A family with massive acute vitamin D intoxication.

Acute massive vitamin D overdosage occurred in a family after eating food cooked in a nut oil containing 5 million units of vitamin D3/ml. The plasma vitamin D was 55 and 60 i.u./ml in the father and mother respectively, and 9.6 i.u./ml in their 11-month-old infant (normal range, 0--1.6 i.u/ml). All the family presented with symptoms of hypercalcaemia and the infant responded quickly to prednisone. After steroids had failed to control the hypercalcaemia in the parents, neutral phosphate was successful, although necessary for 9 months. Before phosphate therapy it was shown that both parents were in strongly negative calcium balance, indicating that the vitamin D was mobilizing calcium from bone. Eleven years later all 3 patients are well but a renal biopsy in one of them shows persistent nephrocalcinosis.

Infective endocarditis with glomerulonephritis associated with cat chlamydia (C. psittaci) infection.

A patient with glomerulonephritis and endocarditis is described who had evidence of feline Chlamydia psittaci infection. Treatment with antichlamydial drugs resulted in resolution of the glomerulonephritis and the endocarditis. It is recommended that screening for chlamydia is included in the investigation of patients with suspected or obscure endocarditis.

Mallory bodies: isolation of hepatocellular hyalin and electrophoretic resolution of polypeptide components.

Mallory bodies (MBs) were obtained in purified form from human liver obtained at autopsy using a new procedure consisting of sedimentation through a Ficoll viscosity barrier. Preparations from six livers ranged in purity from 95 to 99 per cent. MB preparations were autofluorescent. MBs were strongly agglutinated by Concanavalin A. The presence of carbohydrate was also indicated by the fact that MBs bound fluorescently labeled Concanavalin A; no binding was observed in the presence of appropriate inhibitor monosaccharides. Direct analysis indicated that MBs contained variable amounts of neutral hexose (0.65 to 2.4 mumoles of glucose-equivalents per milligram of protein) but no sialic acid. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis indicated that purified MBs contain five major polypeptides possessing apparent molecular weights of 56,000, 48,500 to 45,000 (triplet), and 32,500. Periodic acid-Schiff-positive components were not detected. Scanning electron microscopy of isolated MBs revealed the presence of a rough, fibrous surface, whereas conventional transmission electron microscopy indicated the filamentous nature of MBs.

Polycystic renal disease--occurrence of malignant change and role of nephrectomy in potential transplant recipients.

28 cases of malignant renal neoplasms in patients with polycystic kidneys are reviewed from the literature and 2 new cases are reported. The difficulty in diagnosing this malignant change together with the increased survival of patients with polycystic kidneys on dialysis and transplant programmes leads to the recommendation that all such patients should be considered for nephrectomies. The reasons for this recommendation and its advantages and disadvantages are discussed.

Effect of dialysate calcium concentration on bone disease in patients on hemodialysis.

Plasma biochemistry, bone radiology and morphometry were studied in a group of 20 patients receiving maintenance hemodialysis. The aim was to determine if increasing the dialysate calcium concentration would decrease plasma parathyroid hormone and improve the radiologic appearances of bone in patients without producing serious side effects. Dialysate calcium concentration was increased stepwise from 4.5 to 6.0 and then to 7.0 mg/100 ml. Mean predialysis plasma calcium concentration increased from 9.4 to 9.7 and then to 10.0 mg/100 ml and mean predialysis phosphate concentration increased from 5.3 to 5.6 mg/100 ml. Parathyroid hormone concentration was elevated in all patients but the mean concentration did not change significantly although in seven patients a decrease occurred. Six patients had radiologic signs of renal bone disease, two patients showed improvement and three patients developed bone disease during the study. The patients with radiologic bone disease had the highest parathyroid hormone concentrations and the majority were female. Morphometric bone measurements showed that bone loss during the study occurred mainly in the male patients. Soft tissue calcification continued to appear during the study. Although the response to some patients to an increased dialysate calcium concentration was favorable, it was impossible to predict which types of patient would benefit from the use of a dialysate calcium concentration of 7.0 mg/100 ml.

The influence of surface rugosity on haemolysis occurring in tubing.

Haemolysis was measured in three tubes of the same chemical composition but differing surface texture. It was found that during the first hour of pumping the increase in haemolysis in both human transfusion blood and fresh cattle blood was greatest in the roughest tubes. When pumping of blood was continued for longer periods the rate of further haemolysis increase was equal in all tubes.