Benign intracranial hypertension and recombinant growth hormone therapy in Australia and New Zealand

Benign intracranial hypertension (BIH) is reported in three children from Australia and one from New Zealand, who were being treated with recombinant human growth hormone (rhGH). Three males and one female, aged between 10.5 and 14.2 y, developed intracranial hypertension within 2 weeks to 3 months of starting treatment. A national database, OZGROW, has been prospectively collecting data on all 3332 children treated with rhGH in Australia and New Zealand from January 1986 to 1996. The incidence of BIH in children treated with growth hormone (GH) is small, 1.2 per 1000 cases overall, but appears to be greater with biochemical GHD (<10IUml ^-1), i.e. 6.5/1000 (3 in 465 cases), relative risk 18.4, 95% confidence interval 1.9-176.1, than in all other children on the database. The incidence in patients with Turner's syndrome was 2.3/1000 (1 in 428 cases). No cases in patients with partial GHD (10–20 IUml ^-1) or chronic renal failure were identified. Possible causative mechanisms are discussed. The authors'practice is now to start GH replacement at less than the usual recommended dose of 14IUm-² week^-1 in those children considered to be at high risk of developing BIH. Ophthalmological evaluation is recommended for children before and during the first few months following commencement of rhGH therapy and is mandatory in the event of peripheral or facial oedema, persistent headaches, vomiting or visual symptoms. The absence of papilledema does not exclude the diagnosis.     

Desipramine in the treatment of children with attention deficit disorder

Eighteen children with attention deficit disorder were treated with desipramine in a prospective open trial to assess its efficacy and safety. Improvement occurred within 4 weeks and was sustained without significant adverse effects for up to 52 weeks.     

Fluid and electrolyte balance in the postoperative period

Authors investigated the concentration changes of arginine vasopressin (AVP) and of atrial natriuretic peptide (ANP) in plasma. The renal characteristics of water- and sodium metabolism in the first 24 hours of the postoperative period in 11 children operated with acute appendicitis have been studied. Crystalloid infusion was applied in 60 ml/kg/24 h dose, in 5 cases however, 1 g/kg albumin vas also administered during the operation. In children getting crystalloid infusion (group "A") the initial AVP value was 29.9 +/- 8.8 pg/ml, which further increased to 58.2 +/- 15.2 pg/ml (p 0.05) by the 6. postoperative hour and even in the 24. hour it remained above the physiological value (19.9 +/- 5.3 pg/ml). During the observation time significant Na- and water retention developed. The albumin administration (group "B") stopped the further increase of AVP values, the Na-household remained in equilibrium and the water retention developed only in smaller degree. The ANP plasma concentration of both groups was in the normal range and did not change during observation time. Our data show that for the postoperative water retention first of all the increased AVP activity is responsible. The more intensive AVP secretion may be induced by the relative intravascular hypovolemia since by enhancing the plasma volume the further increase of postoperative hormone activity could be prevented.     

Semiautomated determination of minimum bactericidal concentrations of antibiotics

Using a newly devised 50-channel photometer which records the opacity of growing bacterial cultures, it was shown that the time taken by cultures diluted 1/1000 in fresh broth to reach 50% of the opacity of a fully grown culture was inversely related to the concentration of organisms in the original culture. This relation was used to determine the numbers of survivors after exposure to benzylpenicillin and gentamicin alone and in combination. The procedure is commended as a labour-saving and potentially rapid method of obtaining comprehensive information on the bactericidal action and interaction of antibiotics.