Long-term lithium carbonate therapy causes hyperparathyroidism

Twelve patients taking lithium carbonate for two to 13 years were compared with age- and sex-matched controls to determine whether long-term lithium carbonate therapy is associated with alterations in calcium metabolism. As a group and individually, patients had significantly higher levels of serum total calcium, ionized calcium, and parathyroid hormone. When compared with serum calcium levels, patients' parathyroid hormone levels were significantly more likely than those of controls to indicate hyperparathyroidism. Lithium carbonate-induced mild hyperparathyroidism appears to be more common than had previously been suspected.     

Outcome of Pregnancy in an Oxford-Cardiff Cohort of Women with Previous Bacteriuria

To investigate the influence of asymptomatic bacteriuria inchildhood on subsequent pregnancy, we reviewed the outcome of139 pregnancies in 88 women who were first identified duringa programme of screening schoolgirls for asymptomatic bacteriuriacarried out between 1970–1972 [1]. Data were analysedfor the following groups: 50 pregnancies in 28 women with knownrenal scars (group 1); 16 pregnancies in 14 women with normalkidneys and reflux (group 2); 73 pregnancies in 46 women withnormal urinary tracts (group 3); 139 healthy controls. Women in group 1 had a 3.3-fold increased relative risk of hypertension(p < 0.01) and a 7.6-fold increased risk of pre-eclampsia(p< 0.05) compared to controls, and a higher rate of obstetricinterventions, including emergency caesarean section. Womenin groups 2 and 3 appeared to carry a slightly increased riskof hypertension during the last trimester (RR = 1.8) but therewere no significant differences in this or the incidence ofpre-eclampsia or mode of delivery. Bacteriuria was more prevalentin all index groups compared to controls (37 per cent vs. 8per cent, p < 0.01) and included four cases of acute pyelonephritisin the study group. Fetal outcome was satisfactory in all cases.These results suggest that women with renal scars are at riskof hypertension and pre-eclampsia during pregnancy but thatmodern obstetric care minimizes these risks.     

Famous physicians-botanists

Two hundred years ago a group of physicians laid the foundations of botany with their study of plants for medicinal purposes. Linnaeus of Sweden devised the binomial classification of plants, which is still in use today. Boerhaave of Leyden revitalized bedside teaching and was a major influence in the English-speaking medical schools. Sloane founded the still-existing Physic Garden in London; his natural history collection formed the foundation of the British Museum. Withering prepared digitalis from the purple foxglove and wrote a standard work on the cultivation of vegetables. The gardenia and poinsettia are named after New World physician-botanists Alexander Garden and Joel Poinsett. Swedish physicians Sparrman and Thunberg, pupils of Linnaeus, were the major and original describers of the Cape flora. Atherstone of Grahamstown--the first doctor to use a general anaesthetic (ether) outside America and Europe--is a 19th century example of the naturalist physician as an ardent botanist; he was also a geologist and identified the first diamond found in South Africa.     

Bone marrow transplantation followed by normal pregnancy

A full-term normal male child was delivered using forceps fifteen months after successful allogeneic bone marrow transplantation in a woman who presented with severe acute aplastic anemia. The uneventful course of this pregnancy demonstrates that the high-dose cylcophosphamide administration used to prepare the patient for the procedure need not irreversibly suppress ovarian or endocrine function. This observation has relevance for the increasing numbers of young patients with aplastic anemia or acute leukemia undergoing bone marrow transplantation.     

Averting suicide in terminally ill patients

Possible reasons why some terminally ill patients develop suicidal tendencies are discussed in this paper. Three such patients are described and the author suggests how, by addressing the patients’ needs to feel an increased sense of mastery over their circumstances, the risk of suicide can be decreased.     

Quality control of Tc-99m DTPA for measurement of glomerular filtration: concise communication

When technetium-99m DTPA is used to measure glomerular filtration rate (GFR), the accuracy depends on the supplier of the radiopharmaceutical. The error in GFR is due to protein binding, as we have shown by direct measurement. In 19 patients, GFR measured with Tc-DTPA and corrected for protein binding agreed with that measured simultaneously using Yb-169 DTPA (correlation coefficient 0.991). Without correction, Tc-DTPA gave falsely low values in patients having good renal function, in whom unbound activity cleared rapidly while bound activity remained in the circulation. When Tc-DTPA is used to measure GFR, the in vivo protein binding should be measured and used to correct the data.