Assessment of the efficacy and toxicity of (131)I-metaiodobenzylguanidine therapy for metastatic neuroendocrine tumours.

(131)I-metaiodobenzylguanidine ((131)I-MIBG) is a licensed palliative treatment for patients with metastatic neuroendocrine tumours. We have retrospectively assessed the consequences of (131)I-MIBG therapy in 48 patients (30 gastroenteropancreatic, 6 pulmonary, 12 unknown primary site) with metastatic neuroendocrine tumours attending Royal Liverpool University Hospital between 1996 and 2006. Mean age at diagnosis was 57.6 years (range 34-81). (131)I-MIBG was administered on 88 occasions (mean 1.8 treatments, range 1-4). Twenty-nine patients had biochemical markers measured before and after (131)I-MIBG, of whom 11 (36.7%) showed >50% reduction in levels post-therapy. Forty patients had radiological investigations performed after (131)I-MIBG, of whom 11(27.5%) showed reduction in tumour size post-therapy. Twenty-seven (56.3%) patients reported improved symptoms after (131)I-MIBG therapy. Kaplan-Meier analysis showed significantly increased survival (P=0.01) from the date of first (131)I-MIBG in patients who reported symptomatic benefit from therapy. Patients with biochemical and radiological responses did not show any statistically significant alteration in survival compared to non-responders. Eleven (22.9%) patients required hospitalisation as a consequence of complications, mostly due to mild bone marrow suppression. (131)I-MIBG therefore improved symptoms in more than half of the patients with metastatic neuroendocrine tumours and survival was increased in those patients who reported a symptomatic response to therapy.

Effect of hematocrit on dialyzer urea and creatinine clearance indices in a hemodialysis patient with erythrocytosis.

The association between azotemic index dialyzer clearances and hematocrit was investigated in a 63-year-old dialysis-dependent man with acquired renal cysts. During 43 months of hemodialysis, hematocrit rose from 27.3 to 65.0 vol%, as a consequence of high serum erythropoietin levels. Concomitantly, dry weight also increased from 116.8 to 140.8 kg. Both hematocrit and dry weight correlated with: (a) urea reduction ratio, (b) creatinine reduction ratio (CRR), and (c) KT/V urea. All correlations were negative. Stepwise regression showed that only hematocrit was an independent correlate of the CRR (CRR = 0.662 - 007* Hct, R2 = 0.770); whereas, both hematocrit (Hct) and weight (W) were independent correlates of KT/V urea (KT/V = 2.070 - 0.005*Hct - 0.009*W,R2 = 0.721). In addition to creatinine clearance, urea clearance through the dialyzer is reduced by a rising hematocrit. The effect of hematocrit on urea clearance is relatively small. Therefore, it requires large changes in hematocrit in order to be detected.

Little evidence for anti-endothelial-cell antibodies in microscopic polyarteritis and Wegener's granulomatosis.

Sera from patients with a vasculitis and controls were investigated for the presence of anti-endothelial cell antibodies(AECA), anti- neutrophil cytoplasmic antibodies(ANCA) and anti-myeloperoxidase (MPO) antibodies. Only 19% of patients with Wegener's granulomatosis and 2% of patients with microscopic polyarteritis had AECA. Our data suggests that AECA are a minor antibody system in vasculitis.

Urinary schistosomiasis in Maiduguri, north east Nigeria.

From January to December 1983, 12,207 specimens of urine were examined for ova of Schistosoma haematobium and 753 (6.17%) were positive. From this group, 44 adult patients were investigated for urinary tract abnormalities. Haematuria was the commonest presenting symptom (81.8%) followed by lower abdominal pain (77.3%) and dysuria (68.2%). Urinalysis revealed proteinuria in 55.5%, leucocyturia in 90.9% and microhaematuria in 88.6% of patients. Twenty-four hour protein excretion ranged from 230 mg to 2.2 g (mean 960 mg). Serum creatinine was raised in one patient (2.2 mg dl-1), Urological abnormalities included calcification of the bladder in 36.4%, ureteric strictures and dilatations in 65.9%, hydronephrosis in 9.1%, squamous cell carcinoma of the bladder in 4.5%, vesicle calculus in 2.3%, and multiple granulomatas in the bladder in 2.3% of the patients. The results of the study suggest that a sizeable population of this area is at risk of developing urological complications and consequently chronic renal insufficiency.

Stemming the tide of rural-urban migration in Nigeria: social versus economic considerations.

PIP: Ways of reducing the flow of rural-urban migration in Nigeria are explored. The authors suggest that too much emphasis has been placed on developing social amenities in rural areas. An alternative approach, based on the development of economic opportunities for rural youth, is suggested.^ieng