- Email: [email protected]
HEBERDEN SOCIETY
177 blastoma. All developed symptoms of acute nephritis within six months of the start of radiotherapy and died of renal failure within four weeks. The total incident dosage
relatively high : 5200r to 6850r in four months. a notable publication, Luxton (1953) described serious and alarming renal damage in 27 adults irradiated for seminoma at the Christie Hospital and Holt Radium Institute, Manchester. 13patients developed features of acute nephritis six to twelve months from the start of
was
In
irradiation and 5 died within a few months, while the others developed chronic nephritis. Autopsy showed kidney changes similar to those in our own case and to those described by Zuelzer et al. (1950) in children and by Hartman et al. (1926) in dogs. Death was attributable to renal damage and in no case was there tumour metastasis. The total central dosage varied from 2900r to 3250r over an average of thirty-six days. Notable clinical features in the 13 acute cases were severe albuminuria, hypertension, refractory normochromic anæmia, and raised blood-urea concentration. 12 other patients developed features of chronic nephritis and the remaining 2 presented with fulminating malignant
hypertension. Summary abdominal irradiation for nephroblastoma, a child of 3 had fatal renal damage. Attention is drawn to the possibility of this serious complication of radiotherapy and the necessity for careful regulation of dosage. In experimental pathology, it is suggested that irradiation of the kidneys might prove a useful method of producing hypertension in animals.
Following
We are indebted to Prof. John Craig and to Mr. S. G. Davidson for allowing us to publish clinical details, to Dr. E. F. Ridley for considerable assistance with radiotherapeutic data, to Prof. J. S. Young for valuable suggestions, and to Mr. R. Drummond for the photographs. REFERENCES Dean, A. L., Abels. J. U. (1944) J. Urol. 52, 497. Hartman, F. W., Bolliger, A., Doub, H. P. (1926) Amer. J. med. Sci.
172,487. R. W. (1953) (Quart. J. Med. 22, 215. Shaw Dunn, J., Montgomery, G. L. (1941) J. Path. Bact. 52, 1. Zuelzer, W. W., Palmer, H. D., Newton, A. N. Jun. (1950) Amer. J. Path. 26, 1019.
Luxton,
Medical Societies HEBERDEN SOCIETY A CLINICAL meeting of the Heberden Society was held at the Sheffield Centre for the Investigation and Treatment of Rheumatic Diseases on July 1 and 2, under the presidency of Prof. R. E. TUNBRIDGE. Reablement of Arthritic Patients Dr. G. R. NEWNS (Sheffield) reviewed changes in functional status of 238 patients with rheumatoid arthritis, first seen during a period of twelve months, with particular attention to the results of treatment in 28 patients who required correction of deformity in weight-bearing joints. In 73% of such cases some improvement was maintained three to four years later. In the discussion the importance of supervising the continuation of treatment by active exercises in the home was considered, and the expense of employing trained physiotherapists for this purpose was noted.
Mucoproteins Dr. E. LOCKEY and Dr. A. J. ANDERSON (London) discussed the results of estimating urine and serum mucoproteins in rheumatic diseases. In rheumatoid arthritis the level of serum-mucoprotein was usually higher than normal ; the level was about the same as in other types of inflammatory disease, but below that in cancer. There was no obvious difference between the results in rheumatoid arthritis and Information about urine-mucoankylosing spondylitis. protein levels was scanty, but some correlation with serum levels was found. There was a very rough correlation between serum-mucoprotein values and the erythrocyte-sedimentation
definite one, absent in other diseases, between values and the result,s of flocculation tests. Evidence was presented that mucoprotein is not responsible for the agglutination phenomenon which forms the basis of the Waaler-Rose test. In the discussion, speakers emphasised the difliculty of correlating abnormalities which are themselves not specific for a single disease. Rheumatoid Arthritis in Psychotics Dr. T. L. PILKrNGTON (Sheffield) described preliminary findings indicating a low incidence (less than 0-7%) of rheuunatoid arthritis in schizophrenia-contrasting with a normal incidence in mental deficiency and in epilepsy. In the discussion it was suggested that a study of this sort might usefully include a comprehensive radiographic survey, and that prolonged inactivity might contribute to the low incidence in schizophrenics.
rate ; and
a
serum-mucoprotein
Meticorten Dr. H. F. WEST (Sheffield) described his recent experiences with a new synthetic steroid ’Meticorten.’ In 3 cases changed from hydrocortisone (systemic) or corticotrophin to meticorten, a reduction in blood-pressure and a loss of retained water was observed ; but in 2 of the patients severe epigastric
pain developed. In the discussion
a
fourfold enhancement of anti-inflam-
matory activity by meticorten, compared with cortisone,
was
described. An unexpectedly favourable response in a case of rheumatoid arthritis with advanced amyloid nephrosis was mentioned, and the reduction in blood-pressure and oedema on changing from cortisone to meticorten was confirmed. Lumbar Vertebrae Prof. D. H. COLLINS (Sheffield) described the pathological conditions revealed by routine examination of the lumbar vertebrae in 100 consecutive, unselected necropsies. Metastatic carcinomatous deposits were found in 11 cases, osteoporosis in 9, Paget’s disease in 3, leukaemic deposits in 2, and myeloma in 1. The frequency of osteoporosis rose from 7% in the seventh decade to 21% in the eighth, and 63% in the ninth.
Adverse Effects of Cortisone Dr. WEST surveyed the fatalities and adverse reactions in 52 cases of rheumatoid arthritis treated with cortisone for one to five years. Of 6 patients who died during treatment, amyloid disease was found in 2 and polyarteritis nodosa in a 3rd. Since both these conditions can occur in association with rheumatoid arthritis, their relation to cortisone therapy is difficult to appraise. 1 patient was found at necropsy to have had severe myocardial fibrosis, and 2 others died (1 suddenly) of pneumonia. The non-fatal adverse reactions included psychotic disturbances in 3 cases. Injections of
corticotrophin occasionally produced anaphylaxis.
In the discussion Dr. OSWALD SAVAGE commented on 6 fatalities among 90 patients treated for long periods with cortisone. Gout Dr. R. SOUGIN-MIBASHAN said that in South Africa gout occurs with about the same frequency in the White and Coloured populations of Cape Town, but is almost unknown in Negroes. 50 cases were treated with probenecid : untoward reactions were confined to occasional slight epigastric discomfort in 4. The clinical effects included disappearance of pain and stiffness (after four to eight weeks), reduction in the size of tophi and a return of movement in fixed big-toe joints (after six to nine months), and sometimes radiographic improvement. Colchicine was given during the early stages of treatment with probenecid, to prevent the acute attacks which tend to occur at this time.
Occupational Factors in Joint Disease Dr. J. S. LAWRENCE, of the Walkden Miners’ Clinic, discussed the results of a survey of occupational factors in degenerative joint disease. Miners and dock-workers had a high incidence of disc degeneration in the -lower dorsal and lumbar spine, and also of osteo-arthritis in the knees. Degenerative changes in the cervical spine, however, showed no predilection for miners. Heavy manual work, especially in the stooping position, was a factor in the development of disc degeneration in the lumbar region. Damp working conditions were associated with an increased frequency of symptoms, but The survey showed forcibly not of radiographic changes. the
in terms of disease in miners.
heavy toll,
joint
disability,
taken
by degenerative
relatively high : 5200r to 6850r in four months. a notable publication, Luxton (1953) described serious and alarming renal damage in 27 adults irradiated for seminoma at the Christie Hospital and Holt Radium Institute, Manchester. 13patients developed features of acute nephritis six to twelve months from the start of
was
In
irradiation and 5 died within a few months, while the others developed chronic nephritis. Autopsy showed kidney changes similar to those in our own case and to those described by Zuelzer et al. (1950) in children and by Hartman et al. (1926) in dogs. Death was attributable to renal damage and in no case was there tumour metastasis. The total central dosage varied from 2900r to 3250r over an average of thirty-six days. Notable clinical features in the 13 acute cases were severe albuminuria, hypertension, refractory normochromic anæmia, and raised blood-urea concentration. 12 other patients developed features of chronic nephritis and the remaining 2 presented with fulminating malignant
hypertension. Summary abdominal irradiation for nephroblastoma, a child of 3 had fatal renal damage. Attention is drawn to the possibility of this serious complication of radiotherapy and the necessity for careful regulation of dosage. In experimental pathology, it is suggested that irradiation of the kidneys might prove a useful method of producing hypertension in animals.
Following
We are indebted to Prof. John Craig and to Mr. S. G. Davidson for allowing us to publish clinical details, to Dr. E. F. Ridley for considerable assistance with radiotherapeutic data, to Prof. J. S. Young for valuable suggestions, and to Mr. R. Drummond for the photographs. REFERENCES Dean, A. L., Abels. J. U. (1944) J. Urol. 52, 497. Hartman, F. W., Bolliger, A., Doub, H. P. (1926) Amer. J. med. Sci.
172,487. R. W. (1953) (Quart. J. Med. 22, 215. Shaw Dunn, J., Montgomery, G. L. (1941) J. Path. Bact. 52, 1. Zuelzer, W. W., Palmer, H. D., Newton, A. N. Jun. (1950) Amer. J. Path. 26, 1019.
Luxton,
Medical Societies HEBERDEN SOCIETY A CLINICAL meeting of the Heberden Society was held at the Sheffield Centre for the Investigation and Treatment of Rheumatic Diseases on July 1 and 2, under the presidency of Prof. R. E. TUNBRIDGE. Reablement of Arthritic Patients Dr. G. R. NEWNS (Sheffield) reviewed changes in functional status of 238 patients with rheumatoid arthritis, first seen during a period of twelve months, with particular attention to the results of treatment in 28 patients who required correction of deformity in weight-bearing joints. In 73% of such cases some improvement was maintained three to four years later. In the discussion the importance of supervising the continuation of treatment by active exercises in the home was considered, and the expense of employing trained physiotherapists for this purpose was noted.
Mucoproteins Dr. E. LOCKEY and Dr. A. J. ANDERSON (London) discussed the results of estimating urine and serum mucoproteins in rheumatic diseases. In rheumatoid arthritis the level of serum-mucoprotein was usually higher than normal ; the level was about the same as in other types of inflammatory disease, but below that in cancer. There was no obvious difference between the results in rheumatoid arthritis and Information about urine-mucoankylosing spondylitis. protein levels was scanty, but some correlation with serum levels was found. There was a very rough correlation between serum-mucoprotein values and the erythrocyte-sedimentation
definite one, absent in other diseases, between values and the result,s of flocculation tests. Evidence was presented that mucoprotein is not responsible for the agglutination phenomenon which forms the basis of the Waaler-Rose test. In the discussion, speakers emphasised the difliculty of correlating abnormalities which are themselves not specific for a single disease. Rheumatoid Arthritis in Psychotics Dr. T. L. PILKrNGTON (Sheffield) described preliminary findings indicating a low incidence (less than 0-7%) of rheuunatoid arthritis in schizophrenia-contrasting with a normal incidence in mental deficiency and in epilepsy. In the discussion it was suggested that a study of this sort might usefully include a comprehensive radiographic survey, and that prolonged inactivity might contribute to the low incidence in schizophrenics.
rate ; and
a
serum-mucoprotein
Meticorten Dr. H. F. WEST (Sheffield) described his recent experiences with a new synthetic steroid ’Meticorten.’ In 3 cases changed from hydrocortisone (systemic) or corticotrophin to meticorten, a reduction in blood-pressure and a loss of retained water was observed ; but in 2 of the patients severe epigastric
pain developed. In the discussion
a
fourfold enhancement of anti-inflam-
matory activity by meticorten, compared with cortisone,
was
described. An unexpectedly favourable response in a case of rheumatoid arthritis with advanced amyloid nephrosis was mentioned, and the reduction in blood-pressure and oedema on changing from cortisone to meticorten was confirmed. Lumbar Vertebrae Prof. D. H. COLLINS (Sheffield) described the pathological conditions revealed by routine examination of the lumbar vertebrae in 100 consecutive, unselected necropsies. Metastatic carcinomatous deposits were found in 11 cases, osteoporosis in 9, Paget’s disease in 3, leukaemic deposits in 2, and myeloma in 1. The frequency of osteoporosis rose from 7% in the seventh decade to 21% in the eighth, and 63% in the ninth.
Adverse Effects of Cortisone Dr. WEST surveyed the fatalities and adverse reactions in 52 cases of rheumatoid arthritis treated with cortisone for one to five years. Of 6 patients who died during treatment, amyloid disease was found in 2 and polyarteritis nodosa in a 3rd. Since both these conditions can occur in association with rheumatoid arthritis, their relation to cortisone therapy is difficult to appraise. 1 patient was found at necropsy to have had severe myocardial fibrosis, and 2 others died (1 suddenly) of pneumonia. The non-fatal adverse reactions included psychotic disturbances in 3 cases. Injections of
corticotrophin occasionally produced anaphylaxis.
In the discussion Dr. OSWALD SAVAGE commented on 6 fatalities among 90 patients treated for long periods with cortisone. Gout Dr. R. SOUGIN-MIBASHAN said that in South Africa gout occurs with about the same frequency in the White and Coloured populations of Cape Town, but is almost unknown in Negroes. 50 cases were treated with probenecid : untoward reactions were confined to occasional slight epigastric discomfort in 4. The clinical effects included disappearance of pain and stiffness (after four to eight weeks), reduction in the size of tophi and a return of movement in fixed big-toe joints (after six to nine months), and sometimes radiographic improvement. Colchicine was given during the early stages of treatment with probenecid, to prevent the acute attacks which tend to occur at this time.
Occupational Factors in Joint Disease Dr. J. S. LAWRENCE, of the Walkden Miners’ Clinic, discussed the results of a survey of occupational factors in degenerative joint disease. Miners and dock-workers had a high incidence of disc degeneration in the -lower dorsal and lumbar spine, and also of osteo-arthritis in the knees. Degenerative changes in the cervical spine, however, showed no predilection for miners. Heavy manual work, especially in the stooping position, was a factor in the development of disc degeneration in the lumbar region. Damp working conditions were associated with an increased frequency of symptoms, but The survey showed forcibly not of radiographic changes. the
in terms of disease in miners.
heavy toll,
joint
disability,
taken
by degenerative