800
titre 40; Sept 20, 20; Jan 24, 1991, negative). At the last analysis, urinary findings, routine laboratory tests (ESR, CRP, blood cells), and cardiological examination were unremarkable. This case raises important questions. Was the demonstration of ANCA in this patient with subacute bacterial endocarditis coincidental or was it related to the appearance of extrarenal vasculitis (Osler nodules)? Do ANCA have a pathogenetic role in extrarenal vasculitis? These questions can be answered only by investigation of larger numbers of patients. Department of Internal Medicine, Nephrology, University of Heidelberg, 6900 Heidelberg 1, Germany
J. WAGNER
Division
K. ANDRASSY E. RITZ
Andrassy K, Koderisch J, Rufer M, et al. Detection and clinical implication of antineutrophil cytoplasmic antibodies in Wegener’s granulomatosis and rapidly progressive glomerulonephritis. Clin Nephrol 1989; 32: 159-67. 2. Savage COS, Winearls CG, Jones S, Marshall PD, Lockwood CM. Prospective study of radioimmunoassay for antibodies against neutrophil cytoplasm in diagnosis of systemic vaculitis. Lancet 1987; i: 1389-93. 3. Koderisch J, Andrassy K, Rasmussen N, Hartman M, Tilgen W. "False-positive" anti-neutrophil cytoplasmic antibodies in HIV infection. Lancet 1990; 335: 1.
1227-28.
4. Andrassy K, Koderisch J, Adler D. Diagnostische Bedeutung von neutrophilen zytoplasmatischen Antikörpern in der Nephrologie. Immun Infekt 1990; 18: 53-55. 5. Peen E, Tejle K, Skogh Th. Anti-granulocyte antibodies in Crohn’s disease. APMIS 1990; 19 (suppl): 98. 6. Jorgensen BB, Wiik A, Hoier-Madsen M, et al. Serum antibodies to neutrophils in patients with chronic inflammatory bowel disease. ANCA Workshop, Washington, 1990: abstr 66.
Alarm bells for enuresis SIR,-In your March 2 editorial you omit two important points. Parents should be asked if the child sleeps very deeply and whether bedwetting is more likely when the child is very tired. I believe that bedwetting occurs merely because the child is too deeply asleep to be woken by a full bladder. In the Lancet series Disabilities and how to live with them many years ago you published the story of a hospital sister who had this complaint. She remarked that it was more likely to happen after a tiring day. In the case of a child who had double incontinence a small dose of amphetamine prevented anal incontinence, and a larger dose also prevented urinary incontinence. It should always be made clear to parents that nocturnal enuresis does not result from laziness and is not the child’s fault. "Shame therapy" is cruel and causes the child much misery-furthermore it does not work. It is difficult to know whether alarms work well. Does the child get better spontaneously? Are parents reluctant to upset the caring doctor by telling him that his treatment does not work? Or have they gone to see another doctor?
Fig Left
panel,
1-Intact PTH with calcitriol treatment.
PTH 50-200
pmol/I (n=5); right panel, PTH
titre 40; Sept 20, 20; Jan 24, 1991, negative). At the last analysis, urinary findings, routine laboratory tests (ESR, CRP, blood cells), and cardiological examination were unremarkable. This case raises important questions. Was the demonstration of ANCA in this patient with subacute bacterial endocarditis coincidental or was it related to the appearance of extrarenal vasculitis (Osler nodules)? Do ANCA have a pathogenetic role in extrarenal vasculitis? These questions can be answered only by investigation of larger numbers of patients. Department of Internal Medicine, Nephrology, University of Heidelberg, 6900 Heidelberg 1, Germany
J. WAGNER
Division
K. ANDRASSY E. RITZ
Andrassy K, Koderisch J, Rufer M, et al. Detection and clinical implication of antineutrophil cytoplasmic antibodies in Wegener’s granulomatosis and rapidly progressive glomerulonephritis. Clin Nephrol 1989; 32: 159-67. 2. Savage COS, Winearls CG, Jones S, Marshall PD, Lockwood CM. Prospective study of radioimmunoassay for antibodies against neutrophil cytoplasm in diagnosis of systemic vaculitis. Lancet 1987; i: 1389-93. 3. Koderisch J, Andrassy K, Rasmussen N, Hartman M, Tilgen W. "False-positive" anti-neutrophil cytoplasmic antibodies in HIV infection. Lancet 1990; 335: 1.
1227-28.
4. Andrassy K, Koderisch J, Adler D. Diagnostische Bedeutung von neutrophilen zytoplasmatischen Antikörpern in der Nephrologie. Immun Infekt 1990; 18: 53-55. 5. Peen E, Tejle K, Skogh Th. Anti-granulocyte antibodies in Crohn’s disease. APMIS 1990; 19 (suppl): 98. 6. Jorgensen BB, Wiik A, Hoier-Madsen M, et al. Serum antibodies to neutrophils in patients with chronic inflammatory bowel disease. ANCA Workshop, Washington, 1990: abstr 66.
Alarm bells for enuresis SIR,-In your March 2 editorial you omit two important points. Parents should be asked if the child sleeps very deeply and whether bedwetting is more likely when the child is very tired. I believe that bedwetting occurs merely because the child is too deeply asleep to be woken by a full bladder. In the Lancet series Disabilities and how to live with them many years ago you published the story of a hospital sister who had this complaint. She remarked that it was more likely to happen after a tiring day. In the case of a child who had double incontinence a small dose of amphetamine prevented anal incontinence, and a larger dose also prevented urinary incontinence. It should always be made clear to parents that nocturnal enuresis does not result from laziness and is not the child’s fault. "Shame therapy" is cruel and causes the child much misery-furthermore it does not work. It is difficult to know whether alarms work well. Does the child get better spontaneously? Are parents reluctant to upset the caring doctor by telling him that his treatment does not work? Or have they gone to see another doctor?
Fig Left
panel,
1-Intact PTH with calcitriol treatment.
PTH 50-200
pmol/I (n=5); right panel, PTH
