Intrapericardial triamcinolone hexacetonide in the treatment of intractable uremic pericarditis in a child.

Uremic pericarditis in children on chronic hemodialysis represents a difficult management problem, necessitating vigorous medical therapy and often surgical drainage of the pericardial effusion. Standard therapeutic approaches have met with limited success. The successful use of intrapericardial triamcinolone in a 10-year anephric boy on chronic dialysis is reported and accompanied by a description of the technique applied and literature review.

Seizures and hypothermia due to dietary water intoxication in infants.

I retrospectively describe 20 episodes of water intoxication in 19 infants, with hypothermia, seizures, and hyponatremia. Overdilution of formula or aggressive supplementation with water or clear juices were documented in 16 of the 20 episodes. Seizures and respiratory distress were severe enough in six cases to require intubation and ventilatory support. Marked diaphoresis was noted as a premonitory symptom to seizures in eight children. The children were an average of 5.1 +/- 4.3 months of age; serum sodium values averaged 118 +/- 4.3 mmol/L. No evidence of excess production of antidiuretic hormone was found. Water intoxication in infants is common, and I discuss its possible relationship to demyelinating disease of the central nervous system.

Acute renal failure, hemolytic anemia, and thrombocytopenia in poststreptococcal glomerulonephritis.

We have presented the case of a 13-year-old boy who had an apparent hemolytic-uremic syndrome, with hemolytic anemia, thrombocytopenia, and acute renal failure. Subsequent laboratory investigations indicated poststreptococcal glomerulonephritis as the cause of renal failure. The triad of hemolytic anemia, thrombocytopenia, and renal failure has not been previously reported in a case of proven poststreptococcal glomerulonephritis.

A common pathway for the activation of several molybdoenzymes in Escherichia coli K12.

Three molybdoenzymes, nitrate reductase, formate benzyl-viologen oxidoreductase and trimethylamine-N-oxide reductase which form part of different systems, have been studied in a parental strain of Escherichia coli K12. When the organism is grown in the presence of 10 mM tungstate, these three enzymes are present in an inactive form which may be activated in vivo by the addition of 1 mM sodium molybdate. The mixing of soluble fractions from chlA and chlB mutants grown under the appropriate conditions leads to the activation of nitrate reductase, formate benzyl-viologen oxidoreductase and trimethylamine-N-oxide reductase. The activation of each enzyme is maximal when the mutants are grown under conditions that lead to the induction of that enzyme in the wild-type strain. The employment of purified proteins, the association factor FA and the Protein PA, which are presumed to be the products of the chlA and chlB genes, has shown that these proteins are responsible for the activation of the three enzymes during the complementation process.

Ultrasonic appearance of pyelogenic cysts.

Two cases, one in an adult and one in a child, of ultrasonically demonstrated cystic masses were shown to be pyelogenic cysts on contrast urography. Because of the similar appearance of pyelogenic and simple cysts of the kidney on sonography, contrast urography is important for the differential diagnosis.

Nonoliguric acute renal failure in the newborn: a prospective evaluation of diagnostic indexes.

Fifteen newborn babies with azotemia without oliguria were studied. Group A infants had increased BUN levels and decreased creatinine clearance (Ccr) for gestational and postnatal age, and were compared with group B infants, who had increased BUN levels and normal Ccr. The Ccr was 0.35 mL/min in group A and 0.76 mL/min in group B. Urine volume during the same period was 2.45 mL/kg/hr in group A and 4.66 mL/kg/hr in group B. No significant differences in fractional sodium excretion; urine to plasma ratios of creatinine, osmolality, and sodium; and renal failure index were present between the two groups. The results suggest that nonoliguric acute renal failure is a diagnostic entity in the newborn. The Ccr is the most useful indicator for defining renal function in the presence of azotemia and normal urine volume.

The glomerular basement membrane in benign familial hematuria.

A total of nineteen children were studied because of asymptomatic hematuria. all had normal renal function, and immunologic and urologic studies. Renal tissue was obtained by percutaneous biopsy and examined by light, immunofluorescence and electron microscopy. On electron microscopy, thickness of the glomerular basement membrane (BGM) was found to distinguish benign familial hematuria (BFH - 10 cases) from non familial idiopathic recurrent hematuria (IRH - 9 cases). Measurements were taken in areas of peripheral glomerular capillary loops (minimum of five) where both cell membranes could be resolved to insure tht determinations were uniform and represented ideal cross sections. The mean thickness +/- SE of GBM in IRH of 303.3 +/- 16.9 nM was greater than that noted in BFH of 207.1 +/- 11.99 nM (P less than .002). The mean thickness +/- SE of the lamina densa in IRH of 236 +/- 15.36 nM was significantly greater than that observed in BFH of 128.5 +/- 11.7 nM (P less than .001). In both BFH and IRH the GBM and LD were uniform in thickness (CV = 20%) and qualitatively normal. The uniform attenuation observed in BFH can be used to distinguish this condition from IRH.