bluuebunny/crossref_metadata_2025 huggingface dataset:
Non‐Neural Granular Cell Tumour: A Clinicopathological Review of 11 Cases
Authors: Chaudhry I.H. , Calonje E.
Published: August 2010

Cutaneous granular cell tumour is a well‐characterised benign neoplasm of Schwann cell origin. However, there remains a sub‐category of neoplasms that appears non‐neural in origin and thus requires further appraisal. We present on 11 clinicopathological cases of non‐neural granular cell tumour, highlighting the histological patterns, immuno‐profile, clinical features and behaviour. The results showed that lesions most commonly occurred in young to middle aged adults (9 cases, median = 33 years, age range: 6–56 years), with a slight female predominance. The lesions presented as painless nodules, mainly on the extremities or face. Local excision was the treatment of choice and up to date follow‐up reveals no local recurrence or metastasis. Histologically, the lesions were polypoid (8 cases) or intra‐dermal (3 cases), and composed of elongated spindle‐shaped to polygonal cells with prominent granular cell change and focal, variable nuclear atypia. Low level of mitotic activity was noted. Immunohistochemical labelling of the tumour cells showed expression for NKI‐C3 (n.11) and CD68, with no staining for S100 protein, SMA, desmin and cytokeratin. In conclusion, this analysis of 11 clinicopathological cases will contribute to the characterisation of this recently described entity, which despite some atypical histological features appears to behave in a completely indolent fashion.
Antithyroid Autoantibody‐Associated Dermatitis in Individuals with Undifferentiated Connective Tissue Disease – An Unrecognized Subset of Autoimmune Disease?
Authors: Cheng W. , Gilliam A. , Pazirandeh M.
Published: August 2010

Skin conditions in individuals with undifferentiated connective tissue disease (UCTD) are poorly classified and characterised. We reviewed 892 consecutive cases of individuals who had a workup for UCTD. ATAbs were positive in 526(59%). The ATAb(+) and ATAb(−) groups had similar antinuclear antibody (ANA) positivity (32% versus 28% respectively), average age (59 versus 58), and female‐male ratio (8:1 versus 6:1). ATAb positivity was significantly associated with a dermatitis, manifested as erythematous macules/patches or papules on legs, shoulders or upper backs, in 9%(47/526) individuals versus 2%(7/366) in ATAb(−) individuals (Pearson’s chi‐square = 18.7, p < 0.0001). Sixteen individuals with dermatitis had biopsies, 14 ATAb(+) and 2 ATAb(−). Routine hematoxylin‐eosin and colloidal iron‐stained sections were examined. Eleven biopsies (79%) from ATAb(+) individuals (5 ANA‐negative, 5 with thyroid disease) and one from ATAb(−) ANA(−) individuals showed interface/lichenoid dermatitis with mild basal keratinocyte vaculopathy, variable dermal mucin deposition, and perivascular mononuclear inflammatory cell infiltrates in the upper dermis. The interface dermatitis was not significantly associated with ANA positivity or thyroid disease. In summary, we report an ATAb‐associated interface dermatitis in UCTD patients which may represent a new subset of autoimmune disease, and suggest that ATAb tests may be a useful marker for UCTD.
CD34+ Pigmented Fibrous Proliferations: The Morphologic Overlap Between Pigmented Dermatofibromas and Bednar Tumors
Authors: Chu McAllister J. , Sundram U.
Published: August 2010

Pigmented dermatofibrosarcoma protuberans (Bednar tumor) constitute 5–10% of all cases of dermatofibrosarcoma protuberans, and are usually considered mimics of melanocytic proliferations rather than fibrous lesions. We report two cases of pigmented fibrous proliferations that demonstrate features of both dermatofibromas and DFSP. The first case is a 19‐year‐old man with a three year history of a slowly growing pigmented lesion on the right arm. On clinical exam the lesion was a 7 mm firm pigmented papulonodular lesion. The second case is a 31‐year‐old woman with a 4–5 year history of a slowly enlarging, asymptomatic ‘dark area’ on the right buttock. On clinical exam the lesion is a 2 cm darkly pigmented flat nodule. Morphologically both lesions are primarily dermal proliferations of spindled cells admixed with pigmented dendritic melanocytes. The lesional cells trap collagen fibers at the periphery and there is basal cell hyperpigmentation. Adnexal structures are effaced but significant trapping of subcutaneous fat is not present. By immunohistochemistry both lesions show focal CD34 positivity but are negative for Factor XIIIa and melanocytic markers. Although overlap between dermatofibromas and DFSP is well documented in the literature, pigmented fibrous lesions with features of both entities are not well described.
Melanoma in Situ with Epidermal Effacement: A Compelling Adjunctive Finding
Authors: Dy L , Buckel L , Hurwitz R
Published: August 2010

Since many studies have shown the discordant diagnoses of melanocytic lesions among pathologists despite the existence of an established histologic criteria, we sought to refine the histologic criteria by finding an additional reliable and reproducible objective histopathologic feature, to aid in the diagnosis of melanoma in situ. We performed a retrospective analysis of 100 cases, histologically diagnosed as melanoma in situ and compared to a study control group consisting of junctional benign melanocytic nevi. The epidermis of all the melanocytic lesions were examined for epidermal effacement. Examination of the epidermis in the study group revealed absence of epidermal effacement in only seven (10%) cases, whereas ninety‐three (93%) cases showed absence of rete ridges in some foci, making this an overwhelming majority finding in the cases examined. These results serve as a compelling adjunctive finding that can be used to increase the histologic diagnostic accuracy of melanoma in situ.
Cutaneous Rosai Dorfman Disease
Authors: Higgins R. , Losi‐Sasaki J. , Kinney M.
Published: August 2010

A 61‐year‐old female presented with blurry vision. Questioning revealed “Flu‐like” symptoms preceding the blurry vision by two weeks. An ophthalmologist diagnosed anterior granulomatous dermatitis, which improved with prednisolone drops. One month later, an “itchy rash” and constitutional symptoms including fever, night sweats, and weight loss were reported. Physical examination revealed a viral‐type maculopapular eruption over the trunk and proximal extremities. A few weeks later, repeat examination showed progression to a diffuse, reddish‐brown, slightly edematous, papular eruption. Lymphadenopathy was not present. Laboratory data revealed a normochromic normocytic anemia, a polyclonal gammopathy, and an elevated ESR. Punch biopsies on two occasions showed a proliferation of mononucleated and multinucleated histiocytic cells with abundant pink cytoplasm. Emperipolesis was easily demonstrated. A background of plasma cells and small lymphocytes were noted. Stains for organisms were negative, and polarizable material was not present. By immunohistochemistry, histiocytes marked with S‐100 but were negative for CD1a. A diagnosis of cutaneous Rosai Dorfman was made. The cutaneous symptoms improved over six months without medical therapy. Cutaneous Rosai Dorfman disease with constitutional symptoms and laboratory evidence of systemic involvement but without lymphadenopathy has not been previously described. This unusual case suggests that a wider spectrum of disease presentation may exist.
A Case of Pseudorheumatoid Nodule Arising in a Previous Site of Squamous Cell Carcinoma.
Authors: Iwenofu O.H. , Adelson D. , Crowson A.N.
Published: August 2010

The pseudorheumatoid nodule (PRN) is a subcutaneous palisading granuloma characterized by a pattern of interstitial histiocytes surrounding an area of collagen necrobiosis and typically unassociated with rheumatoid arthritis. It is part of the spectrum of palisading granulomatous dermatitidis which includes the rheumatoid nodule, the rheumatic fever nodule, the spirochaete‐associated juxtarticular nodes of Lyme disease, granuloma annulare, necrobiosis lipoidica and the palisading granuloma of Churg and Strauss. PRN has previously been associated with surgical trauma and with retained suture material at old surgical sites. We present a case of PRN arising in a previous biopsy site of squamous cell carcinoma (SCC). A 48‐year‐old woman with no history of rheumatoid arthritis or a granulomatous diathesis underwent biopsy of a keratotic left forearm skin lesion on 10/14/03 that showed invasive SCC. She had a re‐excision of the the same site on 11/22/03 that grossly showed a central scar. Histology revealed a scar at the site of a recent biopsy with no residual SCC, in the base of which was an area of necrosis palisaded by histiocytes. No residual suture or other polarizable foreign material was identified. Pancytokeratin and Epithelial Membrane Antigen immunostains were negative. The morphology is considered prototypic for PRN.
CD1A Rich Inflammatory Stage of Lichen Sclerosus Et Atrophicans Mimicking Mycosis Fungoides and Extramammary Paget’S Disease
Authors: Luo F. , Ko C. , Binder S.
Published: August 2010

We report a case of inflammatory stage vulvar lichen sclerosus et atrophicans (LSA) with histopathologic features simulating both patch stage mycosis fungoides (MF) and extramammary Paget’s disease. The patient is a 79‐year‐old woman with an erythematous plaque on her vulva. A punch biopsy was performed that revealed mild psoriasiform hyperplasia of the epidermis with spongiosis, marked interface vacuolar alteration, scattered individual necrotic keratinocytes and Civatte bodies. A band‐like mixed inflammatory infiltrate was present in the papillary/upper dermis with prominent intraepidermal lymphocytes. Some intraepidermal lymphocytes showed atypical nuclear contours simulating the cells seen in MF. The presence of numerous intraepidermal epithelioid cells with a pagetoid distribution raised the possibility of extramammary Paget’s disease. A panel of immunohistochemical (IHC) stains showed a reactive lichenoid mixed population of lymphocytes with numerous intraepidermal Langerhans cells. This confirmed the diagnosis of the inflammatory stage of lichen sclerosus. The presence of prominent epithelioid Langerhans cells with activated small lymphocytes represents an immune response in LSA and could cause diagnostic confusion with neoplastic conditions. IHC staining can confirm cell type and rule out MF and extramammary Paget’s disease.
Histologic Features of Melanocytic Nevi in Older Patients
Authors: Martinka M
Published: August 2010

The histology of melanocytic nevi in elderly patients often differs from nevi in younger adults. Our hypothesis was that nevi in patients3 60 yrs would demonstrate histologic patterns different from nevi in younger adults. Biopsies of nevi (n = 214) from 172 patients3 60 yrs (mean age 69 ± 7 yrs) were examined by three dermatopathologists and a consensus diagnosis was rendered. Control specimens (n = 82) from 58 patients 20–40 yrs (mean age 31 ± 5 yrs) were evaluated. Compound melanocytic nevi were commoner in younger patients (37%) versus older patients (12%)(p < .0001). Junctional melanocytic nevi were more frequently diagnosed in older patients (10% versus 3%; p = .027) and a lentiginous, often heavily pigmented, growth pattern was common (12% of nevi) vs control group (3%; p = .028). Atypical (“dysplastic”) nevi had a similar frequency at all ages, however 12/214 nevi in elderly patients (6%) exhibited marked atypia with features suggesting melanoma in‐situ. We conclude that benign junctional nevi are relatively common in elderly patients and that a lentiginous, heavily pigmented growth pattern, typically associated with younger patients, is often seen in both junctional and compound nevi in this older age group. This pattern must be differentiated from dysplastic nevus and melanoma in‐situ, which they may clinically resemble.
Granulomatous Lymphangiitis (Melkersson‐Rosenthal Type)
Authors: Petronic‐Rosic V. , Sattar H. , White L. , Laumann A. , Krausz T. , Shea C.R.
Published: August 2010

A 33‐year‐old Caucasian female presented with a ten‐year history of flushing and facial swelling partially responsive to anti‐inflammatory and anti‐microbial therapies. Progressive edema of the right upper eyelid was recently treated by blepharoplasty. The blepharoplasty specimen had a dense mononuclear inflammatory infiltrate and diffuse non‐caseating granulomas composed of epithelioid and multinucleated histiocytes. The granulomas appeared both peri‐and intralymphatic with prominent molding. Special stains and polarization studies were negative. To confirm the intralymphatic location of these granulomas we performed immunohistochemical staining with Factor VIII and D2–40. D2–40 is a new monoclonal antibody that reacts with an O‐linked sialoglycoprotein found on lymphatic endothelium, fetal testis, and on the surface of testicular germ cell tumors. In recent studies, clone D2–40 has shown staining in lymphatic channel endothelium but not in adjacent capillary. Factor VIII antibody highlighted both lymphatic and blood vessel endothelium, while D2–40 stained only the lymphatic endothelium and confirmed the intra‐lymphatic location of granulomas. The patient was diagnosed with granulomatous lymphangiitis of the Melkersson‐Rosenthal type (orofacial granulomatosis). Granulomatous lymphangiitis is characteristic but not completely diagnostic of the Melkersson‐Rosenthal syndrome. We present the complex differential diagnosis of intralymphatic granulomas and the use of a new monoclonal antibody helpful in verifying their location.
The Pathology of Adulterated Injected Cosmetic Filler Materials
Authors: Pulitzer M. , Tan J. , Levitt J. , Phelps R.
Published: August 2010

We report five cases of illicit injections of filler‐substances for cosmetic purposes in non‐medical clinics. The first two patients, a mother and 30‐year‐old daughter, presented with skin lesions in both legs after calf‐augmentation by paraffin injection 4 years prior. One week later calf hyperpigmentation and induration developed, with progression up the legs, and eventual purulent draining ulceration (daughter). The third patient, a 34‐year‐old female, presented with pink‐brown macules on both buttocks after receiving silicone injections 9 months earlier. The fourth patient, a 31‐year‐old female, developed skin lesions on the buttocks after silicone injections. The fifth patient, a 43‐year‐old female, developed sclerodermoid plaques on the buttocks after silicone injection. The first two biopsies showed large spaces in tissue, calcinosis cutis, dermal sclerosis, granulation tissue, and lymphedema. The third biopsy revealed foreign body reaction to non‐polarizing material, the fourth lipogranulomatous reaction, and the fifth microvacuolar change with scar. Biopsies post‐injection of cosmetic filler materials typically show macrovacuolar “swiss cheese” changes, and later microvacuolar changes with considerable granulomatous reaction. The reactions here were clinically severe, and may reflect adulteration of injected materials. We believe these cases augur a public health epidemic given a proliferation of non‐medical cosmetic “mills” which offer illicit cosmetic procedures.
Lamisil Induced Dermatomyositis
Authors: Seilstad K , Hearne D , Gupta K , Magro C
Published: August 2010

Background: Dermatomyositis, a connective tissue disease syndrome where antibodies to the endothelium of the microvasculature of the skin, muscle and lung are implicated in lesional propagation, is characterized by photodistributed erythema, heliotrope rash, Gottron’s papules, muscle weakness and interstitial pulmonary fibrosis. Endotheliotropic viruses and underlying neoplasia are among the inciting triggers. Uncommonly drugs, namely the lipid lowering agents, have been implicated in dermatomyositis. Case Report: The patient, a 57‐year‐old male, developed a photodistributed rash and muscle weakness following treatment with the antifungal medication Lamisil. A skin biopsy was performed, showing an atrophying interface dermatitis with pandermal mucinosis and striking vasculopathic changes including endothelial cell necrosis with denudement and basement membrane zone reduplication. Direct immunofluorescent testing showed prominent staining of C5b‐9 along the dermal‐ epidermal junction and within the vasculature. Conclusion: We have shown a temporal association between use of Lamisil and the development of dermatomyositis. Terbinafine, the active agent in Lamisil, promotes apoptosis of human endothelial cells in culture. Enhanced endothelial cell apoptosis results in the displacement of various cellular antigens creating a state of neo‐antigenicity; its attendant sequelae has held to be one of antiendothelial cell antibody formation, a defining pathogenetic event in the evolution of dermatomyositis.
Non‐Necrotizing Granulomatous Dermatitis in an Infant: Infantile Sarcoidosis or Initial Manifestation of Blau Syndrome?
Authors: Chandra Pranil , Schaffer Julie , Heller Patricia
Published: August 2010

A 14‐month‐old, otherwise healthy boy presented with a six‐month history of an asymptomatic eruption that began on the face and progressively involved most of the cutaneous surface. The patient’s father and paternal grandfather both had a history of chronic uveitis that began during adolescence. Physical examination revealed numerous 1‐ to 2‐mm, red‐brown, flat‐topped papules on the trunk, extremities, and face. The serum ACE level was elevated. Other pertinent laboratory tests and a CXR were normal. The tuberculin skin test was negative. There were no signs of arthritis or uveitis. A punch biopsy revealed a perifollicular, perieccrine, superficial, and deep perivascular non‐necrotizing granulomatous infiltrate, admixed with a few neutrophils. No polarizable material was present. AFB, Fite, and Grocott stains were negative for organisms. A clinico‐pathologic diagnosis of sarcoidosis was initially rendered. Given the family history, a diagnosis of Blau syndrome, a rare autosomal dominant disorder caused by mutations in the CARD15 gene and characterized by arthritis, uveitis, and a non‐caseating granulomatous dermatitis, is explored. Blau syndrome has substantial overlap with early‐onset sarcoidosis and is thought to represent the familial form of the disease. Analysis of the CARD15 gene is in progress for the patient and his family.
Granular Cell Variant of Dermatofibrosarcoma Protuberans (DFSP)
Authors: Saadat P. , Vadmal M.
Published: August 2010

To date, there are three reported cases of granular cell variant of DFSP. We describe the fourth case in a 21‐year‐old female who presented with an eight months history of a growing, irregular, firm, 2.5 × 2.0 × 1.5 cm nodule on the right cheek. Biopsy revealed a spindle cell neoplasm involving the deep dermis and subcutis exhibiting the characteristic storiform arrangement. The spindle cells had thin, elongated, hyperchromatic nuclei and a moderate amount of cytoplasm. The superficial dermis revealed larger polygonal cells with central oval nuclei and abundant cytoplasm intermingled with the spindle cells. The distinct feature in both cell types was the presence of a characteristic pink granular cytoplasm. The cells exhibited minimal cytological atypia with rare mitotic figures. Immunohistochemically, both cell types demonstrated a positive immunoreaction for vimentin and CD68, the spindle cells stained positively with muscle actins, and dermal dendrocytes stained with Factor XIIIa. The tumor was negative for cytokeratins, S‐100, HMB‐45, desmin, NSE, and CD34. PAS failed to stain the cytoplasmic granules. Ultrastructurally, abundant cytoplasmic organelles composed of pleomorphic secondary lysosomal structures and lipid droplets were noted. The histological, immunohistochemical and ultrastructural features of this tumor are compatible with previously reported cases of granular variant of DFSP.
II. General remarks
Authors: Krogh August
Published: August 2010

“The problems of physiology are so complicated that, to put it tersely, one cannot expect to be able to reason correctly from the facts for more than five minutes at a stretch.”
THE EFFECT OF EXERCISE ON THE SIZE OF THE SHUNT IN PATIENTS WITH ATRIAL SEPTAL DEFECTS
Authors: Nielsen J. Straede , Fabricius J.
Published: August 2010

Abstract The pulmonary and systemic flow was measured at rest and during exercise in 13 patients with atrial septal defects, of whom 12 had a normal pulmonary arterial pressure. The pulmonary flow ratio decreased in all the patients and the decrease was clearly dependent upon the value at rest. The pulmonary blood flow increased during exercise. This increase was greatest in the patients with a small blood flow in the pulmonary artery and smallest in those with the largest pulmonary blood flow at rest. The shunt decreased correspondingly inasmuch as the systemic blood flow was normal both at rest and during exercise. All the changes tend to produce a normalization of the haemodynamic conditions during exercise in patients with uncomplicated atrial septal defects and explain why the working capacity of these patients is independent of the magnitude of the shunt at rest.
PLASMA‐HYDROCORTISONE VALUES IN HEART DISEASE
Authors: Hansen Bent , Beck‐Nielsen Jørgen , Juul Jørgen , Nielsen Bent Lyager , Nielsen Flemming Ultang
Published: August 2010

Abstract The plasma‐hydrocortisone level has been examined in ten patients with acute coronary occlusion and shock, in 12 patients with acute coronary occlusion without shock, in seven patients with congestive heart failure and in five control patients. Owing to the cir‐cadian rhythm of the plasma‐hydrocortisone level, the examinations have been carried out in five daily determinations on three consecutive days. As compared with the control patients, the average values were found to be significantly higher in patients with congestive heart failure and even higher in the patients with coronary occlusion with and without shock. No correlation was found between the plasma‐hydrocortisone concentration and the enzymes SGOT and SLDH, the morning temperature or the blood pressure in the patients with acute myocardial infarction. The plasma‐hydrocortisone level in the patients with coronary occlusion returned to the normal range within 48 hours after admission. The highest values were found in the patients who died, and the increased level was maintained until the last determinations before death.
RENAL TRANSPLANTATION AND MURAMIDASE ACTIVITY
Authors: Hansen Niels Ebbe , Weeke Eva
Published: August 2010

Abstract. Plasma and urinary muramidase activities have been measured in 26 patients with renal allogenic transplants. It was found that increased urinary muramidase rather accurately mirrored post‐transplantation events associated with tubular damage, i.e. rejection, tubular ischemia, and leakage from the ureter. An increase in urinary muramidase sometimes preceded clinical diagnosis. There was no correlation between urinary muramidase activity and such nephrological parameters as proteinuria and creatinine clearance, when creatinine clearance was not grossly impaired. It is suggested that measurements of urinary muramidase may be of value in the clinical management of patients with renal transplants.
INHIBITION OF NORADRENALINE‐INDUCED LIPOLYSIS IN HYPOTHYROID SUBJECTS BY INCREASED α‐ADRENERGIC RESPONSIVENESS
Authors: Rosenqvist Urban
Published: August 2010

Abstract The interaction between thyroid hormones and catecholamines has been studied in vitro in subcutaneous adipose tissue specimens from 18 hypothyroid patients and 13 healthy controls. The lipolytic effect of nor‐adrenaline was found to be totally quenched in tissue specimens from hypothyroid subjects, but was restored by the addition of an α‐adrenergic antagonist, phentolamine. Furthermore, stimulation of the α‐adrenergic receptor by noradrenaline in the presence of the β‐adrenergic antagonist, propranolol, significantly decreased basal as well as theophylline‐induced lipolysis in adipose tissue from both groups of subjects. The dibutyryl cyclic AMP induced lipolysis was, however, unaffected by such α‐adrenergic stimulation. These data suggest that the α‐adrenergic response leads to a decrease in the level and/or production of cyclic AMP in the adipocyte, the most probable mechanism being inhibition of the formation of the nucleotide rather than enhancement of its destruction. The mechanism by which α‐adrenergic stimulation decreases lipolysis was found to be identical in adipose tissue from normal and hypothyroid subjects. The difference in response to noradrenaline between the two groups reflects quantitative rather than qualitative changes that the hypothyroid state induces in the balance between the α‐ and β‐adrenergic receptors.
ATRIAL FIBRILLATION IN ACUTE MYOCARDIAL INFARCTION
Authors: Helmers C. , Lundman T. , Mogensen L. , Orinius E. , Sjögren A. , Wester P. O.
Published: August 2010

Abstract Atrial fibrillation (AF) observed during the first 24 hours in a coronary care unit (CCU) has been analysed in 450 consecutive patients with acute myocardial infarction. AF was seen in 15% of the patients and was found to be associated with a significantly raised hospital mortality, 38% against 18% for the remainder. Repeated episodes of AF were not associated with a raised mortality. The patients with AF were older, more often in left heart failure, and more commonly lacked diagnostic EGG findings of an acute infarction. Sinus rhythm was present at the time of discharge from the CCU, or prior to death in the CCU, in 67% of the patients with AF.
A POPULATION STUDY ON RENAL AND URINARY TRACT DISEASES
Authors: Alwall Nils , Lohi Aarne
Published: August 2010

Abstract. In a previous paper on a population study the prevalence of different degrees of pyuria in conventional urine samples and in clean‐voided midstream specimens was reported. Discussion of the data collected was postponed until this publication, which contains a study of urines obtained by percutaneous suprapubic puncture of the bladder and clean‐voided midstream specimens obtained at the same time. The present series comprises 155 persons in all, 23 of whom were men. 72 had significant bacteriuria in the two urines; 72 and 90% pyuria. For 83 persons with subsignificant bacteriuria or sterile urine the corresponding figures were 20 and 37%. Since the series comprised 76% women the sex factor cannot be estimated. Clean‐voided midstream specimens reduced the occurrence of pyuria by about two‐thirds in comparison to findings in conventional total voided samples. Percutaneous suprapubic aspiration of urine should be done particularly with the occurrence of pyuria without significant bacteriuria in clean‐voided midstream specimens; in our series only in half the cases could the diagnosis be verified through pyuria also in suprapubic urine. There was no correlation between subsignificant bacteriuria and pyuria in midstream specimens. If we confine ourselves to midstream specimens with significant bacteriuria, the agreement with corresponding findings in suprapubic urine was so good that they do not support general indications for aspiration of bladder urine under present conditions. A future paper will account for subjective symptoms and clinical findings in the 155 patients who make up the series presented in this paper dealing with methodological problems.
TREATMENT OF PROGRESSIVE SYSTEMIC SCLEROSIS WITH A SYNTHETIC WEAK ESTROGEN: CYCLOFENIL (SEXOVID®)
Authors: Herbai G.
Published: August 2010

Abstract. Some beneficial effects of a new diphenyl‐ethylene derivative, cyclofenil, on the course of progressive systemic sclerosis in a male patient are presented. The drug was given orally in a daily dose of 300–600 mg over one year. The progress of the disease has apparently ceased and considerable improvement in the physical condition of the affected skin was noticed. Increased joint mobility and regress of arthritic changes were recorded, and dynamic spirometry data suggest an improvement in ventilation. Apart from a slight and transient increase in serum transaminase levels no toxic side‐effects were observed. The drug which is a weak estrogen and has gonadotrophin‐in‐hibiting properties may possibly exert its effect by influencing the metabolism of collagen and proteoglycans.
INCREASE IN PLASMA α‐LIPOPROTEINS IN CHRONIC ALCOHOLICS AFTER ACUTE ABUSE
Authors: Johansson Bengt G. , Medhus Asbjörn
Published: August 2010

Abstract.The plasma α‐lipoprotein levels have been measured in chronic alcoholics admitted to an alcohol clinic. The α‐lipoprotein concentration was found to be increased in 60 of 69 patients after recent drinking bouts. The values were as a rule normalized within two weeks. The increase in α‐lipoproteins was not correlated with other plasma lipoprotein or lipid alterations, nor was any correlation found between high α‐lipoproteins and liver damage detected by analyses of bilirubin, SGOT, SGPT, GT, and bromsulphalein retention tests.
MORPHOLOGY, DIPEPTIDASES AND DISACCHARIDASES OF SMALL INTESTINAL MUCOSA IN CHRONIC RENAL FAILURE
Authors: Denneberg T. , Lindberg T. , Berg N. O. , Dahlqvist A.
Published: August 2010

Abstract. The function of the small intestine has been studied in 29 patients with chronic renal failure (CRF). Small intestinal biopsies were taken from 19 patients (11 haemodialysis (HD), 6 uraemic and 2 nephrotic syndrome patients) and studied histologically and en‐zymatically (disaccharidases and dipeptidases). In half of these patients morphological changes in the form of elongation of the crypts and invasion of plasma cells were found: 14 had decreased sucrase and maltase activities, 10 low glycyl‐L‐leucine and L‐alanyl‐L‐proline dipeptidase activities, only 2 had normal enzyme activities, 10 low glycyl‐L‐leucine and L‐alanyl‐L‐proline the uraemic patients. Pancreatic function, tested in 5 patients, was normal. Increased faecal fat excretion was found in 4 of 14, low serum folate in 8 of 20 (before dialysis), and a flat blood glucose curve was usually found in the peroral glucose tolerance test. All these findings signify that a disturbed function of the small intestine is not uncommon in patients with CRF. This may be of importance when interpreting symptoms from the gut, especially when a carbohydrate‐rich diet is given.
BONE MASS IN OBESE SUBJECTS
Authors: Dalén Nils , Hallberg Dag , Lamke Bertil
Published: August 2010

Abstract The inner and outer diameters of the cortex have been measured in 32 obese subjects in the middle of the second metacarpal bone and in the proximal part of radius. The results, which were compared with an age‐matched control group, showed that the obese subjects had, on an average, an 11% larger cortical area than the controls (p < 0.05). The increased cortical area was caused by the greater outer diameter of the measured bones. There were no significant differences in inner diameters between the groups. The inner diameters increased with age in the same way in both obese and control persons, indicating that the former are not protected against osteoporosis in the form of endosteal resorption.
Calcium, Phosphate and Albumin in Serum
Authors: Ljunghall Sverker , Hedstrand Hans , Hellsing Kristoffer , Wibell Lars
Published: August 2010

ABSTRACT Serum values for calcium, phosphate and albumin have been determined in a population study of 2 322 49–50‐year‐old men participating in a health examination survey. Calcium and albumin were significantly correlated (r=0.34) but adjustment for albumin only caused minor effects on the distribution of calcium. No inverse relationship was found between calcium and phosphate. Seasonal variations over the three years of the health survey could not be established for either calcium or phosphate, whereas there was a slight tendency for albumin to decline during summer. The prevalence of hyperparathyroidism (HPT) in this population of men up to the age of 50 was 0.3% and among those with recurrent renal stones 5.3%. All subjects with verified HPT had a history of recurrent renal stones. One man on thiazide treatment had a slight elevation of calcium which returned to normal after cessation of the drug. No other case of hypercalcemia besides those caused by HPT was found. Mean values and frequency distributions for calcium, phosphate and albumin were almost identical in renal stone formers and matched controls. Hence it seems likely that other factors than those which markedly affect serum levels of calcium and phosphate are of major importance in common renal stone formation.
Acute Effects of Barbiturates in Parkinson's Disease
Authors: Sturfelt Gunnar , Schelin Sonny
Published: August 2010

Parkinsonism has by tradition been treated with sedatives, e.g. barbiturates. The intention has then been to reduce the stress‐related component in extrapyramidal symptoms. On the basis of our own clinical observations we have proposed an effect of barbiturates that seems to be specific pharmacologically.

We have noticed that pentymal sodium has visibly improved the symptoms of morbus Parkinson (MP). Our first observation of this effect was made at the Psychiatric Department when narco‐analysing a patient with psychoneurosis also suffering from MP. We could reproduce the same effect in other patients with this disease without any signs of psychoneurosis. On the basis of this observation we have made a minor pilot study.

Pentymal sodium has been administered slowly i.v. in doses of 0.2‐0.3 g according to body weight. During the initial hypnotic phase a moderate reduction of the tremor seems to be correlated to the sedative effect. After 1–2 hours when the patients are less sedated, a reduction of tremor, brady‐kinesia and rigidity appears. The effect has usually lasted for 12–15 hours. The symptoms have been estimated according to Webster's score (4) before and after the administration.
A Case of Severe Compression of the Coeliac Artery
Authors: Edhag O. , Hogstedt C. , Kövamees A. , Werner B.
Published: August 2010

ABSTRACT A man, aged 42 years, presented as an emergency with a history of stabbing upper abdominal pain, nausea and diarrhoea of two weeks' duration. Apart from abnormal transaminase and alkaline phosphatase values, the routine clinical and laboratory examinations did not reveal any abnormality. As the abdominal pain increased in severity, particularly in association with eating, and projectile vomiting supervened, aortography was carried out and showed severe stenosis of the coeliac axis, involving about 1 cm of the artery. At operation a thick fibrous band, which originated from the median arcuate diaphragm, was seen to constrict the point of origin of the artery and to compress the vessel against the aorta. The band was divided, whereupon the coeliac artery immediately showed strong pulsations and adequate filling. Microscopic examination of the fibrous band revealed, among other structures, those characteristic of a ganglion. The symptoms disappeared after operation.
Intermediate Alpha1‐Antitrypsin Deficiency, Pi M‐
Authors: Larsson Christer
Published: August 2010

ABSTRACT. A 50‐year‐old man was found to have 40% of the normal serum α1‐antitrypsin concentration but subsequent electrofocusing showed a pattern indistinguishable from the ordinary M pattern. This finding and family studies suggested that he was a carrier of a null (‐) allele. Heavy smoking and this Pi M‐ phenotype in interaction probably were responsible for the development of emphysema, documented by an extensive investigation of lung function. Two non‐smoking offspring carrying the null allele had normal lung function. Normal karyotypes were found in all the Pi M‐ subjects.
Zinc Balance before and during Treatment with Bendroflumethiazide
Authors: Wester P. O.
Published: August 2010

ABSTRACT. The present study gives full balance data for zinc in two healthy individuals before and during treatment with chlorthalidone. Positive zinc balances were noted in both subjects without therapy. During chlorthalidone treatment the balances changed in a negative direction. Thus, the normal or slightly increased serum zinc values, which have been observed during diuretic treatment in spite of increased urinary losses of zinc, cannot be explained by increased zinc absorption. Depletion of zinc in tissues seems likely.
HBsAg Transmission from a Cardiac Surgeon Incubating Hepatitis B Resulting in Chronic Antigenemia in Four Patients
Authors: Hærem Jørgen Winther , Siebke Jens‐Christian , Ulstrup Jan , Geiran Odd , Helle Ivar
Published: August 2010

ABSTRACT. A cardiac surgeon experienced an uneventful course of acute hepatitis B. HBsAg was transmitted to 11 persons: 5 of 72 patients operated on during his incubation of hepatitis B, three relatives of the infected patients, one laboratory technician, and two of the surgeon's family members. Two years later, 4 of the 5 operated patients are still infectious, whereas the 7 non‐operated persons have cleared their antigenemia. This study demonstrates the significant risk of hepatitis B transmission from a cardiac surgeon incubating the disease. Furthermore, it indicates that patients who have been infected during open heart surgery and cardiopulmonary bypass run a particular risk of becoming chronic HBs antigen carriers.
Serum Prolactin and Thyrotropin Responses to Thyrotropin‐Releasing Hormone in Men with Alcoholic Cirrhosis
Authors: Hasselbalch Hans Carl , Bech Karine , Eskildsen Peter Claes
Published: August 2010

ABSTRACT. The serum concentrations of prolactin (PRL) and thyrotropin (TSH) in 12 males with alcoholic cirrhosis during basal condition and after stimulation with thyrotropin‐releasing hormone (TRH) were compared with the concentrations in ten thiazide‐treated hypertensive and nine normal men. The basal as well as the TRH‐stimulated increase in serum PRL was significantly elevated in the cirrhotic males, while the increase in serum TSH was unchanged, compared with hypertensive and normal men. No correlation between clinical or laboratory parameters and serum PRL was found. Serum estradiol was equal in cirrhotic and control subjects and no correlation was found between serum PRL and serum estradiol. These findings favour the concept that raised serum PRL in cirrhotic patients might be caused by a diminished dopaminergic neurotransmission.
Physical Activity at Work and at Leisure in Relation to Coronary Risk Factors and Social Class
Authors: Holme I. , Helgeland A. , Hjermann I. , Leren P. , Lund‐Larsen P. G.
Published: August 2010

ABSTRACT. The association between physical activity at work and at leisure, coronary risk factors, social class and mortality has been studied in about 15000 Oslo men, aged 40–49, without known cardiovascular disease or diabetes at a screening examination for coronary risk factors. Four‐year total and CHD mortality showed a decrease with increasing degree of leisure activity, and an increase with increasing work activity. The three conventional coronary risk factors—serum cholesterol, systolic blood pressure (SBP) and number of cigarettes—associated negatively with physical leisure activity, whereas they all associated positively with physical activity at work. Men in lower social classes were less active at leisure but more active at work than men in the higher classes. In a multivariate analysis of variance with coronary risk score (based on SBP, serum total cholesterol and number of cigarettes), social class and physical activity, the predictive power of physical leisure activity for future death was almost as good as the coronary risk score. Physical activity at work, on the other hand, was not an independent risk factor either for total or for CHD mortality.
Early Exercise Test vs. Clinical Parameters in the Long‐Term Prognostic Management after Myocardial Infarction
Authors: Saunamäki K. I. , Andersen J. Damgaard
Published: August 2010

ABSTRACT. An early exercise test was performed in 317 patients with acute myocardial infarction (AMI). The long‐term prognosis was assessed after an average follow‐up of 5.7 years. The patients with a small increase in the pressure rate product from rest to maximal exercise and/or with major ventricular arrhythmias constituted a general prognostic high‐risk group. The survival was analyzed further applying the above mentioned exercise parameters in the following clinical subgroups: I) patients with clinical heart failure during hospitalization and/or previous myocardial infarction, II) patients with anterior AMI, III) patients with inferior or indefinite AMI. Within each clinical group there was a highly significant difference in survival between the exercise‐determined high‐risk and low‐risk patients. The exercise parameters were more sensitive and more specific prognostic determinators than the clinical variables. The most striking difference was found in patients with clinical heart failure and/or previous infarction. In this group the exercise‐determined high‐risk patients had a probability of S‐year survival of 0.238 vs. 0.909 in the corresponding low‐risk patients (p < 0.0005).
Lingual Infarction and Sudden Blindness Due to Giant Cell Arteritis
Authors: STORM TOMMY LYAGER , JØRGENSEN FRANK
Published: August 2010

ABSTRACT. A 72‐year‐old woman suffered from giant cell arteritis (GCA) which developed into lingual infarction and monocular blindness. Temporary obscuration of vision and lingual symptoms such as increasing malaise, pain and intermittent claudication may precede the catastrophic results of arteritis. Emphasis is laid on early recognition and treatment of GCA.
Treatment of Oral Theophylline Poisoning
Authors: AHLMÉN JARL , HEATH ANDREW , HERLITZ HANS , KVIST LENA , MELLSTRAND TORE
Published: August 2010

Abstract Two patients, 15 and 20 years old, were admitted after an overdose of theophylline in a slow‐release preparation. The gradual occurrence of clinical symptoms reflected the slow gastrointestinal absorption of the drug, and therefore active treatment was not started until 10 and 12 hours after intake, respectively. Peak s‐concentrations were 275 and 1295 μmol/l, respectively. One patient was treated with hemoperfusion only, whereas the more severely intoxicated patient was treated with combined hemoperfusion and hemodialysis. Only about 0.2 g theophylline was eliminated by hemodialysis in this patient compared to a calculated amount of 6.9 g by hemoperfusion. Severely theophylline‐intoxicated patients should be treated with supportive therapy and hemoperfusion.
Plasma Vasopressin in Hereditary Cranial Diabetes Insipidus
Authors: OS INGRID , AAKESSON INGVAR , ENGER ERIK
Published: August 2010

ABSTRACT A family comprising 46 members of 4 generations is described; 21 members suffered from incomplete diabetes insipidus (DI) of central origin. The pedigree showed a dominantly transmitted condition. The onset is gradual and starts in early infancy. The clinical symptoms are highly variable and decline in the sixth decade. Plasma vasopressin (AVP) during water deprivation was significantly lower in the DI group than in the controls (4.2±0.5 vs. 10.6±1.7 ng/l) (p<0.01), the difference being more pronounced in the high osmolality range (4.8±0.7 vs. 14.4±3.1 ng/l) (p<0.01). Urine osmolality was lower (241±36 vs. 928±46 mOsm/kg H2O) (p<0.01) despite higher serum osmolality during water deprivation, rendering the ratio between urine and serum osmolality less than unity compared with >3:1 in the control group (p<0.001). In two affected females, addition of a nonosmotic stimulus caused no increase in plasma AVP. The findings are consistent with a partial defect in the production or release of AVP and not with a dysfunction of the intracranial osmoreceptors. The variable features of incomplete DI indicate that to define the condition by excessive urinary output alone is insufficient. The ratio between urine and serum osmolalities after an appropriate osmotic stimulus together with plasma AVP measurements may be necessary to confirm the diagnosis.
Erythropoietin and Renin Substrate in Cerebellar Haemangioblastoma
Authors: ROSENLÖF KATARINA , FYHRQUIST FREJ , GRÖNHAGEN‐RISKA CAROLA , BÖHLING TOM , HALTIA MATTI
Published: August 2010

ABSTRACT. We examined eight cerebellar haemangioblastoma tumours from eight patients, aged 16–63 years, 5 females and 3 males. Preoperative haemoglobin values exceeded 180 g/1 in four patients, and 150 g/1 in four. All high Hb values were normalized upon surgical removal of the tumours. All tumours contained scattered cells which stained positively with antisera against pure human urinary erythropoietin and plasma renin substrate. We conclude that cerebellar haemangioblastomas produce immunoreactive erythropoietin, which shares common antigenic determinants with renin substrate.
Ergonovine Testing in Patients with Exertional Angina
Authors: NORDLANDER ROLF , ORINIUS ERIK
Published: August 2010

ABSTRACT. Nordlander R, Orinius E (Division of Cardiology, Department of Internal Medicine, Thoracic Clinics, Karolinska Hospital, Stockholm, Sweden). Ergonovine testing in patients with exertional angina. Acta Med Scand 1987; 221:47–52.

Injection of ergonovine has been suggested as a diagnostic test in patients with suspicion of a vasospastic component in the pathophysiology of angina pectoris. However, a thorough case history has been considered by others to give the same information regarding the anginal mechanism. Therefore a bedside ergonovine test (0.075–0.675 mg i.v.) was performed in 21 consecutive patients with effort angina in order to study the relation between the outcome of the test and the case history concerning angina at rest. A coronary angiography was performed in all cases and showed significant stenoses in 17 patients and normal coronary arteries in 4. Eight patients had angina only during effort, 11 had angina both during effort and at rest and 2 patients had atypical chest pain. Ten of the 11 patients with concomitant rest angina developed chest pain at the ergonovine test and 9 coexisting ECG changes. However, these effects were about as common among the 8 patients without angina at rest: 7 developed chest pain and 4 also ECG changes. The two patients with atypical chest pain had normal coronary angiograms and in these patients ergonovine provoked the same atypical chest pain but no ECG changes. Thus, a concomitant angina at rest is a common finding among patients with severe effort angina. However, the response to ergonovine was as common in the group with only effort angina as in the group with concomitant rest angina, indicating the limited value of this test in patients with severe angina.
Autonomic Neuropathy in Type I Diabetes: Influence of Duration and Other Diabetic Complications
Authors: BERGSTRÖM BENGT , LILJA BO , ÖSTERLIN SVEN , SUNDKVIST GÖRAN
Published: August 2010

ABSTRACT To evaluate the influence of duration on the development of autonomic neuropathy (AN) a group of type I diabetic patients (n=58) who had been diagnosed between the ages of 15 and 25 years was investigated. The duration of diabetes varied from 2 months to 30 years (mean 13 years). AN tests included a deep breathing test (E/I ratio) and an orthostatic test on tilt table (acceleration and brake indices) and the results were corrected for age. A clear correlation between AN test and duration of diabetes was shown only for the En ratio (r= ‐0.44, p<0.001). On the other hand, deteriorations in the brake index were unrelated to the duration of diabetes and occurred early; 35% of the patients with a duration of 10 years or less showed an abnormal brake index. Autonomic test deviations were related to other diabetic complications. The En ratio and the acceleration index were especially low in patients with retinopathy as well as in patients with symptoms of AN if combined with peripheral neuropathy (PN). The brake index was low in patients with symptoms of AN independent of PN.