Thrombosed hemorrhoid mimicking rectal carcinoma at CT.

A 46-year-old man with cirrhosis and portal hypertension complained of lower pelvic pain. CT of the rectum raised a strong suspicion of a rectal tumor. However, rectal examination, anoscopy, direct rectoscopy, and, unfortunately, post-mortem dissection, failed to confirm its existence.

Palmar rheumatoid nodulosis associated with local pressure.

Rheumatoid nodulosis is a term used to describe adult patients with rheumatoid arthritis with little or no clinical joint inflammation who have numerous subcutaneous nodules indistinguishable from those of patients with active rheumatoid arthritis. This paper reports the case of a woman with quiescent rheumatoid arthritis who developed palmar nodulosis three weeks after the strenuous activity of painting her apartment. This case illustrates the direct association between the appearance of nodulosis and physical pressure despite inactive disease.

Acute colchicine intoxication--possible role of erythromycin administration.

A 29-year-old patient with familial Mediterranean fever and amyloidosis involving the kidney, liver, and gastrointestinal tract received longterm colchicine, 1 mg daily. In the last year she developed diarrhea and abdominal pain, that coincided with toxic colchicine blood levels. After 2 weeks of oral erythromycin therapy she was hospitalized for acute, life threatening colchicine toxicity, with fever, diarrhea, abdominal pain, myalgia and lower extremity parasthesias and later convulsions and alopecia.

Poliovaccines and the course of systemic lupus erythematosus--a retrospective study of 73 patients.

Flare in disease activity occurred in four out of 73 patients (5%) under the age of 45 with systemic lupus erythematosus (SLE) who were immunized against poliomyelitis in a nationwide campaign following the Israeli outbreak of 1988. The flare appeared within 3 months of the immunization, whereas in 37 matched SLE patients who were not immunized, the disease remained stable in the same period. Both oral live-attenuated (OPV) and injected killed poliovaccines (IPV) were implicated in the flares (1/24 and 3/49 patients, respectively).

Colchicine intoxication: clinical pharmacology, risk factors, features, and management.

The use of colchicine for acute gouty arthritis dates to ancient times. In recent years, colchicine also has been used successfully for various other rheumatic and nonrheumatic conditions. Colchicine is a safe drug when used according to established therapeutic guidelines.

Inappropriate secretion of antidiuretic hormone in Sheehan's syndrome: a rare cause of postpartum hyponatremia.

A 27-year-old woman experienced hemorrhagic shock after delivery. One week later she was seen in an obtunded state of consciousness. The results of laboratory evaluation were consistent with the syndrome of inappropriate antidiuretic hormone secretion caused by hypopituitarism.

Etiology, treatment, and prognosis of large pericardial effusions. A study of 34 patients.

During the last 20 years, only a few studies have been published concerning large pericardial effusion. We recently reviewed 34 patients who presented with large pericardial effusion not associated with trauma. Our analysis revealed that half of the patients (52 percent) had pericardial effusion of unknown origin.

Lupus refractory pleural effusion: transient response to intravenous immunoglobulins.

A patient with systemic lupus erythematosus complicated by refractory bilateral pleural effusions is described. High dose corticosteroids with azathioprine, as well as intrapleural instillation of corticosteroids, proved ineffective in management. As our patient remained severely symptomatic and required repeated thoracocentesis, a therapeutic trial of intravenous immunoglobulins (IVIG) was attempted.

Familial erythema nodosum.

Erythema nodosum (EN) is a hypersensitivity reaction associated with many diseases. We describe a family in which 4 sisters had acute or recurrent EN. HLA typing showed a common haplotype in the affected members of the family.

Acute pericarditis: etiology, treatment and prognosis. A study of 115 patients.

One hundred and 15 hospitalized patients with acute pericarditis were analyzed retrospectively for their etiology, management and long-term prognosis. It was found that most of the patients had either idiopathic or viral etiologies (60%), collagen disease (16.4%) or malignancy (6.

Dermatomyositis associated with the recurrence of transitional cell carcinomas and Kaposi's sarcoma.

A 76-year-old male was admitted to our hospital because of dermatomyositis (DM). Fourteen years earlier a transitional cell carcinoma of the bladder was diagnosed. Following repeated resections of the neoplasm, he was free of the disease for the last two years.

Colchicine prophylaxis in familial Mediterranean fever: reappraisal after 15 years.

As determined in this study of 45 patients, the prolonged use of colchicine therapy in familial Mediterranean fever (FMF) is safe and effective in preventing flares of FMF and amyloidosis. It has acceptable adverse effect profile and can be used in children and pregnant women. Its discontinuation predisposes patients to acute FMF attacks and the development of amyloidosis.

Idiopathic sclerosing peritonitis in a man.

Idiopathic sclerosing peritonitis is a rare disease described in young adolescent women, characterized by fibrosis and adhesions of the peritoneum to loops of the small bowel. Here we describe a 35-year-old man who underwent exploratory laparotomy for repeated small bowel obstruction. Only partial resection of the terminal ileum was possible because of adhesions; recurrent abdominal infections and leakage from anastomosis required further resection, which ultimately resulted in short bowel syndrome and malabsorption.

Autoantibodies in familial Mediterranean fever (recurrent polyserositis).

The presence of autoantibodies in our familial Mediterranean fever (FMF) patients was investigated using various immunological techniques. Immunofluorescence screening of 50 FMF sera revealed only one positive for antinuclear antibodies. ELISA assay and nitrocellulose filter assay revealed no difference between FMF sera and healthy controls with regard to the presence of anti-dsDNA antibodies.

Purified recombinant 60 kD SS-A/Ro protein--an antigenic source for ELISA screening of patients with rheumatic diseases.

A 60 kD SS-A/Ro recombinant protein was expressed in E. coli cells and purified by the centrifugation procedure. Since the substrate contained a substantial amount of bacterial proteins it was not sufficient for ELISA.

Dissociation of immune responses to the SS-A (Ro) 52-kd and 60-kd polypeptides in systemic lupus erythematosus and Sjögren's syndrome.

The cellular RNA particle SS-A (Ro) is a target of autoimmune response in many patients with Sjögren's syndrome (SS) and systemic lupus erythematosus (SLE). Recent immunologic, biochemical, and DNA cloning studies have shown that the SS-A particle consists of at least 2 polypeptide components, of 52 kd and 60 kd. Immunodiffusion analysis of 60 sera from patients with primary SS revealed 47 (78%) to be SS-A precipitin positive.

Coexistence of systemic lupus erythematosus and myasthenia gravis: two distinct populations of anti-DNA and anti-acetylcholine receptor antibodies.

A woman with a four-year history of systemic lupus erythematosus (SLE) developed myasthenia gravis (MG). The clinical features of lupus disappeared slowly while the myasthenic syndrome became predominant. However, her serum was positive for anti-DNA and anti-acetylcholine receptor antibodies.

Brucellosis in patients with heart disease: when should endocarditis be diagnosed?

Three patients, 2 with congenital valvular heart disease and 1 with a prosthetic aortic valve developed brucellosis. Brucella melitensis was isolated from blood of all 3 patients. The clinical and microbiological features suggested Brucella endocarditis and following successful antibiotic therapy, no surgery was required.

Acquired congenital heart block. Pattern of maternal antibody response to biochemically defined antigens of the SSA/Ro-SSB/La system in neonatal lupus.

The molecular basis of autoantibody reactivity with components of the SSA/Ro-SSB/La particle exhibited by sera of mothers of infants with severe and permanent manifestations of neonatal lupus (NLE) was investigated using immunoblotting and immunoprecipitation. The characteristics of NLE that were studied included congenital complete heart block (CCHB), second degree heart block, and hepatic fibrosis. Antibodies specific for one or more components of the SSA/Ro-SSB/La particle were found in sera from all 20 mothers of permanently affected infants.