The tubulointerstitial component of chronic glomerulonephritis: its clinico-functional diagnosis

Tubulointerstitial alterations associated with chronic glomerulonephritis (CGN) are definitely dependent on the clinical type of CGN and are accompanied by a decrease of homeostatic functions (the rate of glomerular filtration, osmotic concentration and dilution of urine, hydruresis, the magnitude of CH2O, excretion of ammonium and hydrogen ions, the ratio of ammonium excretion to hydrogen ion excretion). Maximal osmotic concentration and ammonium excretion show an especially considerable decrease. The clinical type permitting one to diagnose rather than to reject the presence of alterations and the status of certain tubular functions, osmotic concentration in particular and, to a less degree, ammonium excretion, permitting to reject the presence of the tubulointerstitial component (TIC) are of known but restricted importance for TIC recognition. The TIC can be diagnosed more adequately in exploring definite pairs of renal functions, particularly osmotic concentration of urine and ammonium excretion and maximal hydruresis and excretion of hydrogen ions. This approach is both helpful in confirming and rejecting the presence of the TIC. Of special value is the combined assessment of the clinical type and maximal osmotic urine concentration data.     

PSEUDOHYPERPHOSPHATAEMIA AND MONOCLONAL GAMMOPATHY

SUMMARY A case is reported of pseudohyperphosphataemia in association with a monoclonal gammopathy of undetermined significance.     

Comparative efficacy of Hanifin and Rajka''s criteria and the UK working party''s diagnostic criteria in diagnosis of atopic dermatitis in a hospital setting in North India

BACKGROUND: Diagnosis of atopic dermatitis (AD) depends on clinical features because no definitive diagnostic test exists. Criteria proposed by Hanifin and Rajka (Acta Derm Venereol (Stockh) 1980; Suppl 92: 44-47) were acceptable for hospital-based studies but were found not to be suitable for field studies. A UK working party formulated clinical diagnostic criteria that could be used in both hospital and epidemiological settings. Validation studies of the criteria showed widely variable results, probably due to different clinical settings and ethnicity. AIM AND OBJECTIVE: This study was undertaken to validate Hanifin and Rajka's criteria and to assess the comparative efficacy of their criteria and the UK working party's diagnostic criteria in the diagnosis of AD in a hospital setting in North India. SUBJECTS AND METHODS: This study serially included 101 patients with AD and 48 controls of paediatric age group. The study period was from July 2003 to December 2004. RESULTS: Hanifin and Rajka's criteria (sensitivity 96%, specificity 93.75%, positive predictive value 97% (PPV) and negative predictive value (NPV) 91.84%) had a statistical advantage over the UK working party's diagnostic criteria (sensitivity 86%, specificity 95.83%, PPV 97.75% and NPV 76.67%), with a P-value < 0.005.     

IMPOTENCE AND ITS NON-SURGICAL MANAGEMENT

SUMMARY Impotence is a common symptom which can cause considerable distress to both the sufferer and his partner. The use of pharmacotherapy to improve erectile function will continue to increase as safe and effective drugs are developed. However, restoring erectile function should not be the only treatment objective. It is also essential to address personal and emotional factors in the sufferer, conflicts in his relationship with his partner, and sexual problems in his partner, all of which may be instrumental in causing or maintaining the presenting impotence. We advocate a combined approach with appropriate medical treatment and sex and couple therapy