Primary ectopic intramuscular meningioma of the thigh.

A case of a primary ectopic intramuscular meningioma of the thigh in a 20-year-old male patient is presented. The possible histogenesis of primary ectopic meningiomas is summarized.

Suspected cutaneous drug toxicity in rheumatoid arthritis--an evaluation.

Cutaneous toxicity from drugs used to treat RA is a major perceived problem. Over a 2-yr period we have prospectively reviewed 114 patients with a suspected adverse cutaneous reaction to anti-rheumatic drugs. In 71 (62%), the rash was thought to be unrelated to drug therapy.

Localisation of alpha, mu and pi class glutathione S-transferases in kidney: comparison with CuZn superoxide dismutase.

We describe studies in whole kidney, cortical and medullary homogenates and, glomerular cells in culture to determine the relative levels of expression of alpha (Ya, Yc, Yk), mu (Yb1/Yb2), pi (Yf) glutathione S-transferases (GST) and CuZn superoxide dismutase (CuZn SOD) in different regions of the nephron. Immunoblotting and immunohistochemistry were used to demonstrate relatively weak expression of alpha, mu GST and, CuZn SOD in the glomerulus compared to that in particularly distal tubules. Whilst expression of Ya was found within glomerular cells, Yc, Yk and Yf were not detected.

Paraganglioma of the cauda equina: a case report and review of the literature.

This case report describes a paraganglioma of the cauda equina in a 57-year-old man. The clinical and pathological features of the 70 cases reported to date are reviewed. The importance of total surgical removal is stressed.

Anticardiolipin antibodies in ischaemic heart disease: marker or myth?

Objectives: To assess the incidence and significance of anticardiolipin antibodies after myocardial infarction and in unstable angina.

Design: A prospective study of all patients under 60 admitted to the coronary care unit over a 12 month period with a diagnosis of acute myocardial infarction who were followed up for a further 12 months. Patients admitted with unstable angina were similarly assessed but not followed up.

The glutathione S-transferases: polymerase chain reaction studies on the frequency of the GSTM1 0 genotype in patients with pituitary adenomas.

The frequency of the GSTM1 0 polymorphism at the glutathione S-transferase M1 locus has been determined in controls and patients with pituitary adenomas by using the polymerase chain reaction to amplify genomic DNA in the exon 4-5 region of the gene. The frequency of the genotype in patients with prolactinomas, non-functional adenomas, corticotrophinomas and somatotrophinomas varied between 52-67% compared with 44% in the controls. In the patients with prolactinomas the frequency of the genotype (67%) was significantly greater than in controls with odds ratio analysis indicating that GSTM1 0 individuals have a 2.

Towards causal inference in occupational cancer epidemiology--II. Getting the count right.

This second paper in the series assessing causal inference in occupational cancer epidemiology highlights the importance of using the right data sources when examining the association between exposure and tumour incidence in groups of workers. Using the wrong ones can lead to omissions which become insidious and cumulative during a long-term follow-up study, often extending over several decades. The main cause is the changing survival pattern of some cancers and it is a new and important factor to be taken into account.

Angiosarcoma in congenital hereditary lymphoedema (Milroy's disease)--diagnostic beacons and a review of the literature.

In cases of congenital lymphoedema the finding of ulceration, violaceous nodules or papules, or apparent traumatic ecchymoses should act as a diagnostic beacon warning of dangers. A case is reported of a high-grade angiosarcoma developing in a patient with congenital hereditary lymphoedema (Milroy's disease). This is the second paper to report this complication, the third case report and the first case in which the diagnosis is substantiated by immunohistochemistry and lectin histochemistry.

Capillaritis: a manifestation of rheumatoid disease.

We present seven cases of capillaritis arising in patients with rheumatoid arthritis and suggest that it is primarily related to disease activity and not drugs. In the majority, the rash resolved spontaneously with the use of a topical steroid to treat the symptom of itch.

Diagnosis and management after life threatening events in infants and young children who received cardiopulmonary resuscitation.

Objective: To determine the mechanisms and thereby appropriate management for apparent life threatening events treated with cardiopulmonary resuscitation in infants and young children.

Design: Prospective clinical and physiological study.

Setting: Royal Brompton Hospital or in patients' homes, or both.

Life quality and psychological morbidity with an ileostomy.

The recent introduction of restorative proctocolectomy for the treatment of ulcerative colitis has reopened the debate about the effects of ileostomy on quality of life. This study analysed life quality and psychological morbidity in 113 patients with an ileostomy using a postal questionnaire which included questions about their opinion of the pouch operation. Of the questionnaires, 73 per cent were suitable for analysis.

Malignant schwannoma of the cerebellum: case report.

A case of malignant cerebellar schwannoma is presented in a woman aged 61 years. A malignant schwannoma of the cerebellum has not been previously reported in the literature. The histological, immunocytological, and ultrastructural properties suggested that this lesion was a malignant, partially epithelioid schwannoma.

Acute febrile neutrophilic dermatosis in association with erythema nodosum and sarcoidosis.

We report two cases of simultaneous Sweet's syndrome and erythema nodosum. We believe this to be a real association rather than the extension of the neutrophilic infiltrate of Sweet's syndrome into the subcutaneous fat. In one of our cases, concurrent erythema nodosum and Sweet's syndrome was a presentation of sarcoidosis with bilateral hilar lymphadenopathy.

Spinal extradural cavernous angioma.

A case of spinal extradural cavernous angioma is described. The symptomatology and prognosis of such lesions is discussed and the relevant literature reviewed.

Wound infection with meningitis caused by Salmonella typhimurium.

We report a case of postoperative wound infection and meningitis with Salmonella typhimurium in a 66-year-old woman who had been operated on for a cerebral meningioma. The diagnostic, therapeutic and prognostic implications are discussed.

The effects of flumazenil on alertness and hypoxia in elderly patients after ERCP.

It is not known whether hypoxia, associated with upper gastrointestinal endoscopic procedures when midazolam sedation is used without narcotics, persists into the post-procedure recovery period. Thirty consecutive patients aged over 60 years, undergoing ERCP using midazolam sedation alone, were monitored clinically and by pulse oximetry before, during and for 2 hours after the procedure. They were randomized prospectively to receive either 0.

Toxic epidermal necrolysis localized to an area of lymphoedema.

We present a man who, on two occasions, developed toxic epidermal necrolysis initially localized to an area of lymphoedema. To our knowledge, lymphoedema as a site of prediliction has not previously been reported.

Sarcoidosis presenting with a granulomatous reaction confined to red tattoos.

A patient with sarcoidosis who presented with a granulomatous tattoo reaction is described. Although tattoo granulomata usually represent a local hypersensitivity reaction to tattoo pigments, they can be a manifestation of systemic sarcoidosis. In this case the lesions were confined to the red areas of tattoos suggesting that tattoo sarcoid may be more than just an example of the Koebner response.

Hydrocortisone sensitivity: clinical features of fifty-nine cases.

Background: Hypersensitivity to topical steroids is becoming increasingly recognized.

Objective: Our purpose was to establish factors associated with allergy to topical hydrocortisone.

Methods: Data from 59 consecutive patients allergic to hydrocortisone were compared with 199 consecutive patients who were not allergic to hydrocortisone.

Potential role of intrapulmonary shunting in the genesis of hypoxemic episodes in infants and young children.

A number of physiologic phenomena during some apneic/cyanotic episodes in infants and young children cannot be explained sufficiently on the basis of a cessation or reduction in alveolar ventilation alone. These include (1) the extremely rapid development of hypoxemia during some episodes, (2) the occurrence of hypoxemic episodes despite continuous ventilation, (3) differences in the speed of desaturation between different forms of apneic episodes, (4) the presence of continued breathing efforts and yet absent airflow despite bypass of the upper airway, and (5) evidence that apnea and hypoxemia may begin simultaneously. Potential mechanisms to explain these phenomena include the sudden development of an unevenness in the matching between ventilation and lung perfusion, the flow of blood through unventilated areas of lung, and a sudden impairment in gas diffusion.

Rheumatoid arthritis: an association with pemphigus foliaceous.

We have observed a high incidence of pemphigus foliaceous, in the absence of therapy with penicillamine, within a small population of patients with rheumatoid arthritis. We suggest that penicillamine as well as inducing autoimmune disease might exacerbate subclinical pemphigus foliaceous in this group, accounting for those few patients whose skin disease fails to resolve following drug withdrawal. Pemphigus and rheumatoid arthritis have both been associated with HLA DR4, which was present in all three of our patients who were tested.