Cutaneous vasculitis associated with acute and chronic hepatitis.

We encountered 11 patients who had rashes associated with hepatitis. Five of six acute hepatitis cases, but only one of five chronic hepatitis cases, were related to hepatitis B. Nine of the 11 patients had rash in the absence of clinically overt liver disease. Skin biopsy specimens showed histologic evidence of cutaneous vascular injury; specimens of urticarial and maculopapular rashes, which were seen in this series only with acute hepatitis, showed a primarily lymphocytic venulitis with focal necrosis, while palpable purpura, which was seen in this series only in chronic hepatitis, showed a primarily neutrophilic necrotizing vasculitis involving small vessels. One patient had lichen planus-like lesions. Demonstration of vascular deposits of immunoglobulins, complement, and fibrin in skin, as well as hypocomplementemia, circulating immune complexes, and mixed cryoglobulinemia, in these patients suggests that cutaneous lesions associated with liver disease resulted from immune complex-mediated vascular injury.

Effects of experience on agonistic behavior among American goldfinches.

I investigated the effect of a winning or losing experience on the outcome of an individual's next aggressive encounter among captive American Goldfinches (Carduelis tristis ). Aggressive encounters occurring over access to a feeder were videotaped during the winter of 1985-1986. Both dominants and subordinates were more likely to win their next encounter after a win than after a loss. Individuals were more likely to initiate their next encounter and use higher risk displays after a win than after a loss.

The predictability and patterns of vigilant behaviour.

While foraging, many animals alternate between feeding and scanning. Spectral analysis of continuous series of scan durations S and inter-scan intervals I for American Goldfinches Carduelis tristis, feeding either on small or large seeds, and choughs Pyrrhocorax pyrrhocorax showed that there were nonrandom fluctuations in the magnitude of S and I is all the examined series. Both the I and S showed cyclical oscillations between short and long events. Within individuals the sequential and temporal patterns in the I and S series were similar. However, the temporal patterns were more affected by variations in food-handling time than were the sequential ones. The predictability of the I and S series and the similarity, within individuals, of their sequential and temporal patterns seem general processes resistant to variations in behavioural constraints, and the temporal patterns in the I and S series fit to the method of handling food.

Extrahepatic biliary obstruction caused by metastatic breast carcinoma.

We describe our experience with seven patients who had extrahepatic biliary obstruction caused by metastatic breast cancer. The interval from the original diagnosis of breast cancer to the development of jaundice averaged 40 months, with a range of 9 months to 8 years. All patients were treated with surgical decompression, radiation, transhepatic catheter drainage, chemotherapy, or a combination of these modalities. Resolution of jaundice was achieved in six patients. Prolonged survival was realized in three; one patient lived for more than 6 years after surgical bypass, and two are alive and well at present (greater than 11 months after relief of biliary obstruction). Extrahepatic biliary obstruction by metastatic breast carcinoma should be distinguished from jaundice due to hepatic parenchymal destruction by this tumor; while the latter implies end-stage cancer, the former has the potential for significant palliation and prolonged survival.

Long-term patency, pancreatic function, and pain relief after lateral pancreaticojejunostomy for chronic pancreatitis.

Ten patients, all with intractable pain due to chronic pancreatitis, were selected for treatment by lateral pancreaticojejunostomy (modified Puestow procedure) after preoperative endoscopic pancreatography in each had revealed dilatation of the main pancreatic duct. Follow-up endoscopic pancreatograms performed 1 yr after surgery show a patent anastomosis in all 10 patients. Eight of these 10 are largely or completely pain-free, but 2 continiue to have pain without improvement after the operation. Surgical success in relieving pain was accompanied neither by improvement in pancreatic function, nor by protection against its further deterioration: Whereas 2 patients had malabsorption and 3 were diabetic preoperatively, 6 had malabsorption and 5 had diabetes postoperatively. This progression of exocrine or endorine pancreatic insufficiency indicates that decompression of the dilated pancreatic duct, although an effective means for relief of pain in chronic pancreatitis, does not prevent continuing destruction of pancreatic glandular tissue.

Essential mixed cryoglobulinemia without evidence for hepatitis B virus infection.

Prompted by reports associating essential mixed cryoglobulinemia with hepatitis B, we tested for hepatitis B markers in serum and cryoprecipitates and searched for virus particles by electron microscopy in cryoprecipitates from 12 patients with essential mixed cryoglobulinemia and 22 control subjects with mixed cryoglobulinemia secondary to recognized disease processes. None of the patients with essential cryoglobulinemia had detectable serum hepatitis B surface antigen (HBsAg) or antibody (anti-HBs), whereas five of the 22 patients with secondary cryoglobulinemia were positive for either HBsAg or anti-HBs. In cryoprecipitates from 10 patients with essential cryoglobulinemia, we could not detect HBsAg by radioimmunoassay or virus particles by electron microscopy, but one cryoprecipitate was anti-HBs-positive; however, four of 12 cryoprecipitates from patients with secondary cryoglobulinemia were positive for HBsAg or anti-HBs. Evidence of liver disease was present in similarly small proportions of both groups. Thus, in almost all our patients, essential mixed cryoglobulinemia was unrelated to hepatitis B infection.