Prognosis of Henoch-Schönlein nephritis in children

All the survivors of a series of 88 patients with Henoch-Schönlein nephritis were examined after a follow-up of six and a half to 21 years (mean 9-9). Sixty-one patients had no demonstrable abnormality; six had minor urinary abnormalities; five had hypertension without urinary abnormally or renal dysfunction; four had heavy proteinuria; eight were in chronic renal failure, three of whom were on regular dialysis; and four patients had died within 25 months of onset. Neither corticosteroids nor immunosuppressive drugs alone or in combination appeared to influence the outcome. A clinical presentation with a combination of acute nephritis and a nephrotic syndrome and a high proportion of crescents in renal biopsy specimens was associated with a poor outcome. Neither the clinical presentation nor the renal morphology were, however, precise determinants of outcome. Outcome was not related to age, associated streptococcal infection, or recurrences of the rash. The clinical state two years after presentation was compared with the state six and a half years or more after presentation in 76 patients. The clinical state had changed in 32 patients, in 17 of whom it had deteriorated. It was not possible to identify with any certainty the patients who would deteriorate (or improve). Patients who have had Henoch-Schönlein nephritis should be followed up for at least five years.

Asymmetric depression in the serum level of IgG subclasses in patients with nephrotic syndrome

Thirty-three nephrotic patients were studied for IgG-subclass levels in matched pairs of serum and urinary specimens. Levels in the serum were compared with those found in the sera of non-nephrotic control children and normal adults. Results have shown an asymmetric depression in the serum level of certain IgG subclasses in some patients with minimal-change nephrotic syndrome, focal glomerulosclerosis, and proliferative glomerulonephritis, indicating that the urinary loss of IgG alone cannot account for the low blood levels of this immunoglobulin class in these conditions.

Comparison of plasma disappearance and standard clearance techniques for measuring glomerular filtration rate in children with and without vesico-ureteric reflux

The plasma disappearance rate, or slope clearance, after a single intravenous injection of 51Cr-EDTA was compared with simultaneously determined standard (UV/P) clearances of inulin, creatinine and 51Cr-EDTA in 4 healthy adults and 18 children with renal disease but no reflux. Slope clearance correlated well with standard inulin (r=0.99) and 51Cr-EDTA (r=0.97) clearances and was more accurate than creatinine clearance. Slope clearance x0.82 estimated standard 51Cr-EDTA clearance with +/- 12% accuracy in these subjects. In 18 children with vesico-ureteric reflux the correlations of the standard clearance methods with slope clearance were significantly reduced. Slope clearance may be measured with only two plasma samples and is recommended as the method of choice for determining glomerular filtration rate in children with gross reflux or impaired ability to empty their bladders.

Cholesterol beta-D-glucoside-6'-O-palmitate, a metabolite of Pythium sylvaticum

Cholesterol beta-D-glucoside-6'-O-palmitate has been identified as a polar metabolite in the mycelium of mated cultures of Pythium sylvaticum grown in the presence of cholesterol. The structure was confirmed by synthesis of the metabolite. Similar steroid beta-D-glucoside-6'-O-palmitates were obtained from beta-sitosterol and campesterol when these sterols were added to cultures of P-sylvaticum. Corresponding esters of myristic and stearic acids were also detected.

Role of dietary energy supplementation in growth of children with chronic renal insufficiency

The effect of dietary energy supplements in children with varying degrees of chronic renal insufficiency was investigated. Despite an increased energy intake of 8-4% there was no increase growth velocity, although some patients reported improved wellbeing and activity. The proportion of dietary energy supplied by protein fell significantly during supplementation. The evidence suggests that the reduced energy intake of children with chronic renal insufficiency is a related but not causal factor in their growth retardation.

Peritoneal dialysis in children. Review of 8 years' experience

During the years 1968-75, 59 periods of peritoneal dialysis were performed on 44 children aged from 2 days to 17 years. The commonest complication was peritoneal infection, which affected 68% of those under 2 years and 30% of older children. This was satisfactorily treated in all but one case which was due to Candida albicans. The use of combined intramuscular and intraperitoneal gentamicin therapy is described. 2 patients died as a result of massive intraperitoneal haemorrhage and one had a nonfatal intestinal perforation. In experienced hands peritoneal dialysis is a convenient, effective, and reasonably safe way of treating acute renal failure; it is best performed in centres capable of handling complex metabolic problems and investigating and treating the underlying renal disease.

Inositol Isomers: Occurrence in Marine Sediments

A combined gas chromatographic-mass spectrometric technique was used to identify and quantitate the occurrence of myo-, chiro-, and scyllo-inositol in marine sediments. The most abundant isomer was myo-inositol. These inositols were found in all the organic-rich sediment samples examined, and the amount of inositol decreased steadily with the age of the sample. A small fraction of the inositols occurred as hexaphosphate esters.

Molecular size of IgG in patients with focal glomerulosclerosis

Nineteen patients with focal glomerulosclerosis and with anomalously high clearance of IgG into the urine have been investigated by G.200 column chromatography. The findings are compared with normal sera, with 14 patients with minimal change disease and with 12 patients with proliferative glomerulonephritis. No significant reduction in the molecular size of IgG was found as compared with normal sera and the other diseases in 18 of the patients. In patients with minimal change disease and focal glomerulosclerosis an increased proportion of the IgG eluted in the void volume

Growth potential and skeletal maturity in children with chronic renal insufficiency

The growth potential of 27 boys with varying degrees of chronic renal insufficiency has been determined from their present height centile for both bone age and chronological age. With increasing age their growth potential diminishes. The delay in bone age is greatest in those children whose disease dates from infancy, but does not correlate with their present state of renal function. Bone age continues to advance in the presence of severe osteodystrophy and growth arrest. Knowledge of the growth potential of children with chronic renal failure is of relevance in interpreting the height increments observed following renal transplantation. Serial determination of bone age is therefore an important aspect of their clinical management.

A department of personal and family medicine

There has been increasing, worldwide dissatisfaction with the relevance of medical education to health care. Recently, a special task group set up by The Royal Australian College of General Practitioners made a study of how a department of personal and family medicine could participate in the education of the medical student. The task was to present first steps in a research and development programme for education of health personnel to work in and near the family setting. Two academics, two nurse educators, two general practitioners, one specialist surgeon involved in medical education and a fifth-year medical student made up the group. It worked at the task during a six-day live-in teaching and leadership seminar at Leura, New South Wales, in February, 1973.

Occurrence of S-methyl thioesters in urines of humans after they have eaten asparagus

Gas chromatography-mass spectrometry was used to determine the odor-causing agent (or agents) present in the urines of humans after they have eaten asparagus. S-Methyl thioacrylate and S-methyl 3-(methylthio)thiopropionate were identified from methylene chloride extracts of such urines and appear to be the odor-causing compounds. Methanethiol, the previously reported odor-causing agent, was not detected in these methylene chloride extracts.

Screening methods for covert bacteriuria in schoolgirls

Screening tests for bacteriuria based on two different principles were evaluated in1582 schoolgirls aged 5-11 years, and in 26 girls aged 3-16 years attending hospitalwith symptomatic urinary tract infection. Tests for hypoglucosuria, performed by a semi-automated fluorometric method and with Uriglox strips on early-morning urine samples voided after overnight fasting, gave unacceptably high false-negative rates (16.7% and 20.8% respectively). Oxoid and Uricult dipslides were immersed in fresh midstreamspecimens of urine obtained at school and read overnight incubation at 37 degrees C. Both gave comparable results, with low false-positive rates and no false-negative responses. The higher cost of screening by dipslides was halved by using the "dipstream" technique, which also gave no false-negative results. Its false-positive rate of 13.5% could be reduced to 1.8% by disregarding colony counts of 10-8 non-faecal organisms and over per litre, which appear unimportant in schoolchildren. Bacteriuria was found in 2.3% of the schoolgirls; 39% of them had symptons, compared with 7.2% of the healthy girls, and 25% showed vesicoureteric reflux, which in 17% was associated with renalscarring. Since the natural history of covert bacteriuria and its relationship withreflux and scarring remain undetermined further research is required. The dipstreamtechnique offers a simple, reliable, and comparatively cheap screening method which could also be applied in general practice.

Diminution and enlargement of the mosquito rhabdom in light and darkness

The rhabdoms of the larval ocelli of the mosquito Aedes aegypti undergo morphological light and dark adaptation over periods of hours. The rhabdom enlarges during dark adaptation and grows smaller during light adaptation. Diminution is exponential, enlargement linear, and rates of change are proportional to log light intensity. Rhabdoms maintained at a constant intensity level off at a constant volume proportional to log intensity. We argue that changes in rhabdom volume after changes in light intensity reflect an influence of light on the turnover of photoreceptro membrane, and that the volumes at which rhabdoms level off represent equilibria between opposed processes of membrane loss and renewal.

The natural history of renal and ureteric calculi

In a prolonged follow-up of a series of 416 patients at The London Hospital Stone Clinic it was found that recurrence could still occur even as long as 10 years after the first stone, though this risk decrease slowly year by year. Recurrence is seldom related to hypercalciuria or urinary infection except when infection is caused by or associated with B. proteus in women. Claims for the value of any form of therapy for stone disease must be evaluated against the background of the natural history of lithiasis.

Membranous nephropathy. Long-term follow-up and association with neoplasia

Sixty-six patients of all ages whose renal biopsy appearances satisfied strict criteria for the histopathological diagnosis of membranous nephropathy were studied and followed for a mean of 5-4 years (range 1 to 20 years). From initial investigation seven patients were found to have associated neoplasia, and in two patients the condition followed treatment with a mercurial diuretic and gold. One patient was Australia antigen positive. Two patients developed renal vein thrombosis, but in both this appeared to follow not precede their nephrotic syndrome. In the remaining 56 patients there was no associated factor. During the follow-up period, approximately one-quarter of the patients (15) died, nine from renal failure; one-quarter (10) had a persistent nephrotic syndrome, another one-quarter (15) proteinuria of lesser degree. The final one-quarter (16) are now in complete remission. The prognosis of the 54 patients with an initial nephrotic syndrome was poorer than the 12 with lesser proteinuria and no oedema at onset; five of 11 children were in complete remission when last seen. All but one of the nine patients who developed terminal chronic renal failure 4 to 18 years from onset had an unremitting nephrotic syndrome, eight of the 10 currently alive with a persistent nephrotic syndrome have reduced renal function. Renal functional deterioration did not occur in the absence of proteinuria. There was only slight correspondence between the stage of biopsy appearance, glomerular filtration rate at time of biopsy, time of the biopsy from apparent onset, or status at last follow-up. Staging is therefore of limited prognostic value. Twenty-two patients were treated with corticosteroids for 2 to 36 months; we detected no short or long-term benefit when compared to patients not so treated.

Urine microscopy as an aid to detection of bacteriuria

Fresh, uncentrifuged urine specimens obtained from children attending a renal clinic were examined microscopically for leucocytes and bacteria, and the results were compared with quantitative bacterial cultures. Of the 51 specimens giving colony-counts larger than or equal to 10-5 per ml., 6 (12 per cent) showed no microscopical bacteriuria and 22 (43 per cent) contained smaller than 10 leucocytes per c.mm.; only 3 specimens (6 per cent) showed neither bacteria nor excess cells. Of the 186 uninfected specimens, bacteria were seen microscopically in 32 (17 per cent) and an excess of leucocytes in 27 (15 per cent); in only 9 (5 per cent) were both observed. Leucocyte-counting alone is therefore an unreliable technique, but microscopy for both bacteria and leucocytes affords a simple and rapid method of preselecting urine specimens for culture, with a high probability of predicting the correct result. While not suitable for population screening, it is ideal for use in hospital clinics and wards, as well as in general practice.

The significance of variation in the selectivity of proteinuria

The selectivity of proteinuria has been determined immunochemically at least 4 times over periods of 3 years or more in 27 children and adolescents who had been investigated by renal biopsy. Variations of the selectivity outside the limits of experimental error were observed in 14 patients, in 8 of whom there was a progressive decline. Six of these 8 had focal and segmental glomerular lesions, including one case of Alport's syndrome, and 2 had proliferative glomerulonephritis. Two different anomalies of relative IgG clearance were noted: in proliferative glomerulonephritis there was a constantly low clearance, and in focal glomerulosclerosis an elevated clearance increasing with time. Indirect evidence suggests that the latter may be due to the presence of low molecular weight IgG fragments in serum and urine.

Long-term stability of remission in nephrotic syndrome after treatment with cyclophosphamide

Fifty-eight children with minimal-change nephrotic lesions who relapsed repeatedly and showed toxic side effects from corticosteroids were treated with cyclophosphamide for an average of 12 weeks. The initial dose was 5 mg/kg/day. Four to seven years (mean 5.8 years) later 20 remained in remission, 34 were still relapsing, and 4 had died (two during relapses, one of measles after cyclophosphamide, and one of a brain-stem astrocytoma). The half time for the relapse-free period after treatment was 2.8 years. There was no relationship between the length of treatment with cyclophosphamide and the stability of remission within the limits studied.

Thrombolytic therapy in haemolytic--uraemic syndrome

The treatment of five children with the haemolytic-uraemic syndrome using streptokinase is described to illustrate the difficulties and limitations of thrombolytic therapy in this disease. This experience is germane to the design of multicentre clinical trials.A multivariate analysis relating clinical outcome to the data obtained at the time of admission was also carried out for 31 children with the disease treated in four centres. The results suggest that this technique may help to identify those patients likely to have a fatal outcome. An expanded form of this type of analysis should be incorporated in future clinical trials.

Rhodopsin of the larval mosquito

Larvae of the mosquito Aedes aegypti have a cluster of four ocelli on each side of the head. The visual pigment of each ocellus of mosquitoes reared in darkness was characterized by microspectrophotometry, and found to be the same. Larval mosquito rhodopsin (lambda(max) = 515 nm) upon short irradiation bleaches to a stable photoequilibrium with metarhodopsin (lambda(max) = 480 nm). On long irradiation of glutaraldehyde-fixed tissues or in the presence of potassium borohydride, bleaching goes further, and potassium borohydride reduces the product, retinal, to retinol (vitamin A(1)). In the presence of hydroxylamine, the rhodopsin bleaches rapidly, with conversion of the chromophore to retinaldehyde oxime (lambda(max) about 365 nm).

Spectral sensitivity of larval mosquito ocelli

The spectral sensitivity of lateral ocelli in both wild-type and white-eyed larvae of the yellow fever mosquito Aedes aegypti L. (reared in darkness) was measured by means of the electroretinogram. The spectral sensitivity is maximal at about 520 nm, with a small secondary peak near 370 nm. When allowance is made for some screening and filtering by the eye tissues, the spectral sensitivity is in reasonable agreement with the absorption spectrum of ocellar rhodopsin (lambda(max) = 515 nm).

Rhodopsin and porphyropsin fields in the adult bullfrog retina

Though it had been supposed earlier that the bullfrog undergoes a virtually complete metamorphosis of visual systems from vitamin A(2) and porphyropsin in the tadpole to vitamin A(1) and rhodopsin in the adult, the present observations show that the retina of the adult frog may contain as much as 30-40% porphyropsin, all of it segregated in the dorsal zone. The most dorsal quarter of the adult retina may contain 81-89% porphyropsin mixed with a minor amount of rhodopsin; the ventral half contains only rhodopsin. Further, the dorsal zone contains a two to three times higher concentration of visual pigments than the ventral retina. The pigment epithelium underlying the retina contains a corresponding distribution of vitamins A(1) and A(2), predominantly vitamin A(2) in the dorsal pigment epithelium, exclusively vitamin A(1) in the ventral zone. The retina accepts whatever vitamin A the pigment epithelium provides it with, and turns it into the corresponding visual pigment. Thus, a piece of light-adapted dorsal retina laid back on ventral pigment epithelium regenerates rhodopsin, whereas a piece of light-adapted ventral retina laid back on dorsal pigment epithelium regenerates predominantly porphyropsin. Vitamin A(2) must be made from vitamin A(1), by dehydrogenation at the 3,4-bond in the ring. This conversion must occur in the pigment epithelium, presumably through the action of a vitamin A-3,4-dehydrogenase. The essential change at metamorphosis is to make much less of this dehydrogenase, and to sequester it in the dorsal pigment epithelium. Some adult bullfrogs, perhaps characteristically taken in the summer, contain very little porphyropsin-only perhaps 5%-still sequestered in the dorsal retina. The gradient of light over the retinal surface has little if any effect on this distribution. The greater density of visual pigments in the dorsal retina, and perhaps also-although this is less clear-the presence of porphyropsin in this zone, has some ecological importance in increasing the retinal sensitivity to the dimmer and, on occasion, redder light received from below.