Watson C. Arnold

Chronic camphor ingestion mimicking Reye's syndrome.

Camphor is a potentially dangerous drug which nevertheless remains popular as a home remedy. Because of its hepatoneurotoxic effects, camphor toxicity may clinically mimic Reyes syndrome. The differentiation between the two requires histologic examination of liver tissue, further emphasizing the need for a liver biopsy to establish the diagnosis of Reyes syndrome.

Increased Circulating Concentration of Atrial Natriuretic Factor in Persons with Pheochromocytomas

To investigate the possible relationship of atrial natriuretic factor (ANF) to hypertension, we examined the circulating levels of ANF in 3 patients with pheochromocytomas before surgery, during increase of their blood pressure with surgical manipulation of their tumors, and after surgery when their blood pressures returned to normal. The circulating levels of ANF were increased 2-fold in patients with both extra-adrenal and intra-adrenal pheochromocytomas. In both the intra-adrenal and extra-adrenal patients their ANF levels increased further during surgical manipulation and returned to normal after surgical removal of their respective tumors. Each of these pheochromocytomas was examined and found to have atrial natriuretic receptors that were functional since ANF could enhance the guanylate cyclase - cyclic GMP system two-fold in these pheochromocytomas. We conclude that ANF circulates at higher concentrations in persons with pheochromocytomas and returns to normal with removal of the tumor. In addition, pheochromocytomas contain specific ANF receptors and ANF itself within these tumors.

Cryptococcal Peritonitis in Patients on Peritoneal Dialysis

Peritonitis is an unusual complication of infections caused by Cryptococcus neoformans and has rarely been reported in patients with end-stage renal disease who are maintained on peritoneal dialysis. We report two patients on chronic peritoneal dialysis in whom the first known manifestation of cryptococcal infection was dialysate cultures positive for Cryptococcus neoformans. One patient was on prednisone for systemic lupus erythematosis. The other patient was severely malnourished with type I diabetes mellitus. Both patients were found to have cryptococcal meningitis. Both patients were treated with intravenous (IV) amphotericin B and removal of the dialysis catheter. Evaluation and care of peritoneal dialysis patients with cryptococcal peritonitis include serial cryptococcal cultures and antigen titers, investigation for cryptococcal meningitis, removal of the peritoneal dialysis catheter, and IV amphotericin B.

The effect of medicaid criteria on pediatric emergency department visits

The use of the emergency department by children on Medicaid was documented, and the effect of new adult Medicaid criteria on a pediatric emergency department was investigated. Eight percent of daytime visits by all patients were nonemergencies, compared to 15% by Medicaid patients. More Medicaid patients required admission than other children (16% v 10%) seen in the emergency department. Emergency department use by Medicaid patients was not decreased by the new criteria. Documentation of inappropriate denials of emergency care when criteria designed for adults were applied to pediatric patients was presented to state health officials and resulted in a change in the state Medicaid criteria for emergency care of children.

Paroxysmal Nocturnal Hemoglobinuria Presenting As Recurrent Hemolytic Uremic Syndrome

Paroxysmal nocturnal hemoglobinuria (PNH) may present with acute anemia, thrombocytopenia and, if hemoglobin nephropathy or dehydration is present, azotemia. Thus PNH may be confused with the hemolytic uremic syndrome (HUS). Recurrent episodes, though common in PNH, are unusual in HUS. A positive acid hemolysis test can be used to differentiate between the two diseases.

Extracorporeal Shock Wave Lithotripsy in A Renal Transplant Patient

We report a case of nephrolithiasis in a transplanted kidney that was treated successfully with extracorporeal shock wave lithotripsy. The patient experienced transient partial obstruction after lithotripsy and, thus, intense monitoring of the transplant patient is necessary.

Parenteral nutrition, and fluid and electrolyte therapy.

The provision of fluid and electrolytes during parenteral nutrition can be a challenge in the malnourished child or the child with complicating illnesses. The practitioner using the basic concepts of maintenance and deficit therapy--in this case for calories--must adapt his or her therapy to the expansion of the intracellular as well as the extracellular fluid compartment. Impairment of other organ systems further complicates the ability to deliver therapy. Careful monitoring and individually tailored solution will provide adequate caloric fluid and electrolyte therapy during parenteral nutrition in children.

Thrombotic thrombocytopenic purpura in an asplenic patient with hereditary spherocytosis: failure of plasmapheresis, antiplatelet therapy, and corticosteroids.

Thrombotic thrombocytopenic purpura (TTP) is a severe multisystem disorder characterized by microangiopathic hemolysis, central nervous system and renal dysfunction, and a very poor prognosis. Recently, however, plasma exchange or infusion therapy has proven effective in the majority of patients with TTP. We report a patient who developed TTP several years after splenectomy for hereditary spherocytosis. Despite aggressive therapy with plasmapheresis (PP), plasma infusion, antiplatelet drugs, and corticosteroids, the patient had progression of TTP that eventually resulted in his death. The occurrence of TTP in an asplenic patient with an intrinsic red cell disorder, a previously unreported association, may predict a poor prognosis.

Chronic Low Dose Growth Hormone Treatment Stimulates Both Hypertrophy and Hyperplasia of Remnant Kidneys in Uraemic Rats

ConclusionIn conclusion, low doses of exogenous rhGH, when administered in a manner similar to clinical practice, are associated with glomerular enlargement and stimulation of hypertrophy and hyperplasia of remnant kidneys from uraemic rats. Increased GV was also seen after short term, high dose rhGH therapy in our previous study.[4] The time interval required before increased GV develops with low dose rhGH therapy and whether or not further rhGH exposure subsequently leads to worsening glomerular hypertrophy, glomerulosclerosis[7] and renal failure cannot be determined from the current study. Although we observed no significant changes in renal function with rhGH therapy, we recommend that children with CRI be carefully monitored to ensure that long term rhGH treatment has no such deleterious effects.

Ureteropelvic Junction Obstruction Presenting With Recurrent Abdominal Pain: Diagnosis by Ultrasound

Three cases of ureteropelvic junction obstruction are presented in which the only symptom was recurrent abdominal pain. Results of physical examination and urinalysis were normal. Ultrasound established the correct diagnosis in the two patients in whom it was performed. Because it is safe, involves no radiation exposure, and is useful in evaluating the gallbladder, pancrease, and liver, as well as both kidneys, abdominal ultrasound should be performed prior to contrast radiography in the evaluation of children with recurrent abdominal pain.