[Hereditary sensory-motor polyneuropathy. Case report and problems in differential diagnosis]

The study reports a family in which three children were found to have marked sensory-motor polyneuropathy. Clinical investigations revealed a recessive hereditary form of highly progredient mostly motor polyneuropathy with atrophy and weakness of distal muscle groups and electrophysiologic evidence of neurogenic lesion-delayed neural conduction. Apart from the peripheral nerves, clinical examination and additional investigations showed that the degenerative process encompassed central nerve system structures, posterior bundles of the spinal cord, spinal cerebral pathways, cerebellum and cerebrum (cerebral sings, mental retardation, epilepsy, brain atrophy on CT, increased IGG in the liquor are present). Although clinical and electrophysiological analyses suggest type III HSMN, muscle and nerve biopsy, as well as additional diagnostic methods broaden the differential diagnostic range toward other forms of hereditary polyneuropathy, whose differentiation in practice is, in spite of clear diagnostic criteria, rather difficult, due to the presence of its transitive forms.

[Clinical significance of the QRS-complex in the determination of myocardial infarct size]

In 60 patients myocardial infarction size was determined by electrocardiogram (ECG) using Selvester's QRS scoring system. These values were compared with the size of infarction as determined enzymatically using gram equivalent isoenzyme MB creatine kinase (gEq) and using maximum values of isoenzyme MB-CK. The results showed no statistically significant difference between the size of anterior and inferior infarction determined by gEq (25.19 +/- 13.59 vrs 22.48 +/- 14.04; p = 0.12 NS) and by maximum MB-CK (125.5 +/- 76.0 vrs 98.4 +/- 60.7; p = 0.12 NS). The size of myocardial infarctions determined by ECG was significantly larger anteriorly compared with the inferior infarcts (9.6 +/- 2.9 vrs 4.5 +/- 2.6; p = 0.001). In patients with anterior infarcts good correlations between the size of infarction determined by QRS scoring system and by gEq or maximum MB-CK were found (r = 0.69; p = 0.004 and r = 0.72; p = 0.001). In patients with inferior infarcts the correlations between QRS score and gEq or maximum MB-CK were poor (r = 0.37; p = 0.02 and r = 0.45; p = 0.15). The causes of weak correlations in the results of described methods in inferior infarcts are discussed. Thus QRS scoring system provides new noninvasive and simple possibilities in determining the size of anterior and in inferior infarctions of the left ventricle.

[Drug therapy of vesico-ureteral reflux in children]

The results of medical management of primary vesicoureteric refluc in 138 children aged 3 months to 15 years are presented. All children were kept on long-term, low-dose continuous chemoprophylaxis of urinary tract infection. During the 2-6 years follow-up period serial urine cultures, interval radiographic revaluation, renal function tests and blood pressure measurements were performed. Refluc disappeared spontaneously in 91 patients (66%), persisted in 9.4% and was later on surgically corrected in 20% of children. The refluc grade at presentation was the most important factor affecting the outcome: the refluc disappeared from 72% of affected ureters with grade I and II, and from 28% of ureters with grade III and IV. The presence of renal scaring and recurrence of urinary tract infection during the chemophylaxis did not influence the percentage of cured patients. Nevertheless, the mean duration of refluc from diagnosis to its spontaneous resolution was significantly longer in children with renal scars and urinary tract infections compared with its duration in children who had neither scars, nor further infections. Renal scarring progressed in 2.8% patients. Chronic renal failure developed, in spite of spontaneous resolution of refluc, in only one child with hypertension and bilateral renal scars at presentation. It is concluded that medical treatment of vesicoureteric refluc in most of the children is successful and in regard of preserving renal function stage.

Haemolytic-uraemic syndrome associated with Aeromonas hydrophila enterocolitis

Haemolytic-uraemic syndrome (HUS) associated with Aeromonas hydrophila enterocolitis is reported in a 23-month-old female infant. The A. hydrophila strain isolated from the patient's stool sample produced cytotoxin against verocells; increasing levels of cytotoxin-neutralizing antibody in the patient's sera were demonstrated, suggesting a recent infection. This report indicates that A. hydrophila should be suspected as a possible cause of HUS, and that this pathogen should be looked for in cases of post-diarrhoeal HUS.

[Delayed effect of cyclophosphamide on testicular function after treatment of nephrotic syndrome in childhood]

The authors present the results of study of testicular spermatogenetic and endocrine function in adult males treated with high doses of cyclophosphamide for nephrotic syndrome during childhood and/or adolescence. Seventeen males, mean age of 22.5 years (range, 17-30) were examined after mean follow-up of 11.8 (5-17.3) years. Mean age at the time of treatment was 10.8 (3.6-17.6) years; mean duration of cyclophosphamide treatment was 240 (39-701) days, and mean total cumulative doses were 641 mg/kg body weight (103-1999) or 16.4 (3.9-55.7) grams. All the patients undergone normal pubertal development and had normal sexual characteristics. Eleven were normospermic (more than 20 x 10(6)/ml spermatozoa), one oligospermic and five azoospermic. There was a significant inverse correlations of sperm density with cyclophosphamide dosage and duration of treatment. These variables seem to be more important for cyclophosphamide toxicity, than stage of sexual development at time of treatment. Raised basal and stimulated FSH concentrations in oligoazoospermic patients were in keeping with impaired spermatogenesis. These patients had also raised basal and stimulated LH concentrations suggesting compensated Leydig cell failure. Subgroup of normospermic patients with lower spermatozoa concentrations (20-40 x 10(6)/ml) had significantly raised FSH and LH responses on stimulation with gonadotropin releasing hormone, suggesting dysfunction both tubular and interstitial cell component of the testis. In other normospermic patients gonadotropin responses were not different from controls. Basal and HCG stimulated testosterone concentrations showed no differences between patients and controls. These results confirmed significant inverse correlations of cyclophosphamide dosage with its effect on spermatogenesis, and documented the long-term effect on the Leydig cell function requiring further follow-up.

[Percutaneous biopsy of the kidney in children: indications, results, and complications]

The authors present results of systematic use of percutaneous renal biopsy in children in the first three years of practice. From 1986 to 1989, 153 renal biopsies were done in 144 children and adolescents (75 males, 69 females) aged 4 months to 18 years. The most common indications were as follow: primary nephrotic syndrome, most often resistant to corticosteroid treatment (28.5%), haematuria (28.5%), secondary glomerulopathies, either with or without nephrotic syndrome (9.7% and 15.3%, respectively), and proteinuria (4.9%). 90.8% of biopsies were successful obtaining adequate tissue for light microscopic diagnosis, containing a n average number of 16 glomeruli. An overall number of 29 complications (18.9% of biopsies) in 23 patients was observed. Gross haematuria was the most common, lasting no more then one (9.8% of biopsies) or three days (2.6%) requiring blood transfusions in three cases (1.96% of biopsies). Others complications were fever (1.96%), perirenal haematoma (1.3%), and severe pain at the site of biopsy (1.3%). There were no significant differences between three annual periods with regard to the incidence of successful biopsies or complications, but more serious complications occurred during the first year of practice. In children younger than five years the rate of successful biopsies was higher and incidence of complications was lower than in older children. The authors' results correlate favourably with data published in the foreign literature.

The role of orbital wall morphological properties and their supporting structures in the etiology of "blow-out" fractures

The stiffness and strength of the orbital walls are proportionally dependent on the anatomical structures which support and strengthen these walls from the opposite side. The medial wall is therefore strong due to the support of ethmoid cells. The floor is stronger the less surface there is and the more supported it is by trabeculae of the maxillar sinus. The strength of the upper and lateral walls are proportional to their thickness. The orbital floor is on the average the weakest, followed by the medial and upper walls. The lateral wall is the stiffest and the most rigid. Computed tomography (CT) has improved structural analysis of the orbital contents and orbital walls enabling the visualisation of superficial and deep soft tissues and bone structures.

Recurrent haemolytic-uraemic syndrome with hypocomplementaemia: a case report

A boy who developed haemolytic-uraemic syndrome (HUS) at 8 years 6 months of age had four further episodes of the disease during the next 3 years. No renal abnormalities were detected between the attacks nor in the 2.5 years after the last recurrence. Reduced levels of serum complement were found during four of the episodes and in two intervening periods.

Can prazosin be used in the treatment of refractory heart failure only on the basis of clinical monitoring?

25 patients are presented with chronic cardiomyopathy (NYHA class IV), who were refractory to conventional digitalis and diuretics treatment which was administered over at least 3 weeks. The patients were split in 2 groups: the first group consisted of 10 patients who were haemodynamically monitored while being administered nitroprusside for 24 hours. After the treatment, the cardiac index significantly increased (by 36%), left ventricular filling pressure decreased (by 48%), and systemic vascular resistance fell (by 47%). The second group, consisting of 15 patients, was administered prazosin in addition to conventional treatment. The effects of prazosin were clinically monitored. After 3 weeks of continual prazosin treatment, the clinical condition of 12 patients was improved to NYHA class II whereas the condition of the other 3 was improved only to NYHA class III. During further treatment this improvement was maintained. The effects of the treatment can be easily followed and assessed on the basis of clinical features, so that other, more complex methods of follow-up are not required. The results of our study show that patients with refractory heart failure can be safely administered prazosin without previous assessment of haemodynamic parameters.

Selective effects of human cord serum on distinct events of the lectin-induced activation and proliferation of thymic T-cells

The results of this study demonstrate that human cord serum, but not adult serum, contains a factor(s) which without being by itself mitogenic for unstimulated resting cells, enhances the PHA- and ConA-induced proliferation of rat thymocytes. Dissection of the effects of HCS on the distinct events involved during lectin-induced activation and growth of thymic T cells, revealed the basic mechanisms by which the stimulatory factor(s) exerts its action. HCS does not affect the IL-2-dependent proliferation of ConA-blasts derived from thymocytes. Furthermore, it does not act via macrophages but rather directly on thymic T cells by increasing their capacity to proliferate in response to the activating signals delivered by lectins in conjunction with IL1. Thus, HCS enhances the lectin-induced expression of IL2-receptors as evidenced by both increased responsiveness to IL2 and increased capacity to absorb IL2 of HCS-treated thymocytes. On the other side, HCS also enhances the lectin-induced production of IL2 by thymocytes.