Total creatinine kinase and isoenzyme MB activity in serum and skeletal muscle of a patient with dermatomyositis.

Total creatine activity was greatly increased, and creatine kinase MB isoenzyme was measurable in the serum of a patient with dermatomyositis. In contrast, total CK activity in an extract of skeletal muscle from this patient was markedly decreased as compared with normal muscle extracts, but contained about the normal proportion of the MB isoenzymes, 1.5%. We believe skeletal muscle to be the source of the MB isoenzyme in the serum, because the patient's electrocardiographic pattern was normal and she had no signs or symptoms of myocardial infarction.

Budd-Chiari syndrome in women taking oral contraceptives.

The report concerns a 21-year-old woman who, after having taken oral contraceptives for three months, developed the Budd-Chiari syndrome as the results of a widespread chronic obliterative process involving the intrahepatic venous system. The diagnosis was established by liver biopsy. She was treated with supportive measures and completely recovered after 28 days of hospitalization. The literature is reviewed regarding the Budd-Chiari syndrome in women taking oral contraceptives and the clinical and pathological features seen in those reported patients are discussed.

PIP: Sine 1966 when the 1st reference of OCs (oral contraceptives) as a cause of Budd-Chiari syndrome was made, 18 such cases have been reported. A further case of a 21-year-old woman who, having taken OCs for 3 months, developed the Budd-Chiari syndrome as the result of a widespread chronic obliterative process involving the intrahepatic venous system is reported. The Budd-Chiari syndrome, i.e., occlusion of the hepatic veins, was diagnosed by liver biopsy. The treatment is described and recovery was complete following 28 days of hospitalization. The literature regarding the incidence of Budd-Chiari syndrome in women taking OCs is reviewed. In recent years, aggressive surgical treatment has been recommended for this syndrome.

Invasion of the Fallopian tube by Enterobius vermicularis.

A solitary granuloma containing a gravid female pinworm was incidentally found in the fallopian tube of a 27 year old woman. On rare occasions, pinworms have been found outside the gastrointestinal tract, most frequently in the peritoneal cavity. The reported cases have been found at all levels of the female reproductive tract from the introitus to the fallopian tube. Thus, the hypothesis is supported that the worms reach the pelvic cavity via the genital tract. In addition, pinworm granulomas have also been found in the liver, lung, prostate and the renal pelvis. Awareness that such lesions may occur is important since the lesions may be interpreted as being malignant with subsequent unnecessary surgical intervention.

A review: adverse effects of oral contraceptives.

PIP: A summary of what is currently known about the negative side effects associated with oral contraceptive usage is presented, and recommendations for prescribing OCs (oral contraceptives) are made. According to the results of several investigations, 2-18% of all women who take OCs develop hypertension. For most of these women the effects are mild; however, for some the increase in blood pressure is marked and results in renal damage. Several studies demonstrate that the risk of peripheral venous thrombosis and pulmonary embolism is enhanced for women who use OCs compared to nonusers. The risk is somewhat reduced for those who take low estrogen OCs. Women aged 30-39, who take OCs, are 3 times more likely to suffer a myocardial infarction than those who do not use OCs. This risk is markedly increased among OC users who either smoke or suffer from hypertension, diabetes, or hypercholesterolemia. OC users have a 9.5 times greater risk of thrombolic stroke and a 2.0 times greater risk of hemorrhagic stroke than nonusers. For women over 27 years of age, OC usage is associated with the development of benign hepatic adenoma. This risk increases markedly with duration of pill use and is greater for women who take pills containing mestranol compared to those who take pills containing ethinyl estradiol. Occasionally cases of pulmonary hypertension, peripheral arterial occlusion, mesenteric vascular insufficiency, Budd-Chiari syndrome, and noninflammatory cholestatic liver injury are reported among OC users. Recommendations are: 1) women with thromboembolic disorders and women over 34 years old, who smoke or who are obese or hypertensive should be advised to consider other forms of contraception; 2) prescriptions should be written for a 6 month supply and renewed only after a follow-up visit; 3) women who experience elevated blood pressure readings should be advised to discontinue usage; 4) serum triglyceride and cholesterol should be checked every 6 months; and 5) consider the use of low dose heparin for OC users who are recovering from trauma or surgery or who are confined to bed for long periods of time.^ieng