MALIGNANT HYPERTENSION AND ANTIPHOSPHOLIPID ANTIBODIES AS PRESENTING FEATURES OF SLE IN A YOUNG WOMAN USING ORAL CONTRACEPTIVES

A 24-year-old woman developed malignant hypertension while onoral contraceptives (OCs). She was found to have incompletesystemic lupus erythematosus (SLE) with DNA antibodies and highlevels of antiphospholipid antibodies (APLA). She later developedSLE and has had three miscarriages and a cerebellar infarction. KEY WORDS: Lupus erythematosus, Ethinyloestradiol, Risks     

METABOLIC AND HORMONAL STUDIES IN A PATIENT WITH PRIMARY ALDOSTERONISM,PRESENTING WITH ACUTE HYPOKALÆMIC PARESIS INDUCED BY CHLOROTHIAZIDE

Primary aldosteronism was discovered in a woman aged 27 years known to have been hypertensive for four years, and who presented with severe muscular weakness of acute onset after one week's treatment with chlorothiazide. Metabolic studies were carried out at three levels of sodium intake—“ normal ”(84 mEq per day), “ high ”(200 mEq per day) and “ low ”(16 mEq per day)—and also during treatment with desoxycorticosterone acetafe or spironolactone. Sodium loading caused a significant fall in the serum potassium concentration from 4·6 to 3·4 mEq/l., and a significant increase in the urinary potassium excretion from 165 mEq per day to 215 mEq per day. The plasma renin activity was abnormally low, being suppressed under all conditions of testing to a level below the lower limit of sensitivity of the assay used. The plasma aldosterone concentration was consistently high (mean 45, range 18 to 64 mµg. per 100 ml). Removal of an aldosterone-producing tumour resulted in correction of the abnormal plasma levels of aldosterone and renin, and relief of hypertension and hypokalæmia.     

PRIMARY ALDOSTERONISM DUE TO A MALIGNANT OVARIAN TUMOUR

Abstract The case of a woman with autonomous aldosteronism, hypertension, and malignant ovarian tumour is reported. Hormone studies revealed high plasma aldosterone levels, and low plasma renin concentration. Following surgical removal of a malignant sex cord stromal tumour, the hyperaldosteronism regressed, and the hypertension improved. Subsequently the tumour recurred, as did hyperaldosteronism.     

OSTEOARTICULAR TUBERCULOSIS OF THE SYMPHYSIS PUBIS PRESENTING AS A HYPOGASTRIC CYSTIC MASS IN A WOMAN WITH PRIMARY SJOGREN'S SYNDROME

A 79-year-old woman with primary Sjögren's syndrome andimmune thrombocytopenia presented with a hypogastric cysticmass. Twenty-three months previously she received a 7-monthcourse of prednisone at moderate doses to control the thrombocytopenia.A computed tomography showed a cystic mass, destruction of theleft pubis with involvement of the symphysis and erosion ofthe right pubis. The cystic mass was surgically removed. Epithelioidgranulomata were found on pathological examination and Mycobacteriumtuberculosis was grown in Löwenstein medium. This is thefirst reported case of osteoarticular tuberculosis with sucha presentation and only the second localized to the pubis. KEY WORDS: Osteoarticular tuberculosis, Primary Sjögren's syndrome     

EOSINOPHILIC POLYMYOSITIS PRESENTING AS A PSEUDOTUMOUR IN THE HYPEREOSINOPHILIC SYNDROME

This report describes an unusual case of pseudotumour of musclecaused by an eosinophilic myositis associated with peripheralblood eosinophilia, systemic illness and a pericardial effusion. The relationship of this case to other reported cases of eosinophilicmyositis and the hypereosinophilic syndrome is discussed briefly. KEY WORDS: Eosinophilic myositis, Hypereosinophilic syndrome, Pseudotumour, Pericardial effusion     

PORCINE CALCITONIN AS A RENAL VASODILATOR IN MAN

Porcine calcitonin in intravenous doses of 1, 5, 10 and 20 MRC units produced acute increases in urinary volume and sodium, potassium, chloride and bicarbonate excretion in four normal subjects. Infusion of 10 MRC units over a 30 min period in six normal men produced significant increases in urinary volume and sodium, calcium, magnesium, chloride and urea excretion. Urinary potassium, phosphate and bicarbonate were also increased but the increases were not significantly different from control values. These changes in urinary composition accompanied a significant increase in effective renal plasma flow (para-amino hippurate clearance) and a smaller increase in inulin clearance. It is suggested that porcine calcitonin acts as a renal vasodilator in man and that changes in renal electrolyte excretion occur as a consequence. It is possible that renal vasodilation is effected by an active intermediary released by calcitonin rather than by the hormone itself.     

PRIMARY EXTRA‐AMPULLARY DUODENAL NEUROENDOCRINE CARCINOMA IN AN ADULT MALE

A primary extra‐ampullary duodenal neuroendocrine carcinoma was found in a 40‐year‐old man who presented with upper abdominal pain and weight loss. Duodenoscopy and hypotonic duodenography revealed a protruding fungating mass with luminal occlusion at the third part of the duodenum (D3). Although the metastatic work‐up was normal, the tumor was inoperable intraoperatively, hence a palliative bypass was carried out followed by chemotherapy with 5‐fluorouracil and leucovorin. Examination of the biopsy by immunohistochemistry and ultrastructural study revealed it to be neuroendocrine in nature, expressing synaptophysin, chromogranin and cytokeratin and containing dense core cytoplasmic granules. However, there was no evidence of clinical endocrinopathy. The present case emphasizes the need for better detection, further analysis and evaluation of such rare cases to identify their clinical course and effective treatment modalities.     

尿液假尿嘧啶核苷对原发性肝癌诊断价值的探讨

应用高效液相色谱法测定了４２例原发性肝癌（ＰＨＣ），６５例其它各种肝病，１１例消化道恶性肿瘤和４０例正常对照者的尿液假尿嘧啶核苷（假尿苷，Ψ）ＰＨＣ组的尿Ψ浓度（７．０±４．２ｎｍｏｌ／μｍｏｌ肌酐）明显高于正常对照组（３．２±０．７ｎｍｏｌ／μｍｏｌ肌酐）肝炎组（３．３±０．７ｎｍｏｌ／μｍｏｌ肌酐）肝硬化组（３．０±１．１ｎｍｏｌ／μｍｏｌ肌酐）及肝良性占位病变组（３．０±０．８ｎｍｏｌ／μｍ     

TYPE 1 HYPERLIPOPROTEINEMIA PRESENTING AS SUDDEN DEATH IN INFANCY

A routine post-mortem investigating sudden death in an eight week old male infant revealed gross Type I hyperlipoproteinemia (triglyceride concentration 825 mmol/L). Death was attributed to generalized cerebral anoxia. Study of the family revealed the parents were first cousins both of whom had depressed postheparin lipolytic activity, as did five out of seven of the remainder of the family members tested. This family is a notable example of deficiency of extrahepatic lipoprotein lipase.     

青年人胃癌40例的临床,内镜及病理分析

４０例青年人胃癌，占同期我院胃镜检出胃癌６９９例的５．７％。男性２６例，女性１４例。３１～３５岁为１５例（３７．５％），最小年龄为１５岁。早期胃癌３例（７．５％），进展期癌３７例。手术切除率为４２．５％。５年生存率为１５％（６／４０）。本组发现５例胃癌与十二指肠溃疡共存。本文分析了青年人胃癌的特点与预后差的主要原因，并讨论了青年人胃癌与胃溃疡关系以及与十二指肠溃疡共存问题。     

ADDISON'S DISEASE PRESENTING AS A HYPERCALCAEMIC CRISIS IN A PATIENT WITH IDIOPATHIC HYPOPARATHYROIDISM

A patient with idiopathic hypoparathyroidism complicated by Addison's disease is described. The development of adrenal insufficiency was accompanied by a hypercalcaemic crisis. The hypercalcaemia appeared to result from a reduction in the filtered load and enhanced renal tubular reabsorption of calcium. Cortisone therapy was followed by the characteristic renal tubular leak of calcium associated with hypoparathyroidism and a return of the serum calcium to normal. The possible mechanisms for these changes in calcium homeostatis are discussed.     

NON-HODGKIN'S LYMPHOMA AS A CAUSE OF HYPOADRENALISM

Abstract Non-Hodgkin's lymphoma which presents as adrenocortical insufficiency is rare, however, it should be a well-recognised entity because, in addition to specific chemotherapy or radiotherapy, it needs hormonal replacement. We report a patient with diffuse histiocytic lymphoma, who had remission for seven years and relapsed with Addisonian crisis.     

TEMPORAL ARTERITIS PRESENTING AS A SYMMETRICAL PERIPHERAL POLYARTHRITIS

:An 83 year old female presenting with a symmetrical peripheral polyarthritis resembling rheumatoid arthritis, subsequently developed biopsy-proven temporal arteritis. This case report draws attention to this uncommon presentation of temporal arteritis and briefly reviews common presenting features of this condition. (Aust NZ J Med 1983; 13: 639–640.)     

LEUCOCYTE/SKIN CULTURES AS A MEASURE OF HISTOCOMPATIBILITY IN MAN

Isolated human epidermal cells induced blastogenesis and D.N.A. synthesis in allogeneic leucocytes, but not in autologous leucocytes. No blastogenesis occurred in mixed leucocyte/skin cultures between a pair of phenotypically HL-A identical siblings not reacting in a mixed-leucocyte test. This correlation suggests that epidermal-cell-induced blastogenesis and leucocyte-induced blastogenesis reflect the same alloantigenic differences, and that both may be determined by the same genetic locus.     

原发性肝癌,肝硬化及肝炎患者中丙型肝炎病毒基因型调查

应用逆转录－套式聚合酶链反应和限制性片段长度多态性分析方法，对丙型肝炎病毒（ＨＣＶ）感染的３３例原发性肝癌、１８例肝硬化、１０例肝炎（慢性活动性４例，慢性迁延性２例，急性３例，重型肝炎１例）患者及２例献血员进行ＨＣＶ５｀－末端非编码区基因分型。结果表明此６３例所感染的ＨＣＶ均属于Ⅱ型病毒，未检出Ⅲ／Ⅳ型病毒。提示Ⅱ型ＨＣＶ感染在重庆地区ＨＣＶ相关性肝癌和肝硬化的发生中可能起着主导作用，本地区丙型肝炎患者中的流行毒株亦属于Ⅱ型病毒。     

ALLERGIC FUNGAL SINUSITIS PRESENTING AS A PARANASAL SINUS TUMOUR

Allergic fungal rhinosinusitis is a rare complication of atopic upper airways disease which may present initially as an expansive tumour of the paranasal sinuses. This reported case was caused by the rare fungal pathogen Bipolaris hawiiensis and illustrates typical clinical and laboratory features of this disorder. Although the optimum management of allergic fungal sinusitis is controversial, combined therapy with surgical clearance, antifungal agents and corticosteroids produced a favourable outcome.     

LYMPHOMATOID GRANULOMATOSIS PRESENTING AS A PROGRESSIVE CERVICAL CORD LESION

A 50-year-old male presented with symptoms of a progressive spinal cord lesion over two and a half months. Investigations, including myelography, CT scan and magnetic resonance imaging (MRI), did not show cord compression although the MRI scan demonstrated thickening of the posterior cervical meninges. CSF examination revealed pleocytosis, increased total protein and cells suggestive of a lymphoproliferative disorder. Open lung biopsy of an asymptomatic toft mid-zone mass was diagnostic of lymphomatoid granulomatosis. We believe this to be a case of lymphomatoid granulomatosis presenting as a progressive cervical myelopathy.     

PAROTID GLAND ULTRASONOGRAPHY AS A DIAGNOSTIC TOOL IN PRIMARY SJOGREN'S SYNDROME

The diagnostic value of parotid gland ultrasonography (Acuson128, 7 MHz transducer) was studied in 62 patients with primarySjögren's syndrome (SS) and in 69 controls of similar ageand sex distribution. Different degrees (mild, evident or gross)of parenchyma] inhomogeneity (PIH) were the most important sonographicchanges in SS; they occurred in 83.9% of the patients. The sonographicresults (the presence or absence of PIH) were in accordancewith the parotid sialographic and scintigraphic findings andthe histology of the minor salivary glands in 87.3, 84.7 and84.3% of the cases, respectively. Of the degrees of PIH, onlyevident and gross PIH are thought to be of true diagnostic valuefor SS. On the basis of the good agreement between the sonographicand sialographic results, consideration of the introductionof parotid sonography as an alternative to sialography is suggestedin SS if the latter method cannot be performed. KEY WORDS: Primary Sjögren's syndrome, Parotid gland ultrasonography, Parenchyma inhomogeneity