Donald Gribetz

Resolution of renal amyloidosis

A patient with renal amyloidosis and the nephrotic syndrome consequent to extensive infected burns demonstrated both clinical resolution of the nephrotic syndrome and morphologic regression of the renal amyloid deposits over a six year period. The regression of the amyloid deposits was associated with several changes in the glomerular capillary wall resulting in a double capillary wall contour. This case indicates that deposits of amyloid in the kidney may regress and suggests a sequence of events in this resolution.

Arteriovenous Fistula after Percutaneous Needle Biopsy — Surgical Repair with Preservation of Renal Function

PERCUTANEOUS renal biopsy has become an established diagnostic technic in the evaluation of both adults and children with parenchymal renal disease. Although complications are few,1 the increasing use of renal arteriography has demonstrated an appreciable incidence of arteriovenous fistula after biopsy.2 , 3 Most fistulas are small and disappear spontaneously,3 4 5 but there are several reports of hemorrhage or hypertension requiring operative intervention.6 7 8 9 10 11 Renal exploration has most often resulted in nephrectomy,7 8 9 although there are occasional reports of partial nephrectomy with preservation of the uninvolved portion of the kidney.10 , 11 The case reported below illustrates the extent of hemorrhage that can occur after renal biopsy. .xa0.xa0.

Acute parathion poisoning: Diagnosis and treatment

The increasing use of alkyl esters of phosphoric acid (parathion) as insecticides and therapeutic agents has resulted in a greater number of human poisonings. Parathion intoxication may result from absorption through skin, eyes, respiratory, and gastrointestinal tracts. The use of the new antidote 2-PAM (2-pyridine aldoxime methiodide), together with atropine and supportive measures in the treatment of an 18-month-old child with acute parathion poisoning is described. The first dose of 2-PAM was given 3 1/2 hours after ingestion of the poison. Cholinesterase determinations are discussed in relation to therapy, and a plan of treatment is recommended.

Non-Invasive Estimates of Serum Bilirubin in Neonates. 905

We evaluated the Chromatics Skin Reflectance Meter for the estimation of serum bilirubin in 285 jaundiced neonates (term & preterm) of multiple ethnicities and skin pigments who had both standard laboratory measurements and visual (M.D./RN) estimates of jaundice performed. The hand-held device uses a computer algorithm which takes into account skin pigmentation and other visual characteristics. Physicians and nurses are unable to accurately assess jaundice (y=0.74x + 1.77, r=0.69) with some estimates differing by 10 mg% from the laboratory measurement. The use of the skin meter provided a remarkably accurate (y=0.89x +0.98, r=0.93) and clinically useful estimate of total bilirubin in this diverse neonatal population. Figure

THE COURSE OF GROWTH RETARDATION IN CHILDREN WITH ULCERATIVE COLITIS

38 children with adequate height data were culled from a larger series of children with onset of ulcerative colitis (u.c.) before age 16, Data were analyzed to determine growth patterns as influenced by the disease itself, corticosteroid therapy and surgery. 8 patients were retarded in height at the onset of symptoms. In 5 the terminal ileum was not involved.21 patients were treated only medically. 6 received azul-fidine or rectal steroids - “low dose steroid” (<12 mg/m2/day cortisol). They showed no growth retardation. 15 received “high-dose steroid” therapy (>12 mg/m2/day cortisol). Of these, 11 had growth retardation lasting 6 months or longer although 2 showed accelerated growth at a reduced dose; 4 had retardation lasting less than 6 months. 17 patients were treated by subtotal or total colectomy (all had received some prior steroid therapy). 14 showed significant growth increases postoperatively; one showed no height increase.It is concluded that growth retardation, a well known complication of u.c. in childhood, may manifest itself for years prior to the onset of bowel symptoms similar to ileitis. Although it is difficult to separate the effects of the disease from those of steroid, it is apparent that “high-dose steroid” therapy significantly depresses growth. Colectomy will reverse the growth retarding effect of the u.c. if not delayed too long. Growth retardation, if not reversed by medical therapy, may be an indication for surgery.

Renal Disease in Acute Rheumatic Fever.

Excerpt Although antecedent streptococcal infection is involved in the pathogenesis of both rheumatic fever and glomerulonephritis, their simultaneous appearance and even their occurrence at differ...