The treatment of refractory anaemia of chronic renal failure with cobalt chloride

Twelve anephric patients on maintenance haemodialysis received treatment with oral enteric coated cobalt chloride 25 to 50 mg daily. The change in haemoglobin concentration, and packed cell volume, are recorded and discussed with special reference to possible toxicity and mechanism of action of cobalt. Six of eight patients who completed the first course with cobalt chloride 50 mg daily for 12 weeks showed a significant rise in haemoglobin concentration of 26 to 70 per cent and a fall to near pre-therapeutic levels when cobalt was withdrawn. Evidence of a response was present within two months of starting treatment. Four patients showed a diminution in their blood transfusion requirements and three patients experienced a definite sense of increased well-being during treatment. One patient suffered from side effects of the drug and failed to complete the study because of gastrointestinal disturbance. The improvment in haemoglobin concentration was reproducible in four patients who were given second, and in one case third courses courses with varying doses of cobalt over differing periods of time. Serum cobalt levels tended to stabilize after two months continuous treatment to the therapeutic range of 40-100 mumg per 100 ml. A rapid fall in serum cobalt was seen on cessation of treatment. It is suggested that therapy with enteric coated cobalt chloride at a dose of between 25 and 50 mg per day has a definite place in the treatment of the refractory anaemia of chronic renal failure.

A method of determining daily nitrogen requirements

A simple formula for calculating daily nitrogen requirements and balance is presented. A close correlation was observed between calculated and actual nitrogen balance studies. For better precision a different correction factor is suggested for patients receiving protein hydrolysates and crystalline amino acid solutions. This formula will greatly aid those who have to devise complete intravenous nutrition regimes for patients whose condition varies daily. The biochemistry required for application of this formula is within the capacity of any small hospital laboratory.

Intravenous nutrition. Why, when, and with what?

The catabolic reaction to operation or severe trauma will give rise to a real risk of starvation unless sufficient attention is paid to the patient's energy and nitrogen requirements as well as to his fluid and electrolyte balance. The indications for intravenous nutrition in such cases are outlined and the various preparations available for the supply of energy and nitrogen are detailed. In the planning of an intravenous feeding regimen the patient's daily nitrogen losses must be estimated and a formula is provided for this purpose. The technique of parenteral nutrition is discussed and attention drawn to the various metabolic and complications that may be encountered. Neither hepatic impairment nor renal failure need be regarded as a contra-indication to intravenous feeding.

Vick vapour rub intoxication

So far as we are aware there has been no previous report of Vick vapour rub intoxication presenting as iron deficiency anaemia with minimal liver functional impairment. We present this case for its interest and to illustrate the rewards of a routine and detailed drug-taking history.

Investigations into the optimum nitrogen and caloric requirements and comparative nutritive value of three intravenous amino acid solutions in the post-operative period

Complete nitrogen balance studies have been conducted in 17 patients undergoing vagotomy and pyloroplasty during the first 6 post-operative days. All patients received only intravenous nutrition during this period and there were no metabolic complications. These studies have shown that the optimum nitrogen and energy intake in the post-operative period in adults are 0.24g nitrogen and 46 kcal/kg body weight/day, respectively. These studies throw further doubt on the use of the E/T ratio as a predictor of nitrogen source solution efficiency in intravenous nutrient regimes. It is suggested that more attention should be directed to the non-essential nitrogen constituents in those solutions where the essential amino acid nitrogen contributes 30% of the total nitrogen. A new solution, Amodex, with an E/T ratio of 2.62 and an essential amino acid nitrogen content of 30% of the total nitrogen content has been found to compare favourably with two other well-established solutions in the post-operative period. These studies suggest that of the three solutions, Vamin 7% may be marginally more efficient.

A mino acid tablet-substituted diets in the management of chronic renal failure

Low protein Giovannetti diets in three patients with chronic renal failure have been compared with isonitrogenous, iso-caloric amino acid tablet-substituted regimes. Another patient has been managed on such a regime after regular haemodialysis treatment had to be suspended. The amino acid diets proved palatable and were effective in maintaining nitrogen balance when the caloric supply was adequate. Improved nitrogen balance correlated with diminished faecal nitrogen excretion and falling or stable blood urea levels implying improved urea nitrogen re-utilization. It is suggested that when the caloric supply is adequate for generation of sufficient α-ketonic acid derivatives, ammonia nitrogen is preferentially utilized for the synthesis of non-essential amino acids rather than more urea formation. Metabolic acidosis is a potential hazard of such regimes.

The effect of caloric intake on nitrogen balance in chronic renal failure

1. Nitrogen balance in uraemic patients on similar nitrogen intakes improves with increasing caloric intake in the range of 36–55 cal/kg body weight.

2. The degree of improvement in nitrogen balance is compatible with increased utilization of endogenous nitrogen probably as a result of increased dietary calories.

Cloxacillin and sodium fusidate in management of shunt infections

The effectiveness of two oral antibiotics, cloxacillin and sodium fusidate, has been evaluated in the treatment of shunt infections among 37 patients allocated at random to two treatment groups. Both proved to be safe bactericidal agents giving adequate serum M.I.C. when taken by mouth. Treatment should always be started on the basis of the clinical presentation without waiting for the bacteriologist's report. The commonest infecting organism is Staphylococcus aureus. Nine shunts were lost in this study, eight through Staphylococcus aureus infection. The nasal carrier state is of considerable importance in perpetuating these shunt infections.

Comparison of coil and Kiil dialysers

To assess the comparative efficiency, safety, and cost of maintenance dialysis, the treatment of 13 patients with a Kiil dialyser (representing 1,477 hospital and 735 home dialyses) was compared with that of 11 patients using a coil dialyser (898 hospital and 396 home dialyses). Kiil and coil dialysers proved equally satisfactory from a medical standpoint and equally acceptable to the patients. The capital costs of home dialysis were considerably reduced without any threat to safety or efficiency. The running costs of coil dialysers approximate to those of Kiil dialysers.

Drowning. Its clinical sequelae and management

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Acute glomerulonephritis in middle-aged and elderly patients

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Retinal detachment with spontaneous regression in renal failure

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Late Glacial and Postglacial Hudson Bay Sea Episode

Geological investigations, archeological studies, and radiocarbon dates indicate a similarity of events around Hudson Bay, commencing at the time Hudson Bay Basin was freed of glacier ice. The sea that then spread around Hudson Bay 7000 to 8000 years ago is here named "Tyrrell Sea." The subsequent rate of land emergence decreased exponentially.

THE DISTRIBUTION OF THE ROOTS OF SUGAR CANE IN THE SOIL IN THE HAWAIIAN ISLANDS

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