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[Medicinal therapy for lysosomal storage diseases].

Lysosomes contain several dozen different enzymes, mostly acid hydrolases. Materials not digested due to deficient lysosomal enzymes are usually large cellular molecules, which are deposited within the cells. The strategy for medicinal therapy of lysosomal storages disease may be to develop the activators of enzymes, to promote coenzyme and cofactor supplementation and to eliminate undegraded materials from blood into urine. In the last several decades, many trials for these strategies has been done. Cysteamine for cystinosis and penicillamine for Wilson's disease has proved useful in treating these patients. Recently, DMSO has been proved to be an activator of acid sphingomyelinase and to accelerate the intracellular mobilization of LDL-derived cholesterol. We treated patients with Niemann-Pick disease type C by oral administration of DMSO, resulting in some clinical benefits such as decreased size of hepatosplenomegaly, and lesser frequency of seizures with improved EEG. However, the progressive clinical course has not been changed although it appeared to slow down. New activators of lysosomal enzymes should be developed for medicinal therapy of lysosomal storage diseases.

Child↗

[The value of diagnostic laparotomy in patients with malignant lymphomas].

UNLABELLED: From 1972 to 1974 a collaborative prospective study was undertaken to determine the incidence, causes and clinical course of chronic renal failure (CRF) in pediatric patients (age 1/2-16 years) in Switzerland. In addition, information concerning the occurrence of terminal CRF observed between 1967 and 1971 was obtained. CRF is defined as persistently elevated serum creatinine greater than 2 mg/100 ml. The small size of Switzerland (population 6.27 million) and the availability of specialized medical care favoured relative completeness of data. RESULTS: a) Non-terminal CRF. - Prevalence was 4.5 per million total population = 18.5 per million children (1/2-16 years old)(n = 28 at 31. 12. 1974); Causes: renal disease was acquired in 14% and congenital in 86% (hereditary nephropathies excluding polycystic kidneys 4%, polycystic kidneys 14%, hypoplasia 14%, urinary tract abnormalities 54%). Progression of CRF: mean time interval in which serum creatinine doubled was, in the group of acquired renal diseases, 8.3 months (n = 6); in hereditary nephropathies 14.3 months (n = 4); in the group of polycystic kidneys and hypoplasia 41.2 months (n = 6), and in patients with urinary tract abnormalities 35.8 months (n = 15). Body height was reduced in all groups as compared with normal children: 1.0 SDS (standard deviation scores) in acquired renal diseases (n = 9), 5.1 SDS in cystinosis (n = 2), 0.4 SDS in polycystic kidneys (n = 4), 1.6 SDS in hypoplasia (n = 5), and 2.3 SDS in urinary tract abnormalities (n = 16). b) Terminal CRF. - Mean yearly incidence (1967-1974, n = 68) was 1.36 per million total population = 5.6 per million children (1/2-16 years). Causes: In contrast to the situation in non-terminal CRF, acquired diseases were observed in 56% of all patients. Hereditary nephropathies were found in 12%, polycystic kidneys in 1.5%, hypoplasia in 4.5%, and urinary tract abnormalities in 26%. TREATMENT: Between 1970 and 1972, 7 of 21 patients, and during 1973/1974 13 of 1n. On 31. 12. 1974, 18 of these 20 treated patients were alive, and of these 14 had a functioning graft.

Adolescent↗