Unusual Presentation of Metastatic Carcinoma to the Small Bowel

Metastatic carcinoma to the small intestine produces a galaxy of roentgen findings including multiple areas of partial intestinal obstruction, ascites, fixation, pleating and thickening of the bowel folds, angulation and nodularity.¹⁺² In the following case the patient presented with a solitary obstruction of the mid ileum with marked proximal dilatation.     

The Haematological and Biochemical Changes in Severe Pulmonary Tuberculosis

This study surveys the extent and severity of haematologicaland biochemical abnormalities which occurred in 265 patientswith pulmonary tuberculosis, and records the haematologicalchanges that occur with treatment. Anaemia was present in 60 per cent of patients, more frequentlyin males than in females. Leucocytosis with neutrophilia occurredin 40 per cent, lymphopenia in 17 per cent and monocytopeniain 50 per cent. Platelet count and erythrocyte sedimentationrate were elevated in 52 and 80 per cent respectively. Bonemarrow aspiration and trephine biopsy were of limited diagnosticvalue. Ferritin and vitamin B₁₂ levels were increased in 94and 57 per cent of subjects respectively whilst serum and redcell folic acid were within normal limits in 83 per cent. Thefrequency of the important biochemical changes were hyponatraemia(43 per cent) and hypoalbuminaemia (72 per cent); alkaline phosphatase,aspartic transaminase and lactic dehydrogenase levels were elevatedin approximately a third of patients possibly due to unsuspecteddissemination. There was a close correlation between the acid-fast bacilliin sputum and abnormal values, particularly those of body weight,haemoglobin, platelet count, whlte cell count and erythrocytesedimentation rate. Failure of these indices to return to normalwas invariably associatd with persistent excretion of acid-fastbacilli. We have shown that haematological and biochemical abnormalitiesin pulmonary tuberculosis are common and may be valuable aidsto diagnosis. Some haematological markers also reflect resporrseto treatment.     

Clinical Management of Patients with the Long QT Syndrome: Drugs, Devices, and Gene-Specific Therapy

The familial long QT syndrome (LQTS) is now recognized as a genetic cbannelopatby with a propensity to arrhythmogenic syncope and sudden death. Three genetic mutations have been identified that involve the slow and fast delayed potassium rectifier currents and the sodium current. Distinctive ECG T wave phenotypes are associated with each of the tbree genotypes. Current day therapy includes: β-adrenergic blocking drugs; pacemakers; left cervicothoracic sympathetic ganglionectomy; implanted cardioverter defibrillators; and possibly, drugs that improve mutant ionic cbannel dysfunction. LQTS bas provided unique insight into the complex relationsbip between ionic cbannel dysfunction and ventricular tacbyarrbytbmias.     

The Effect of Procainamide on Delayed Activation Potentials in a Patient with Ventricular Tachycardia

In a patient with ventricular tachycardia and previous myocardial infarction, delayed activation potentials were recorded from a region of the posterolateral wall of the left ventricle at electrophysiological study. Procainamide, administered intravenously, initially caused increased delay and later, in higher dosage, second-degree block of the delayed potentials.     

The Management of Ventricular Septal Rupture Following Myocardial Infarction

Twenty-six patients were treated for ventricular septal rupturefollowing myocardial infarction over a five year period. Twenty-threepatients underwent full haemodynamic investigation with a viewto surgery and nineteen underwent operative closure of the defect.Overall hospital mortality was 47 per cent in the surgical group.Eleven patients had surgery within two weeks of infarction becauseof marked haemodynamic deterioration soon after septal rupturebut only two survived to leave hospital. Eight patients underwentoperation two weeks or longer after infaction, all were aliveand well at discharge from hospital, six were well at one yearand four at three years. Seven patients did not undergo surgeryand the maximum survival for these was eight months. No patient in cardiogenic shock before septal rupture benefitedfrom repair. Rapid clinical deterioration following rupturecarried a poor prognosis. In all the shunt was large and medicaltreatment was ineffective. It is concluded that early surgical repair should be consideredexcept when cardiogenic shock antedates the septal rupture.     

Febrile Ulceronecrotic Mucha-Habermann''s Disease with Interstitial Pneumonitis

A case of febrile ulceronecrotic Mucha-Habermann's is presented. This disorder is a severe form of pityriasis lichenoides et varioliformis acuta (PLEVA) characterized by the sudden eruption of diffuse coalescent ulcerations associated with high fever. In the present case the disease was preceded by the milder typical form of PLEVA. Histologically a leukocytoclastic vasculitis was seen in addition to the usual lymphocytic perivascular and lichenoid infiltrate. During the course of the disease the patient developed an interstitial pneumonitis which resolved concomitantly with the cutaneous lesions. Adenovirus type II recovered at the height of the illness from the patient's urine may have etiologic implications in the pathogenesis of the disease.