[Assessment of adrenal function on steroid using renal diseases in children using the modified original ACTH tolerance test: comparing nephrotic syndrome with non-nephrotic syndrome].

Steroid therapy occupies a very important position in various types of kidney diseases in children. The period of steroid therapy in kidney disease tends to extend over a long time and the amount of medication tends to be high. Inhibition of the adrenal function because of steroid therapy is one of the major side effects requiring considerable care. In the present investigation, we examined the inhibition of adrenal function in various pediatric renal diseases using synthetic ACTH. In this study, we checked the serum 11-OHCS and cortisol levels and found that in nephrotic syndrome, the inhibition already existed at sideration. In other diseases we found inhibition of adrenal function using steroid and improvement of the function on reduction of the steroid dose. Patients who used steroid every other day showed better improvement. Therefore, we suggest that in nephrotic syndrome, the inhibition of adrenal function may participate in sideration in the syndrome. It was also found that reduction of the steroid given every other day inhibited the adrenal function to a lesser extent. We found that our challenge test using ACTH is safe and very useful for determining adrenal function.

Direct assessment of triploid cells in mosaic human fetuses by fluorescence in-situ hybridization.

Villous tissues from 30 spontaneous abortions and the same number of artificial abortions were obtained and analysed for the frequency of polyploid cells. Single cell suspensions were made from these tissues without culture and the ploidy of > 100 cells was analysed. Trisomies of chromosomes 17 and 4 have rarely been reported in villous cells of spontaneous abortions, suggesting that the presence of more than three copies of chromosomes 17 and 4 per cell indicates polyploidy. The number of chromosomes 17 and 4 was detected by fluorescence in-situ hybridization analysis using centromeric probes D17Z1 and D4Z1. Most villous cells from cases of spontaneous and artificial abortions had two D17Z1 or D4Z1 signals per cell, with very small percentages of cells (0.5 +/- 0.4%) showing three signals per cell. However, in four cases of spontaneous abortions, 2-12% of cells had three D17Z1 or D4Z1 signals per cell. This indicates the presence of triploid cells in these cases of spontaneous abortion, at a significantly higher frequency compared to artificial or the remaining 26 cases of spontaneous abortion. In addition, three cases contained 0.2-0.4% of cells showing six signals, indicating that these cells were dividing triploid cells. The low frequency of mosaicism reported here would not be detectable by conventional chromosomal analysis.

Use of digitised left ventricular echocardiograms in assessment of mitral stenosis.

In order to establish a new echocardiographic index of the severity of mitral stenosis, left ventricular echocardiograms were digitised using manual tracing and a computer. The instantaneous left ventricular dimension was measured in 15 patients with mitral stenosis. The peak rate of change of left ventricular dimension (peak dD/dt) and the normalised peak rate (peak dD/dt/D) during early diastole were significantly lower in mitral stenosis than in normal subjects. Also, the time between the second heart sound and peak dD/dt was significantly shorter in patients with mitral stenosis than in normal subjects. Correlation between the mitral valve area calculated from the Gorlin formula and peak dD/dt/D was good, while valve area was poorly correlated with the EF slope of the anterior mitral leaflet echo. It is suggested that by continuous measurement of left ventricular dimension and of its first derivative, the reduced atrioventricular blood flow in mitral stenosis can be shown, and that peak dD/dt/D during early diastole is a possible index of its severity.