Urticaria in association with etiocholanolone fever

A 17-year-old girl is reported with a history of recurrent febrile episodes during her menstrual bleeding accompanied by a generalised exanthem. Increased plasma levels of unbound etiocholanolone were noticed during the febrile attacks. Both the fever and the skin eruption could be suppressed by oral contraceptives.     

The Effect of Coronary Bypass Graft Surgery for the Prevention of Sudden Cardiac Death: Recurrent Episodes After ICD Implantation and Review of Literature

Sudden cardiac death (SCD) accounts for at least 50% of the mortality of patients with ischemic heart failure. Ventricular arrhythmias are responsible for most cases of sudden cardiac death. There is some evidence that coronary artery bypass graft (CABG) surgery may reduce the incidence of recurrent episodes of SCD by prevention of myocardial ischemia. To test the hypothesis that CABG surgery is effective in the prevention of SCD, we compared the recordings of implantable cardioverter defibrillators (ICD) in patients who underwent ICD implantation alone (n = 64) or ICD implantation and concomitant CABG surgery respectively (n = 11). All patients had experienced out of hospital cardiac arrest. ICD recordings were obtained every 3 months and the number of recurrent episodes of ventricular tachycardia (VT) for each time period was noted. Three months foilowing ICD implantation patients in the surgically treated group had an average of one episode of VT per patient as compared to 2.7 episodes in the nonsurgical group. This difference was observed during the following months as well. However, at nlo time (up to 18 months of follow-up) this difference reached statistical significance. There were no deaths in the surgically treated group. Although we could not demonstrate a statistical significant difference between the two groups, there was a tendency in the surgically treated group to have less episodes of recurrent VT than in the medically treated group. We, therefore, conclude that survivors of SCD presenting with multivessel coronary artery disease (CAD) should undergo coronary artery bypass grafting to prevent myocardial ischemia as the triggering event for lethal ventricular arrhythmias.     

Prognostic indicators in breast cancer-morphometric methods

Morphometric methods were applied to predict the clinical course of individual patients with breast cancer. Measurement of tumour diameter, assessment of mitotic and cellular indices, and quantitative microscopy of nuclear features were assessed together with nuclear features and histological grades. Of the tumours from 78 patients investigated, 42 had died from metastases within 6.5 years ('non-survivors'), while the other 36 were alive and well without evidence of metastases at the end of the follow-up period (minimum 6.5 years) ('survivors'). If the tumours of the 42 non-survivors are compared with those of 36 survivors, there are many reproducible significant differences, the most important being cellularity index and mitotic activity index, followed by quantitative microscopical nuclear parameters and nuclear and histological grade. Discriminant analysis, of the quantitative microscopical data alone showed 82% of all patients to be correctly classified as survivor or non-survivor. By contrast with the axillary lymph node invasion status alone, or the tumour diameter and axillary lymph node status together, 59% and 64% of the patients were predicted correctly as survivor or non-survivor. With a more realistic statistical approach of discriminant analysis, 78% of the patients were classified correctly with quantitative microscopy, in place of 54% with the axillary lymph node status, 56% with the TNM-system and 64% with a combination of TNM system and nuclear and histological grade. Morphometry thus seems possible to predict the outcome of individual patients more accurately than with the usual staging/grading methods. This technique might therefore prove to be useful in the selection of patients for adjuvant chemotherapy.