Partial efficacy of clindamycin against Chlamydia trachomatis in men with nongonococcal urethritis

Tetracyclines are the drugs of choice for treatment of Chlamydia trachomatis infection, but alternative antimicrobial agents are needed. Clindamycin has moderate in-vitro activity against C. trachomatis. In this study clindamycin (600 mg orally three times daily for seven days) was given to 76 men with nongonococcal urethritis. Initial microbiologic and clinical responses were significantly better in men from whom C. trachomatis was initially isolated, compared with men from whom Ureaplasma urealyticum was initially isolated, but by 42 +/- 7 days after initiation of treatment, persistence or recurrence of urethritis had occurred in 39% of men with either organism initially isolated. C. trachomatis was ultimately reisolated at follow-up evaluation from seven of 23 men who initially had had positive cultures for C. trachomatis. There was no apparent relationship between the in-vitro susceptibility of C. trachomatis and the ultimate response. These results indicate that clindamycin cannot be relied upon to eradicate C. trachomatis from men with urethritis.

Paediatric accident & emergency services. Are we meeting the need?

Paediatric Casualty has evolved into a blend of true Accident and Emergency and Primary Care Services. With the impending redevelopment of the Accident and Emergency Department at the Camperdown Children's Hospital a survey of families utilising the service was conducted to assess their perceptions of the services provided. It emerged that although many families travelled long distances to the Hospital and had to contend with long waits, they perceived the trip as worthwhile with most finding the quality of care satisfactory (95%) and friendly (90%), coming away with a good understanding of their child's problem (94%), the investigations performed and management prescribed (97%), and arrangements made for follow up (89%). A large percentage (51%) came to the hospital seeking a second opinion for which they had already consulted another agency. Nineteen percent were directly referred, with the remainder seeking a second opinion on their own initiative. This high referral rate necessitates a staffing formula that provides appropriate expertise and supervision. As the demand on hospitals to provide primary care facilities is likely to remain, recommendations are made for improvement in the services provided as well as making more use in forward planning of available expertise and supervision.

Tyrosinaemia II

Four cases of tyrosinaemia type II (Richner-Hanhart syndrome) are reported. This syndrome consists of corneal erosions, palmar and plantar hyperkeratoses, and sometimes mental retardation. Presentation with photophobia and dendritic corneal ulceration or circumscribed palmoplantar keratoderma should alert the physician to the possible diagnosis of tyrosinaemia II. Early diagnosis is important, as the clinical picture can be modified by dietary restriction.

Generalized arterial calcification of infancy: three case reports, including spontaneous regression with long-term survival

Generalized arterial calcification in infancy is a rare disorder in which death usually occurs in infancy, the diagnosis generally being made at autopsy. Three patients are reported. The diagnosis was made during life in two, enabling new information to be collected. Cardiac catheterization in one provided evidence suggesting stiffness of pulmonary and systemic arterial walls. Another is a long-term survivor with spontaneous regression of calcification. The third case, diagnosed at necropsy, was associated with endocardial fibroelastosis.

Tetracycline in nongonococcal urethritis. Comparison of 2 g and 1 g daily for seven days

In a previous study treatment with minocycline 100 mg orally every day for seven days was as effective for nongonococcal urethritis (NGU) as 200 mg for seven days or 100 or 200 mg for 21 days. In this prospective, randomised study men with NGU received tetracycline either 500 mg or 250 mg four times daily for seven days. of 200 men initially enrolled, Chlamydia trachomatis was isolated from 40% and Ureaplasma urealyticum from 48%. Eight of 10 homosexual men compared with 39 (21%) of 190 bisexual or heterosexual men had negative culture results for both C trachomatis and U urealyticum (x2 = 15.5, P < 0.0005). U urealyticum was isolated more frequently from chlamydia-negative men and from men with 10 or fewer sex partners during their lifetime. Both regimens were equally effective in their in-vivo activity against C trachomatis and U urealyticum. Failure rates were similar with the two regimens. More obvious failure with purulent or profuse mucoid discharge and pyuria occurred more frequently with the 250-mg regimen (20% of 76 men on the 250-mg regimen compared with 7% of 67 men on the 500-mg regimen; x2 = 4.45, P < 0.05). Failure occurred more frequently in men who were initially chlamydia-negative and in men in whom U urealyticum persisted after medication. Thus, the 250-mg regimen appeared to be as effective as the 500-mg regimen in the initial treatment of NGU. However, one-third of men had persistent or recurrent urethritis with these regimens, and there is a need for antimicrobial agents with greater in-vivo activity, especially against chlamydia-negative NGU.

Childhood cystinuria in New South Wales. Results in children who were followed up after being detected by urinary screening in infancy

Homozygous cystinuria was diagnosed in 45 children and 19 of their siblings in the course of routine urine screening of 6-week-old infants in New South Wales. These children were followed for up to 14 years. During this time there were 5 clinical episodes of renal disease which could be ascribed to cystinuria. There was normal mental development in all the children except one. Of 49 children over 3 years, 4 had height centiles less than the midparent height centile, while 45 had height centiles equal to or above the midparent centiles. Family testing in these 45 cases showed that 60% were type I cystinurics, and 35% were of the mixed or compound type (5% were not classified). Data from the parents and grandparents showed that renal tract calculi had occurred in 14 of them. This study shows that children with homozygous cystinuria, detected by urinary screening in infancy, rarely have renal symptoms. Mental development was normal as was growth in height. There was an increased incidence of noncystine stone formation among the relatives of these children. The incidence of homozygous cystinuria in New South Wales in one in 17 286.

Natural history of Hartnup disease

Hartnup disease was diagnosed in 12 children and 3 of their 15 sibs in the course of routine urine screening of 6-week-old infants in New South Wales. These children were followed for up to 8 years, during which time there were only two clinical episodes which might be ascribed to Hartnup disease. The mental development of all the children was normal. 10 had height centiles less than the midparent height centiles, while 4 had centiles equal to or above the midparent centiles. The study shows that in children with Hartnup disease in Australia symptoms are very uncommon. Mental development is normal, and heights are possibly slightly below that expected. Hartnup disease has an incidence of approximately 1 in 33 000 in New South Wales.

Pycnodysostosis. A variant form with visceral manifestations

The history of a 3-year-old boy is presented who has clinical and radiological features of pycnodysostosis. He also suffers from haematological and visceral complications suggestive of osteopetrosis, which have not previously been described in pycnodysostosis. This variant form of dense bone disease appears to provide the clinical link between pycnodysostosis and osteopetrosis and shows yet another example of phenotypic and perhaps genotypic heterogeneity in metabolic diseases.

Neonatal hepatitis in premature infants simulating hereditary tyrosinosis

Three premature infants are reported who developed obstructive jaundice in the first 3 months of life, with a chemical and histological picture consistent with neonatal hepatitis. The disease was complicated by gross generalized aminoaciduria, rickets, and anaemia. Serum tyrosine levels were raised to 0·28-1·64 μmole/ml in 2 infants, and did not fall in response to ascorbic acid given orally. The infants recovered over the next 3 to 5 months without specific therapy. Many features of the illness in the 3 infants are suggestive of hereditary tyrosinosis, but the transient nature of the illness excluded this diagnosis. It is suggested that the infants had neonatal hepatitis and that the aminoaciduria and rickets were complications of the hepatitis and the prematurity. The recognition of this syndrome of neonatal hepatitis simulating tyrosinosis is important, if unnecessary and possibly dangerous therapy directed at hereditary tyrosinosis is to be avoided.

Osteopetrosis

The clinical histories of nine children with osteopetrosis are reported. Two of them had the malignant infantile variety of the disease: one died within 3 months of birth and the other has survived 20 months on a regimen of a low calcium intake, cellulose phosphate, and steroids. The beneficial effect of a low calcium intake, in early infancy, is supported by the clinical course in the infant with the malignant variety and in another child with the more benign form of the disease. No calcium balance studies were performed. This study suggests that the active measures outlined may favourably influence the haematological and osteosclerotic course of the disease, pending further knowledge of its aetiological basis, and more specific therapy.

Atypical phenylketonuria. An approach to diagnosis and management

Nine children with atypical phenylketonuria are described from a Phenylketonuric Clinic of 56 children. The diagnostic criteria are (i) raised serum phenylalanine level, 4-20 mg./100 ml.; (ii) phenylalanine intolerance indistinguishable from classical phenylketonuria on loading; (iii) abnormal urinary metabolites after loading. They differ from classical phenylketonuria in their greater tolerance to dietary phenylalanine and better prognosis for future intelligence. The arguments for dietary restrictions in these infants are discussed and their dietary management outlined. Their greater tolerance to phenylalanine results in an increased danger of phenylalanine deficiency. This requires closer supervision in the first months of treatment. It is speculated that dietary restrictions will be eased by pre-school age, but that females with atypical phenylketonuria will again require dietary restrictions when pregnant.

Phenylketonuria: a review

The development of a practical screening procedure for phenylketonuria and the improvement in methods of chemical analysis have led to a realization that Folling's (1934) disease of phenylketonuria is not a single entity.

In this commentary, the current view on some aspects of phenylketonuria will be reviewed and the problems illustrated by experience gained in the Phenylketonuria Clinic at the Royal Alexandra Hospital for Children in Sydney, at present attended by fifty-six children. From April 1964, fifty-six infants and children were referred because of a positive screening test. Six were no longer abnormal at the time of retesting, forty-two had classical phenylketonuria and eight showed an atypical pattern. Subsequent family studies revealed five other classical phenylketonuric children, all of whom were retarded, and one other atypical phenylketonuric boy.