Budd-Chiari syndrome with inferior vena cava obstruction associated with systemic lupus erythematosus.

The Budd-Chiari syndrome is an uncommon condition in which hepatic venous outflow is obstructed by thrombosis of the major hepatic veins. Many of the cases are idiopathic, but it has been described in association with vena caval webs, abdominal trauma, retroperitoneal neoplasms, and hypercoagulable states. A patient with systemic lupus erythematosus (SLE) who developed the Budd-Chiari syndrome with inferior vena cava thrombosis led to a review of the possible association between SLE and the Budd-Chiari syndrome. The therapy of the Budd-Chiari syndrome with associated vena cava thrombosis is also discussed.

An investigation of the possible inverse relationships between the occurrence of rheumatoid arthritis, osteoarthritis and schizophrenia.

One hundred and eleven inpatients with schizophrenia and 51 with other psychiatric conditions were compared for the frequency of rheumatoid arthritis, other connective tissue disorders and other physical illness. Evidence both of rheumatoid arthritis and osteoarthritis was significantly less in the schizophrenia group. Latex Agglutination Tests were positive to the same extent in both groups. One possible explanation of the findings is that they are due to the reduced frequency of trauma or stress to the joints in schizophrenic inpatients, many of whom lived in hospital, compared with the control group. Other explanations are also considered.

Septic Discitis.

The clinical and laboratory findings in 15 patients with septic discitis are reported. The clinical picture was that of a sub-acute illness characterized by back pain, spinous process tenderness, and sciatic nerve root irritation. There was a considerable delay from clinical presentation to diagnosis (average 14 wk). The erythrocyte sedimentation rate was the most useful diagnostic laboratory blood test and the best indicator of disease activity. The relative value of plain radiographs, tomography, and radionuclide bone scans is discussed. Needle aspiration of the disc space was found to be a useful diagnostic test. We found that a diagnosis of septic discitis could be made even in the absence of positive bacterial cultures from various biologic fluids or from the disc space. Long-term oral and intravenous antibiotic therapy with controlled rest resulted in a favourable outcome.

Gold-induced thrombocytopenia.

Ten patients with rheumatoid arhritis treated with gold sodium thiomalate developed thrombocytopenia without bone marrow asplasia. There was no life-threatening blood loss, but petechiae, purpura, or echymoses were seen in eight patients. The serum gold levels monitored in one patient did not exceed levels seen in patients without thrombocytopenia. In three cases peripheral blood lymphocytes were cultured in the presence of gold and tritiated thymidine incorporation was significantly increased. Eight patients responded to steroid therapy, one patient to BAL and pencillamine, and one patient to vincristine.

Recent investigative procedures for diagnosing rheumatic disease.

Recent advances in investigative procedures have improved diagnosis of arthritis. Serologic tests such as rheumatoid factor and antinuclear antibody determinations, although not diagnostic, may be used to support or exclude a clinical diagnosis of rheumatoid arthritis or systemic lupus erythematosus. A systematic approach to joint fluid analysis has helped in the differential diagnosis of rheumatic diseases. Radionucleotide joint scanning and determination of histocompatibility antigens appear promising, although they are still under investigation.