Uncontrollable life-threatening status asthmaticus--an indicator for termination of pregnancy by cesarean section

Two pregnant women with severe status asthmaticus unresponsive to intensive medical treatment are reported. Termination of pregnancies by cesarean section was followed by a dramatic improvement within 24 h. Termination of pregnancy is indicated in life-threatening status asthmaticus.

Familial cryoglobulinemia and C4 deficiency

The coexistence of cryoglobulinemia and C4 deficiency was found in one family. Twelve subjects were examined, most of them being asymptomatic. Cryoglobulins were found in 9 members and its type was defined in 6 of them, 3 having mixed IgM-IgG and 3 having monoclonal IgM cryoglobulins. The concentration of the third component of the complement system was normal in 10 subjects, while the concentration of the fourth one was found to be below the lower limit of normal in 9 subjects. Only C4 deficiency--and not cryoglobulinemia--was HLA-linked. There was no evidence of HBs antigenemia. The results of this study are discussed in the light of the pertinent literature.

Adenine arabinoside in severe thrombocytopenia due to hemorrhagic varicella

An 18-year-old man, admitted because of severe bleeding manifestations due to varicella thrombocytopenia was administered 800 mg/day adenine arabinoside (Ara-A) intravenously for 5 days. 2 days after the start of this treatment the bleeding phenomena became markedly reduced and a progressive increase in the platelet count was noted thereafter. Although a spontaneous improvement is known to occur in patients with varicella thrombocytopenia, the rapid clinical improvement after the Ara-A administration is suggestive for its beneficial effect in the presented patient.

Systemic lupus erythematosus and lymphoma. A family study

After 3 years of treatment with azathioprine and prednisone, immunoblastic lymphoma appeared in a patient with systemic lupus erythematosus. An increased incidence of immunological aberrations and malignancies was found in her family and their relation to the pathogenesis of this patient's diseases is discussed.

Systemic lupus erythematosus - a state of hyperinterferonemia?

On the basis of immunologic and microbiologic data as well as recent observations it is postulated that interferon is responsible for many of the clinical signs and symptoms in systemic lupus erythematosus such as alopecia, joint manifestations, fever and leukopenia. Recognition of the important role of interferon in active systemic lupus erythematosus leads to some practical conclusions: a) a new therapeutic approach to active lupus must consider a treatment which will lead to reduced interferon activity; b) one of the laboratory parameters of activity of the disease may be interferon measurements.

Generalised pustular psoriasis, psoriatic arthritis and nephrotic syndrome associated with systemic amyloidosis

The case report is presented of a psoriatic patient with arthropathy, generalised pustular psoriasis and nephrotic syndrome, in whom systemic amyloidosis developed. The literature reports 13 cases of psoriasis associated with amyloidosis, 3 of whom suffered from pustular psoriasis as does our case. With the addition of our case, 12 of these 14 had concomitant arthropathy. This seems to suggest that arthritis is an important factor in the appearance of amyloidosis. Rectal biopsy and/or renal biopsy may be helpful in establishing the diagnosis of amyloidosis relatively early in patients with psoriatic arthritis.

Relapsing polychondritis associated with mixed cryoglobulinemia

The case of a patient with mixed-type cryoglobulinemia and cutaneous necrotizing vasculitis, who later suffered from relapsing polychondritis affecting the auricle and the nose, is described. To the best of our knowledge, this combination is unique.

Hypothesis: antagonism to interferon as a possible cause of the deleterious effects of corticosteroids in HBsAg-positive chronic active hepatitis

Corticosteroids hasten relapse and shorten survival of patients with HBsAg positive chronic active hepatitis. A hypothesis is advanced suggesting that the steroid hormones, acting as interferon antagonists, may compromise the establishment of a cellular anti-viral state. under such circumstances the hepatitis virus replicates undisturbed, is propagated from cell to cell and precipitates terminal liver failure at a faster rate. The hypothesis provides a theoretical basis for condemning the administration of corticosteroids to patients with HBsAg positive chronic active hepatitis.

Small skin blood vessel occlusions by cryoglobulin aggregates in ulcerative lesions in IgM-IgG cryoglobulinemia

The skin biopsy specimens from six patients with primary mixed IgM-IgG cryoglobulinemia were examined by immunofluorescence, light and electron microscopy. The biopsy taken from the involved skin of one patient with leg ulcers revealed small blood vessel occlusions by cryoglobulin aggregates. Since a similar finding was not observed in the biopsy material taken from the other five patients who had no ulcerative skin lesions, it seems that the cryoglobulin aggregates play a role in the development of the skin ulcerations in primary mixed IgM-IgG cryoglobulinemia.

Synovial fluid examination in hyperuricemic psoriatic patients

Aspiration of the first metatarsophalangeal joint in asymptomatic hyperuticemic psoriasis was performed in order to see whether there are specific findings which could help to predict who is prone to develop gout and to find out whether a distinction can be established between psoriasis and gouty arthritis. Since crystals were not found, it seems that the aspiration of the first metatarsophalangeal joint is not likely to yield monosodium urate crystals and is not contribute to the differential diagnosis.

Comparative tissue absorption of oral 14C-aspirin and topical triethanolamine 14C-salicylate in human and canine knee joints

The local, articular, and systemic absorption of oral and topical salicylates was studied in dogs and humans using radioisotope techniques. Topical triethanolamine 14C-salicylate was found capable of percutaneous absorption into the knee joint and surrounding tissues. In dogs, topical salicylate application resulted in higher salicylate concentrations than oral aspirin in a number of tissues, despite lower blood levels. In patients with rheumatoid arthritis, intraarticular 14C-salicylate levels after triethanolamine 14C-salicylate cream were 60 per cent of those obtained with oral aspirin. Four of six patients reported equal improvement in local discomfort after oral and topical salicylates. A potential role for topical salicylate cream in the treatment of localized rheumatic disorders is suggested.

Morphological platelet anomalies in thrombotic thrombocytopenic purpura

A patient with thrombotic thrombocytopenic purpura was treated with 8 U of fresh frozen plasma, resulting in a rapid improvement in her condition and subsequently followed by a prolonged clinical remission. The transmission and scanning electron microscopic examinations of the platelets performed before treatment demonstrated marked anomalies of the platelet morphology, namely, an increased number of abnormally elongated pseudopods with terminal knobs, a decreased number of platelet granules and excess of glycogen and marked anisocytosis. These anomalies remained unchanged when reexamined 2 months after the achievement of the clinical remission. The question whether these platelet abnormalities are an integral part of thrombotic thrombocytopenic purpura and play a role in its pathogenesis, is raised.

Arthritis in acute leukemia. Clinical and histopathological observations

Eight patients had acute leukemia and arthritis. In five the arthritis had no evident cause other than the leukemia, and three had crystal-induced arthritis. Effusions from both groups of patients were often inflammatory. The average synovial fluid leukocyte count from the five effusions attributed to leukemia was 8,790/cu mm. A synovial needle biopsy specimen from one of these patients showed acute and chronic inflammation but no leukemic infiltration. Bone involvement was suggested by bone pain in only one patient. In no case did arthritis persist in the presence of a hematologic remission. In the three patients with crystal-induced arthritis, the average synovial fluid leukocyte count was 13,000/cu mm. There were crystals of monosodium urate in one and of calcium pyrophosphate dihydrate in two patients. Suspected blast forms were seen in the synovial fluid of only one patient, one of those with pseudogout. Electron microscopic studies of needle biopsy specimens of synovial membrane from leukemic patients with arthritis described herein for the first time showed no blast forms, virus-like particles, or electron-dense deposits in vessel walls to suggest specific mechanisms for the arthritis.

Experimental joint trauma: synovial response to blunt trauma and inflammatory reaction to intraarticular injection of fat

Blunt trauma to knee joints of dogs produces clear usually non-bloody synovial effusions with prominent fat globules. Increased vascular permeability of synovial membrane in areas not directly traumatized can be shown by leakage of intravenously-injected carbon black. To see whether fat released from synovium into the joint might contribute to a low grade inflammation and altered vascular permeability we also injected intraarticular autologous fat and demonstrated its phagocytosis by exudate cells and induction of definite inflammation. These effects of trauma in dogs which closely resemble some human injuries might be a model for evaluating conservative treatment of joint trauma.

Familial systemic lupus erythematosus and C4 deficiency

A heterozygous state for C4 deficiency was found in 14 members of a family with familial SLE. The HLA analysis in this family permitted us to re-establish the linkage assumed to exist between the gene (or genes) controlling the synthesis of the fourth component of the complement and the major histocompatibility complex. In addition, it was found that the complement deficiency is not necessarily associated with any serological or clinical abnormality. The heterozygous state for C4 deficiency can be added to the various serological abnormalities described in asymptomatic members of families with familial SLE. It is as yet unknown whether this deficiency may predispose to the subsequent development of SLE.

A hypothesis on the possible role of interferon in the initiation of acute gouty arthritis attack

There is some evidence that unidentified factors might play a role in the initial events of acute gouty arthritis. Serum interferon activity was found to be high in several arthritides; interferon stimulates the production of prostaglandin E, an established mediator of inflammation. It is postulated that interferon can play a role in the pathogenesis of an acute gouty arthritis.

Absence of interferon activity during acute attacks of familial Mediterranean fever

The pharmacokinetics of interferon, the symptoms caused by its administration, the decreased prevalence of viral diseases in FMF patients and the fact that colchicine, the drug of choice in the prevention of FMF attacks is an interferon antagonist, raised the question whether interferon may have a role in the pathogenesis of FMF attacks. An interferon activity was not detected in sera obtained at the height of FMF attacks in 8 patients, six of them under colchicine treatment. It is possible that the interferon activity has to be searched at the very beginning of FMF attacks, since at their height it already disappeared from the serum, while the symptoms of the attack are further mediated by other interferon-induced lymphokines.

Diagonal ear lobe crease and coronary risk factors

The prevalence of ear lobe crease (ELC) was determined in 421 patients with myocardial infarction (MI) and in 421 controls. A higher prevalence (p less than 0.05) of ELC was found in MI patients (77 percent) in comparison to controls (40 percent), regardless of age. In addition, a higher prevalence was found in patients in whom MI was combined with diabetic retinopathy or hypertension, and in Ashkenazi Jews compared to non-Ashkenazi Jews. Ear lobe biopsies in 12 subjects revealed tears of the elastic fibers in all subjects with ELC, and prearteriole wall thickening in subjects with MI and/or ELC, but not in the 2 subjects with neither MI nor ELC. The early appearance of ELC may imply the existence of coronary heart disease with or without coronary risk factors.

Diffuse melanosis secondary to disseminated malignant melanoma

A patient with melanosis and melanuria in whom disseminated malignant melanoma was found is described herein. The primary malignant process was not detected in the skin. Light and electron microscopic examinations, as well as cytochemical studies, revealed numerous melanin-containing macrophages in the skin.

Life-threatening hypophosphatemia in a patient with acute myelogenous leukemia

A patient with acute myelogenous leukemia developed severe hypophosphatemia manifesting by extreme weakness, confusion, loss of sphincter control, nuchal rigidity, hyperesthesia, hemolysis, congestive heart failure and liver dysfunction. The possible causes for this condition were starvation, parenteral glucose and saline administration, sepsis, hypokalemia and treatment with acetazolamide. A dramatic improvement was noted following phosphate administration.

Extensive soft tissue calcification (calcinosis universalis) in systemic lupus erythematosus

A 21-year-old woman with long-standing systemic lupus erythematosus developed extensive calcification of the soft tissues of the thoracic and abdominal walls and extremities early in her illness, and these calcifications gradually disappeared over the course of her disease. The extent of this calcinosis and apparent spontaneous regression are unusual events in systemic lupus erythematosus.