Transient subcutaneous granulomatosis of the upper extremities in Crohn's disease.

Skin lesions occur fairly commonly in patients with Crohn's disease of the colon (14%). Erythema nodosum and pyoderma gangrenosum are the most frequently recognized. Granulomatosis of the skin, continuous with bowel involvement, has been reported. Involvement of the subcutaneous tissue, discontinuous with intestinal disease, is unusual and we wish to report a case of Crohn's disease of the colon complicated by infraepidermal perivascular granulomas of the forearms. The lesions disappeared spontaneously.     

Diabetic and hypoglycemic neuropathy--a comparison in the BB rat

Functional and structural neuropathy was examined in hyperglycemic (diabetic) BB rats maintained on small maintenance doses of insulin, hyperglycemic BB rats receiving no insulin, and BB rats in whom hypoglycemia was induced by the administration of excessive insulin doses. The data were compared with those of non-diabetic age- and sex-matched BB rats. Functional deficits and structural abnormalities were comparable in diabetic rats with and without insulin supplementation, suggesting that the generally necessary insulin dosing in this model does not per se account for the neuropathy. Hypoglycemic neuropathy was characterized by slowing of nerve conduction velocity, marked loss of anterior horn motoneurons and Wallerian degeneration, as well as loss of large myelinated fibers, suggesting a neuropathy involving predominantly motoneurons. Diabetic neuropathy was not associated with nerve cell loss but showed marked axonal atrophy involving predominantly sensory fibers. Thus, diabetic and hypoglycemic neuropathies are two distinguishable entities under strict experimental conditions, but may overlap in human diabetic subjects in whom tight insulin control is desirable.     

Ocular changes with oral and transepidermal diethylcarbamazine therapy of onchocerciasis.

Twenty men with moderate infection of Onchocerca volvulus were studied in a double-masked, controlled clinical trial to compare the safety and efficacy of oral diethylcarbamazine (DEC) with topical DEC lotion. Visual acuity and colour vision did not alter during the 6 months of observation, although 2 patients receiving DEC lotion and 3 patients receiving oral DEC developed either visual field constriction or optic atrophy. Fluffy corneal opacities were common in both groups. Intraocular microfilariae also appeared in both groups but to a greater extent in those receiving DEC lotion. New chorioretinal changes developed in 4 men receiving lotion and in only 1 receiving tablets. It is concluded that DEC lotion offers no advantage over tablets in the treatment of ocular onchocerciasis and in fact may be associated with more ocular complications than the conventional oral treatment.     

The relationship of embryotoxicity to disposition of 2-methoxyethanol in mice

Paw development of CD-1 mice is uniquely sensitive to 2-methoxyethanol (ME) given by gavage (po) on gestation day (gd) 11 (copulation plug day = gd 0). The relation between induction of paw dysmorphogenesis and disposition of po ME (3.3 or 4.6 mmol/kg) in the maternal and conceptus compartments was investigated. The expression of digit malformations depends on metabolism of ME to methoxyacetic acid (MAA). ME and MAA were equipotent in causing teratogenicity. Alcohol dehydrogenase (ADH) catalyzes the initial rate-limiting oxidation that leads to embryotoxicity. The ADH inhibitor 4-methylpyrazole (0.12 or 1.2 mmol/kg) or ethanol (43.3 mmol/kg, single dose concomitant with ME or additional ethanol 5 and 10 hr later) reduced the incidence of malformations 60-100%, depending on the dosing regimen. Elimination of 14C from 1,2-14C-ME occurred predominantly via urine where 80% of a teratogenic dose was excreted and 6% appeared in CO2. Oxidation of ME to MAA was nearly complete after 1 hr when approximately 90% of 14C in maternal plasma and conceptus coeluted with authentic 14C-MAA upon HPLC. 14C-MAA levels in embryos were 1.2 X those in plasma 1 and 6 hr after dosing, although by 6 hr concentrations had declined to approximately 50% of 1-hr values. Concomitant ethanol did not affect 14C kinetics as measured in maternal blood after oral 14C-ME, but retarded ME conversion to MAA by about 2 hr. Furthermore, embryo 14C-MAA levels then reached only 50% of the peak in embryos from dams dosed with ME alone, an effect that coincided with less 14C incorporation into macromolecules synthesized by the embryo within 6 hr. These data imply that the attenuation of digit malformations by concomitant ethanol may be explained by changes in MAA disposition. However, delayed ethanol (5 and 10 hr after 3.3 mmol ME/kg) reduced teratogenicity by 25%, although MAA was present in the embryo up to 5 hr. Dams given 14C-MAA by iv injection had higher 14C blood levels than after MAA po but their offspring had fewer digit malformations. Peak and steady-state plasma levels of MAA as well as embryo concentrations of the chemical do not appear to determine the embryotoxic outcome whereas further metabolism of MAA does.     

Falloposcopic cannulation, oviductal appearances and prediction of treatment independent intrauterine pregnancy

The purpose of this study was to determine whether there isan association between the appearance of the oviductal lumenduring falloposcopic examination, and the occurrence of intrauterinepregnancy or ectopic pregnancy independent of treatment. Sixty-twoconsecutive women were recruited who were examined falloposcopicallyin-office, and who did not require subsequent surgical interventionto restore tubal patency. There was a heterogeneous group ofpresentations including unilateral and bilateral proximal tubalocclusion, unexplained infertility and the presence of minorlaparoscopic abnormalities which might suggest the possibilityof occult endotubal pathology. A stepwise Cox's model of lifetable analysis selected the number of falloposcopically normaland patent Fallopian tubes as the only variable significantlyassociated with intrauterine pregnancy, when all clinical, demographicand investigative data were analysed. The presence of minordistal intra-tubal adhesions was selected on stepwise analysisas the only variable significantly associated with the occurrenceof ectopic pregnancy. A number of falloposcopic abnormalitieswere significantly associated with outcome in the clinical sub-groupwho presented with bilateral proximal tubal occlusion. Thesedata suggest that falloposcopy is a valuable clinical tool whichprovides useful prognostic data for the prediction of intrauterinepregnancy or ectopic pregnancy.     

Steatohepatitis in Obese Children: A Cause of Chronic Liver Dysfunction

Adult obese patients have been reported to present with hepatic abnormalities characterized by fatty hepatitis, fibrosis, and cirrhosis. These abnormalities however, have not been reported to occur in children. We report three obese children with steatohepatitis that presented with nonspecific abdominal pain and abnormal liver-function tests. Obese children should have a thorough investigation of their liver function even in the absence of symptoms or signs.     

The problem-oriented medical record applied to communicative disorders.

A continuing interest in clarity of reporting generated a change in our reporting format from the traditional report to the problem-oriented structure. This article discusses the differences and the advantages and disadvantages of each.