Comparison of a needle-free high-pressure injection system with needle-tipped injection of intracavernosal alprostadil for erectile dysfunction

Patients identified from hospital records as using alprostadil injections for erectile dysfunction were invited to take part in this open crossover study. On alternate weeks eight patients were given intracavernosal needle injections and transdermal needle-free injection of alprostadil in a randomized order. Efficacy of injection and associated pain were assessed and compared for the two methods. Pain produced during injection was significantly greater with the needle-free system than with the needle-tipped injection whilst efficacy was significantly less. Bruising was reported in all except one patient following needle-free injection only. Patient ratings of the needle-free injector were significantly lower than ratings for needle-tipped alprostadil delivery and when asked to express a preference, every patient chose the needle-tipped injection over the needle-free device.

Correlates of emergency response interval and mortality from severe anaemia in childhood

A retrospective study to determine the influence of blood transfusion emergency response interval on Mortality from childhood severe anaemia was carried out. Admission records of all children with severe anaemia over a 5-year period was reviewed. Those who either died before transfusion or got discharged against medical advice were excluded. A total of 5790 patients were admitted during the 5 year period. Ten percent (10%) had severe anaemia. Malaria, the leading cause of anaemia in this series, was found in 80% of the patients. Twenty patients (3.3%) died before transfusion while 50 discharged from the hospital against medical advice. There was male preponderance. Ages 2-5 years were the peak age group for severe anaemia. No patient had haematocrit less than 5% but 20 (4.2%) had heaematocrit above 20%. The hospital stay for majority (74.8%) of the patients was 72 hours or less. Mortality (Case fatality) increases with increase in transfusion emergency response interval within 24 hours. Based on the transfusion emergency response interval versus mortality curve, a mortality risk assessment scores were derived for use in clinical practice to determine the risk of dying from the disease. We recommend that national or hospital policy on blood transfusion be enunciated to ensure that all patient with severe anaemia get transfused within 2 hours of diagnosis.

European Society for Impotence Research--third meeting. 30 January-2 February 2000, Barcelona, Spain

The role of sildenafil (Viagra; Pfizer Inc) in a variety of indications, including spinal cord injury following prostatectomy, was presented. Results obtained by comparing different therapies were also presented. The role of sildenafil in long-term users of intracavernous and intra-urethral therapy was presented by at least two groups with interesting results. Conversely, a presentation on the role of intracavernosal therapy in patients who had failed to respond to sildenafil revealed thought provoking-findings. The anticipation by delegates of an opportunity to preview new therapy was also satisfied, at least in part, with presentations on Invicorp (Senetek plc), sublingual apomorphine (TAP Pharmaceuticals Inc), BAY-38-9456 (Bayer Yakuhin Ltd), and a yohimbine/arginine combination. MUSE therapy (VIVUS Inc) was also revisited. The various presentations on the treatment of erectile dysfunction revealed a trend towards a more practical approach.

Packed red cell volume pattern in Nigerian preterm babies

Weekly packed red cell volume (PCV) was estimated in 57 Nigerian preterm babies whose gestational ages were less than 34 weeks. Babies were excluded if they required exchange blood transfusion or had major congenital malformations. The mean (SD) PCV at birth was 54.6% (8.3). The nadir of the PCV drop was at the 10th-11th week of life. The PCV at the nadir was 29.3% (SD 2.9). The rate of drop in the PCV was most rapid in the 1st 2 weeks (velocity -4.6% per week), but by the 7th week this had decreased to -1.2% per week. The findings indicate a slower rate of postnatal fall in PCV among Nigerian preterms. We recommend that PCV and systemic signs of anaemia be monitored for the 1st 12 weeks of life.

International Association for the Study of Pain--Ninth World congress. 22-27 August 1999, Vienna, Austria

At this meeting, novel analgesic effects were described for a number of compounds. Gabapentin was significantly effective in the treatment of pain associated with phantom limb pain after amputation and traumatic avulsion of the brachial plexus. Capsaicin analog, EC-665, prevented referred viscero-somatic hyperalgesia associated with bladder inflammation. Indomethacine was compared with UP-454-21, a selective COX-2 inhibitor showing comparable effectiveness between both drugs in their anti-inflammatory/analgesic properties. Contralateral treatment with local anesthetics resulted in a long-lasting anti-inflammatory effect in unilateral carra-geenan-induced inflammation. Spinal neostigmine reduced spinal bupivacaine-induced hypotension while lamo-trigine showed a definite benefit in varied patients with neuropathic pain. Intra-articular administration of a ketorolac and morphine combination following arthroscopic knee surgery showed a significant decrease in postoperative pain and the need for postoperative analgesic. Oral CR oxycodone was shown to be an effective analgesic for the oral management of postoperative pain.

American Urological Association--94th annual meeting. 1-6 May 1999, Dallas, USA

Traditional urological concerns, such as bladder instability, bladder cancer, prostate cancer and incontinence, were focused upon. In addition, significant attention was paid to erectile dysfunction, with varied developments in the field. Capsaicin was presented as having a role to play in the reduction of bladder instability, while a new formulation of oxybutinin was shown to improve female urge incontinence. The combination of topical estrogen and an oral agonist, phenylpropanolamine, also gave significant improvement in menopausal urinary urgency and incontinence. Tetrahydropyranyladriamycin (THPA) will possibly be effective for adequate prophylaxis against the recurrence of early bladder cancer. COX-2 receptor modulation has a role in the treatment of bladder cancer, whilst the endothelin receptor antagonist ABT-627 (Abbott International Ltd) may prove effective in the treatment of prostate cancer. Melanotan II (PNU-83757; Pharmacia and Upjohn Inc) and IC-351 (Icos Corp) are new compounds for the treatment of erectile dysfunction (ED), and more light is shed on a role for apomorphine for the same indication.

Prevalence of antibodies to parasitic infections in Nigerian children

Sixty-six sera from Nigerian children who attended a paediatric clinic at University College Hospital, Ibadan were tested with Plasmodium falciparum, P. brazilianum, Entamoeba histolytica, Toxoplasma gondii and Schistosoma mansoni antigens using indirect fluorescent antibody technique. These sera were tested using ELISA technique for Schistosoma antibodies. Sera from all proven cases of infections gave positive results. Highest antibody prevalence rate was for P. falciparum (69.6%), followed by P. malariae (63.6%) and E. histolytica (42.4%) infections. About 17% and 16% were reactive with Toxoplasma and Schistosoma antigens respectively. Only nine (13.6%) children were negative with all antigens. Forty-four (66.6%) children were positive to two or more parasitic antibodies indicating exposure to those diseases. The significance of these antibodies in children is discussed.

Studies on the immunopathology of the nephrotic syndrome associated with Plasmodium malariae. 1. Serum levels of an immune adherence inhibitor

A comparative study of the serum levels of an immune-adherence inhibiting factor was carried out on serum samples from eighty-seven nephrotic syndrome children, twenty-eight nephrotic adults, 202 normal school children, 116 blood donors, twenty-five falciparum malaria children and 172 patients with miscellaneous diseases. Low titres (1/32 and below) of the factor were present in sera from 63.2% of the nephrotic children 60.7% of nephrotic adults and 60.0% of children malaria, as compared with 30.7% of the normal children, 25.5% of the patients with miscellaneous diseases and 41.4% of the blood donors. There is a significant difference between nephrotic children and normal children with low titres (P less than 0.05). Furthermore, 36.8% of the nephrotic children had serum titres of 1/4 or less, as compared with 6.4% of normal children. The serum factor is tentatively referred to as 'C3b-inase'. Its similarity to conglutinogen-activating factor (KAF) and its possible role in the pathogenesis of the immune-complex nephropathy of childhood nephrotic syndrome associated with malaria are discussed.

Sarcoma botryoides in a Nigerian female infant

A case of sarcoma botryoides has been reported in a 10-month-old Nigerian female infant. The tumor has behaved true to form by its location and histologic appearance. The prognosis in this child is still guarded, as chemotherapy has been the only form of treatment. Although she has been under observation for one year now, there has been no local recurrence of the tumor.

Quartan malarial nephrotic syndrome in children

Quartan malarial infection causes an immune complex nephritis in some individuals, which, once established, is sustained by mechanisms not yet fully explained, but which probably involve autoimmune processes. The presenting clinical and biochemical findings of the quartan malarial nephrotic syndrome are similar to those classically described for the nephrotic syndrome in childhood, but the renal pathology seen on light, electron, and immunofluorescent microscopy show striking differences and distinctive features. The disease tends to pursue a chronic course and in most patients is nonresponsive to treatment with antimalarial drugs, prednisolone, and immunosuppresive drugs. The overall prognosis is poor, with most patients developing hypertension and evidence of renal failure within 3 to 5 years of onset.

A controlled trial of cyclophosphamide and azathioprine in Nigerian children with the nephrotic syndrome and poorly selective proteinuria

In a controlled trial, symptomatic treatment alone, or 12 weeks of cyclophosphamide or azathioprine were compared in Nigerian children with nephrotic syndrome (mainly quartan malarial nephropathy) and poorly selective proteinuria. Full remission in 2 patients in each of the two groups treated with drugs, and diminution of proteinuria in most patients in the cyclophosphamide group showed possible evidence of benefit. Infections during treatment were significantly more common in the drug-treated groups but were controllable. Mortality from renal failure in the 2nd year after treatment was significantly greater in the azathioprine-treated group than in the other two, suggesting that the drug may have exacerbated the nephritis. The 5-year survival rate was similar in the cyclophosphamide and the control group.

Fatal herpes zoster in Burkitt's lymphoma following contact with chicken pox

Burkitt's lymphoma presented atypically in a six-year-old Nigerian girl with back pain, oliguria and facial oedema following a fall at school. Two weeks later, she developed bilateral ptosis, hepatomegaly and ascites. Burkitt's lymphoma cells were found in both ascitic and cerebrospinal fluids. She was successfully treated with intravenous cyclophosphamide and intrathecal methotrexate but later developed fatal herpes zoster at the same time as the resident doctor developed chicken pox. Chart's review showed that she had been in brief contact with chicken pox during a short stay in a transit ward prior to full admission.

Plasma immunoglobulin levels in Nigerian infants in the first year of life

Serial estimations of plasma immunoglobulins IgG, IgM and IgA were undertaken in the first year of life of healthy Nigerian infants by the single radial immunodiffusion method. High levels of IgG present at birth dropped below half their values in the first month of life and remained low for about four months after which a sustained rise was observed although birth levels were not attained at 1 year of age. IgM was low at birth and IgA was absent but was detached at one month. Both IgM and IgA rose rapidly in the first four months of life which is in keeping with immunological competence and primary antibody response to various subclinical infections in infancy.

Differential protein clearances and response to treatment in Nigerian nephrotic children

Remission followed prednisolone therapy in 9 out of 21 Nigerian children with the nephrotic syndrome who had highly selective proteinuria (CG/CA less than 15%). Of these, 5 patients have remained well off all treatment during a follow-up of nearly 5 years, 4 have relapsed more than once but have responded to further courses of prednisolone. 3 of 21 with less selective proteinuria also remitted but all relapsed and only one of these has responded again. The other two have relapsed and further courses of prednisolone have not totally abolished their proteinuria though they are asymptomatic and in good health. Toxicity (hypertension, sometimes with encephalopathy and infection) was commoner in the patients with less selective proteinuria treated with steroids than in those with highly selective proteinuria. 3 steroid-sensitive patients who had had repeated relapses became free from relapse off all treatment after a course of cyclophosphamide, given during steroid-maintained remission. All but 2 of the renal biopsies taken were regarded as abnormal. The lesions were less severe in those who responded than in those who did not. There is some evidence to suggest that Plasmodium malariae may be a cause of some of the steroid-sensitive disease, as well as the steroid-resistant.

Rickets in Nigerian children--response to vitamin D

The findings in 20 cases of nutritional rickets treated on an out-patient basis with oral calciferol and calcium gluconate are reported. Attention was paid to their clinical, biochemical and radiological responses. If was noted that presentation at the hospital out-patient department was always delayed until there were obvious and sometimes severe deformities in the children. Biochemical changes noted during the early phase of treatment showed an initial fall in the level of serum calcium and plasma phosohorus and a rise in the serum alkaline phosphatase. About three months after initiating treatment, calcium and phosphorus reverted to normal levels but serum alkaline phosphatase still remained high. Twelve of our cases (60 per cent) suffered from protein calorie malnutrition of the marasmic type and showed an apparent resistance to vitamin D therapy in what may be regarded as normal dosages. Response was however, achieved with substantial increase in the amount of vitamin given. There was a striking sex difference in the ratio of 15 males to five females indicating that males are more likely to develop nutritional rickets than females when subjected to predisposing environmental conditions. Vitamin D resistant type of rickets was not encountered in this study.

Immunoglobulin classes and complement in biopsies of Nigerian children with the nephrotic syndrome

Pretreatment diagnostic renal biopsies from fifty Nigerian children with the nephrotic syndrome were investigated by immunofluorescence for immunoglobulin classes, complement and specific antigens. Nineteen of these were re-examined after an interval of 10–15 months. Forty-eight first biopsies were positive for bound γ-globulins, usually IgM and IgG but sometimes for one of these alone; IgA was not detected. Thirty-three were positive for bound complement (C₃ component). IgM was associated with granular deposits and complement, IgG with both granular and continuous deposits, the latter usually lacking complement. Plasmodium malariae antigen was found in nine of thirty-six cases examined; no P. falciparum or streptolysin-O antigens were observed. Immunoglobulins G and M were found in tubules in seventeen of the fifty patients, in five together with complement. P. malariae antigen was observed in tubules in eleven of thirty-six cases.

Repeat biopsies from four patients who had recovered were negative with all reagents. Patients on anti-malarial therapy only, and those responding poorly to steroids or cyclophosphamide, showed no significant change in glomerular fluorescence, but a higher incidence of tubular fluorescence was noted in second biopsies. In patients with a poor response to Imuran treatment the pattern of glomerular fluorescence changed from granular to diffuse and tubular staining was not observed. In some patients increased levels of antiglobulins (rheumatoid factor type) were detected in later sera. The nature of the bound immunoglobulins was confirmed by elution of complexes and immunodiffusion.

It is suggested that an antigen–antibody complex with P. malariae antigen can produce renal damage with liberation of autoantigens which have the capacity to initiate self-perpetuating autoimmune disease.