Paediatric urolithiasis in a remote Australian Aboriginal community

Abstract: A retrospective study of Community Health Service patient records revealed 10 cases of urolithiasis in Aboriginal children under 5 years of age in a remote central Australian Aboriginal community over a 4 year period, out of a total under-5 population estimate of 62. The highest attack rate was in the 0–2 age group, where nearly one in 10 children presented per year. All children had significant associated morbidity. Two children underwent pyelolithotomy.
Aboriginal children in the remote arid zone study community suffer exceptionally high rates of urolithiasis. Inadequate diet, dehydration and recurrent infectious disease are factors in pathogenesis. Further study may elucidate aetiology, but the implications of these data for improving environmental conditions and health service delivery in Aboriginal communities are urgent.     

Lactate and glucose minimum speeds and running performance

This study aimed to analyse the validity of glucose minimum speed (GMS) for lactate minimum speed (LMS) assessment during running and their relationship to endurance performance. Eight male trained runners (28.7 +/- 9.0 years) volunteered to take part in this study and underwent an official 10-km road race and a track lactate minimum test (LMT) (0.5-km sprint plus 6 x 800 m from 87 to 98% of maximal 3-km speed). Lactate and glucose minimum speeds were considered those related to the minimum blood lactate and glucose concentrations respectively attained during the graded phase of LMT. Significant correlations (p < 0.05) were found between LMS and GMS (r = 0.72) and LMS and 10-km performance (r = 0.83), but not between GMS and 10-km performance (r = 0.49). No significant differences (p > 0.05) were found between LMS (4.75 +/- 0.08 m/s), GMS (4.73 +/- 0.07 m/s) and 10-km mean speed (4.79 +/- 0.17 m/s). In conclusion, we found GMS to be a good predictor of LMS during track LMT, LMS being well related to endurance running performance.     

Value of radiopaque markers in identifying partial small bowel obstruction

Confirming partial small bowel obstruction is often a diagnostic challenge. In this case report, 4-mm solid radiopaque markers were used in 4 patients to show partial small bowel obstruction. Results of enteroclysis were normal in 2 of the 4 patients, and the markers were used to challenge suspected partial obstruction. The markers coalesced in the region of the partial obstruction, which was confirmed at surgery. Enteroclysis is the examination of choice in the diagnosis of partial small bowel obstruction. However, examinations with false- negative results can occur, particularly with adhesive and/or intermittent obstructions. The use of radiopaque markers in these cases proved an effective and useful method of establishing the diagnosis of partial small bowel obstruction, particularly in the 2 cases in which enteroclysis results were normal. Prospective studies are needed to establish the feasibility of this novel technique. (Gastroenterology 1996 Jun;110(6):1958-63)     

Endocrine Function, Psychiatric and Clinical Consequences in Patients With Macroprolactinomas After Long-term Treatment With the New Non-ergot Dopamine Agonist CV205-502

Although bromocriptine is the mainstay of treatment of macroprolactinomas,its therapeutic usefulness may be limited by poor tolerance,lack of consistent reduction in serum prolactin levels and tumoursize, and the necessity for multiple dosing. Consequently newdopamine agonists have been developed, including the long actingnon-ergot agonist CV205–502 which has been shown to dateto be consistently effective in reducing serum PRL levels andcausing tumour shrinkage. Twelve patients were treated for periods of up to 24 monthswith CV205–502 in doses ranging from 0.075 mg to 1.65mg once daily. Clinical and psychiatric assessments, biochemicalparameters, tumour size determination, and anterior pituitaryfunction tests were performed regularly. Tumour shrinkage wasnoted in all patients, and varied from 11 per cent reductionto complete disappearance of tumour. Prolactin levels becamenormal in seven patients and were reduced by more than 90 percent in the remaining five. Normal menstruation resumed in sixof the eight women, one of whom conceived after one year oftherapy; libido returned in all patients. Psychiatric complicationsoccurred in three patients necessitating withdrawal of therapyin one. Significant weight loss was noted in 11 of 12 patients. Triglyceride concentrations fell from 1.5±0.1 to 1.0±0.1mmol/l at 12 months (p=0.006), and cholesterol fell from 6.3±0.4to 5.3±0.3 mmol/l (p=0.04). The mean TSH response 20min following TRH injection fell from 14.3±2.9 to 8.7±1.3mU/l at 2 months (p=0.027). There was a significant increasein the peak growth hormone response to the insulin stress testfrom basal median (25th–75th centiles) values of 15 (4.4–25.5)mU/l to 24.5 (9–37) mU/l at 2 months (p<0.01) and 31(19.3–63.5) at 12 months (p<0.005). CV205–502 is highly effective in the medical managementof patients with macroprolactinomas, reducing prolactin levelsand tumour size and restoring normal anterior pituitary function.It is, however, associated with the important side effects ofweight loss and pychiatric complications which should be drawnto the attention of clinicians.     

Morphologic characteristics of acute lymphoblastic leukemia (ALL) with abnormalities of chromosome 8, band q24.

The CALGB prospectively studied 140 adult acute lymphoblastic leukemia (ALL) patients for cytogenetic abnormalities. Seven (5%) patients with adequate cytogenetic preparations had t(8;14)(q24;q32) or t(8;22)(q24;q11). Patients were compared with non-8q24 patients for clinical and laboratory characteristics, response to therapy, and survival. The median age of patients with translocations involving 8q24 (71% males) was 40 years. Forty-three percent had lymphadenopathy, 29% splenomegaly, and 29% hepatomegaly. None exhibited central nervous system (CNS), skin, or gum involvement. These features did not differ significantly from non-8q24 ALLs. Patients with 8q24 translocations had higher hemoglobins (11.5 vs. 9.8 g/dl; P = 0.04) and lower percentage of blasts in the peripheral blood (8.5% vs. 69%; P = 0.007). Although all seven were finally categorized as ALL-L3, a marked variation in the proportion of typical L3 blasts was observed that initially resulted in the diagnoses of ALL-L2 in three cases and prolymphocytic leukemia in one. In five of five patients, the blasts typed as B cells (SIg+ and CD19+). Complete remission rates for patients with 8q24 translocations were 43%, whereas they were 68% for non-8q24 ALLS (P = 0.22). Furthermore, patients with 8q24 abnormalities exhibited significantly shorter survival (4.8 vs. 18.4 mo; P less than 0.001). We conclude that ALL with translocations of 8q24 in adults shows a mature B-cell immunophenotype (SIg+), poor prognosis and morphology ranging from classical ALL-L3 to ALL with a subpopulation of L3 cells. Thus, the diagnosis of ALL-L3 should be made when blastic cells possess a mature B-cell immunophenotype (SIg+) and an 8q24 translocation, even though the number of L3 cells is low.     

Sustained high levels of circulating chaperoned interleukin-6 after active specific cancer immunotherapy

In a phase 1 study of recombinant interleukin-6 (rIL-6) in patients with advanced solid tumors (n = 15), we discovered that the endogenous IL-6 levels, in pretreatment plasma or serum samples, were distributed into two groups. One set of patients (designated "type 1"; n = 9) was characterized by low plasma IL-6 levels (48 to 1,700 pg/mL) as measured using enzyme-linked immunosorbent assays (ELISA) for IL-6. In the second set of patients (designated "type 2"; n = 6), IL-6 ELISAs showed high levels of plasma IL-6 (50 to 600 ng/mL). Neither group had detectable B9 hybridoma cell growth factor activity associated with the IL-6 in their pretreatment plasma or serum. Plasma C-reactive protein (CRP) levels were markedly elevated in type II patients suggesting that the circulating IL-6 was biologically active in vivo. In both groups of patients there was a small but significant increase in B9 activity in the plasma within three hours after rIL-6 administration (n = 5). Gel filtration profiles showed that circulating IL-6 in type 1 patients, 15 to 120 minutes after rIL-6 administration was of approximate mass 20 to 40 kD, whereas in type 2 patients, the IL-6 before and after exogenous rIL-6 administration was indistinguishable and was of an approximate mass of 200 kD. IL-6 immunoaffinity purification of the 200 kD complexes showed these to contain multiple isoforms of IL-6 (14 to 31 kD) and the soluble IL-6 receptor (sIL-6R; 50 to 55 kD). A distinguishing clinical history was that all of the type 2 patients had been actively immunized with an anti-idiotypic monoclonal antibody (MoAb) (MK2-23) 3 to 12 months before initiation of this study for advanced melanoma. An analysis of the plasma IL-6 content in other melanoma patients (n = 16) during antiidiotypic MoAb immunization indicated that marked (up to 600 ng/mL) and sustained (several months) elevations of circulating "chaperoned" IL-6 were induced by active immunization regimens.     

Thrombocytopenia in septicemia: the role of disseminated intravascular coagulation

The mechanism of isolated thrombocytopenia in septicemia is unknown, but compensated disseminated intravascular coagulation (DIC) has been suggested as a possible cause. To investigate this possibility, platelet counts and sensitive assays for in vivo thrombin and plasmin generation, including fibrinogen gel chromatography and fibrinopeptide A (FPA) assays, were obtained on 31 septicemic patients. Fifteen of 17 patients with gram-negative septicemia and 8 of 14 patients with gram- positive septicemia had thrombocytopenia. Platelet survival studied demonstrated a decreased platelet survival. In 11 of 12 patients with severe thrombocytopenia (platelet count less than 50,000mul), there was laboratory evidence of intravascular coagulation. In contrast, there was little evidence of intravascular coagulation in 8 of 11 patients with moderate thrombocytopenia (platelet counts 50,000 to less than 150,000/mul) or in 7 of 8 patients with normal platelet counts. This report indicates that while DIC accompanies thrombocytopenia in many patients with severe thrombocytopenia, there is frequently little evidence for intravascular coagulation in patients with moderate thrombocytopenia. It is apparent that factors other than intravascular thrombin must play a role in producing the thrombocytopenia of septicemia.