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Immunologic thrombocytopenic purpura (ITP) is a condition that affects four to 18 per 100 000 children every year. In most cases, spontaneous remission occurs, but splenectomy may be proposed. Exploring the site of platelet sequestration can help to better predict potential poor responders to splenectomy, but 111 In-radiolabeled platelet scintigraphy (IPS) can be difficult to perform in children with very few platelets. A 12-year-old boy suffering from refractory ITP was referred for evaluation of platelet survival and sequestration and consideration of splenectomy. His platelet count consistently remained below 10 000/mm 3 . An exceptional procedure was set up to use homologous platelets to perform the IPS. Splenectomy was ruled out based on the results of 111 In-radiolabeled homologous platelet scintigraphy. The attending pediatrician intensified medical treatments, resulting in a significant improvement in platelet count. This increase in platelet levels allowed for 111 In-radiolabeled autologous platelet scintigraphy, which confirmed the absence of splenic sequestration. This allowed us to reject splenectomy in this child. Homologous IPS could help clinicians to choose splenectomy as a treatment option for ITP in children with a very low platelet count, and its use should be promoted after failed thrombopoietin receptor agonist (TPO-RA) treatment. More systematic studies are needed to confirm the predictive response to splenectomy of homologous IPS., (© The Author(s) 2024.)

Objectives: Technetium-99m mercapto-acetyl-triglycine ([ 99m Tc]Tc-MAG3) is a radiopharmaceutical diagnostic agent used in nuclear medicine intended for the exploration of nephrological and urological disorders. Patient safety and reliability of this imaging procedure especially depend on the radiochemical purity (RCP) of the [ 99m Tc]Tc-MAG3 preparation. Recently, the Summary of Product Characteristics (SPC) of NephroMAG, a kit dedicated to [ 99m Tc]Tc-MAG3 preparation, proposed a two-strip thin layer chromatography (TLC) based quality control (QC) method. Also, Straub et al recently proposed another TLC based QC method. We sought to evaluate the transferability of these QC methods in our hospital radiopharmacy and compared them to our currently employed TLC method and radio-HPLC (high-pressure liquid chromatography) to select the most appropriate in the context of hospital radiopharmacy., Methods: Ten consecutive [ 99m Tc]Tc-MAG3 preparations were controlled using: HPLC combined with a radiodetector (radio-HPLC), a single strip TLC method (method 1) in current use in our centre, a two-strip TLC method described in the SPC (method SPC) and a two-strip TLC method (method 2) described by Straub et al . Quantitative results for the four tested QC methods were measured and compared in terms of RCP (%), sodium pertechnetate ([ 99m Tc]TcO 4 - ) (%) and duration of analysis (min)., Results: RCP was significantly different between method SPC and radio-HPLC (p<0.001) and method 2 (p<0.001). Also, the percentage of [ 99m Tc]TcO 4 - was statistically different between the radio-HPLC and the method SPC (p<0.001), but not with the method 1 and method 2 group (p>0.05). The duration of analysis (min) was significantly different between the four QC procedures (p<0.001) with method 2 and method SPC being the quickest., Conclusions: Our study showed it is possible to transfer and select a quick and reliable QC method for the preparation of NephroMAG kits in our centre. We therefore advise the widespread use of the method from Straub et al in hospital radiopharmacies., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Inflammatory liver diseases display higher levels in serum ADA activity compared to non-inflammatory ones. The most pronounced increases in activity are found in acute virus-induced hepatitis, in active liver cirrhoses, extremely high levels in some liver tumours. Due to correlative relations, the ADA is mainly attributed to the mesenchymal parameters by factor analysis. This can be validated by assessment of histological criteria. The highest correlation coefficient could be demonstrated for ADA in relation to all parameters under investigation by means of the semi-quantitatively evaluated mesenchymal reaction within the histological section. The determination of the serum ADA is valuable in assessing the inflammatory reaction of the liver and for diagnosing active cirrhosis in particular. Increases in activity based on an elevated nucleic acid metabolism in tumours and regenerative processes have to be taken into consideration. This interpretation is evidenced by correlative relations between the activity of ADA in liver biopsy homogenate specimen and the hepatic inflammatory reaction.

With the help of the haemofiltration on the capillary dialysator CDAK 4 the behaviour of lysozyme (muramidase) was investigated in 20 dialysis patients. In 6 of 55 cases a measurable lysozyme concentration in the haemofiltrate was found. A relation to the size of the serum lysozyme level could not be established. The influence of defective capillaries is discussed. Despite the in most cases not measurable lysozyme concentrations in the haemofiltrate a decrease of the serum lysozyme level taking place parallel to creatinine could be proved during dialysis. Examinations of the influence of the renal rest function in dialysis patients with a rest diuresis resulted in a lower lysozyme concentration in the serum than in patients with complete anuria. These findings allow conclusions to the behaviour of low-molecular proteins in the kidney of dialysis patients and to their losses on the dialysis membrane.

In patients with hyperthyroidism the serum activities of the leucine aminopeptidase (LAP) and the alanine aminopeptidase (AAP) as well as the alanine aminopeptidase excretion in the urine were determined. A significantly increased activity of the leucine aminopeptidase in the serum and an increased excretion of alanine aminopeptidase in the urine were found. The AAP in the serum did not show a significant increase of activity. On account of the changes in the serum and in the urine before and during therapy a low-grade participation of the hepatobiliary and renal systems which are clinically not uppermost is to be assumed. Increased excretion of AAP and hyperthyroidism coincide nearly without exception in out patients. Correlation-statistical investigations make it probable to regard the increased excretion of AAP in the urine as an indirect parameter of the peripheral metabolism in hyperthyroidism.

Aminoglycosides lead to an increase of number and size of secondary lysosomiotics in the cells of the renal size of secondary lysosomes in the cells of the renal tubuli. Myeloid bodies appear in the lysosomes. As a sequel of the aminoglycoside antibiotics accumulated in the kidney a rhythmic change of the function of the cells of the tubuli with hyperenzymuria, decreased reabsorption of low molecular weight proteins, decreased concentration of urine and decreased glomerular filtration develops. Despite continued drug exposure these deviations are reversible. Simultaneous application of cephalotin, dextran or furosemid increase the toxic effect. A summarizing hypothesis concerning the aminoglycoside-induced nephropathy is presented which takes into consideration the specific receptor binding of the aminoglycosides at the membrane of the tubulus, their accumulation in the lysosomes and their ways in the cell of the tubulus. The lysosomes are regarded as primary working point of the aminoglycosides.

Of a greater number of biochemical tests in hepatobiliary diseases by means of methematico-statistical methods (calculation of specificity and sensitiveness, variance analysis, discrimination analysis with following discrimination experiments) the parameters should be established which in a step programme with multivariate observation and non-discriminated approach give the best possible information. The recognition of patients with liver diseases (preliminary diagnostics) is at nearly 94% possible with a scale comprising GOT, AAP, some relevant clinical data (touch findings, jaundice, hepatic skin signs) and the hepatitis B-antigen. In non-discriminated approach according to our findings the following scale should not be trangressed: GPT, GOT (compare preliminary diagnostics), LAP, AP, AAP (compare preliminary diagnostics), cholesterol, TTT, bilirubin, beta-GC. As to aimed questionings the bromsulphalein test belongs to the enlarged basic scale.

9 patients with chronic pyelonephritis were given gentamicin intramuscularly in an appropriate dosage for a period of 10 days. The urinary excretion of cells, protein, alanine aminopeptidase (EC 3.4.11.2),N-acetylglucosaminidase(EC 3.2.1.30) and alpha-galactosidase (EC 3.2.1.23) was determined daily. The most striking enzyme increase occurred in alanine aminopeptidase. The enzyme and protein output appears to be rhythmic and discontinuous. A 2--3-day rhythm is suggested. Rhythmic alterations of the digestion activity of the lysosomes are assumed to be the cause of these changes.