Grey scale ultrasound in Crohn's disease

Grey scale ultrasound examination was performed in 20 patients with Crohn's disease of varying extent and severity. In 15 of the 20 patients studied, thickening of the wall of the terminal ileum and caecum, with adjoining inflammatory changes in the mesentery, produced recognisable patterns on longitudinal and transverse ultrasonographs. Grey scale ultrasound, although not providing the specificity or detail of conventional radiology, can be helpful in the assessment of ileocaecal Crohn's disease, particularly in younger patients where the radiation hazards of repeated x-ray examinations are undesirable.

High flow oxygen therapy for pneumatosis coli

Symptomatic and radiological resolution of pneumatosis coli was achieved by intermittent high flow oxygen therapy in five patients. In each case the extent of the disease was defined by colonoscopy and contrast radiography before treatment. Despite the confirmation of pneumocyst resolution, recurrence of colonic gas cysts was noted in two patients at six months and one year after treatment. Bacteriological studies indicated that resolution of the disease, induced by oxygen therapy, was not associated with eradication of anerobic bacteria from stool and colonic mucosa. The clinical features and response to treatment of this group of patients are discussed, with particular reference to previously reported methods of oxygen administration.

Hazards of hepatic artery infusion of streptozocin

Three patients with metastatic malignancy received streptozocin by hepatic artery infusion through a percutaneous transfemoral catheter. Two patients developed major arterial thrombosis, from which one died. The other suffered renal damage following displacement of the catheter tip. Possible avoidable risk factors are identified.

Myocardial infarction and marijuana

Myocardial infarction in the virtual absence of risk factors occurred in a 25-year old man shortly after smoking a cigarette containing marijuana. Subsequent coronary arteriography was normal.

Effect of gel fibre on gastric emptying and absorption of glucose and paracetamol

To determine the part played by altered gastric emptying in the modification of glucose absorption by gel fibres, glucose tolerance tests were done in seven healthy volunteers with and without the addition of pectin to the ingested glucose solution and after pharmacological inhibition of gastric emptying with propantheline. Compared with the controls, pectin significantly reduced blood-glucose. Propantheline had a similar but more pronounced effect. Pectin and guar gum did not substantially alter glucose tolerance in a patient who had had total gastrectomy. In a further investigation, gastric emptying and paracetamol absorption were studied simultaneously in fourteen subjects. In eight of these the study was repeated after addition of guar gum and pectin to the ingested paracetamol. Both gastric emptying and paracetamol absorption were slower after gel fibre but the total absorption of the drug, reflected in urinary recovery, was not significantly reduced. The results suggest that the effects of guar gum and pectin on glucose tolerance and paracetamol absorption could be due simply to alteration in the rate of gastric emptying.

Interatrial abscess

A large abscess of the interatrial septum developed during the course of acute bacterial endocarditis affecting the aortic valve. Septic involvement of the cardiac conducting system produced atrioventricular dissociation, and subsequent abscess rupture resulted in an aorto-right atrial communication. The clinical presentation of this rare complication of acute bacterial endocarditis is correlated with the post-mortem findings.

A teratoma of the lung containing thymic tissue

A case of a benign, cystic intrapulmonary teratoma occurring in the left lobe of a 63-yr-old female is described and the typical clinical symptoms and distinguishing X-ray appearances which may be helpful in diagnosing this rare tumour are mentioned. The connection between the tumor and the segmental bronchus clearly established the true intrapulmonary nature of the lesion in this case and the unusual finding of thymic tissue within the wall supports previous speculation regarding the possible thymic origin of these neoplasms.

Multiple concentric ring sign in the ultrasonographic diagnosis of intussusception

Gray scale ultrasound examination of two patients with abdominal space-occupying lesions demonstrated characteristic ring shadows on longitudinal scans. In one case a multiple concentric ring shadow resulted from an ileocolic intussusception, and in the other a "bull's eye" image was due to an infiltrating carcinoma of the pyloric antrum. A study of these patients confirms the suspicion [1] that there is a characteristic ultrasonic appearance of intussusception in bowel loops.

Spontaneous mid-oesophageal rupture

The clinical presentation and management of spontaneous rupture of the middle third of the oesophagus is described in two patients. Early presentation and treatment in one case led to uncomplicated recovery. In the other patient late presentation and diagnosis resulted in delayed surgical intervention with an unsuccessful outcome. The nature of this rare lesion is discussed and nine previously described cases are reviewed.

Cephalothin induced neutropenia during the treatment of bacterial endocarditis

The occurrence of cephalothin induced neutropenia in 3 patients with infective endocarditis is described. In each patient, withdrawal of cephalothin was followed by rapid haematological recovery. It is apparent that granulocytopenia may frequently occur in patients receiving prolonged, high dose, intravenous cephalothin for the treatment of bacterial endocarditis.

Fluorouracil cardiotoxicity

Our of 140 patients treated with intravenous 5-fluorouracil, four developed ischaemic chest pain within 18 hours of either the second or third dose. In three of these patients the pain recurred after subsequent doses. Predose electrocardiograms in two cases were normal. None of the four patients had a history of ischaemic heart disease, although all had received left ventricular irradiation. Although cardiotoxicity is a rare complication of fluorouracil treatment, it merits wider recognition.

Polyradiculoneuritis and Mycoplasma pneumoniae infection

A patient with severe Mycoplasma pneumonia developed polyradiculoneuritis and respiratory failure. The acute phase of the illness was complicated by a myocarditis, and recovery of neurological function was slow. Residual left hemidiaphragmatic paralysis was present 1 year after onset of the illness.

The relationship of defective cell-mediated immunity to visceral disease in systemic sclerosis

Phytohaemagglutinin-induced lymphocyte transformation and circulating thymus-dependent (T) lymphocyte numbers were studied in twenty-eight patients with systemic sclerosis (SS), in fifty normal controls and eleven elderly controls. Patients with SS were found to have impaired lymphocyte transformation responses which showed a positive correlation with both the number of circulating T lymphocytes and the extent of visceral involvement by the disease. This defect of cell-mediated immunity could not be attributed to the effects of increasing age, corticosteroid treatment, iron and folate deficiency or inhibitory serum factors and may have pathogenetic implications for the disorder.

Pneumothorax and hydrothorax after subclavian vein cannulation

A patient is described who developed a right pneumothorax and a left hydrothorax following percutaneous subclavian vein cannulation. The prevention, diagnosis and treatment of this complication are discussed.

Syphilitic ostial occlusion

A patient presenting the picture of congestive cardiomyopathy was found to have syphilitic obliteration of the left coronary artery. Aortic regurgitation, angina, and myocardial infarction were notably absent.

Haemothorax after subclavian vein cannulation

A patient in whom pulmonary arterial bleeding occurred during percutaneous supraclavicular puncture of the subclavian vein is described. A retrospective survey of over 600 subclavian venepunctures disclosed seven patients in whom serious traumatic complications occurred, six of them in the hands of inexperienced operators.

Severe mycoplasma pneumonia

A patient who developed who developed a protracted illness following severe mycoplasma pneumonia is described. The acute phase of the infection was complicated by myocarditis and haemolytic anaemia. The respiratory symptoms abated and lung function tests improved with the administration of systemic and inhaled corticosteroids.

Cytomegalovirus-induced haemolytic anaemia after cardiac surgery

A patient, who underwent aortic valve replacement, developed a transient, autoimmune haemolytic anaemia in association with a significant rise in titre of antibodies against cytomegalovirus. A serological survey of blood donors indicated that the source of infection was fresh blood transfused during and shortly after surgery. A number of cases of short-lived haemolytic anaemia after large volume blood transfusion with cardiac surgery may be explained by this mechanism. It may be preferable to use only blood that has been screened for evidence of recent cytomegalovirus infection if post-perfusion complications of this disease are to be avoided.

Thymus-dependent (T) lymphocyte deficiency in progressive systemic sclerosis

Circulating thymus-dependent (T) lymphocytes were estimated in twenty-seven patients with progressive systemic sclerosis (PSS) and in forty-five normal controls using the property of T lymphocytes to form rosettes with sheep red blood cells. The patients with PSS were found to have a reduction of T lymphocytes which correlated with the extent of visceral involvement by the disease, those with the lowest counts having the most extensive disease. These findings support the suggestion that immunological factors may be involved in the pathogenesis of PSS.

Diffuse myelitis associated with rubella vaccination

Two patients who had received live rubella vaccine developed diffuse myelitis shortly afterwards. Neither patient fully recovered her motor function. In one patients the time between vaccination and development of neurological signs was rather too short to indicate definitely a causal relation. Nevertheless, the chronological association is suggestive, and other observations of such an association may strengthen the suspicion that rubella vaccination may occasionally cause severe neurological damage.