Cisplatin in children: hearing loss correlates with iris and skin pigmentation

Pigmentation is reported to affect cisplatin-induced ototoxicity in adult humans. The hearing loss is worse in people with brown irises, than in those with blue irises. We assessed the hypothesis that cisplatin-treated children with dark irises suffer more deterioration in auditory thresholds than do those with less pigmentation. For the 19 children whose data met the requirements of this observational retrospective study, we found a weak correlation (Spearman's r = 0.50; p < 0.05) of high frequency hearing loss (at 4000 Hz) and pigmentation. Blue or hazel-eyed children averaged 2.9 dB worsening at 4000 Hz, in contrast to 14.2 dB worsening for brown or black-eyed children. Pigmentation may account for some of the individual susceptibility to cisplatin ototoxicity. We suggest that iris colour be included in future reports of cisplatin-related hearing loss.

Max Schultze and the living, moving, phagocytosing leucocytes: 1865

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Axonal damage in Crohn's disease is frequent, but non-specific

We have attempted to confirm the claim by Dvorak and Silen that 'Crohn's disease is accompanied by a severe and extensive necrosis of gut axons...[which] may serve to differentiate Crohn's disease from other inflammatory conditions'. In this electron microscope study the diagnoses were withheld until the assessment of axonal damage was completed. We assessed the axonal damage in ileostomy biopsies in 13 cases of Crohn's disease, four cases of ulcerative colitis, and two 'controls'. In Crohn's disease we found a mean per cent of abnormal axons of 29.85, in ulcerative colitis of 21.25 per cent, and in the two 'controls' of 12.11 and 10.63 per cent, respectively. The difference between the 13 cases of Crohn's disease and the six cases of non-Crohn's disease is not significant. We found considerable numbers of abnormal, very small axons of uncertain nature but probably related to regeneration following surgery. Including or excluding such axons did not significantly alter the incidence of abnormal axons. We conclude that axonal damage is common in chronic inflammatory bowel disease and is not specifically related to Crohn's disease.

Proteinuric glomerular disease in adults: cumulative life tables over twenty years

Outcome in 425 patients with persistent proteinuria has been assessed over a period of five to 20 years. Nephrotics and non-nephrotics are analysed separately. Clinical and laboratory findings do not correlate with renal histology. Seventy-eight patients had minimal histological lesions and four died (only one in renal failure). Fifty-one patients had endothelial cell proliferation, and 20-year survival was 70 per cent; renal failure occurred within five years in all 17 who progressed, and was independent of nephrotic status. In both membrano-proliferative disease (98 patients) and membranous glomerulopathy (59 patients) 20-year survival was 20 to 30 per cent. Epithelial cell proliferation (85 patients) had the worst prognosis, and survival after 12 years was negligible. In these last three groups decay in survival was almost linear against time and independent of nephrotic status. In focal proliferative disease 20-year survival in nephrotics (31 patients) was only 30 per cent, contrasting with non-nephrotics (23 patients) with 80 per cent survival. Of 105 patients presenting with proteinuria without symptoms, in 30 the proteinuria was postural and biopsies were not done. The other 75 showed a range of histological changes and prognosis similar to the group with symptoms.

Further studies on the glomerular tip lesion: early and late stages and life table analysis

The glomerular tip lesion is a distinctive abnormality of the kidney associated with steroid-responsive proteinuria. It was first recognized at the stage at which there is a group of intracapillary foam cells adherent to Bowman's capsule next to the tubular origin. Late stages were investigated by studying changes to the lesion with time in seven patients known to have the foam cell stage in their first renal biopsy, and by identifying 13 patients whose biopsies had similar changes. Early stages were investigated by the study of biopsies from three patients who at some time had evidence of the tip lesion. The lesion appears to begin with leak of protein through glomeruli that are normal on light microscopy, with damage to proximal tubular epithelium. Adhesion of the glomerular tuft to Bowman's capsule and the development of foam cells then follows. The lesion is permanent but evolves either into a thin tip adhesion or into a larger area of hyalinosis and sclerosis, at first segmental and then global. The lesion can be specifically identified at all stages except the earliest. Actuarial analysis of 37 patients with the tip lesion indicated a 10-year survival of 55 per cent. The only factor identified that appeared to have an influence on survival was satisfactory control of proteinuria.

The glomerular ultrastructural distribution of immunoglobulin G in hyperalbuminaemic (protein-overload) proteinuria

Female Munich-Wistar rats were given intraperitoneal injections either of bovine serum albumin to induce proteinuria or of water as a control. Their kidneys were fixed in situ. An ultrastructural technique was used to demonstrate IgG antiperoxidase antibodies either injected from a heterologous species or autologous, induced by immunization with horseradish peroxidase. Photometry of electron micrographic negative was used to determine the distribution of antiperoxidase antibodies. In glomeruli of control animals IgG was present in the basement membrane. There were three sites at which the passage of IgG across the basement membrane was hindered: between blood plasma and the lamina rara interna, between the lamina densa and the lamina rara externa, and between the lamina rara externa and the urinary space. Glomeruli of proteinuric animals were variable in appearance, some showing little structural damage and others showing marked changes with loss of epithelial foot processes and accumulation of vacuoles and protein droplets in epithelial cells. Both types of glomeruli contained IgG in the urinary space. The distribution of IgG in the basement membrane of both types was similar. Compared with control animals there was less IgG in the basement membrane and IgG was distributed uniformly across the basement membrane. The proteinuria in hyperalbuminaemia (protein-overload) is associated with a diffuse change in the barrier function of the glomerular basement membrane to IgG which is, at least in the initial stages, not related to structural changes in glomerular epithelial cells.

Glomerular lysozyme binding in protein-overload proteinuria

Binding of the cationic molecule lysozyme to the glomerular basement membrane and to the glomerular epithelial cell coat was investigated in the glomerulus of normal female Wistar rats and in rats in which heavy proteinuria was induced by the daily administration of 1 g of bovine serum albumin. In normal rats the binding of lysozyme to the anionic groups in the glomerular basement membrane and the cell coat had no effect on the ultrastructure of the glomerular epithelial cell, in particular the foot processes were unchanged. In the proteinuric rats the lysozyme-binding to the glomerular basement membrane and the epithelial cell coat was completely lost in the damaged glomeruli. In the apparently normal glomeruli present in these proteinuric animals binding was similar to that seen in normal rats. These results suggest that in protein-overload proteinuria there is a loss of glomerular anion and hence a reduction in the glomerular charge barrier. This may account, at least in part, for the increased glomerular leak of negatively charged serum albumin in this experimental model of proteinuria.

Cortical microcystic disease of the kidney with dominant inheritance: a previously undescribed syndrome

We report a family in which the father and all three children had symptomless chronic renal failure and, in the case of the children, normocytic, normochromic anaemia. None had hypertension, proteinuria, or abnormality of urinary deposit. Renal biopsy specimens showed microcysts confined to the renal cortex; some cysts contained vestigial glomerular tufts. This family appears to represent the first known example of hereditary cortical microcystic disease. The distribution of the disease suggests dominant inheritance without sex linkage.

Ultrastructural localization of anionic and cationic ferritin in the rat glomerular basement membrane in protein-overload proteinuria

The penetration into the glomerular basement membrane of anionic and cationic ferritin has been studied in rats made proteinuric by intraperitoneal administration of bovine serum albumin. In comparison with control animals anionic ferritin penetrated the glomerular basement membrane to a much greater extent in proteinuric rats. Some ferritin particles were observed in small invaginations of the epithelial cell membrane adjacent to the glomerular basement membrane and incorporated in pinocytotic vesicles within the epithelial cell cytoplasm. This was not seen in control animals. Cationic ferritin distribution in the glomerular basement membrane was similar in control and proteinuric rats suggesting that the increased anionic ferritin penetration observed occurs without any reduction in fixed anionic charge.

A study of glomerular basement membrane anionic sites and glomerular visceral epithelial cell coat in protein overload proteinuria in the rat

The presence and distribution of anionic sites in the glomerular basement membrane and visceral epithelial cell coat has been demonstrated. No definite decrease in intensity or periodicity of staining of basement membrane particulate sites was seen in protein overload proteinuric animals and only one staining technique employed for electron microscopy (alcian blue 8GX) demonstrated a focal decrease in visceral epithelial cell coat staining in severely damaged glomeruli. A decrease in overall glomerular staining was also demonstrated by quantitative analysis of colloidal iron staining by light microscopy. The findings differ from those described in puromycin aminonucleoside nephropathy and nephrotoxic nephritis. Staining was demonstrated also in other basement membranes, in Bowman's capsule and along interstitial collagen fibres.

The glomerular tip lesion: a previously undescribed type of segmental glomerular abnormality

We describe a distinctive and previously undescribed abnormality of the kidney. It consists of a combination of changes in the glomerulus and in the proximal convoluted tubule. The glomerular abnormality consists of a well-localized collection of intracapillary foam cells and marked vacuolation of the adjacent glomerular epithelial cells. The abnormality is always situated in the same position in the glomerular tuft namely adjacent to the origin of the proximal convoluted tubule, with adhesion to Bowman's capsule. The rest of the tuft appears normal by light microscopy but shows foot-process fusion by electron microscopy. The abnormality of the proximal convoluted tubular cells invariably affects the first part of the tubule adjacent to the glomerulus but in some cases involves the tubules more extensively in the cortex. Study of a series of 100 2-micron serial sections from one case indicated that probably every glomerulus had a lesion at the origin of the tubule. A study of 185 renal biopsies nearly all with segmental lesions revealed biopsies from 20 patients with this distinctive abnormality. There were 14 males, age 20-57, median 44 years, and six females age 19-65, median 22 years, all presenting with proteinuria, nearly all with the nephrotic syndrome. All except four were treated with steroids and in all those treated the proteinuria improved. Only one patient not treated with steroids had progressive renal impairment. Four patients died, none from renal failure. This lesion, the glomerular tip lesion, as we have called it, seems to be a well-defined and specific pathological entity. It has some similarities to minimal change nephropathy but there are clear and important differences. Previously it may have been included in series of cases of 'focal glomerulosclerosis' but that term is imprecise and is generally taken to have an unfavourable clinical course. For these reasons it is inappropriate to use 'focal glomerulosclerosis' as a name for the glomerular tip lesion.

Effect of molecular charge on the induction of proteinuria and glomerular ultrastructural damage in hyperalbuminaemic female Wistar rats

Intraperitoneal injection of anionic carbamylated bovine albumin derivatives induced glomerular epithelial cell foot process loss and increased urinary protein excretion, the severity of which rose with the dose administered. The effects induced at a given albumin dose were significantly lower than those previously measured after the administration of normal bovine albumin. The amount of epithelial cell foot process loss induced after the injection of carbamylated bovine albumin derivatives correlated well with the level of induced proteinuria but, at a given level of proteinuria, the amount of foot process was lower in these rats compared with those given normal bovine albumin. The results obtained are consistent with the interpretation that the more anionic carbamylated bovine albumin derivatives were not only filtered less readily at the glomerulus than their less negatively charged counterparts but were also reabsorbed to a lesser extent by the tubular epithelium.

Glomerular ultrafiltration and tubular reabsorption of bovine serum albumin and derivatives with increased negative charge in the normal female Wistar rat

Urinary clearances of bovine albumin derivatives rose with their increasing negative charge. A mathematical model has been developed to assess the relative contributions of glomerular ultrafiltration and tubular reabsorption to overall urinary protein clearance. This model indicates that the increased urinary clearance seen with negatively charged bovine albumin derivatives was due to a large reduction in the amount of protein absorbed by the proximal tubular epithelium, which swamped the effects of a small decrease in glomerular ultrafiltration. Derivatives of bovine albumin with increasing negative charge were also cleared with correspondingly greater rapidity from the blood stream.

An electron microscopic study of the effects of vinblastine sulphate on the ultrastructure of the kidney, trachea, liver, peripheral nerve and small intestine of the rat

The effects of vinblastine in high doses on the kidney, liver, trachea, peripheral nerve and small intestine of rats have been studied by scanning and transmission electron microscopy. Dramatic structural changes were seen in glomerular visceral epithelial cells, hepatocytes and small intestinal epithelial cells which appear to be due to the effect of vinblastine on microtubules and possibly also on other proteins and cell membranes. Ciliary microtubules appeared resistant to vinblastine effects.

Extra-tubular deposits of Tamm-Horsfall protein in renal allografts

Sections from 266 renal allografts that had been transplanted and removed were studied to determine the prevalence of deposits of Tamm-Horsfall protein outside tubules and resulting from tubular rupture, detected by the periodic acid-Schiff (PAS) reaction. The PAS-positive material was shown to be Tamm-Horsfall protein by an indirect immunoperoxidase method. Deposits were found in 152 kidneys (57.1 per cent.), and were commonest at the cortico-medullary junction and in arcuate veins. Deposits were rarely associated with thrombosis or an inflammatory response, and often contained tubules that were reforming. The lesions were rare in grafts totally infarcted from occlusion of the main vessels. Deposits were mostly found in kidneys that had tubular damage from acute rejection reactions, often with ureteric damage, but a few had ureteric obstruction alone. Old deposits were identified in kidneys showing chronic vascular rejection. No features of the deposits themselves could separate cases with ureteric obstruction alone from the other cases. Not every case with ureteric obstruction had the lesions. Extra-tubular deposits of Tamm-Horsfall protein are common in renal allografts and only rarely indicate a specific, surgically-correctable cause of graft dysfunction, namely ureteric obstruction.

A morphometric, biochemical and histochemical comparison of puromycin aminonucleoside and hyperalbuminaemic induced proteinurias in the female Wistar rat

Biochemical, immunological, histochemical and electron microscope morphometric techniques were used to monitor the changes in urinary protein composition, albumin clearance and glomerular ultrastructure induced in female Wistar rats following i.p. injection of puromycin aminonucleoside (PAN) or bovine albumin (BSA). BSA injected rats maintained a high degree of selectivity with albumin constituting 90 per cent. of the total protein excreted even when mean protein excretion was in the order of 500 mg/24 hr. A similar degree of selectivity was only evident in PAN nephrotic rats at low levels of proteinuria. Levels of 500 mg/24 hr only 57 per cent. of the total protein was albumin. These differences correlated well with the increased number of glomeruli from PAN nephrotics compared with hyperalbuminaemic rats which, at these high levels of proteinuria, had bare areas of glomerular basement membrane caused by epithelial cell detachment (88 and 7 per cent. respectively). Detailed electron microscope morphometric and immunohistochemical studies showed that there were also important quantitative differences in a number of superficially similar glomerular structural alterations. In PAN nephrotic rats all glomeruli showed very marked epithelial cell foot process loss and reduced staining with colloidal iron. In glomeruli from hyperalbuminaemic rats there was a wide variation in the extent of epithelial cell foot process loss and reduced colloidal iron staining was only demonstrable in those glomeruli which had swollen epithelial containing large numbers of vacuoles and protein droplets. Similarly, while protein droplets were smaller and less numerous in glomeruli from PAN-injected rats, they were present in most glomeruli whereas their distribution was much more variable in glomeruli from BSA-injected rats. All the data collected therefore indicated that there were important differences in the types of proteinuria and glomerular ultrastructural damage present in PAN nephrotic and hyperalbuminaemic rats and suggested that their induction may have involved entirely different mechanisms. Evidence gathered from one experimental model should thus only be used with extreme caution to aid in interpretation of data obtained from the other.

Studies on the relationship between proteinuria and glomerular ultrastructural change in hyperalbuminaemic female Wistar rats

Increased albumin filtration was shown to cause glomerular epithelial cell foot process loss in female Wistar rats made hyperalbuminaemic by means of a series of intraperitoneal bovine albumin injections. It appeared to act by stimulating glomerular epithelial cell endocytosis with the result that protein droplets and vacuoles accumulated within the epithelium causing marked cytoplasmic swelling which forced the foot processes to spread out and fuse. The severity of this glomerular ultrastructural damage rose with increasing bovine albumin dose and correlated well with induced proteinuria.

A biochemical and immunological investigation into the physiological basis of the increased albumin filtration induced in hyperalbuminaemic female Wistar rats

1. The level of proteinuria induced in female Wistar rats after bovine albumin injection intraperitoneally was highly dose dependent. 2. The proteinuria remained highly selective, with albumin constituting approximately 90% of the total protein excreted, even in the most severely affected rats. 3. Calculations relating the amount of bovine albumin available in the serum for filtration to the amount excreted in the urine indicated that complete saturation of the reticuloendothelial and tubular protein reabsorption systems may have occurred during the course of the 5 day injection period in rats given more than 3.5 mg of bovine albumin day-1 g-1 body wt. 4. When this situation was attained there appeared to be no further increase in glomerular permeability to either rat or bovine albumin and an equilibrium state seemed to exist where, when serum albumin levels were raised above the normal level, all the excess albumin passed across the glomerular filter to be excreted in the urine. 5. The passage of these large quantities of albumin across the glomerular filter may have resulted not from ultrastructural damage to the filter itself but rather from the generation of vastly increased concentration gradients across the glomerular basement membrane, which were sufficiently large to overcome the electrostatic repulsive forces which normally severely restrict albumin filtration.

Effect of strain and sex on the induction of hyperalbuminaemic proteinuria in the rat

1. Male and female rats representing the four inbred strains [Wistar (albino), Sprague-Dawley (albino), DA (brown) and PVG (hooded) rats] were injected intraperitoneally with 4 . 5-5 . 5 mg of Cohn V bovine albumin day-1 g-1 body wt. 2. The levels of proteinuria and glomerular ultrastructural damage induced in response to hyperalbuminaemia varied widely with the strain and sex of rat studied, being highest in the male Wistar and lowest in the male Sprague-Dawley. 3. A survey of the relevant literature shows that these results probably explain most of the reported inconsistencies and anomalies concerning the effect of parenteral protein injection in the rat.

Normal urinary protein composition in the female Wistar rat and its relationship to the proteinuria induced by intraperitoneal bovine albumin

1. Normal female Wistar rats showed a wide range of baseline protein excretion and albuminuria and could be divided into two distinct groups: (a) low-to-intermediate excretors, where daily baseline albumin excretion was below 1.8 mg/24 h and (b) high excretors, where daily baseline albumin excretion was 1.8-22 mg/24 h. 2. In low-to-intermediate excretors "sex-associated' by urinary specific proteins, supposedly present only in male rat urine, were excreted in larger quantities than albumin which constituted only 10-15% of the total urinary protein. 3. In high excretors up to 50% of the urinary protein was albumin and other serum proteins were also present in relatively larger quantities than the urinary specific proteins. 4. Baseline albumin excretion appeared to be a good indicator of the inherent efficiency of the glomerular filter and this was reflected in the response to intraperitoneal injection of heterologous serum albumin since, during periods where no significant glomerular epithelial cell foot-process loss had been incurred, the levels of proteinuria induced correlated well with baseline albuminuria.

A scanning and transmission electron microscopic study of glomerular damage in the rat following heterologous serum albumin overload

Female Wistar strain rats injected intraperitoneally with 1 g of BSA per day for 5 days, a total of 5 g of BSA, developed heavy proteinuria. Characteristic morphological abnormalities were seen by both TEM and SEM in the large majority of glomeruli from these animals and were similar overall, but not identical to, those seen in puromycin aminonucleoside nephrosis. The heterologous protein overload model seems to present considerable opportunity for study of the basic mechanisms of glomerular visceral epithelial cell handling of protein.

Cadmium-induced osteomalacia

The detailed study of a battery plate maker, who had worked with cadmium for 36 years, showed that proteinuria, typical of renal tubular dysfunction, had been observed for 25 years and during the last 12 years of his life the patient had suffered increasing disability from gross bone disease. Several bone biopsies and detailed metabolic studies showed typical severe osteomalacia, which responded well initially to calcium and vitamin D treatment. Examination of the liver both in life and after death showed a gross excess of cadmium. This was also found in the kidneys after death. Previously unreported changes were present in the bones, especially the lumbar vertebrae which were probably more the result of gross bone deformity than cadmium deposition. The mechanism of development of the severe acquired Fanconi syndrome was thought to be a combination of dietary calcium and vitamin D deficiency and impaired calcium absorption from abnormal vitamin D synthesis, related to the cadmium deposition in the renal tubules, which also caused the defect in renal tubular reabsorption.

Measurement of thyroid hormone in experimental thyroid tumours in rats

Rats treated with 131I and propylthiouracil were shown to develop thyroid tumours 7--9 months after treatment. In this group, the levels of total thyroxine and tri-iodothyronine, and free thyroxine and tri-iodothyronine in the serum were low, and that of TSH was raised. In a group of rats treated with 131I and then propylthiouracil and thyroxine, thyroid tumours were found despite normal concentrations of total and free thyroxine and tri-iodothyronine in the serum. The level of TSH in the serum was significantly raised in this group. Thyroid tumours were not found in the various control groups of rats.

Irreversible glomerular damage following heterologous serum albumin overload

Rats injected intraperitoneally with 1 g of bovine serum albumin (BSA) daily for 5 days develop heavy proteinuria and there is swelling and loss of the foot processes of the glomerular epithelial cells. Initially the urinary protein consists of about 55 per cent. BSA and about 40 per cent. rat serum albumin. Proteinuria persists when the injections of BSA are stopped. BSA disappears from the urine and 80-90 per cent. of the urinary protein is rat serum albumin. The persisting proteinuria is caused by glomerular damage resulting from disruption and necrosis of the glomerular epithelial cells leading to complete sclerosis of glomeruli. This damage does not appear to be immunologically determined.

The morphometry of the glomerular epithelial cell and its foot processes after the injection of bovine serum albumin or egg albumin

The intraperitoneal injection of 1 g of bovine serum albumin daily for 5 days was shown by electron-microscope morphometry to cause swelling of the glomerular epithelial cells and very severe loss of foot processes. However, these changes were found in only 70 per cent. of glomeruli and the other 30 per cent. remained normal. After 7 days' recovery following five daily injections of 1 g of bovine serum albumin, the swelling of the glomerular epithelial cells had subsided and the foot process reappeared. These changes were accompanied by severe proteinuria which resolved only slowly when the injections were stopped. After daily injections of 0-8 g of egg albumin for 5 days there was no swelling of the glomerular epithelial cells and only very slight loss of foot processes detectable only by morphometry. There was a less severe proteinuria than after injections of bovine serum albumin and it resolved more rapidly when injections were stopped. It is suggested that these differences arise from the fact that bovine serum albumin is reabsorbed by the glomerular epithelial cell but egg albumin is not. Two of four rats allowed to recover for 7 days after five daily injections of 1 g of bovine serum albumin had unusual glomerular lesions.

Degranulation of chicken heterophil leucocytes during phagocytosis, studied by phase contrast and interference microscopy

The dynamic aspects of degranulation of chicken heterophil leucocytes during phagocytosis have been studied by phase contrast and interference microscopy. Both standard (8 fps) and high-speed (400 fps) cine-photomicrographic recordings of this process under phase contrast are presented. Lysis of individual granules is usually completed in less than 60 milliseconds. During lysis of each granule a rounded phase dense body is ejected into the phagocytic vacuole. Measurements made by interference microscopy show that there is usually a substantial fall from a protein concentration of c. 100 per cent. w/v for intact granules to a concentration of 16 per cent. w/v for the vacuole resulting from their lysis; this can only be explained by a rapid intake of water into the granule matrix following membrane fusion. The intake of water that accompanies granule lysis causes swelling of the granule matrix, and is thought to explain the mechanism of ejection of the phase dense body. Granule lysis is not dependent on the intake of water, since occasional vacuoles have been observed which showed no fall in protein concentration relative to the intact granules. The membrane around the intact granule effectively excludes the entry of water into the concentrated hygroscopic granule matrix, but once membrane fusion occurs this barrier to the entry of water is usually lost.

Echocardiographic manifestations of single ventricle

Eight patients with single ventricle were studied echocardiographically. In six, the ventricular septum was not detectable; in two, a septal-like bulboventricular ridge was identified. Two atrioventricular (A-V) valves were found in all patients; in six, both valves were identified simultaneously with the transducer held stationary along the left sternal edge. Dextro-transposition of the great arteries was noted in three patients. The echocardiogram of one of four patients with levotransposition of the great arteries was consistent with later proved left A-V valve stenosis associated with Ebstein's malformation. Mitral-semilunar valve continuity was presented in five cases. Echocardiographically, the absence of the ventricular septum in a patient with two A-V valves make a diagnosis of single ventricle likely. The presence of ventricular septal-like echoes does not exclude the diagnosis of single ventricle since the right ventricular infundibulum may remain as a small outlet chamber separated from the left ventricle by an eccentric bulboventricular ridge.

Fibrogenesis imperfecta ossium

The case history, clinical course and laboratory findings in a 66-year-old woman with fibrogenesis imperfecta ossium are reported, the sixth case in the literature. The condition is characterized clinically by intractable skeletal pain and progressive immobility. Though serum alkaline phosphatase has been raised in all patients, there are no specific haematological or biochemical findings. The radiological features of coarse and dense trabecular pattern with symmetrical and diffuse involvement of all bones without expansion or change of shape, together with periosteal reactions and soft tissue calcification are characteristic. The macroscopic appearance of bone shows large areas of opaque white and brittle trabeculae. The histological findings mimic those of osteomalacia unless examined under polarized light which shows the loss of normal birefringence. On electron microscopy the normal lamellar pattern made up of orientated collagen fibrils all about 80 nm diameter is replaced by a random tangled pattern of much thinner irregularly curved fibrils, some as thin as 5nm. The condition appears to be acquired, leading to erosion of the normal skeleton and replacement with an abnormal fibre deficient matrix. There is no definitive therapy at present.

Combined light and electron-microscope morphometric studies of acute puromycin aminonucleoside nephropathy in rats

Morphometric observations were made on rats injected subcutaneously daily with puromycin aminonucleoside after two, four, six and eight daily injections. As a result it was possible to correlate the morphological alterations of the various glomerular components with the biochemical manifestations of the nephrotic syndrome particularly the onset of proteinuria. There was already significant loss of foot processes of the glomerular epithelial cells by the 2nd day, that is before the onset of proteinuria, suggesting that the loss of foot processes is a consequence of some metabolic impairment produced by the puromycin aminonucleoside which also subsequently causes the proteinuria. Swelling of the glomerular epithelial cells became significant by the 6th and 8th day of injection after the development of proteinuria, suggesting that it is a consequence of the increased amount of protein in the glomerular filtrate. Two independent morphometric methods suggest a decrease in the amount of glomerular basement membrane. Unfortunately because of difficulties in the determination of mean glomerular volumes it is not possible to be absolutely certain that this is a true finding, however it is what would be expected if the synthesis of basement membrane was depressed by the puromycin aminonucleoside.

Activities of the neutrophil polymorph

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Quantitative study of infarcted myocardium in cardiogenic shock

A post-mortem study of the heart was performed in 20 patients dying of cardiogenic shock. The extent of infarcted myocardium was defined by using a mitochondrial dehydrogenase stain nitro-BT which allowed macroscopical recognition of tissue death as early as 12 hours. Extensive myocardial injury was found to accompany cardiogenic shock predominantly affecting the left ventricle and the interventricular septum. Severe atheromatous involvement of the coronary arteries was noted.

Controlled trial of prednisone in adult patients with the nephrotic syndrome

A multi-centre controlled trial of steroid treatment of the nephrotic syndrome was carried out on 125 patients. Of these, 64 were controls and 61 received prednisone in a recommended dose range of 20-30 mg./24 hours. The actual initial dose averaged 29 mg./24 hours. Treatment was continued for a variable period, but not less than six months. More than 10 mg./24 hours was given on average for 12 months to all patients, and for longer periods to some. Patients were classified, on the basis of biopsy specimens, into three groups: A, minimal change; B, membranous nephropathy; and C, proliferative glomerulonephritis. In groups B and C prednisone did not have any strikingly favourable effect on proteinuria or on renal function as compared with the control group. In group A, however, prednisone reduced proteinuria to a striking and statistically significant extent. It had little if any effect on long-term renal function in any group. The death rate was higher in the combined prednisone groups (17/61) than in the control groups (12/64). This difference was not statistically significant, but there was a significantly higher number of deaths from cardiovascular disease in the prednisone group, whereas the numbers of deaths from renal failure were not significantly different in the two groups.

The fibroblast

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