Bartter syndrome associated with nephropathic cystinosis

Bartter syndrome is a rare inherited defect in the thick ascending limb of the loop of Henle. It is characterized by low potassium levels (hypokalaemia), increased blood pH (alkalosis) and normal to low blood pressure. There are three types of Bartter syndrome: neonatal, the classic type and Gitelman syndrome. Nephropathic cystinosis is an autosomal recessive disorder characterized by accumulation of free cystine in lysosomes due to disorder of lysosomal transport that can lead to end stage renal failure within 10 years and multiorgan impairment. We report a 5 year 9 month old child with Bartter syndrome associated with nephropathic cystinosis, hypothyroidism and rickets. Hitherto, only a handful of similar cases have been reported in the literature.

Kasabach - Merritt syndrome: A case report

Kasabach-Merritt syndrome is characterised by the combination of rapidly growing vascular tumour, thrombocytopenia, microangiopathic haemolytic anaemia and consumptive coagulopathy. The blood clotting disorder results from platelets and other clotting factors of the blood being used up within the tumor. We report a two- and- half month old Saudi female infant who presented with epistaxis, conjunctival haemorrage and bilateral periorbital ecchymosis.

Recurrent Kawasaki disease resistant to initial treatment with intravenous immunoglobulin

Kawasaki disease (mucocutaneous lymph node syndrome) is a disease of unknown etiology characterized by vasculitis which may affect the coronary arteries. Young children are most commonly affected although the disease has been described in adults. Kawasaki disease (KD) was first described by Dr Tomisaku Kawasaki in 1967. Since then, more cases have been reported worldwide, the majority being from Japan. We report on a 6-year-old child with recurrent attacks of Kawasaki disease which was initially resistant to the conventional treatment.

Successful separation of craniopagus conjoined twins

Craniopagus conjoined twins represent a rare phenom- enon of congenital malformation/ dysmorphism. The clinical pathology of this complex entity is reviewed and placed in perspective. Confusion surrounds the severity of craniopagus conjoined twins especially in relation to the difficulty of separation and subsequent outcome. Successful separation of craniopagus twins remains a rarity, however modern neurosurgical tech- niques have created opportunities for successful sepa- ration and brought hope for a normal survival of these children who in the past were often left as historical footnotes or put on display as oddities of nature. We report on a craniopagus conjoined twins from Sudan who had been successfully separated.

Cord and maternal glycosylated haemoglobin levels: a study in Sudanese pregnant diabetic women

Blood glucose and glycosylated haemoglobin levels measured at delivery in 27 normal and 19 diabetic women were compared with those of the corresponding fetuses and their birthweights. In both groups, neonatal blood glucose levels were significantly higher (p much less than 0.001) than the maternal levels despite significantly lower (p much less than 0.001) glycosylated haemoglobin values in the neonates. In the control group, there was a significant correlation of maternal glycosylated haemoglobin with both cord glycosylated haemoglobin and birthweight ratio (p less than 0.01). The same was not obtained in the diabetic group, suggesting a dissociation in glucose homeostasis between the diabetic pregnant mother and her fetus.

Maternal-infant transmission of hepatitis B in Egypt

In order to determine whether maternal-infant (vertical) transmission of hepatitis B is a common route of infection leading to chronic antigenemia in Egypt, 901 asymptomatic women in labor were evaluated. Forty-three women (4.8 percent) were positive for HBsAg, but only one woman was positive for HBeAg. From one year of observation of children born to 13 of the HBsAg-positive mothers, vertical transmission of hepatitis B was estimated to have occurred in approximately 1.7% of births, with chronic antigenemia resulting from 0.6% of births. It was also possible to observe 29 children born to women negative for HBsAg. Horizontal transmission of hepatitis B occurred in 17.2 percent of these children during the first year of life. Maternal-infant transmission of hepatitis B at birth does not appear to be the predominant mechanism of hepatitis B transmission or a common cause of chronic antigenemia in Egypt. The first year after birth appears to be a more important period of hepatitis B transmission. Therefore, vaccination of all children at birth with hepatitis B vaccine could be an effective vaccine strategy despite a low incidence of vertical hepatitis B transmission.

Amelioration of cisplatin-induced nephrotoxicity by the diuretic acetazolamide in F344 rats

Renal toxicity following a single iv nonlethal dose (6 mg/kg) of cisplatin (CDDP) was investigated in male F344 rats pretreated with 20 mg/kg of acetazolamide (ACZ) sc 30 minutes before CDDP administration. There was a decrease in nephrotoxicity as indicated by a smaller elevation of BUN, a milder histopathologic lesion, and a more rapid recovery of BUN in ACZ-pretreated animals. Renal platinum content of rats receiving ACZ was significantly lower than that in animals treated with CDDP alone. There was no change in platinum level in the plasma or the liver but there was a decreased platinum excretion in urine during 24 hours after treatment. Reduction of platinum concentration in the kidney might account for protection against the renal toxicity. The diuretic ACZ might be useful in the hydration regimens used clinically to prevent renal toxicity from CDDP.

Effects of the diuretics mannitol or acetazolamide on nephrotoxicity and physiological disposition of cisplatin in rats

The anticancer drug cisplatin has been known to produce severe renal lesions characterized by high levels of blood urea nitrogen (BUN), toxic nephrosis, and platinum (Pt) retention in the kidney. The effect of IV pretreatment with acetazolamide (ACZ) 30 min before or mannitol (MAN) immediately prior to IP administration of 5 mg/kg cisplatin on Pt excretion, tissue distribution, and nephrotoxicity was investigated in male F344 rats. ACZ pretreatment reduced the cisplatin-induced nephrotoxicity, as indicated by only a slight elevation of BUN, a milder histopathologic lesion, and a more rapid recovery of renal function and structure. Although MAN-pretreated animals exhibited similar changes in BUN to ACZ-pretreated animals, the renal damage was similar to that seen in animals treated with cisplatin alone. A reduction of kidney Pt content was observed with both diuretics, although there was significantly less retention after ACZ pretreatment. The diuretic ACZ was more effective than MAN in reducing the renal lesions induced by cisplatin and it might be clinically useful in preventing cisplatin nephrotoxicity.

Effect of probenecid and N'-methylnicotinamide on renal handling of cis-dichlorodiammineplatinum-II in rats

The renal handling of cisplatin was investigated in Sprague-Dawley rats in the presence and absence of probenecid and N'-methylnicotinamide. The renal clearance of free cisplatin was not significantly different from the glomerular filtration rate. N'-Methylnicotinamide, an organic cation, did not affect cisplatin clearance. Administration of probenecid, an organic anion, resulted in a significant increase in cisplatin clearance to 169% of the glomerular filtration rate. These results suggest that cisplatin or a metabolite is excreted by the kidney by a complex process which includes glomerular filtration, secretion and active reabsorption via the organic acid transport system.

A psychosocial study of accidental poisoning in Egyptian children

One hundred and twenty-seven accidentally poisoned children from the emergency room of the Islamic Girls College, Cairo, were compared with an equal number of controls. The highest age incidence for both sexes in poisoned children was 36 months. Males outnumbered females at a ratio of 3:2. Behavioural problems such as hyperactivity, temper tantrums, aggression, stubbornness, nocturnal enuresis and impulsiveness occurred more often in poisoned children than in controls and more often in those (24 patients) referred with accidental poisoning on more than one occasion. The families of poisoned children differed significantly from the controls in their large size, low level of education, disturbed home atmosphere and the accessibility to the child of the poisonous substance.