A 19-year old man with IgA vasculitis after vaccination

A 19-year-old patient who mistakenly received two doses of influenza vaccine 10 days before presentation, was admitted with malaise, weakness, and a purpuric non-blanching rash most prominent on the ankles followed by abdominal pain and hematochezia 72 h later. The diagnosis of influenza vaccine-related Henoch–Schonlein vasculitis was made. This complication, although rare, is the most common vasculitis related to immunization.     

A patient with tremors and breathlessness.

We describe a patient with Parkinson's disease who developed bilateral pleural effusions and pleural fibrosis associated with pergolide therapy. Pergolide is an ergot-derived dopamine agonist used in the treatment of Parkinson's disease. This case report illustrates that physicians should have a high index of suspicion and consider drug-induced adverse effects in any differential diagnosis.     

65岁老年男性持续发热和呃逆一例

1病例要 患男性，65岁，主因脑出血术后2个月，持续高热12d，呃逆7d入院。患于2006年2月因大脑左侧基底部出血，行穿刺抽液术，术后遗留有右侧肢体活动障碍，近期记忆丧失。3月18日再次出现脑梗死，伴有癫痫发作，给予对症治疗后好转。4月7日受凉后出现头晕，恶心，呕吐伴发热，在当地医院就诊，考虑上呼吸道感染，给予抗感染及营养支持等治疗，体温持续在38℃以上，胸片显示右下肺感染，且于4月11日无明显原因出现持续呃逆，为了进一步治疗，收入解放军总医院。     

A 20-year-old man with persistent aminotransferase elevations

Through intravenous drug abuse, this 20-year-old man contracted chronic active hepatitis due to hepatitis D superinfection of hepatitis B. The correct diagnosis, made after a hiatus of 20 years, awaited advances in the understanding of viral hepatitis, the discovery of the hepatitis D virus, and the development of immunostaining techniques that could be applied to his liver biopsy specimen. The case illustrates how immunoperoxidase staining may be done retrospectively and may be particularly useful in diagnosis of individual cases where serologic testing is not available or possible, as well as in scientific surveys of HBV and HDV infection. Since staining for HBcAg and HDAg can provide clinically useful information not available by other methods, it should be considered as a part of the assessment of the liver biopsy in every patient with HBV infection.     

A 79-year old man with hypertension, hypokalemia, hyporeninemia and hypoaldosteronemia similar to Liddle's syndrome]

A 79-year old man with hypertension, hypokalemic metabolic alkallosis, hyporeninemia and hypoaldosteronemia was studied. Blood pressure fell and serum potassium returned to normal after sodium restriction and the administration of triamterene. Serum DHEA, DOC, corticosterone, 18-OH-corticosterone, 11-deoxy-cortisol, cortisol were within normal range. Adrenal CT scanning did not reveal an adrenal tumor. The excretions of urinary kallikrein and prostaglandin E2 were within the normal range. Although an atrophic juxtaglomerular apparatus and arteriosclerotic change were observed by renal biopsy, there was no evidence of hypokalemic nephropathy. From these results, it is suggested that this patient has a defect in handling sodium and potassium in the distal tubules. This is similar to that observed in Liddle's syndrome.     

Duodenal ulcers: early and late onset.

A hospital series of 1042 duodenal ulcer patients was examined to determine the relationship of the age of onset of ulcer dyspepsia with the blood group and with the family history of ulcer dyspepsia. It was found that those patients whose symptoms begin in the first two decades of life (early onset patients) contain a significantly larger proportion of group A, B, and AB subjects and a significantly stronger family history of dyspepsia than those whose symptoms begin from the fourth decade of life onwards (late onset patients), in whom blood group O prevails. The group O status is shown to be associated with a significant proneness to duodenal ulceration and a significant proneness to bleed, and in the late onset patients a significant proneness to bleed recurrently and severely. Bleeding is the predominent complication in the early onset patients. There is a significantly increased tendency for the late onset ulcers to perforate, to become stenosed, to have severe pain, and to be virulent--that is, to be multiple, post-bulbar, or giant. While these features do not appear to be related to the effect of ageing, the occurrence of associated gastric ulceration and the mortality rate was shown to be related.