Large-cell lymphoma presenting as acute cholecystitis.

A 62-year-old woman presenting with a clinical picture of acute cholecystitis was found to have lymphoma upon pathological examination of the gallbladder. Such a presentation of large-cell non-Hodgkin's lymphoma is unique and has not been described before.

The effect of acutely reduced plasma osmolality on acute renal failure in rats.

The present study was designed to evaluate the effect of acute fall in plasma osmolality in three models of acute tubular necrosis in rats: (a) glycerol, (b) arterial clamping and (c) mercuric chloride. Plasma osmolality was reduced by a water loading during a mild anaesthesia from 305 +/- 7 to 270 +/- 12 mosmol/kg of water (P less than 0.01). In the ischaemic models of acute tubular necrosis (glycerol and arterial clamping), during the first 24 h in rats with reduced plasma osmolality, the respective creatinine clearance rates (CCR), 0.04 +/- 0.02 and 0.06 +/- 0.04 ml/min, were strikingly lower than those in rats with normal osmolality, 0.21 +/- 0.03 and 0.26 +/- 0.06 ml/min (P less than 0.001) respectively. The control CCR were 0.65 +/- 0.07 and 0.62 +/- 0.07 ml/min respectively. During the second day after induction of ischaemic (glycerol and arterial clamping) acute tubular necrosis, rats with reduced plasma osmolality exhibited a similar worsening in CCR as on the first day, when compared with that in rats with normal osmolality. In rats with acute tubular necrosis induced with mercuric chloride reduction in plasma osmolality did not aggravate the severity of renal failure. These results show that acute fall in plasma osmolality worsens the renal failure in the ischaemic but not in the nephrotoxic models of acute tubular necrosis.

Conservative approach in treating acute renal carbuncle.

During the years 1980-82 seven patients with renal carbuncles successfully underwent conservative treatment with antibiotics alone. Early diagnosis was made using excretory urography and nephrotomography, ultrasound and computerized tomography scan. Follow-up studies showed a normal kidney in six of the seven patients. One patient had a clinical remission, but ultrasound follow-up showed a small area in the right kidney with a few low-level echoes, representing focal scarring.

Blockade of the renal tubular effects of vitamin D by cycloheximide in the rat.

To further characterize the mechanisms by which 25(OH) vitamin D3 (25(OH)D3) and 1.25(OH)2 vitamin D3 (1,25(OH)2D3) suppress the phosphaturic action of parathyroid hormone (PTH) we have studied the effects of cycloheximide (cyclohex), a protein synthesis inhibitor, on the interaction between PTH and vitamin D metabolites in parathyroidectomized (PTX) rats, both in vivo and in vitro experiments. In clearance studies PTX PTH-infused rats were pretreated with cyclohex 2 h before the administration of vitamin D. In control, PTX PTH-infused rats not pretreated with cyclohex, the administration of 25(OH)D3 and 1,25(OH)2D3 was associated with a fall in fractional excretion of phosphate (CP/CIN) from 0.30 +/- 0.05 to 0.16 +/- 0.02 and from 0.31 +/- 0.05 to 0.13 +/- 0.01 (P less than 0.005) respectively. Cyclohex-pretreated PTX PTH-infused rats failed to respond to both 25(OH)D3 and 1,25(OH)2D3, and CP/CIN, which rose after PTH, remained 0.32 +/- 0.05 and 0.29 +/- 0.03 respectively. In vitro, both 25(OH)D3 and 1,25(OH)2D3 inhibited the PTH-induced activation of adenylate cyclase in the renal isolated membrane fractions. Pretreatment with cyclohex abolished this effect of vitamin D metabolites. These results show that cyclohex blocks the antiphosphaturic effects of both 25(OH)D3 and 1,25(OH)2D3 but does not alter the response to PTH. These findings are consistent with the possibility that the acute renal action of vitamin D depends on de novo synthesis of protein.

The management of laryngotracheal stenosis in burned patients.

Following burns of the upper respiratory tract, laryngotracheal stenosis is associated with considerable morbidity. This paper deals with the cumulative effect of various pathologic processes involved in burn trauma of the upper airway. Emphasis is placed on the extended use of endotracheal intubation and the avoidance of tracheostomy whenever possible. When laryngotracheal stenosis develops, it may be safely and successfully treated by prolonged stenting, as has been borne out by our experience with the T-shaped silicone tubes. Limited reconstructive procedures can be performed to facilitate proper placement of the stent. In our opinion, laryngotracheal resection and reconstruction are not the procedures of choice in burn cases. Our experience in following the preceding guidelines is described. Three illustrative cases serve to exemplify the difficulties and problems involved in the various stages of treatment and the results obtained. The patients are symptom-free 18 to 24 months following stenting, and all enjoy an adequate airway and good voice. There were no complications resulting from this treatment and we suggest that it is worthy of trial.

Thermography as a diagnostic aid in tennis elbow.

Thermal screening was used in order to distinguish between Tennis Elbow and entrapment of posterior interosseous nerve. Both conditions have a very similar clinical picture but there should be an altogether different approach concerning treatment. The differential diagnosis is therefore of great importance and thermography of the elbow is a valuable aid in this distinction.

Reevaluation of the polyvinylpyrrolidone sedimentation test in the diagnosis of ABO hemolytic disease of the newborn.

The rate of cord erythrocytes sedimentation in 1.5% polyvinylpyrrolidone (PVP) solution was investigated. Of 70 infants showing accelerated sedimentation rate, 49 had signs of hemolytic disease. Rh incompatibility did not affect the sedimentation rate. Infectious diseases might cause a slight increase in the rate of sedimentation. The test was found to be very sensitive. It could detect ABO incompatibilities even in absence of marked bilirubinemia. Furthermore, positive identification of incompatibilities were obtained in ABO-HDN cases where both direct and indirect Coombs tests were negative. High correlation was noted between anti A and B titer of maternal sera and the accelerated sedimentation of newborn red blood cells. The erythrocytes sedimentation test in PVP (PVP-ESR test) is recommended for the early detection of cases in which the red cells are affected by IgG anti-A or anit-B.