Microangiopathic haemolytic anaemia and systemic vasculitis.

Two cases of systemic vasculitis complicated by microangiopathic haemolytic anaemia (MAHA) are described: this association has not previously been reported. Both patients had atypical presentations of their primary disease, one with parotitis and one with a Guillain-Barré syndrome. Other causes of MAHA were excluded and a possible link with macromolecular von Willebrands factor is speculated upon.

Optic neuropathy in uraemic patients on dialysis.

Optic nerve disease has been reported in patients with renal failure. A toxic aetiology has been postulated. The incidence of this complication of renal failure has not been determined. We observed 60 patients with renal failure on dialysis for 24 months to determine the incidence of optic neuropathy. Four patients developed typical acute ischaemic optic neuropathy. Their case notes were reviewed in order to determine the pathogenesis. Each patient had long-standing renal failure and its sequelae of anaemia and hypertension. The immediate causes of ischaemia were hypotension in 1, severe anaemia in 1, and generalised atherosclerosis in 2 patients.

Listeriosis and recurrent abortion in a renal transplant recipient.

A 29-year-old farmer's wife had received a kidney from her brother (of identical HLA type) at the age of 22 years. She was afterwards immunosuppressed with prednisolone and azathioprine. Her first pregnancy had been uneventful but the second and third had terminated spontaneously at 15 and 24 weeks gestation respectively. Following the third pregnancy, Listeria monocytogenes (serotype 4) was grown from the fetus, the placenta and maternal blood. Over the next 18 months, antibody titres which were assessed by an IgG indirect immunofluorescent antibody assay remained high. When the patient became pregnant for a fourth time, 9 months after her second abortion, 250 mg ampicillin were administered three times daily for the remaining duration of the pregnancy. A second child was successfully delivered by Caesarean section at 39 weeks' gestation.

Monotherapy with felodipine, a new calcium antagonist, in mild and moderate hypertension.

The role of felodipine, a new calcium antagonist, in monotherapy for mild and moderate hypertension was investigated in a placebo-controlled double-blind study of 109 patients from 13 centres. The patients were randomised in a double-blind fashion to receive felodipine, 2.5 mg b.i.d. (32 patients), 5 mg b.i.d. (30 patients), 10 mg b.i.d. (24 patients), or placebo (23 patients). Two hours after the first tablet was administered, there was a reduction in systolic and diastolic blood pressure, both supine (p less than 0.05) and standing (p less than 0.001), that was significantly correlated with dose. Three and 8 weeks later, 2 h after dosage, this correlation was still apparent in both supine and standing blood pressure (p less than 0.001). One week after randomisation, at 12 hours after administration there was a significant correlation with dose in the standing systolic (p less than 0.05) and diastolic (p less than 0.01) blood pressure. After 8 weeks therapy, a significant correlation with dose occurred in both supine and standing systolic (p less than 0.05) and diastolic (p less than 0.01) blood pressure 12 h after therapy. The proportion of patients completing the study who achieved a supine diastolic blood pressure of 90 mm Hg or less after 8 weeks therapy at 2 h after dosage was 9% on placebo, 67% on felodipine 2.5 mg b.i.d., 57% on felodipine 5 mg b.i.d., and 92% on felodipine 10 mg b.i.d. Felodipine was generally well tolerated although 10 patients on the highest dose withdrew due to adverse experiences. Plasma felodipine levels were significantly correlated with dose.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute renal failure due to glomerulonephritis associated with staphylococcal infection.

Acute renal failure developed in a diabetic with staphylococcal arthritis and septicaemia in the absence of endocarditis. Renal biopsy showed proliferative glomerulonephritis and there was evidence of alternative pathway of complement activation. Renal function recovered following haemodialysis for 2 months. The association of glomerulonephritis with staphylococcal infection is reviewed.

Multifocal fibrosclerosis and renal amyloidosis.

A 34-year-old female with a 14-year history of multifocal fibrosclerosis developed the nephrotic syndrome due to renal amyloidosis. Although the association between chronic inflammatory processes and amyloidosis is well known, this is the first report of amyloidosis occurring in a patient with multifocal fibrosclerosis. Other interesting features of this case are the involvement of subcutaneous adipose tissue in the inflammatory-fibrotic process and the presence of features of multifocal fibrosclerosis in the patient's twin sister.

The fatty acids of erythrocytes of myocardial infarction patients.

Arachidonic acid (C20 : 4 omega 6) and eicosapentaenoic acid (C20 : 5 omega 3) are precursors of two different series of prostaglandins important in homeostasis of the cardiovascular system. The levels of these and other fatty acids have been measured in a group of 20 patients who had suffered myocardial infarction (samples taken within 12 h of infarction) and a group of 17 healthy age-matched controls using the erythrocyte as a lipid probe. There was no significant difference between the level of C20 : 4 omega 6 in patients and controls. There was however a highly significant difference in the level of the peak containing C20 : 5 omega 3 i.e. 6.60% +/- 0.29 (mean and SE of mean) for controls; 3.91 +/- 0.36 (mean and SE of mean) for patients with myocardial infarction. In each of the two groups the relationship between the levels of the two fatty acids arachidonic acid, eicosapentaenoic acid and their essential fatty acid precursors has been investigated. No significant functional relationship was found except between C18 : 3 omega 3 and C20 : 5 omega 3 in the control group. These results are discussed in relation to homeostasis and recent evidence that levels of these fatty acids can be altered by dietary manipulation.