No abstract

A case of a 32-year-old XY genotype female is described, presenting with mediastinal and abdominal lymphadenopathy and associated with an elevated serum angiotensin I converting enzyme (SACE) level. Lymph node histology showed a malignant dysgerminoma of ovarian origin. Combined chemotherapy led to a radiological regression of the lymphadenopathy and coincided with a decrease in SACE concentration. The authors suggest that SACE may be a marker for disseminated germinoma tumours and may be useful for monitoring treatment.

SUMMARY1. In a group of healthy humans, plasma vasopressin (AVP) levels fell on drinking either Tyrode or mannitol solutions isosmotic with plasma. Both the timing and magnitude of the fall were appropriate to account for the transient diuresis which followed the drinking.2. Although plasma expansion follows drinking Tyrode solution it occurred too late to account for the fall in plasma AVP. It was also too small to inhibit AVP secretion.3. Even though plasma volume tended to contract on drinking isosmotic mannitol solution a fall in plasma AVP and a diuresis occurred, similar to those found after drinking Tyrode solution.4. These findings appear to eliminate plasma volume expansion as the stimulus for the fall in plasma AVP and the associated diuresis on drinking isotonic fluids.5. In a further group of human subjects, bypassing the oropharynx by intragastric infusion resulted in a slower onset of diuresis after a water load.6. We suggest that receptors, as yet undefined, in the upper gastrointestinal tract contribute to the early stages of a water diuresis and account for the apparently inappropriate transient diuresis which follows the drinking of isotonic fluids.

The aim of this study was to correlate tuberculin reactivity with the Kveim test in sarcoidosis. Case records 1983-91 inclusive, of those patients with positive Kveim tests and recorded tuberculin tests in an acute regional general hospital serving south-west Ireland (counties Cork and Kerry) were reviewed. Of 39 patients with positive Kveim tests 28 (72%) were tuberculin negative to a test dose of 10 tuberculin units or more. The group was slightly though significantly younger (p < 0.05) in age than the corresponding group (n = 11; 28%) with positive tuberculin tests. The incidence of tuberculin reactivity in the presence of Kveim reaction is higher than that expected for sarcoidosis. Corresponding studies in Britain and Scandinavia show a considerably lower tuberculin positive rate, which may be due to a lower prevalence of tuberculosis in these countries. However the younger age of the tuberculin negative group in our study may reflect a continuing decline in tuberculosis prevalence in south-west Ireland.