Antineutrophilic cytoplasmic antibody-positive systemic vasculitis associated with propylthiouracil therapy: report of 2 children with Graves' disease.

Systemic vasculitis is a rare complication of therapy with antithyroid medication. Antineutrophilic cytoplasmic antibody (ANCA)-associated vasculitis has been described in patients treated with propylthiouracil (PTU) and methimazole (MMI). The majority of cases have underlying Graves' disease. The authors report 2 children who developed ANCA-associated systemic vasculitis during PTU therapy of Graves' disease. One patient, after PTU treatment for 3 years, developed severe systemic vasculitis. After 3 weeks of arthritis, she abruptly presented with hematuria, proteinuria and edema concomitant with anemia. Her serum creatinine was elevated, to 6 mg/dl. Renal biopsy revealed crescentic glomerulonephritis. After admission, she developed intracerebral hemorrhage and pulmonary hemorrhage. She had positive perinuclear-ANCA (p-ANCA) with a titer of 1:160. Despite intensive therapy with immunosuppressive agents and plasmapheresis, as well as discontinuation of PTU, she died of the complications of severe systemic vasculitis. The other patient developed fever, arthralgia and leukocytoclastic vasculitis of the skin during treatment with PTU for about 2 years. Her symptoms and skin lesions disappeared after discontinuation of PTU. However, she has had a persistently high titer of p-ANCA 1:320 through 17 months follow-up time. Thus, patients who are treated with PTU can develop ANCA-positive vasculitis in a mild or severe form. Therefore, they should be carefully followed and monitored, not only for their thyroid status but also the serious complications of PTU.

Earlier onset of pubertal maturation in Thai girls.

BACKGROUND: Recent studies in the USA and Hong Kong demonstrated the onset of puberty in girls has shifted toward a younger age. Based upon previous studies on variations of pubertal maturation in Thai girls, the secular trend has also moved toward an earlier age. The latest study in 1995 revealed the mean age of menarche was 12.3 years. OBJECTIVES: To identify the onset of puberty, menarche and pubarche in female children and adolescents in 2 Bangkok schools. METHOD: Three hundred school girls aged 9-19 years were enrolled in the study. Data were collected from January 1997 through December 1999. Assessment of pubertal staging by Tanner's criteria was performed by a trained pediatrician. All were in good physical health and had normal height and weight. The median ages of thelarche, menarche and pubarche were estimated by probit analysis. All other parameters were expressed as mean +/- SD. RESULTS: The median ages of thelarche and pubarche were 9.4 and 11.1 years, respectively. Two hundred and twenty one girls had experienced menstruation. The median age of menarche was 11.2 years, whereas, the mean age was 12.1 years. Most girls reached near final adult height after 14 years old. CONCLUSION: The secular trend in decline of the ages of thelarche (or puberty) and menarche was observed in Bangkok girls. Further study in a larger population including a younger age group is required to define the current reference interval of onset of puberty.

Accuracy of glucose meters in measuring low blood glucose levels.

BACKGROUND: Hypoglycemia is an emergency condition requiring treatment as soon as possible. Therefore, rapid and reliable blood glucose measurements are necessary. There are 2 systems of glucose meters (GMs), the reflectance photometer system (RPS) and the electrochemical biosensor system (BSS). GMs are widely used in monitoring blood glucose (BG) in patients with diabetes. BG values measured by GMs have been confirmed to be accurate especially in measuring normal and high BG levels. However, the data on the accuracy of GMs in measuring low BG levels are limited. OBJECTIVE: To compare accuracy and reliability of different systems of GMs in the measurement of low BG values. PATIENTS AND METHOD: Venous and capillary whole blood specimens were collected from patients who were investigated for pituitary dysfunction. The patients underwent an insulin-induced hypoglycemia test by intravenously administering human regular insulin. The low BG level was defined as having venous plasma glucose (PG) of less than 60 mg/dl (mean +/- SD = 36.59 +/- 9.19, n = 54). Capillary blood samples were obtained from fingertips. Venous BG (vBG) and capillary BG (cBG) were measured by GMs. Venous PG which considered a reference value was measured by the glucose dehydrogenase method. RESULTS: The correlation coefficient (r) between vBG measured by GMs-RPS and PG was 0.86 (p < 0.001), whereas, that between vBG by GMs-BSS and PG was 0.75 (p < 0.001). Similarly, the r between cBG by GMs-RPS and PG was 0.73 (p < 0.001), whereas, that between cBG by GMs-BSS and PG was 0.69 (p < 0.001). The mean difference between vBG by GMs-RPS and PG values was 0.01 +/- 4.90 mg/dl, whereas, that between vBG by GMs-BSS and PG values was 10.50 +/- 7.07 mg/dl which was significantly greater than the former (p<0.001). Moreover, the mean difference between cBG by GMs-RPS and PG values was 14.45 +/- 8.76 mg/dl, whereas, that between cBG by GMs-BSS and PG values was 23.87 +/- 9.48 mg/dl which was also significantly greater than the former (p < 0.001). These results demonstrated that vBG measured by GMs-RPS was comparable to PG values. In addition, cBG values by GMs-RPS and GMs-BSS were approximately 14 mg/dl or 38 per cent and 24 mg/dl or 65 per cent greater than PG values, respectively. CONCLUSION: In measuring low blood glucose levels, glucose meters using the reflectance photometer system are more accurate than those using the electrochemical biosensor system.