Adult-onset Still''s disease with atypical cutaneous features

INTRODUCTION: The diagnosis of adult-onset Still's disease (AOSD) can be very difficult. There are no specific tests and reliance is usually placed on a symptom complex and the well described typical rash seen in most patients. In recent years, however, other cutaneous manifestations of AOSD have been reported but these are not so well known. OBSERVATIONS: We report a patient with urticaria and fixed plaques and review the other 'atypical' cutaneous findings associated with AOSD. CONCLUSIONS: The diagnosis of AOSD can be made in the absence of the typical Still's rash but in the presence of other atypical cutaneous features.     

Psychotherapie-Vergütung nach Ablehnung durch die GKV

Abstrakt Ein Vertragsarzt darf seine psychotherapeutischen Leistungen bis zur H?he der EBM-Betr?ge bei dem Kassenpatienten liquidieren, wenn die Krankenkasse die erforderliche Zustimmung versagt und der Patient in Kenntnis der Ablehnung die Therapie fortführt. (Leitsatz des Bearbeiters)     

The value of immunoglobulin and complement levels in the early diagnosis of neonatal sepsis

Serum IgG, IgGl, G2, G3, G4, IgM, C3c and C4 concentrations were measured in 24 term neonates with sepsis and 17 healthy normal neonates of similar age, sex and weight (control group). The serum IgG, IgG1, G2, G3, G4, IgM, C3c, and C4 levels were similar in the patients with sepsis and the control group ( p > 0. 05). In the neonates with sepsis, serum IgG, G1, G2, IgM and C4 levels were not significantly different between the 1st and 10th days, while there were significant differences for IgG3, G4 and C3c ( p < 0. 05). We conclude that the serum levels of IgG, IgG1, G2, G3, G4, IgM, C3c and C4 concentrations are of no value for the early diagnosis of neonatal sepsis.     

Differential Renal Function Studies in the Diagnosis of Renal Hypertension

Over a 10-year period, positive criteria of the Howard test and the Rapoport Index have shown consistently good correlation with sustained relief or marked improvement in hypertension, in patients with main renal artery lesions. Similar correlation was obtained with ischemic criteria from histopathologic studies.

Differential function studies did not reveal positive ischemic criteria in any patient operated upon for unilateral parenchymal disease. Histopathologic criteria of ischemia were also infrequent in this group. Nevertheless, marked improvement or cure of hypertension occurred in 62% of the latter. No factor can be used to predict improvement in this type of renal hypertension. Differential renal function criteria may occasionally appear to indicate renal artery ischemia in the more normal kidney in patients with unilateral parenchymal renal disease; wrong interpretation is avoided by taking differential creatinine clearance into account. Until vasopressor substances can be easily measured and accurately interpreted, aortography is indicated in selected patients.

     

Basilar venous plexus of the posterior fossa: a potential source of error in petrosal sinus sampling

Sampling of serum from the inferior petrosal sinus can provide important information about the source of elevated adrenocorticotropic hormone (ACTH) levels. This often leads to improved results of pituitary surgery for Cushing disease. The authors describe a successful catheterization technique and illustrate the venous anatomy of the inferior petrosal sinuses and basilar plexus.     

Acquired C1-esterase inhibitor deficiency: Three case reports and commentary on the syndrome

Acquired C1-esterase inhibitor deficiency is a rare syndrome which usually presents with episodes of angioedema. Most patients have an underlying lymphoproliferative disorder. It is important to gastroenterologists, haematologists, immunologists and dermatologists, as these are the more likely specialties to which the patient will present. Recognition of the syndrome is important not only for diagnostic purposes but for investigating and treating any associated underlying lymphoproliferative disorders. In some instances the angioedema may precede the lymphoma by many years. Optimal patient management requires that both angioedema and the underlying lymphoma be recognized and treated.