Background/Aims: Recent study suggests that activation of parietal epithelial cells (PECs) contributes to pathogenesis of glomerulosclerosis and the activation marker CD44 increases in evolving glomerulosclerosis. Here we examined the pathogenic roles of CD44+ epithelial cells in mouse adriamycin nephropathy (ADRN), a representative rodent model for idiopathic focal segmental glomerulosclerosis (FSGS). We also evaluated whether the prevalence of CD44+ PECs reflects different levels of podocyte injuries. Methods: As a model of FSGS with different degrees of podocyte injury, ADRN models in mice of different ages were utilized. Immunohistochemistry and immunofluorescence were used to determine roles of CD44 expression. Results: By immunohistochemistry, CD44 expression became positive in claudin-1+ PECs and an increase in CD44+ PECs was associated with reduced expression of synaptopodin and podocin in diseased glomeruli. Furthermore, immunofluorescence staining demonstrated co-expression with osteopontin, a CD44 ligand that plays a significant role in the progression of glomerulosclerosis, thereby suggesting interactions between these molecules. Analysis of the number of WT-1+ podocytes and the levels of electron microscopic foot process effacement revealed a milder degree of podocyte injury in younger ADRN models compared to older ones. Comparative immunohistochemical analysis indicated that the prevalence of CD44+ PECs consistently reflects different degrees of podocyte injury within each different-aged ADRN model. Conclusion: CD44+ PECs play significant roles in progressive glomerulosclerosis and the prevalence of the cells reflects different degrees of podocyte injury in ADRN.

Electrolyzed strong acid aqueous solution is acidic water that contains active oxygen and active chlorine and possesses a redox potential. We performed peritoneal and abscess lavages with an electrolyzed strong acid aqueous solution to treat 7 patients with peritonitis and intraperitoneal abscesses, who were seen in our department between December 1994 and April 1995. The underlying disease was duodenal ulcer perforation in 4 of these 7 patients and gastric ulcer perforation, acute enteritis, and intraperitoneal perforation of pyometrium in 1 patient each. Irrigation was performed twice a day. Microbiological studies of the paracentesis fluid were negative in 3 cases, and the irrigation period was 2 4 days. Anaerobic bacteria were isolated in 3 of the 4 positive cases (Bucferoides in 2, Prevotellu in l), and a fungus (Cundirlu) was isolated in the remaining patient. The period of irrigation in these patients ranged from 9 to 12 days, but conversion to a microorganism negative state was observed in 3-7 days. Key Words: Electrolyzed strong acid aqueous solution-Peritoneal lavageLavage of intraperitoneal abscess-Redox potential.Electrolyzed strong acid aqueous solution is produced on the anode side by electrolyzing salt-containing water through a diaphragm; it contains active oxygen and active chlorine and a redox potential (1). This electrolyzed strong acid aqueous solution is said to create an environment beyond the boundaries of the region in which microorganisms can survive and to have a germicidal effect on all bacteria and fungi as a result of the action of the active oxygen and active chlorine that it contains. It has recently come to be used in a variety of medical settings.It is also being used in our department, for hand washing in the outpatient clinic and on the ward and for disinfecting floors, disinfecting contaminated wounds, and so forth. However in this study, we tried to use it for lavage of foci of contamination within the peritoneal cavity.

Keywords Kawasaki disease · Pyuria · C-reactive protein · Erythrocyte sedimentation rate Sirs,We read with interest the article by Ristoska-Bojkovska et al. [1]. The authors reported that Japanese pediatricians are very familiar with pyuria coexisting with the nonspecific findings of severe inflammation, such as increased C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in Kawasaki disease (KD). A possible diagnosis of urinary tract infection (UTI) is not automatically considered.It is sometimes difficult to differentiate KD from infections such as sepsis, streptococcosis, or pyelonephritis in the early period of KD. Upon admission, we routinely perform the septic work-up, including urine culture, even if the most likely diagnosis is KD. We describe here a patient with KD associated with acute pyelonephritis.A 2-year-old boy was admitted to our center with a 4-day history of high fever (40.0C) and anorexia with moderate throat pain and malaise. He had conjunctivitis, injected pharynx, and lymphadenopathy, but no rash or changes of the peripheral extremities. Initial laboratory results showed an increased ESR of 119 mm/h and CRP of 5.44 g/dl. White blood cell count showed 11,190/mm 3 with neutrophilia (79%). Pyuria was present. Past history included KD with intravenous immunoglobulin therapy (IVIG) (400 mg/kg daily, given for 5 days) and aspirin (30 mg/kg daily) treatment at the age of 11 months. At that time, his urinalysis was normal.A presumptive diagnosis of recurrent KD was made but bacterial lymphadenitis or UTI was undeniable. He was treated initially with intravenous cefotiam hydrochloride (100 mg/kg per 24 h). Two days later, he remained febrile with a temperature of 40.0 º C. Blood analysis showed a CRP of 9.08 g/dl and a white blood cell count of 16,880/mm 3 . We diagnosed recurrent KD and stopped antibiotic therapy. IVIG and flubiprofen (4.2 mg/ kg daily), because of hepatitis (aspartate aminotransferase 169 IU/l, alanine aminotransferase 111 IU/l), were administered. Within 1 day of initial IVIG infusion, the boy became afebrile. On the 14th hospital day, he had periungual desquamation of the fingers and toes, and he met the five clinical signs of KD. His electrocardiogram and echocardiography were normal.The urine culture performed upon admission showed 10 6 colonies of Escherichia coli. On the 2nd hospital day renal ultrasonography demonstrated left hydronephrosis. A diagnosis of acute pyelonephritis was established and additional cefotiam hydrochloride was administered. On the 18th hospital day a voiding cystourethrogram showed left vesicoureteral reflux.KD often presents with abnormal urinary findings that are due to urethritis in most cases as shown by RistoskaBojkovska et al. [1]. The clinical manifestations of KD are similar to severe infections. We diagnose KD after confirming the negative results of cultures of all specimens because the etiology of KD still remains unclear [2]. Moreover, there is no specific diagnostic marker for KD except the clinical criteria. Had we not or...

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