Antineutrophil cytoplasmic antibodies in IgA nephropathy and Henoch-Sch?nlein purpura.

The frequency, isotype, and specificity of antineutrophil cytoplasmic antibodies were investigated in a cross-sectional study of 100 patients with IgA nephropathy and 30 children with Henoch-Sch?nlein purpura. Two of the patients with IgA nephropathy had high titres of antineutrophil cytoplasmic antibodies which were of IgG isotype and confirmed as antimyeloperoxidase antibodies in solid-phase ELISA and inhibition experiments. Antineutrophil cytoplasmic antibodies were not detected in the children with Henoch-Sch?nlein purpura and none of the patients in either group had IgA antineutrophil cytoplasmic antibodies. A further 20 IgA nephropathy and 10 Henoch-Sch?nlein purpura patients were studied longitudinally in different clinical phases at 4-monthly intervals over a 2-year period. None of these patients had or developed antineutrophil cytoplasmic antibodies. We conclude that IgA antineutrophil cytoplasmic antibodies are not involved in the vasculitis of Henoch-Sch?nlein purpura or in the pathogenesis of glomerular injury in IgA nephropathy. The detection of IgG antimyeloperoxidase antibodies in a small minority of IgA nephropathy patients extends the spectrum of diseases associated with autoimmunity to this antigen but is of uncertain significance.     

High dose melphalan and total body irradiation with autologous marrow rescue in childhood acute lymphoblastic leukaemia after relapse

High dose melphalan (HDM 110-140 mg/m2) and total body irradiation (TBI, 10.5 Gy, single fraction) followed by infusion of autologous bone marrow (ABMT) was evaluated for toxicity and efficacy in 24 children with acute lymphoblastic leukaemia (ALL) in second (CR2) or third remission (CR3). Marrow was purged with Campath 1 in six children (four were children in CR3). All children had engraftment with a median of 30 days (range 18-70 days) to neutrophil count greater than 0.5 x 10(9)/l. Four children (16%) died from toxicity 1-4 months after autograft, two from pneumonitis, one from an intracerebral haemorrhage and one from sepsis. Apart from fever and mucositis the procedure was well tolerated. Nine of 17 children treated in CR2 remain in complete remission 6-72 months after ABMT (median 25 months). Seven of these have a follow-up of greater than 12 months. Three of the seven children treated in CR3 are alive 17, 22 and 29 months post ABMT. Seven children relapsed within 10 months (median 4 months) of the autograft. Only one relapse has occurred beyond 10 months. HDM and TBI followed by ABMT is a relatively well tolerated regimen and may contribute to survival in children with relapsed ALL.     

Test-retest reliability of the pain drawing instrument

Test-retest reliability of a pain drawing instrument was investigated. Pain drawings of chronic pain patients (n = 51) were scored for percentage of total body surface in pain and location of pain. A test-retest reliability coefficient of r = 0.85 was calculated for a time interval that averaged 71 days. In addition, a percentage of agreement based on distribution of pain over time was calculated at 88.2%. The effect on reliability of age, gender and time-interval differences was investigated. The utility of the pain drawing instrument as a measure of extent of pain and location of pain over time is discussed.     

Role of topical lignocaine during carotid endarterectomy.

Forty carotid endarterectomies were undertaken in 34 patients. Operations were prospectively randomized to periarterial application of either 1 per cent lignocaine (n = 19) or normal saline (n = 21), and detailed measurements taken of intraoperative pulse rate and blood pressure. Patients receiving lignocaine demonstrated a lower pulse rate, and lower systolic and mean blood pressures than those receiving placebo, with significance in relation to clamp application and shunt removal (P < 0.05). It was particularly noticeable that patients receiving lignocaine demonstrated less intraoperative variation in pulse rate and blood pressure. Topical lignocaine stabilizes pulse rate and blood pressure during carotid endarterectomy.     

The monitoring of growth and nutritional status in South Africa

Analyses of the economic, political, demographic, and health indicators of South Africa place it within the context of the developing nations of the world. In particular current urbanization and population growth rates will lead to an increase of the Black urban population from 6.5 million in 1985 to over 20 million by the year 2000. Such dramatic social change will place major stress on the health of urban children. Few studies are available, however, that may be used to monitor the growth, and by implication the health, of rural children and thereby act as a baseline for the investigation of the effects of the urban environment. Research since 1985 on the growth and nutritional status of children has concentrated on longitudinal studies of rural children to form a basis for comparison to their urban counterparts. The results of these rural studies demonstrate growth patterns characteristic of children living in developing countries with some degree of variation, particularly with regard to weight and subcutaneous fat, between different rural groups. Rural children have a superior growth status in comparison to “average” urban children but are inferior to “well-off” urban children. The urban environment thus favors those children with adequate socioeconomic support but may be disadvantageous to children from “average” backgrounds. Interpretation of the effects of the rural environment will be greatly enhanced with information relating to nutritional intake and morbidity.     

Mediation as a new technique for resolving disputes in the mental health system

In the mental health service system, disputes take on various forms and exist in both clinical practice and management. Existing policy and administrative practice has favored a combination of medical and judicial/legal models to handle conflicts among consumers, mental health professionals, and others. The authors propose the addition of mediation as a third form of resolving issues, explicate some of the differences between mediation and current methods of resolving conflicts, and suggest benefits of using mediation.Noel Mazade is Executive Director, National Association of State Mental Health Program Directors Research Institute and a practicing mediator. Andrea Blanch is Director of Community Support Programs for the New York Office of Mental Health in Albany, NY.The views presented in this article are those of the authors only. Endorsement by the authors' organizational affiliations is not implied nor should it be inferred.     

Wegener's disease. Unusual initial symptomatology: acute pain in the lower limbs

The authors report a case of Wegener's granulomatosis unusual for its initial signs. The first evidence of disease consisted in pains in the lower limbs, probably caused by inflammatory processes involving the fascia. Biochemical, radiological and histological examinations allowed the diagnosis to be made.