Jennifer M. Brown

Lack of benefit of intravenous synthetic human secretin in the treatment of autism.

The objective of this study was to determine if an intravenous infusion of synthetic human secretin improves language and behavioral symptoms in children with autism. Forty-two children with the diagnosis of autism were randomized to one of two groups in this double-blind cross-over trial. One group received 2 IU/kg of intravenous synthetic human secretin at the first visit, followed by an equal volume of intravenous saline placebo at week 6. The other group received treatments in the reverse order. All children were evaluated at weeks 1, 3, 6, 9, and 12 with standardized assessments of language, behavior, and autism symptomatology. There were no significant differences in the mean scores on any measure of language, behavior, or autism symptom severity after treatment with secretin compared to treatment with placebo. The results of this study do not support secretin as a treatment for autism.

The Variability and Dietary Dependence of Urinary Oxalate Excretion in Recurrent Calcium Stone Formers

Twenty-two recurrent calcium stone formers had 24-h urinary oxalate excretions on their home diets which were significantly greater than those of 30 normal subjects (0·48±0·23 mmol/d; mean±SD compared with 0·31±0·11; P<0·01). The stone formers also demonstrated marked day to day variability in oxalate excretion indicating that a single normal urinary oxalate measurement did not exclude significant hyperoxaluria at other times. On a hospital diet containing 1000 mg calcium per day, urinary oxalate excretion fell significantly from 0·48±0·23 mmol/d to 0·32±0·12; P<0·01. As the urinary calcium excretion in and out of hospital was similar, it seems unlikely that low calcium intake at home was responsible for the hyperoxaluria. All patients had recurrent symptomatic stone disease and had been advised to avoid foods rich in oxalate. Whilst poor compliance is a possible explanation for the variability in oxalate excretion, we believe it is more likely that there is an inadvertent intake of oxalogenic precursors in their diet. As normal subjects do not demonstrate hyperoxaluria on similar home diets, stone formers may have a metabolic defect in the handling of these precursors.

HISTOLOGICAL EXAMINATION OF THE VENTRICULAR MYOCARDIUM IN 62 CASES OF CONGENITAL HEART DISEASE

A search through the journals and standard texts (e.g. Gould, 4960) yields plenty of data on the relation ofhypertrophy of the four heart chambers to various structural cardiac defects, but evidence on the presence or absence of irreversible damage to the muscle fibres, in the form of necrosis or replacement fibrosis, is singularly scanty. With the increasing importance of surgery in the treatment ofcongenital cardiac anomalies, information on this aspect would obviously be ofvalue, and with this in mind a series of62 hearts showing various congenital structural deformities was investigated.

Corticotropin deficiency: A rare cause of hyponatremia mimicking siadh

&NA; We describe 2 patients presenting with severe chronic hyponatremia in whom clinical and biochemical features strongly suggested the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Both, however, were proven to have a primary pituitary deficiency of corticotropin. Their short synacthen tests were only mildly abnormal but associated with low basal ACTH levels. The diagnosis of ACTH deficiency was made more convincingly by their dramatic response to glucocorticoid replacement therapy. In patients in whom no cause for SIADH can be found, a trial of maintenance Cortisol therapy is warranted to exclude this eminently treatable condition.

Hydroxycarboxylate Malabsorption and Calcium Oxalate Nephrolithiasis

In Queensland, Australia, there is a high incidence of calcium nephrolithiasis (16.8 hospital admissions per 10,000 population) which is among the highest incidences reported for Westernized societies (1). Our initial investigation of 40 recurrent calcium-oxalate stone formers indicated that they have significantly elevated urinary oxalate and calcium excretions and decreased excretions of ascorbate and citrate (1). The raised oxalate excretion was shown not to be due to a hyperactive 2-carbon pathway, or to be derived from fat or carbohydrate metabolism (2).

CHILDREN'S WARFARIN CLINIC-AN AUDIT OF THE NEW PHARMACIST-LED TELEPHONE SERVICE BASED ON A UNIQUE COMPUTERISED SYSTEM COMPARED TO THE WARD BASED PAPER SYSTEM

Aims To audit the new pharmacist-led telephone service for warfarin dosing and monitoring of INR, and compare it to the previous system. The previous system was based on the paediatric cardiology ward, dosing by junior medical staff to dose and documented on a paper system. Also to audit the parent satisfaction of the new system. Methods Search the computerised system to reveal 73 patients on warfarin with a total of 1547 INRs, and looked for any complications or out of range results. This to be compared to a previous audit of the original system of 44 patients on warfarin with a total of 1289 INRs. For parent/carer satisfaction, a questionnaire was sent to parents/carers of all patients who were under the care of the pharmacist-led childrens warfarin clinic. Results The pharmacist-led childrens warfarin service was fully compliant for NPSA safety standards for warfarin dosing. There was no significant difference in the safety indicators from the original service and the pharmacist-led service. 11 patients (25%) were lost to follow up from the original service, compared to none in the pharmacist-led service. No patients from either service had an inappropriate target INR and every patient had been given the correct information. 38 out of 53 (72%) parents/carers returned the satisfaction survey. 28 (78%) reported that their overall experience of the clinic was excellent and the rest found it satisfactory. Discussion Changing to the pharmacist-led service has meant that it is now compliant with NPSA standards and the safety indicators are comparable to the original service. The service has generally been very well received, with all parents/carers finding the service at least satisfactory and 78% found it excellent. The pharmacist-led service is unique, as it uses a computerised system for documentation, with the aim to produce a paediatric dosing algorithm.

Drug-induced lymphadenopathy with special reference to the reed-sternberg cell

The case was presented of a 22-yr.-old octoroon who, from the age of 8 yr., suffered from epilepsy and had been taking Dilantin. She had signs of oesophageal obstruction and was found to have lymphadenopathy ind splenomegaly; a diagnosis of Hodgkins disease was made on scalene node biopsy. Treatment was vithheld because she was pregnant. Subsequently the diagnosis was questioned and since a drug-induced ymphadenopathy was a possibility a period of 1 mth. without Dilantin was tried. She did not improve and ippropriate treatment was given; 5 mth. later her condition deteriorated and a trephine biopsy revealed eplacement of the bone marrow with Hodgkins tissue. This then represented a case of Hodgkins disease developing in an epileptic who had been on Dilantin or 14 yr. The literature on drug-induced lymphadenopathy was reviewed and it was emphasized that the teed-Sternberg cell once considered to be the sine qua non of Hodgkins disease can probably no onger remain the criterion of this diagnosis.