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IgA nephropathy is described in 11 cases out of a total of 177 renal biopsies examined representing an incidence of 6.2 per cent.Reference is made to comparable studies from other centres. Clinical and pathological findings are presented and discussed.

Researchers of ‘amuk’ behavior in Southeast Asia have normally adopted either a psychiatric or ethno-behavioral position, both of which impose an outside theoretical model. An ethnopsychological view of (ng)amuk in Java reveals it to be a poetic idiom of distress, reflecting cultural anxieties about mental illness, aggression, loss of control and vulnerability of the self. Ngamuk as mental/social suffering in Java occurs in a political context that promotes strong repression of emotion and dissent. A model of ngamuk as an exegesis of mental/social distress, reflecting everyday experiences of anxiety, vulnerability, danger and transgression, is proposed.

IgA nephropathy is a common glomerulonephritis for which there is no effective cure. It may recur after renal transplantation and cause graft loss. To determine the prevalence and predict recurrence of IgA disease in transplant recipients. A retrospective analysis was performed of all renal allografts in patients with IgA disease attending a National Renal Unit between 1984 and 1995. An immunopathological grading system was devised to assess the severity of disease at initial presentation and each patient was assigned a simple severity index. A total of 42 patients with IgA disease received 44 renal allografts. Biopsies were performed in 21 of the 44 transplants. Recurrence was diagnosed in five grafts (24%) and recurred only in the ‘moderate’ and ‘severe’ IgA groups. Recurrence was associated with younger age, glomerular crescents on the original renal biopsy, better donor/recipient HLA matching and greater number of rejections. The prevalence of recurrent IgA disease following transplantation in an Irish population is less than that reported at other centres (24% versus 60%). The severity of the original disease and transplant factors may predict recurrence post-transplantation.

The importance of the nuclear receptor peroxisome proliferator–activated receptor-γ (PPARγ) in regulating insulin resistance and blood pressure has been demonstrated in families with loss of function mutations. Gain of function mutations has been associated with severe obesity. However, previous population studies of the common variant Pro12Ala have produced conflicting results. As it is likely that the natural ligands for this receptor may include fatty acids, we hypothesized that the effect of this common variant may be altered by the character of the diet, particularly the ratio of dietary polyunsaturated fat to saturated fat (P:S ratio). We studied 592 nondiabetic participants in an ongoing population-based cohort study who were genotyped for the Pro12Ala polymorphism in the PPAR γ2 isoform. As the Ala homozygotes were uncommon (2.0%), all analyses were conducted comparing Pro homozygotes (79.1%) to Ala allele carriers. There was no difference in fasting insulin concentration or BMI between Ala allele carriers and Pro homozygotes. The fasting insulin concentration was negatively associated with the P:S ratio (P = 0.0119) after adjustment for age and sex, and a strong interaction was evident between the P:S ratio and the Pro12Ala polymorphism for both BMI (P = 0.0038) and fasting insulin (P = 0.0097). The data suggest that when the dietary P:S ratio is low, the BMI in Ala carriers is greater than that in Pro homozygotes, but when the dietary ratio is high, the opposite is seen. This gene-nutrient interaction emphasizes the difficulty of examining the effect of common polymorphisms in the absence of data on nongenetic exposures, and may explain the heterogeneity of findings in previous studies.

We describe five patients with glomerulonephritis (GN) associated with cerebrospinal fluid shunt insertion to relieve hydrocephalus. A ventriculo-atrial (V-A) shunt had been placed on average 12.5 years prior to the diagnosis of nephritis (range 0.5-21 years). Four patients developed membranoproliferative glomerulonephritis (MPGN) with associated hypocomplementaemia. A single patient developed focal proliferative glomerulonephritis. Coagulase-negative staphylococci were cultured in four patients, either from blood or from the shunt. Four patients had their shunts removed, two of whom also received antibiotics. The other patient received antibiotics alone for infective endocarditis due to staphylococcal bacteraemia which originated in the shunt. All patients had substantial renal impairment at the time of diagnosis (GFR, glomerular filtration rate, 20-45 ml/min). There was significant improvement in renal function after appropriate treatment; four of the five patients doubled their GFRs and two patients regained normal function.

Immunofluorescent studies were performed on the clinically normal skin of 16 patients with systemic lupus erythematosus involving the kidney to detect the presence of immune deposits at the dermal-epidermal junction—positive lupus band test (L.B.T.). Our results suggest a significant correlation between L.B.T. positivity and degree of clinical activity, presence of active nephritis, and a more severe histological pattern of lupus nephritis.

Fifty-seven patients with spastic diplegia underwent one-stage bilateral proximal soft tissue release for correction of lower limb deformities. The indications for surgery were improvement of gait and posture and facilitation of toilet care. Significant improvement in ambulatory status followed operation, and most parents were pleased.

We report an incidence of IgA neph ropathy of 14.9% encountered in a total of 562 renal biopsies examined over a period of three years. Reference is made to the incidence reported in other countries. Details of light and fluorescence microscopical findings are correlated with clinical presentation and renal function in an effort to establish prognostic parameters. The results suggest that the presence of IgM deposits with extensions into capillary loops are associated with the more severe histological patterns. In contrast, the finding of classical IgA-IgG nephropathy and the occurrence of the lesion in younger patients is associated with less extensive structural damage.

Femoral stem failure in total hip replacement is uncommon. It tends to occur predominantly in males over 1.8 m in height and over 76 kg in weight. Poor or inadequate cementing technique may lead to cement failure, which may be seen as roentgenographic lucencies present by as much as 12 months prior to actual stem failure. This article reports on a case of double stem failure, together with a full metallurgical examination, which indicated loosening of the implant prior to eventual failure from overload. Although one of the fractures occurred across an area of relative weakness in the stem material, this was not felt to be the principal cause of failure.

Summary Nephrotic syndrome has been observed in association with different types of neoplasia. This appears to be the first report of the occurrence of the nephrotic syndrome due to membrano proliferative glomerulonephritis in association with carcinoma of the oesophagus. Although proteinuria was present before excision of the tumour, the nephrotic phase occurred subsequently. Eventually it disappeared leaving the patient with a clear urine and biochemical and histological improvement of the renal lesion (including immunofluorescent and electronmicroscopy studies). Possible mechanisms responsible for the nephrotic syndrome in this case are discussed.

The use of trochanteric osteotomy in lateral approach to the hip joint is a fundamental part of Charnley's low-friction arthroplasty. Its use allows adequate exposure and easy orientation of the hip. Reattachment using a single transverse and double vertical wires was evaluated in 500 consecutive hip arthroplasties. Of 500 patients, 466 (93.2%) showed complete bony union of their trochanteric osteotomy at three months. A further 20 (4%) patients united by 12 months, giving a union rate of 97.2%; 34 (6.8%) patients who showed incomplete or defective union at three months. There were five dislocations. Only one patient required removal of the wires, for bursitis. The patients with defective bony union had a relatively high rate of wire breakage at three months. Despite a 1.8% complete detachment and 1% fibrous union, the transtrochanteric approach allows easy access without fear of shaft fracture in very difficult cases, with surprisingly little ill effect or loss of function even in those failing to reunite.