An epidemic of acute postinfectious glomerulonephritis in Armenia

AIM

To evaluate the presentation and course of acute postinfectious glomerulonephritis (APGN), which has increased dramatically in Armenia after serious deterioration in the living conditions.

STUDY DESIGN

Observational study, based on case notes, of a large homogeneous group of patients hospitalised for APGN at one centre over a five year period (1992-6).

PATIENTS

474 patients aged < 16 years with a diagnosis of APGN.

RESULTS

The annual number of patients increased tenfold from 19 (average 1992/3) to 196 in 1995. Sixty two per cent were in the age group 4-9 years and 65% were boys. Upper respiratory infections, scarlet fever, and skin infections preceded APGN in 51%, 23%, and 13%, respectively. All patients had haematuria (93% gross), 84% had oedema, and 72% had hypertension. C3 was initially decreased in 95% of the patients examined. Renal function was impaired (serum creatinine > 100 mumol/l) in 29%. Four patients with renal failure had crescentic glomerulonephritis at biopsy; of these, three required temporary haemodialysis. Main extrarenal complications were heart failure (10%) and convulsions (3%). One patient died and five (3%) did not recover completely.

CONCLUSIONS

APGN in children is associated with considerable initial morbidity, and long term outcome is not uniformly benign. Outbreaks of APGN may occur anytime in countries such as Armenia that are suffering from a sudden decline in socioeconomic conditions.

The role of middle ear muscles in the development of resistance to noise induced hearing loss

The role of middle ear muscles (MEMs) in the development of increased resistance to noise induced hearing loss (NIHL) was studied using monaural chinchillas. Animals with severed MEMs as well as those with intact MEMs were exposed to an octave band noise (OBN) centered at 0.5 kHz at 95 dB for six hours/day for ten consecutive days. Results indicated that animals with severed MEMs showed greater initial threshold shifts (TS) than the animals with intact MEMs. Both the groups showed a decrease in TS over the ten days of exposure. The subjects were given five days of recovery and then re-exposed to the same noise at 106 dB for 48 h. Permanent threshold shifts (PTS) in each group was compared against those in a control group exposed to the noise only at the higher level. Interestingly, both the 'conditioned' groups incurred substantially less PTS than the control group exposed only to the higher level.

Aneurysms of the temporal bone

Aneurysms of the internal carotid artery in the temporal bone are rare lesions which can present clinically as a growth in the middle ear cleft. Hemorrhage, occurring spontaneously or iatrogenically, is a primary concern. This study describes morphological and embryological characteristics of the internal carotid artery in relationship to the protympanum and temporal bone. Concepts of pathogenesis and pathology are discussed, with reference to the neurosurgical and otolaryngologic literature. Clinical characteristics, including methods of surgical repair, are presented using three illustrative case reports. Methods of surgical repair include: 1) reinforcement; 2) ligation; and 3) primary excision and reanastomosis.