Outpatient drug-induced parenchymal liver disease requiring hospitalization.

A case-history study of drug-induced liver disorders requiring hospitalization was carried out at the Group Health Cooperative of Puget Sound, a health maintenance organization with about 280,000 members, for the five-year period from January 1, 1977 to December 31, 1981. During this time, there were 12 instances of hospitalization for liver disorders judged to be probably (nine cases) or possibly (three cases) attributable to outpatient drug ingestion (other than antitumor agents). The rate was on the order of one per 100,000 person-years at risk. Drugs implicated as probable causes were ampicillin (two cases), carbamazepine (one case), erythromycin (one case), methyldopa (one case), sulfasalazine (one case), quinidine (one case), trimethoprim/sulfamethoxazole (one case), and multiple drugs (one case).

Simple production method for a Nd:YAG pumping cavity.

We propose a simple method of laser cavity production in which pumping is performed with two lamps.

Rectal biopsy helps to distinguish acute self-limited colitis from idiopathic inflammatory bowel disease.

A retrospective blind evaluation of rectal biopsy specimens from 44 patients with acute self-limited colitis and 104 patients with idiopathic inflammatory bowel disease was done. Seven histologic features proved highly discriminant because they occurred often in idiopathic inflammatory bowel disease but rarely, if at all, in acute self-limited colitis. The features with a high predictive probability (87%-100%) of diagnosing idiopathic inflammatory bowel disease were distorted crypt architecture, increased numbers of both round cells and neutrophils in the lamina propria, a villous surface, epithelioid granuloma, crypt atrophy, basal lymphoid aggregates, and basally located isolated giant cells. One or more of these features was present in 79% of all idiopathic inflammatory bowel disease cases. They were seen in both acute and chronic idiopathic inflammatory bowel disease. The biopsy features favoring acute self-limited colitis were less useful. Biopsy diagnosis of acute self-limited colitis is thus primarily based on the absence of histologic criteria favoring idiopathic inflammatory bowel disease. This study provides objective validation of histologic criteria in rectal biopsy that help differentiate acute self-limited colitis from idiopathic inflammatory bowel disease.

An inflammatory axonopathy of the myenteric plexus producing a rapidly progressive intestinal pseudoobstruction.

A previously well 39-yr-old man presented with a 4-wk history of abdominal pain, nausea, vomiting, and weight loss. An upper gastrointestinal examination showed retained food in the stomach and duodenal dilatation. A radioisotope meal showed little gastric emptying; esophageal manometry was normal. Because of persistent symptoms, a duodenojejunostomy was done. However, the patient remained symptomatic and after an episode of profuse vomiting, aspirated and died 10 wk after initial presentation. At autopsy, no tumor was found. Hematoxylin and eosin stains throughout the gastrointestinal tract showed many lymphocytes and plasma cells within the myenteric plexus. Silver stains showed the argyrophilic and argyrophobic neurons to be normal, but axons showed beading, fragmentation, and dropout in all areas. We therefore concluded the following: intestinal pseudoobstruction can be caused by an inflammatory neuropathy of the myenteric plexus, not associated with a distant carcinoma, and this process produced an axonopathy while sparing neuron bodies.