Seasonal variations of urinary stone colic in Arabia.

The western region of Saudi Arabia is an area with a high prevalence of urolithiasis. This study was designed to find the effect of climatic changes on the occurrence of urinary stone colic as well as the effect of Ramadan fasting and pilgrimage festival. The emergency room (E.R.) records at King Abdulaziz University Hospital in Jeddah were studied for 3 consecutive years. Males diagnosed as urinary colic during this period were recorded on monthly basis with correction for 30 days a month. Data were recorded before, during and after the fasting month as well as before and after the pilgrimage festival. The results showed a steady increase in urinary stone colic in the hot season with a maximum rate in the months of June, July and August. The mean number of males with stone colic in these months was 45.33, 44.19 and 45.16 respectively. The lowest number was in March (28.06) with a rate of 4.11 per 1000 patients. A strong correlation was found between urinary stone colic and both temperature and atmospheric pressure with a P value of < 0.0001. No significant correlation was observed with relative humidity and similarly no significant change in relation to Ramadan fasting or the pilgrimage festival. These results suggest that there is a clear stone season in this area corresponding to the hot summer months. No significant increase in urinary stone colic was observed in relationship to the fasting month of Ramadan or the pilgrimage festival.

The effects of therapy with rifampicin and isoniazid on basic investigations for Cushing's syndrome.

Rifampicin(R) is a potent enzyme inducer which is now widely used to treat many conditions. We have investigated its effect on adrenal function tests in 18 adults with tuberculosis on rifampicin (R) and isoniazid (INH) as in-patients. Midnight cortisol was above 250 nmol/l in 11 patients with a mean +/- (SD) of 340 +/- 193 nmol/l. The morning serum cortisol following 1 and 4 mg dexamethasone overnight was abnormal in 88.9 per cent and 83.3 per cent respectively. The respective mean values +/- (SD) were 350 +/- 179 and 336 +/- 279 nmol/l. The mean 24-hour urinary free cortisol +/- SD was 513 +/- 375 nmol and was above normal in 6 (33.3 per cent) patients. These results show that midnight cortisol, dexamethasone suppression tests and 24-hour urinary free cortisol are misleading in patients with tuberculosis on (R) and should not be employed for investigating such patients for Cushing's syndrome.

Catecholamines in heat stroke.

In order to find out whether the sympatho-adrenal system is activated in relation to heat stroke, plasma levels of norepinephrine (NE) and epinephrine (E) were measured using high pressure liquid chromatography in seven patients with heat stroke. The mean NE +/- SD levels on admission and six hours afterwards were 1397 +/- 317 and 717 +/- 239 pg/ml, respectively. The corresponding values for E were 257 +/- 55 and 32 +/- 15 pg/ml. The levels of both NE and E on admission were considerably higher than those of the controls: 328 +/- 62 and 88 +/- 16 pg/ml (12 normal subjects). This increase in both NE and E indicates activation of the sympatho-adrenal system in patients with heat stroke. The alpha-mediated effect of catecholamines may be important in impairing heat dissipation and thus may contribute to the pathogenesis of heat stroke.

Altered cortisol levels in relation to Ramadan.

During the month of Muslim fasting (Ramadan) many people alter their sleeping habits and stay awake most of the night. We investigated the effect of this alteration on morning and midnight cortisol levels in 10 healthy adults in their homes. Four of the subjects showed alteration of the cortisol rhythm during the last 2 weeks of fasting with reversal of the morning/midnight ratio in some values. One lady was admitted for 24-h cortisol profile on Day 15 of Ramadan when the acrophase and nadir showed a forward shift by about 5-6 h, consistent with the shift of the subject's sleep. The morning cortisol returned to normal in all subjects 4 weeks after Ramadan. However, the midnight value was above 250 nmol/l in three of the subjects who exhibited the alteration during Ramadan. These findings suggest that single-point cortisol values can be misleading in many Muslin countries during or shortly after Ramadan.

Benzylpenicillin-induced neutropenia.

Neutropenia is a potentially serious complication of parenteral benzylpenicillin administration. It is thought to occur more frequently in patients receiving infusions of stored penicillin solutions. We report three cases of neutropenia produced after bolus injections of freshly prepared benzylpenicillin. Twenty-five other cases were reviewed from the literature and the data summarized.