DOSAGE OF SALICYLATES FOR CHILDREN WITH JUVENILE RHEUMATOID ARTHRITIS A Prospective Clinical Trial with Three Different Preparations of Acetylsalicylic Acid

Abstract. 41 children with juvenile rheumatoid arthritis (JRA) and 6 with postinfectious arthropathies, aged 3–15 years, were treated with acetylsalicylic acid for 14 days during which time the patients were hospitalized. Three different acetylsalicylic acid preparations were used: a microencapsulated form, an enteric-coated form and standard acetylsalicylic acid tablets. Serum salicylate concentrations were measured by Trinder's photometric method. With doses of 90–120 mg/kg/day symptoms of salicylism appeared in about 50% of the cases. Daily doses of 2 g/m² (not exceeding 70 mg/kg) proved relatively safe in this study, whereas symptoms and signs of intoxication appeared at doses exceeding 3 g/m²/day. In this respect there were no significant differences between the three acetylsalicylic acid preparations used. The results of this study also suggest that the serum salicylate concentrations should not exceed 2000 μmol/1 (about 27 mg/100 ml). The symptoms of salicylism correlated closely with serum salicylate levels, which, in turn, correlated well with the dosage in g/m². Elevation of serum aspartate aminotransferase was noted in 1/3 of the cases. All of these had a dose exceeding 2 g/m², and the frequency of elevated enzyme activities increased with increasing dosage. In the group receiving enteric-coated form of acetylsalicylic acid, there were fewer positive benzidine tests (12%) than in the two other groups (22–28%).     

ACUTE LIVER FAILURE AND ENCEPHALOPATHY (REYE'S SYNDROME?) DURING SALICYLATE THERAPY

ABSTRACT: Sillanpää, M., Mäkelä, A.-L. and Koivikko, A. (Department of Paediatrics, University of Turku, Turku, Finland). Acute liver failure and encephalopathy (Reye's syndrome?) during salicylate therapy. Acta Paediatr Scand, 64: 877, 1975.–A case of hepatotox-icity and encephalopathy (Reye's syndrome?) associated with salicylate therapy is presented and the aetiology of this syndrome is discussed. Hepatotoxicity developed with salicylate serum concentrations not exceeding therapeutic serum levels. The importance of controlling serum salicylate concentration and transaminase activity particularly during the first fourteen days of therapy is emphasized.     

Initial Electroencephalographic Findings in Children with Acute Lymphoblastic Leukaemia

ABSTRACT. Electroencephalography (EEG) was performed on 66 children with acute lymphoblastic leukaemia, 45 before treatment and 21 during the first 5 days of chemotherapy. The patients, aged 7 months to 16 years, 33 boys and 33 girls, had been admitted to the Department of Paediatrics, University of Oulu, between March 1976 and January 1987. The EEG findings were compared with those in 66 age and sex-matched control children chosen at random from the local population. The patients had significantly more frequent and more severe disturbances in background activity ( p < 0.001) than the controls and increased slow waves in the occipital ( p < 0.001) and temporal regions ( p < 0.01). The patients who had received chemotherapy before the EEG recording had EEG disturbances significantly more frequently than the other patients ( p < 0.01), but the latter still had EEG abnormalities significantly more frequently than their matched controls, although they did not have severe changes (grade 3). The results suggest that chemotherapy increases EEG changes during the early days of induction therapy and possibly induces long-term disturbances in brain function. The associations between EEG changes and clinical findings were also analysed and the results show that a long duration of leukaemic symptoms or an aggressive disease may lead to EEG abnormalities.     

PRETERM INFANTS FED HUMAN MILK ATTAIN INTRAUTERINE WEIGHT GAIN

ABSTRACT. The adequacy of human milk for lowbirth-weight infants remains controversial. In this study, 35 healthy preterm infants with gestational age from 31 to 36 weeks and a birth weight less than 2 200 g, were followed until they attained a weight of 2 400 g at about 5 to 7 weeks of age. These infants were fed pooled, expressed human milk, partly supplemented with their own mother's milk, at intakes of 185 and 200 ml/kg/day. There were no consistent differences between the feeding groups in the rate of gain in weight, length, or head circumference, in serum total protein, in acid-base status, or in plasma amino acid concentrations. It is concluded that pooled, expressed human milk in volumes of 185 or 200 ml/kg/day produces a postnatal weight gain (196±6 or 205±7 g/week, respectively) in healthy preterm infants with a gestational age over 31 weeks which compares to intrauterine weight gain (207 g/week). This growth is achieved without apparent metabolic stress.     

Smooth Muscle Antibodies in Complicated Early Pregnancies*

ABSTRACT: The titer, immunoglobulin class, and staining pattern of smooth muscle antibodies (SMA) were assayed by indirect immunofluorescence in 15 patients with threatened abortion, 46 patients with spontaneous abortion, and 45 normal pregnant women in the first trimester to investigate possible abnormality of humoral immunity. An increased incidence of moderate and high titer SMA was found in both abnormal groups. SMA were mainly of the IgG class and gave a “vessel wall” staining pattern in immunofluorescence. This staining pattern suggests non-actin specificity of SMA. The more precise characterization of the antigen specificity of SMA in complications during pregnancy requires further investigation.     

Adrenal Pheochromocytoma—Ganglioneuroma Producing Catecholamines and Various Neuropeptides

Abstract. A 65-year-old woman presenting with back pain, difficulties in walking and watery diarrhea. A right adrenal tumor and high excretion of catecholamines were found. Laboratory examinations showed raised levels of vasoactive intestinal polypeptide, pancreatic polypeptide, gastrin and calcitonin. Histology showed a combined pheochromocytoma—ganglioneuroma. The neoplastic cell population was immunohistochemically shown to contain tyrosine hydroxylase, neuropeptide Y, met-enkephalin, substance P, vasoactive intestinal polypeptide, calcitonin and calcitonin gene-related peptide. Postoperatively, the patient recovered fully and the hormone levels returned to normal.     

Monitoring of smooth muscle antibodies in hypertensive complications during pregnancy.

Smooth muscle antibodies (SMA) were monitored in terms of titer, immunoglobulin class and staining pattern by indirect immunofluorescence assay during the pregnancies of 32 women with pregnancy induced hypertension (PIH), 21 with essential hypertension (EH), and 43 with a normal pregnancy. The mean SMA titer was higher both in PIH and EH than in normal pregnancy. SMA were mainly of the IgG class and gave a "vessel wall" staining pattern in immunofluorescence. The tendency for the mean SMA titer to increase was observed in PIH, whereas a falling tendency was found in EH and normal pregnancy. These tendencies suggest that hypertension, the duration of which has been shorter in PIH, induces SMA production. The observed staining pattern suggests the same kind of non-actin specificity for SMA as in our previous study of complications in early pregnancy.