Effects of shell lesions on survival, growth, condition and reproduction in the New Zealand blackfoot abalone Haliotis iris

The pathogenicity of shell lesions in Haliotis iris Martyn was examined in a laboratory experiment in which 73 apparently healthy and 106 lesion-bearing abalone were maintained for up to 12 mo. The abalone were collected from the wild and kept in cages (1 ind. cage(-1)) for 4, 8 or 12 mo, at which times estimates of survival, growth, condition and reproductive capacity were made for each of 3 groups: 'healthy' (n = 73), 'mildly affected' (n = 61) and 'severely affected' (n = 32). Unaffected abalone showed a 2.7% mortality (n = 73) compared to 7.5% (n = 93) in lesion-bearing individuals over the entire experiment. Growth rates were significantly decreased in mildly and severely affected abalone: the relative von Bertalanffy growth coefficient (K), calculated over 12 mo, was -0.176 for unaffected, -0.079 for mildly affected and -0.048 for severely affected individuals. The asymptotic length (L(infinity)) was calculated to be 131.5 mm for unaffected, 142.1 mm for mildly affected and 150.3 mm for severely affected abalone. Significantly (p < 0.05) lower condition indices and decreased reproductive capacity (p > 0.05) were obtained for the severely affected group compared to unaffected abalone. These trends were consistent over the course of the experiment.

Evaluation of radiography, ultrasonography and endoscopy for detection of shell lesions in live abalone Haliotis iris (Mollusca: Gastropoda)

Radiography, ultrasonography and endoscopy were examined for their efficacy as non-destructive techniques for the detection of shell lesions in the marine gastropod Haliotis iris Gmelin. X-rays provided 69% correct diagnoses, with detection being restricted to those lesions which were mineralised. Ultrasound also showed potential to reliably detect lesions (83% correct diagnoses), but only where the lesions demonstrated a clear 3-dimensional relief. Lesion dimensions were underestimated using ultrasound. Endoscopy, applied to anaesthetised individuals, provided the most accurate method (92% correct diagnoses) for lesion detection and, although invasive, had no discernible effect on survival of the abalone 8 mo after screening.

The use of diagnostic radiology to detect shell irregularities in the New Zealand paua (abalone) Haliotis iris

A method is described for the non-destructive, non-invasive, detection of shell lesions in the New Zealand paua, a marine gastropod Haliotis iris using diagnostic radiology. The X-ray method reliably detected the presence of shell lesions in 96% of the cases examined once lesion dimensions exceeded 6.2 x 7.1 mm. The extent of lesions above this size can be reliably and accurately determined from X-ray images viewed on a video display unit (VDU). Biofouling on the outside of the shell can cause misdiagnoses. This method is a significant animal welfare refinement in the identification of marine gastropods with shell lesions, when compared with traditional techniques which kill the animals.

CLINICAL AND BIOCHEMICAL OUTCOME OF HEPATORENAL TRANSPLANTATION FOR HEREDITARY SYSTEMIC AMYLOIDOSIS ASSOCIATED WITH APOLIPOPROTEIN AI Gly26Arg1

BACKGROUND

Treatment of systemic amyloidosis comprises measures to support failing organ function coupled with attempts to reduce the supply of the respective amyloid fibril precursor protein. Orthotopic hepatic transplantation is effective in familial amyloid polyneuropathy associated with variant transthyretin, because this protein is produced almost exclusively in the liver. Hepatic transplantation has not been performed in hereditary apolipoprotein AI (apoAI) amyloidosis, and the liver's contribution to plasma apoAI levels has not been determined in vivo.

METHODS

A 57-year-old Irish man with hereditary systemic amyloidosis associated with apoAI Gly26Arg, which had led to end-stage renal failure and progressive liver dysfunction, underwent hepatorenal transplantation. His outcome was followed clinically and his amyloid deposits were monitored with serum amyloid P component scintigraphy. The proportion of variant apoAI in the plasma was estimated by quantitative isoelectric focusing before and after liver transplantation.

RESULTS

Plasma levels of variant apoAI decreased by 50% after liver transplantation, and the patient was asymptomatic 2 years after surgery. Subclinical amyloid deposits that were present in his spleen and heart preoperatively have regressed and stabilized respectively.

CONCLUSIONS

Orthotopic liver transplantation substantially reduces the supply of the amyloid fibril precursor protein in hereditary apoAI amyloidosis, and the excellent outcome in this patient probably reflects the balance between deposition and turnover of amyloid having been altered in favor of the latter. These findings support the use of liver transplantation in patients with hereditary apoAI amyloidosis who develop hepatic dysfunction.

Von Hippel-Lindau disease: an important differential diagnosis of polycystic kidney disease

Von Hippel Lindau disease is a dominantly inherited familial cancer syndrome, characterized by retinal, spinal, and cerebellar haemangioblastomas, renal cell carcinomas, and phaeochromocytomas. Cysts of the kidney and pancreas may also occur. We describe a large three-generation Irish family with VHL disease who initially presented with features typical of autosomal dominant polycystic kidney disease. Eight clinically affected individuals were found. Visceral complications were particularly prominent within the family. There were no cases of retinal angiomata or phaeochromocytoma. The diagnosis was confirmed by genetic linkage analysis in this family, although the exact mutation has yet to be defined.

Skin cancer in an Irish renal transplant population

One hundred and forty-nine renal transplant patients attending 2 centres in Dublin were examined. Twelve patients (8.1%) were found to have cutaneous malignancy while dysplastic lesions (premalignant and/or malignant) were identified in 34 (22.8%). The prevalence of cutaneous malignancy in this study is substantially greater than that of previous Irish studies. The introduction of cyclosporin A (CyA) as a new and more effective immunosuppressive agent in renal transplantation may in part explain this increase.

Reduction of proteinuria with captopril therapy in patients with focal segmental glomerulosclerosis and IgA nephropathy

Angiotensin-1 converting enzyme inhibitors (ACEI) have been shown to reduce proteinuria in azotaemic diabetics and in other glomerulopathies, and such treatment has also slowed the development of experimentally-induced glomerulosclerosis in animals. We have treated 13 patients with focal segmental glomerulosclerosis (FSGS) and IgA nephropathy (IgAN) with Captopril 12.5 mg twice daily for six months and assessed their response in terms of 24 hour urinary protein excretion, blood pressure, glomerular filtration rate, effective renal plasma flow and derived values for filtration fraction and renal vascular resistance. A mean fall of 29 per cent in urinary protein excretion was observed over the six months treatment schedule. No significant changes were observed in other parameters of renal haemodynamics measured. We conclude that Captopril therapy in patients with FSGS and IgAN reduces urinary protein excretion consistently over a six month period, and that this may in the longer term retard the progression of their renal failure.

The effect of peritoneal dialysate on pulmonary function and blood gasses in C.A.P.D. patients

There have been many reports showing diminished vital capacity (VC), total lung capacity (TLC), and functional residual capacity (FRC), after the infusion of peritoneal dialysate in patients on continuous ambulatory peritoneal dialysis (C.A.P.D.) for chronic renal failure. We also examined the effects of the infusion of two litres of dialysate on airways resistance (Raw) using total body plethysmography and on arterial blood gasses. Ten patients on C.A.P.D. were selected. The mean results of dialysate infused (in) and dialysate drained (out) are as follows: FVC 3.66 l (in) and 3.73 l (out) (not significant); VC 3.81 l (in) and 3.99 l (out) (p less than 0.05); FEV1 3.02 l (in) and 2.94 (out) (n.s.); TLC 5.89 l (in) and 6.33 l (out) (p less than 0.05); FRC 3.56 l (in) and 3.78 l (out) (p less than 0.05); Raw 4.79 cmsH21/l/s (in) and 4.72 cmsH20/l/s (out) (n.s.); Pa02 11.03 kPA (in) and 11.35 kPA (out) (p less than 0.001). We conclude that two litre dialysate causes significant reduction of TLC, VC and FRC, and a reduction in Pa02 and A-a02 but has no effect on airways resistance.

Immune complex glomerulonephritis secondary to tuberculosis

A 63 year old man with pulmonary tuberculosis developed nephrotic syndrome secondary to immune complex nephritis. The nephrotic syndrome and renal lesion resolved with standard chemotherapy.

Haemolytic uraemic syndrome with shigella

A 49-year-old male developed bloody diarrhoea whilst on a visit to India. Sigmoidoscopy and rectal biopsy showed acute colitis. Shigella dysentery type I was isolated from stool culture. Cytotoxin production by the organism was demonstrated. The patient developed acute renal failure, thrombocytopaenia and microangiopathic haemolytic anaemia. He required mechanical ventilation, haemodialysis, blood transfusion and antibiotic therapy and achieved a complete recovery. This is an unusual case of haemolytic uraemic syndrome complicating shigellosis in an adult.

Aluminium osteomalacia in chronic renal failure patients neither on dialysis nor taking aluminium containing phosphate binders

The incidence of aluminium osteomalacia (ALO) in patients with chronic renal failure neither on dialysis nor taking aluminium-containing phosphate binders (ACPB) is not well documented. Biochemical and histological bone investigations were performed in 35 patients fulfilling the above conditions, among whom we found an incidence of ALO of 17%. In the ALO group, salient findings were PTH level (mean +/- s.d.) of 3.1 +/- 1.4 ng/ml (normal less than 0.5 ng/ml); elevated home tap-water aluminium levels of 6.5 +/- 1.2 umol/l (normal less than 2 umol/l); and a GFR of 20.5 mls/min/1.73m, (range 2-50 mls/min/1.73m). We conclude that the aetiology of ALO in this group involves the absorption of toxic home water aluminium in the presence of an elevated PTH level and a GFR less than 50 mls/min/1.73m.

Acute epidemic aluminium osteomalacia secondary to water supply contamination

When the aluminium content of the water supply to our Haemodialysis Unit rose from less than 0.5 mumol/l to 6 mumol/l over a two month period, we carried out bone biopsies and desferrioxamine infusion tests on twelve (12) patients who had been on haemodialysis for less than one year (mean 8 months) and had normal serum aluminium levels. The patients had no bone symptoms. Eight patients had positive aluminium bone stains. The aluminium osteomalacia group (n = 8) had a mean PTH of 1.4 ng/ml s.e. 0.3 whereas the non-ALO group had a mean PTH of 2.9 ng/ml s.e. 0.7. The difference in mean PTH is significant (p less than 0.05). There was no evidence of encephalopathy, fractures or microcytic anaemia in the ALO positive group. The aluminium contamination of the water supply occurred because of a change in the reservoir purification system from sand-filtration to alum.

A case of IgA nephropathy associated with vitiligo, primary hypothyroidism and primary adrenocortical insufficiency

A 14 year old boy presented with recurrent attacks of macroscopic haematuria preceded by tonsillitis. Clinical examination revealed generalised vitiligo. Renal function was normal with microscopic haematuria. Percutaneous renal biopsy showed mesangial proliferation on light microscopy with deposition of IgA and IgM in a granular pattern in the mesangium and glomerular basement membrane compatible with a diagnosis of IgA nephropathy. Biochemical investigations revealed primary hypothyroidism and primary adrenocortical insufficiency with negative organ specific autoimmune screen. Renal function has not deteriorated after three years follow-up. This particular association has not been previously described to our knowledge.

Pulmonary berylliosis on corticosteroid therapy, with cavitating lung lesions and aspergillomata--report on a fatal case

A fatal case of pulmonary berylliosis in a 42 year old male is described. The patient was exposed to beryllium while working in a chemical plant over a 9 year period, and presented two years after ceasing such employment. The berylliosis was diagnosed on open lung biopsy in 1971. The patient was commenced on steriod therapy at that time. He suffered progressive dyspnoea from severe restrictive lung disease over the next 14 years. A chest X-ray of June 1985 revealed a lesion in the left upper lobe suggestive of a mycetoma. Before any therapy could be instituted he suffered a massive haemoptysis and died. Post-mortem examination revealed two large mycetomata in the right and left upper lobes. Parenchymal histology showed evidence of chronic inflammation with non-caseating granulomata and the cavity wall showed localized invasion by Aspergillus fumigatus. It is possible that the long term steroid therapy with multiple boosters of treatment may have contributed to the development of the mycetoma. This is the first case report known to the authors of a fatal aspergilloma in association with chronic berylliosis treated with steroids.

Transient leucopenia and thrombocytopenia associated with sodium nitroprusside infusion

The case history of a 42 year old male on CAPD who was receiving sodium nitroprusside (SNP) for hypertensive encephalopathy is described. Leucopenia and thrombocytopenia developed but were resolved by hydroxocobalamin infusion during administration.

Renal vein thrombosis with recurrent pulmonary emboli in the nephrotic syndrome: use of the Greenfield filter

We describe a case of renal vein thrombosis in association with the nephrotic syndrome. The patient had recurrent pulmonary emboli which, having failed to respond to routine anticoagulant treatment, were managed successfully by the insertion of a Greenfield filter into the inferior vena cava above the renal vein thrombosis site. The only coagulation abnormality in this patient was a deficiency of antithrombin III.

Treatment of essential hypertension and hypertension associated with renal impairment with pinacidil: a new vasodilator

Twenty patients with uncontrolled hypertension were treated with pinacidil for a mean period of 43 weeks (range 10-63 weeks). All patients achieved and maintained significant reductions in blood pressure. The supine blood pressure at baseline was 184/116 mmHg; after one week it was 161/95 mmHg and at 43 weeks it was 138/79 mmHg. The mean dose of pinacidil was 30 mg/day. There was no significant difference between the two groups with respect to the dose of pinacidil or the blood pressure response. Pulse rate and weight remained stable for the group as a whole. Five patients were not taking beta-blockers. The mean baseline pulse rate for this group was 78 beats/min and when maintained on pinacidil it was 82 beat/min (NS). Six patients were not taking diuretics. The mean baseline weight for this group was 78.5 kg and while maintained on pinacidil it was 79.2 kg (NS). There was no occurrence of oedema, hirsutism or first dose phenomenon. The mean glomerular filtration rate and renal plasma flow for the renal plasma flow for the renal group was 35.4 ml/min and 192.3 ml/min before pinacidil and after six months they were 32.7 ml/min and 183.2 ml/min (NS) respectively. Six patients experienced minor side-effects. We conclude that pinacidil is a potent, well tolerated antihypertensive agent which merits further study.

Long-term effects of pinacidil in hypertensive dialysis patients

In an open study, thirteen chronic dialysis patients with nonvolume dependent uncontrolled hypertension were treated with pinacidil for a mean period of 43 weeks. Seven patients were taking concomitant antihypertensive therapy. Twelve patients achieved long-term blood pressure control on a mean dose of 33 mg/day. The baseline supine blood pressure was 184/116 mmHg. After 1 week it had fallen to 161/95 mmHg and blood pressure control was maintained over the study period. Patient weight remained stable. The baseline reading was 61.6 kg and at the end of the study it was 59.7 kg. Pulse rate did not change significantly. For the eight patients not taking beta-blockers the mean change in pulse rate was 7.6 beats/min supine and 6.3 beats/min erect (NS). Pretrial urea and creatinine were 27.6 mmol/l and 1027 mumol/l and after 25 weeks they were 29.6 mmol/l and 1087 mumol/l, respectively (NS). Four patients had ECG evidence of left ventricular hypertrophy before the study and one on completion of the trial. Five patients showed correction of T-waves on their ECG's. Six patients experienced side effects, none of which warranted withdrawal of treatment. These findings suggest that pinacidil is a valuable alternative treatment for hypertensive dialysis patients.

1-Deamino-8-D-arginine vasopressin as a therapy for the bleeding diathesis of renal failure

The treatment of the bleeding diathesis of renal failure remains unsatisfactory. 1-Deamino-8-D-arginine vasopressin (DDAVP) has recently been shown to shorten the prolonged bleeding time of renal failure and may as a result diminish the risk of clinical hemorrhage. We describe 2 cases where DDAVP was used successfully in the management of hemorrhage in the setting of renal insufficiency.

Effect of 1-deamino-8-D-arginine vasopressin on the prolonged bleeding time in chronic renal failure

The prolonged bleeding times of 12 patients with chronic renal failure were significantly shortened at 1 and 2 h after an infusion of 0.4 microgram/kg 1-deamino-8-D-arginine vasopressin (DDAVP). In 5 of these patients, the bleeding times 24 h after infusion had returned to approximate baseline values, suggesting that the effect of DDAVP is a temporary one. The levels of factor VIII coagulant activity, factor VIII related antigen activity, and factor VIII ristocetin cofactor activity were all normal or elevated prior to infusion, and a tendency to further elevation, although significant only for the factor VIII ristocetin cofactor activity, was observed after infusion of DDAVP. The latter observation suggests that the effect of DDAVP infusion on the bleeding time is unrelated to alteration of factor VIII activities.

Anaphylactoid reaction to mannitol

A 16-year old boy with a lesion of the right eye developed, during the preoperative administration of a mannitol infusion, an anaphylactoid reaction characterized by hypotension, periorbital oedema and bronchospasm. This quickly resolved following cessation of the infusion and appropriate therapeutic measures. There were no long-lasting effects. We considered mannitol the causative agent because of its temporal relationship to the reaction and our inability to seriously implicate any other medication. A history of childhood atopy may have been a predisposing factor.