(153 +/- 155 mg/dl vs. 16 +/- 4 mg/dl, p<0.01), ceatinine(2.96 +/- 1.21 mg/dl vs. 0.92 +/- 0.36 mg/dl, p<0.01), cholesterol(466 +/- 125 mg/dl vs. 94 +/- 27 mg/dl, p<0.01), and triglyceride(337 +/- 237 mg/dl vs. 111 +/- 36 mg/dl, p<0.05) as well as increased amounts of proteinuria(428 +/- 90 mg/day vs. 136 +/- 130 mg/day, p<0.01). Lesions of focal segmental glomerulosclerosis(FSGS) were more frequently observed in rats with UN and PAN injections than rats with PAN infections only(39.5 +/- 17.2% vs. 4.3 +/- 4.7%, p<0.01). Ultrastructural examination of the glomeruli from rats with UN and PAN injections revealed severe epithelial cell changes including foot process effacement, vaculoar change or pseudocyst formation and focal detachment of epithelial cells from the underlying basement membrane. The results suggest that chronic nephrosis induced by PAN showed functional and morphologic features similar to those of human FSGS. Cytotoxic effect of PAN on the glomerular epithelial cells may be an initiating factor for the development of FSGS. which may be aggravated by some hemodynamic changes induced by uninephrectomy.
Humans ; Rats ; Animals

No abstract available.
Aged* ; Humans ; Hypertension* ; Self Care*

There have been a few reports suggesting that the imune response to pulmonary tuberculosis provides the appropriate setting for the development of IgA nephropathy (IgAN). To define better the relation between pulmonary tuberculosis and IgAN, we evaluated the prevalence of pulmonary tuberculosis among 386 Korean patients with IgAN. Seventeen cases (4.4%) showed abnormal chest X-ray findings suggestive of pulmonary tuberculosis. Ten patients were male and seven were female. Only one case was a child. Urinary abnormalities were detected during the course of antituberculous medication in 11 patients, and after completion of chemotherapy in 2. Chest abnormalities were noted in the remaining 4 patient after IgAN had been diagnosed. Clinical diagnosis of tuberculosis was made mainly based on the chest X-ray findings, but sputum Acid-Fast Bacilli were detected in one patient and pulmonary granulomo was noted in 2. The patients presented various clinical manifestations such as gross hematuris (5 cases), nephrotic syndrome (5 cases), asymptomatic urinary abnormalities (4 cases) and pyuris (1 case) at time of biopsy. Histologic grading of the glomerular lesions was made with modified Meadow classification (1972): one had grade I lesion, 8 grade II, 5 GRADE III and 3 showed grade IV. Follow-up studies were made in 7 patients. Six showed resolution of urinary abnormalities after completion f antituberculous medication, while one pursued chronic renal failure 20 days after the onset. The above clinical and morphologic features suggest that pulmonary tuberculosis may be partly related to the occurrence of IgAN in some Korean patients.
Child ; Male ; Female ; Humans ; Follow-Up Studies

Anterior interosseous nerve paralysis observed in a 13-year-old boy with supracondylar fracture of the left humerus was reported. During the conservative management at a bone setter of the fracture, the gradual loss of pinch action of the thumb and index finger became conspicuous, and with operative reduction of the fracture and release of the fibrous compression and adhesion to the nerve at the ulnar head of the pronator teres, the paralysis could be relieved.
Adolescent ; Child ; Fingers ; Head ; Humans ; Humerus ; Male ; Paralysis ; Thumb

A case of disseminated bone tuberculosis was reported, observed in a 23 year old male who visited with chronic ulcer on the midportion of the left upper arm and painful, tender swelling at the proximal part of the left tibia. Brief review was done regarding its pathogenesis and controversy of its nomenclature.
Arm ; Humans ; Male ; Tibia ; Tuberculosis, Osteoarticular ; Ulcer

Low back pain and sciatica is one of the most frequent and troublesome problem in the orthopedic field. A study of the effectivity and reliability of the anterior interbody fusion with autoiliac bone graft for the spondylogenic and Discogenic back pain was done on 166 patients who had been hospitalized from January 1978 to December 1984. The approach to the lesion was retroperitoneal with anterior approach. The anterior interbody fusion was performed by using one block or two block from autoiliac bone. The status of the spine fusion after operation was decided by the plane roentgenogram or clinical sign, and the tomogram or dynamogram in some case. We analysed 116 patients having anterior fusionto study whether fusion rate has any relation with the number of the grafted bone, preoperative diagnosis and the level of fusion. At 9 months after operation, the clinical result was assesed and was compared between the group of the preoperative diagnosis. The following results were obtained from analysis of the cases studied. 1. The fusion rate for the grafted bone was 92.2%. There was no difference in fusion rates between the group of patients operated using one block and two-block. 2. The fate of the grafted bone could be categorized into 5 different types. 3. In patients with spondylolisthesis or spondylolysis, there was high incidence of non union.Also in terms of the vertebral level, the fusin between the L5-Sl showed high incidence of non union. 4. High fusion rate was obtained by using back brace without cast immobilization. The average duration of brace wearing was 6.6 months. 5. Overall clinical results were as follows:excellent or good 64.6%, fair 31.9%, poor 3.5%,and spondylolisthesis showed better clinical results than other diseases. 6. Post sympathectomy symptoms were noticed in 12 patients after operation and there were no permanent genitourinary problem.
Arthrodesis ; Back Pain ; Braces ; Diagnosis ; Equidae ; Humans ; Immobilization ; Incidence ; Low Back Pain ; Orthopedics ; Receptors, CXCR4 ; Sciatica ; Spine ; Spondylolisthesis ; Spondylolysis ; Sympathectomy ; Transplants

The distribution of fibronectin and laminin in early chick embryos has been studied by immunohistochemical method. Fibronectin was detected not only at the basement membranes of neural tube, dorsal aortae and somites but also at the entire mesenchyme area. But laminin only appeared at the basement membranes. During the development of chick embryo, the distribution pattern of these glycoproteins was not changed but showed strong intensity of staining. The dorsal aorta of a 2-day-old chick embryo had several layer of fibronectin-producing cells, but was devoid of laminin. Laminin expression commenced faintly after Day 3. In the brain capillary wall, fibronectin was distributed but laminin was not at Day 10. In the cardiac jelly, fibronectin was detected as thin dotted strands but laminin was not expressed at Day 2. Along the endocardium, fibronectin was detected but laminin was not found. After Day 3, fibronectin was found as increased in endocardium, myocardium and cardiac jelly, whereas laminin expression commenced. Cushion mesenchymal cell migration and development of myocardial trabeculae were inhibited by antifibronectin injected in the cardiac jelly but not anti-laminin. Conclusively, this study suggests that fibronectin and laminin are glycoproteins in the extracellular matrix but there is a difference between their distributions. Cushion mesenchymal cell migration from endocardium and development of trabeculae in chick embryonic heart are inhibited by anti-fibronectin. This result suggests that fibronectin is a `stepping stone` for the embryonic migrating cells and triggers cell migration. But laminin may not serve as a matrix for cell migration.
Animals ; Aorta ; Basement Membrane ; Brain ; Capillaries ; Cell Movement ; Chick Embryo* ; Endocardium ; Extracellular Matrix ; Fibronectins* ; Glycoproteins ; Heart ; Laminin* ; Mesoderm ; Myocardium ; Neural Tube ; Somites

In this study, the feasibility of identification and genotypic differentiation of enteroviruses was investigated by using nested reverse transcription-polymerase chain reaction (nested RT-PCR), single-stranded conformation polymorphism (SSCP), and restriction fragment length polymorphism (RFLP) techniques. Two hundred seventy-four clinical samples were assayed by both nested RT-PCR and tube culture method using MRC-5 and MK cells; 58 (86.6%) out of 67 enterovirus culture-positive samples contained enteroviral RNA. In addition, 114 (55.1%) of 207 samples from patients with suspected enteroviral CNS disease with negative viral cultures were positive by the nested RT-PCR. The nested RT-PCR products were genotyped by the SSCP method and the results were compared with serotypes. We could differentiate 6 subtypes, 3 of which are similar to coxsackievirus B3, B5, echovirus 11, plus 3 other subtypes. RFLP cleaved with Sty I, Bgl I, and Xmn I yielded characteristic patterns for each laboratory strains. This study demonstrates the usefulness of the RT-PCR for the rapid diagnosis of enterovirus infection and the potentials of the SSCP method for differentiation of enterovirus strains.
Central Nervous System Diseases ; Diagnosis ; Enterovirus B, Human ; Enterovirus Infections ; Enterovirus* ; Genotype* ; Humans ; Polymorphism, Restriction Fragment Length ; Polymorphism, Single-Stranded Conformational ; RNA