D-penicillamine induced myasthenia gravis in rheumatoid arthritis: an unpredictable common occurrence?

Five patients out of 71 with rheumatoid arthritis (RA), who received D-penicillamine, developed myasthenia gravis (MG) within a two-year period. They all responded promptly to discontinuation of the drug and pyridostigmine administration. None of the patients had anti-Ro(SSA) antibodies or features of Sjögren's syndrome, whereas three of the five had the HLA-DR1 phenotype.

Mesenteric fibromatosis.

Mesenteric fibromatosis is commonly associated with Gardner's syndrome and familial polyposis. These lesions may have an insidious onset via compression of the small or large intestines, or may be noted for the first time during abdominal exploration for some other cause. Differential diagnosis may be difficult.

Excessive fibrosis of supraclavicular lymph-node granulomas in a patient with progressive systemic sclerosis.

The case of a 29-year-old white female with a 7-year history of typical scleroderma is presented who developed excessive fibrosis of the supraclavicular lymph nodes. After 3 years of disease, firm right supraclavicular lymphadenopathy appeared, accompanied by a high fever. Biopsy revealed non-caseating granulomas and short-term antituberculous therapy was ineffective.

Subcutaneous edema: an "unrecognized" feature of acute polymyositis.

The case of a man with acute onset of muscle pain, weakness, anasarca, severe dysphagia and dysphonia, and biochemical, electromyographic and histologic evidence of polymyositis is presented. The literature on the occurrence of subcutaneous edema in polymyositis was reviewed. It is concluded that this particular symptom, with no other apparent cause, including heart failure from the underlying disease, is a rare but definite feature of polymyositis itself.

Intravesical bacillus Calmette-Guérin administration in the prophylaxis of superficial bladder cancer.

A total of 68 patients received prophylactic/adjuvant intravesical Pasteur strain bacillus Calmette-Guérin (BCG) instillations following transurethral resection for superficial bladder carcinoma. An induction phase consisting of 6 weekly instillations was followed by a maintenance phase consisting of 1 instillation given every 3 months. A second 6-week course of BCG was administered to initial failure followed again by a quarterly maintenance therapy.

Aspects concerning posterior urethral valves.

Twenty-six boys were evaluated and treated for posterior urethral valves. At the time the valves were diagnosed unilateral or bilateral vesicoureteral reflux was present in 58% of the ureters and 69% of the children, while dilatation of the upper urinary tract was present in 88% and 92%, respectively. There was a variety of symptoms and signs, but the most prominent in neonates and infants were vesical urine retention, palpable kidneys and failure to thrive, whereas in the older children voiding dysfunction, incontinence and urinary infection were the most common.

Etiology of acute scrotum in 100 boys with regard to age distribution.

A review of 100 boys less than 15 years old who were hospitalized for an acute scrotum revealed that the most common causes of the disorder were testicular torsion, including torsion of the spermatic cord (42 per cent) and torsion of the appendages (32 per cent). The remaining 26 per cent of the cases were owing to idiopathic scrotal edema (8 per cent), epididymitis and orchitis (6 per cent each), and incarcerated hernia and acute hematocele (3 per cent each). The age distribution of these children was biphasic, with the highest frequency in newborns (with exclusively extravaginal torsion) and in boys 13 years old, whereas in boys with appendiceal torsion the single peak frequency was at age 10 years.