CHILDHOOD ACROMEGALY SUCCESSFULLY TREATED WITH INTERSTITIAL IRRADIATION USING YTTRIUM-90

ABSTRACT. A child with a growth hormone producing tumour presented at the age of 4 1/2 years. The onset of the disease was at 18 months of age. Treatment was given with three doses of interstitial irradiation using yttrium-90 implants. There were no local complications from the procedures. Now, 11 years after diagnosis, she is asymptomatic, of normal appearance, and her height and the size of the pituitary fossa are normal. Growth hormone levels are almost normal, thyroid function is intact, and she is maintained on prednisone and sex hormones.     

THYMOPOIETIN IN RHEUMATOID ARTHRITIS

In a controlled study involving 36 patients, thymopoietin wasshown to be more effective than levamisole and as effectiveas penicillamine in improving the clinical status of patientswith rheumatoid arthritis. There were small reductions in erythrocytesedimentation rate and IgG which did not achieve statisticalsignificance. Rheumatoid factor titre did not change. Althoughits mechanism of action is almost certainly related to its immunomodulatoryproperties it does not seem to be the same as that of levamisole.     

Dermatitis herpetiformis: a review of 119 cases

Between 1954 and 1980 119 cases of dermatitis herpetiformis have been seen. IgA examination of uninvolved skin was positive in 93·6%, of patients. Jejunal biopsy showed villous atrophy in 6%, of patients. HLA typing showed HLA-B8 present in 83·7%, HLA-Ai in 74·4%, and HLA-B8 or -Ai in 93%, of patients. Antinuclear factor was present in 19%, thyroid antibodies in 6%, and parietal cell antibodies in 8%, of the patients. Two out of twenty patients (10%) examined had anti-reticulin antibodies. Twenty per cent of the patients had a positive family history of atopy, and 6%, had a positive personal history of it. Fourteen patients (11-7%) had relatives with coeliac disease. A gluten-free diet is advocated for all patients. Dapsone will control the rash if patients are unwilling to take the diet.     

The Acromegaly Syndrome: RELATION BETWEEN CLINICAL FEATURES, GROWTH HORMONE VALUES AND RADIOLOGICAL CHARACTERISTICS OF THE PITUITARY TUMOURS

One hundred and fifty-five acromegalics, 76 males (mean age44 ± 1.3 years) and 79 females (45 ± 1.4 years)were studied. The frequency of clinical features were: acralenlargement 100 per cent, hyperhidrosis 65 per cent, headache55 per cent, paraesthesiae 49 per cent, cardiac problems 34per cent, hypertension 32 per cent, diabetes mellitus (clinicaland chemical) 27 per cent, and visual field defects 6 per centSigns and symptoms, and particularly headache, did not showany relation with the size or shape of pituitary tumours, norwith growth hormone (GH) values, age, sex or weight Mean ofGH values at 60, 90 and 120 minutes during a GTT averaged 135mIU/I, range 8–1833. Diabetes mellitus was more frequentand severe in patients with higher GH values, occurring in 32per cent of patients with mean GH values 50 mIU/1 and only in16 per cent of the rest (p < 0.05). GH values correlated positively with size of tumours. Forty-nineper cent of patients presented with entirely intrasellar tumours,27 per cent with suprasellar extensions and 23 per cent withpartially empty sellae. The mean GH (238 mIU/I) of patientswith suprasellar extensions was significantly higher (p <0.004) than those of the others. Younger acromegalics showeda tendency to larger tumours. Early treatment of acromegaly, particularly in young patientsand those presenting with high GH values, is recommended.