Pyomyositis associated with Epstein-Barr virus infection.
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Biomedical subjects
Publications and source records attributed to H M Markusse.
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A 26 year old man with a nine year history of adult onset Still's disease (AOSD) developed sensorineural hearing loss during an exacerbation of his disease. This complication has not previously been described in association with adult onset Still's disease. He responded favourably to steroid treatment.
A patient with long-standing rheumatoid arthritis developed hypercalcemia (3.13 mmol/l) and was subsequently found to have a B-cell lymphoma (centroblastic type). The hypercalcemia was associated with high circulating concentrations of 1,25-dihydroxyvitamin D (235 pmol/l) and both abnormalities were corrected with treatment. A lymph node was excised before treatment and was incubated in vitro with either labeled or unlabeled 25-hydroxyvitamin D3. After purification of the extract and chromatography on three different HPLC systems, material comigrating with authentic 1,25-dihydroxyvitamin D3 was identified. This was shown to bind to a specific chick intestinal cytosol receptor and to dilute in parallel with synthetic 1,25-dihydroxyvitamin D3 in the receptor binding assay. In conclusion, hypercalcemia in malignant B-cell lymphoma can be due to extrarenal production of 1,25-dihydroxyvitamin D by lymphomatous tissue.
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Subcutaneous fat biopsy was investigated for its sensitivity in giving a diagnosis in 44 consecutive patients with rheumatoid arthritis or ankylosing spondylitis suspected of systemic amyloidosis. In 26 of these patients amyloidosis could be demonstrated by fat or rectal biopsy or biopsies from organs suspected of amyloid deposition. Fourteen of the 26 (54%) fat biopsy specimens of the patients with amyloidosis were positive after staining with Congo red and 22 (85%) of the rectal biopsy specimens were positive. All 12 kidney biopsy specimens and 4 biopsy specimens from other organs of these 26 patients were positive for amyloidosis. In 2 patients with a negative rectal biopsy specimen, fat biopsy would have obviated the need for a more invasive biopsy. All patients experienced fat biopsy as less demanding compared to other biopsy procedures. These results imply that in patients with chronic arthritis subcutaneous fat biopsy is a useful screening procedure. In this patient group fat biopsy is less sensitive for the diagnosis of amyloidosis compared to rectal biopsy.
Tear fluid analysis was performed in 44 patients with primary SS, 21 patients suspected of having primary SS in whom the syndrome had been excluded, and 24 control subjects. In the primary SS patients the tear fluid levels of lactoferrin and a1-antitrypsin were increased and the tear fluid levels peroxidase, lysozyme and amylase were decreased. However, a considerable overlap in the concentrations of all of the tested substances in the different groups was found and the measurement of these substances cannot be advocated for diagnostic use.