High incidence of hypoglycaemia in African patients treated with intravenous quinine for severe malaria.

Changes in plasma glucose and insulin concentrations were monitored over 24 hours in 28 African patients receiving quinine intravenously in an average dose of 8.5 mg base/kg over one hour eight hourly for severe malaria. The patients (nine children and 19 adults) were moderately undernourished; none was pregnant or had renal insufficiency. Plasma insulin concentrations rose during the infusion and then declined. Plasma glucose concentrations were decreased at two, three, and four hours after the start of the infusion. Insulin: glucose ratios were raised between half an hour and two hours after the start of the infusion. The three infusions of quinine increased plasma insulin concentrations in a similar way. In nine patients, including four children, plasma glucose concentrations fell below 2.8 mmol/l on one or two occasions. At the time of the hypoglycaemia plasma insulin concentrations were inappropriately high as shown by a consistent and often considerable increase in the insulin:glucose ratio. Hypoglycaemia that may pass unnoticed in comatose patients is thus a common complication of treating severe malaria with quinine, in particular in children. Its high incidence calls for attentive monitoring and preventive measures.     

High incidence of vincristine-induced neuropathy in lymphomas.

The incidence of vincristine-induced neuropathy was studied in 60 unselected patients, of whom 23 had lymphoma and 37 had other malignant disease. All were treated with vincristine combined with other cytotoxic agents. Fourteen of the patients with lymphoma (61%) developed neuropathy compared with five patients with leukaemia or non-lymphoid cancer (14%), even though all patients received comparable doses of vincristine. The difference between the two groups in the incidence of neuropathy was highly significant. Of the patients who developed neuropathy, 17 did so within the first three months of treatment and seven in the first month. Patients with lymphoma who are receiving vincristine should be observed carfully for symptoms and signs of neuropathy. Vincristine should be withdrawn if progressive neurotoxicity develops.     

Kinetics of ionic transport across frog skin: Two concentration-dependent processes

Summary Sodium and chloride influxes across the nonshort-circuited isolated skin ofRana esculenta were measured at widely varying external ionic concentrations.The curve describing sodium transport has two Michaelis-Menten components linked at an inflection point occurring at an external sodium concentration of about 7 meq. Chloride transport can also be represented by two saturating components. A possible explanation of these kinetics is discussed.At sodium concentrations lower than 4 meq it is possible to define a component of the sodium transport mechanism as having a high affinity for sodium and which is independent of the nature of the external anion. A high affinity for chloride of the chloride transport system functioning at low external concentrations is also found but is significantly different from that of sodium. These systems show the physiological characteristics of the countertransports (Na _ext ⁺ /H _int ⁺ ; Cl _ext ^– /HCO _3int ^– ) functioning at low external concentrations.At external concentrations higher than 4 meq a low affinity transporting system in which chloride and sodium are linked superimpose on the high affinity components.The physiological significance of these results is discussed.     

High frequency of skin reactions in patients with leishmaniasis treated with meglumine antimoniate contaminated with heavy metals: a comparative approach using historical controls

We analyzed data from historical controls treated with meglumine antimoniate to compare the frequency of adverse events observed in patients with cutaneous leishmaniasis treated with the same dose of meglumine antimoniate contaminated with heavy metals in an endemic area of the State of Bahia, Brazil. Group A patients were treated in 2000 with the drug produced by Eurofarma Laborat rios Ltda., S o Paulo, Brazil (lot A) and group B patients were treated in 1996 with the reference drug produced by Rhodia Farma Ltda., S o Paulo, Brazil (lot B). We observed an unusual higher frequency of skin reactions in group A patients. However, all type of adverse events observed in group A were also observed in group B. The physico-chemical analysis of these lots revealed that lot A had lower pH and higher concentration of total and trivalent antimony, lead, cadmium, and arsenic. Our findings suggest that the skin reactions could be attributed to heavy metal contamination of lot A.     

High incidence of chronic lymphocytic thyroiditis in apparently healthy school children: epidemiological and clinical study.

An epidemiological survey on the incidence of juvenile chronic lymphocytic thyroiditis was performed in 10,220 apparently healthy school children in Ishikawa district, Japan. The subject of present study included 6,244 school children (2,831 boys and 3,413 girls, ages 6-18 yrs.) in Kanazawa City and 3,976 children (2,055 boys and 1,921 girls, ages 6-18 yrs.) in Wajima City. The first group was selected as a representative of urban area and the second group as that of seaside area. Children who have goiter or firm thyroid were selected for testing antithyroglobulin and anti-microsomal antibodies in sera. Final diagnosis of chronic lymphocytic thyroiditis was made on histological specimen obtained by needle biopsy on the antibody positive subjects. The overall incidence of chronic lymphocytic thyroiditis in these children was 3.0 per 1,000, whereas the incidence in adolescent girls was as high as 8.2 per 1,000. There was a considerable sex difference in the prevalence, the ratio of female to male was 6.5:1, and the incidence increased with age. The incidence in seaside area was 5.3 per 1,000 that was significantly higher than in urban area, 1.4 per 1,000 (p less than 0.005). Histologically, 26 of 30 cases (87%) were classified as focal thyroiditis and 4 cases (13%) were diffuse thyroiditis. Serum T4-I and T3 values within normal range in all patients, but resting TSH was elevated in 1 of 23 cases and TSH response to TRH was exaggerated in 3 of 23 cases. Impaired organification of iodide was observed in 6 of 32 cases by iodide-perchlorate discharge test. The present study demonstrates that juvenile chronic lymphocytic thyroiditis is highly prevalent among apparently healthy school children and early recognition of the disease with preventive care for hypothyroidism in future should be stressed.     

Chromosomal investigations in epileptic children during long-term therapy with phenytoin or primidone

Summary In epileptic children the long-term therapy with anticonvulsant drugs is absolutely necessary. However, anticonvulsant drugs have been suspected to be mutagenic and teratogenic. To investigate this problem metaphase chromosome observations were performed using short-time culture of peripheral blood lymphocytes from twenty children. Ten of the children had been treated with phenytoin and the other ten with primidone on monotherapy. The long-term administration of anticonvulsant drugs was monitored by measurement of the serum concentrations of phenytoin and primidone, by seizure anamnesis, and by repeated EEG investigations. Analyzing 100 mitoses from each proband, we found no increase of structural or numerical aberrations in our patients compared with six controls. In adults, however, anticonvulsant drugs have been found to cause structural aberrations and chromosomal damage. The absence of these lesions in children may reflect the higher efficiency of DNA-repair in local DNA-damage.Dedicated to Prof. Dr. H. Schoenenberg, Aachen, on his 65th birthdayThis work contains parts of the M.D. theses of U.M. and E.M.     

Increased sister chromatid exchanges in epileptic children during long-term therapy with phenytoin

Summary In lymphocyte cultures of nine children suffering from epilepsy and therefore treated with phenytoin (DPH), increased sister chromatid exchanges (SCE) were found. Their average SCE-rate exceeded that of a normal control group by 55%.This work contains parts of the M.D. thesis of C. Stumpf     

High incidence of selenite-resistant bacteria from a site polluted with selenium

The level of selenium-resistant bacteria in water, algal mats, and sediment from Kesterson reservoir, Calif., a site with known selenium pollution, was compared with that in nearby Volta reservoir, a site with low selenium levels. A high percentage (greater than 50%) of all isolates from the Kesterson samples were resistant to 10 mM selenite. In contrast, only a small percentage of the Volta isolates were resistant to this level of selenite. The identity of some selenite-resistant isolates and MICs of selenite, selenate, arsenate, tellurite, and tellurate were determined.     

The incidence of skin manifestations by dermatophytes in patients with psoriasis

Thirty-four psoriatic patients (23 males, 11 females) were found to have skin manifestations of dermatophyte infection. Tinea pedis was observed in 20 cases, tinea cruris in 6 and tinea mannum in 2. T. rubrum was the causative agent in all of these with the exception of 2 cases caused by E. floccosum. Lesions of tinea corporis were found intermingled with psoriatic plaques in various areas of the body skin in 6 patients (4 males, 2 females); T. rubrum was isolated from 5 of these and M. canis from one. Twenty-one of these psoriatic patients also had lesions caused by C. albicans in the toe-webs and interdigital aspects of the fingers, the latter being associated with paronychia in 9 cases. These findings indicate that we should remain aware of the possibility of fungus manifestations in patients with psoriasis, which would not appear to be an exceptional occurrence.     

Prolongation of skin allograft survival and inhibition of graft versus host reaction in rodents treated with "middle molecules".

“Middle molecules” (MM), isolated from the urine of patients with chronic renal failure by means of gel filtration, had been shown to inhibit lymphocyte proliferation after mitogenic or allogeneic stimulation in vitro. MM also caused a significant reduction of the graft versus host reaction (GVHR). CBA mice, having received a lethal dose of radiation, were injected with MM-treated spleen cells from C 57/B1 6 mice and were found to have a spleen weight × 1000/body weight ratio of 1.2, whereas mice injected with untreated allogeneic cells had a ratio of 1.7 Isogeneic controls were found to have a ratio of 0.8. The effect of MM was then analyzed in the Lewis and Sprague-Dawley rat models. Those rats which received a continuous infusion of MM had a significant delayed rejection time: 17.4 ± 1.06 days, as opposed to 12.1 ± 0.35 days in control rats which were infused with a saline solution. These results suggest that MM have an inhibitory effect on T-lymphocyte proliferation, which is not exclusive of other MM activities nor of additional mechanisms responsible for the immunodeficiency secondary to renal failure.     

Diabetic crises in children treated with small doses of intramuscular insulin.

A new regimen for the management of diabetic crises in children using small doses of intramuscular insulin and generous amounts of intravenous fluids has been devised. Insulin dosage was calculated from the patient''s weight and was independent of the degree of hyperglycaemia. Minimum demands were made upon the laboratory.