Results Of Routine Laboratory Tests Research Articles

A case of adrenal gland dependent hyperadrenocorticism with mitotane therapy in a Yorkshire terrier dog

Hyperadrenocorticism, a disorder characterized by excessive production of cortisol by the adrenal cortex, is well-recognized in dogs. A 10-year-old, intact male, Yorkshire terrier dog was evaluated because of corneal ulceration and generalized alopecia. Diagnosis was made based on history taking, clinical signs, physical examination, and results of routine laboratory testing (complete blood count, serum biochemical analysis, and urinalysis). In addition, adrenocorticotropic hormone (ACTH) stimulation test and abdominal ultrasonography were also used to diagnose this case. The patient was diagnosed as adrenal gland neoplasia and medical therapy using the adrenocorticolytic agent, mitotane, was initiated. An ACTH stimulation test was performed after initial therapy. After successful induction was obtained, maintenance therapy with mitotane still continued.

Cystic Pulmonary Lesion in a Patient With Cough and Eosinophilia

A n 18-year-old male patient from Kasachstan, who had lived in Germany for the previous 20 months, presented during a short vacation in Kasachstan at a local hospital with dyspnea and hemoptysis. Several diagnostic punctures of a pulmonary cyst were seen on a chest radiograph without a definite diagnosis. After returning to Germany, the patient presented at our institution with persisting cough. On physical examination, the patient was afebrile and had absent breath sounds over the right lung base with no other abnormal findings. Routine laboratory test results were normal, apart from an elevated WBC count, with 12,300/ L and a marked eosinophilia of 30%. IgE was elevated (1,224 U/mL). The chest radiograph revealed a large cyst at the base of the right hemithorax (Fig 1). A CT was performed (Fig 2, 3).

Eosinophilic Pleural Effusion in Gnathostomiasis

To the Editor: Moore et al. reported a case series of patients infected with imported gnathostomiasis who had typical intermittent, migratory skin manifestations or peripheral blood eosinophilia or both, as well as undiagnosed eosinophilia with nonspecific symptoms (1). We would like to add some comments based on a recent patient treated in Marseille, France. In April 2003, a 66-year-old man living in Marseille indicated a history of fever for 8 days. He had returned from Vietnam 1 month earlier, where he had stayed for 4 weeks in the Ho Chi Minh City area and 2 days in the Mekong Delta area. He was well during his trip, and reported no arthropod bites except from mosquitoes. He had no direct skin contact with river water. Dietary intake included local dishes with rice, fish, pork, shrimp, and chicken. His symptoms started 3 weeks after he returned to Marseille and included fever (temperature 38°C), asthenia, chills (1 day), moderate dyspnea during exercise, transient bilateral pain of the testes, and an episode of hemospermia. He was referred by his family doctor to the Infectious and Tropical Diseases Unit, North Hospital. On admission, the patient's temperature was 38°C. Physical examination of the patient, including the testes, was normal except for a systolic heart murmur (preexisting and known to the patient), and clinical signs of left pleural effusion. The effusion was subsequently confirmed by chest x-ray, which also showed a discrete diffuse bilateral lung infiltrate. Results of routine laboratory tests conducted on blood samples were normal except for an elevated eosinophil count of 5.2 109/L. Blood smears for plasmodia and microfilaremia were negative. Urologic examination, including echography and prostate-specific antigen, showed no abnormalities except a prostatic adenoma (preexisting and known to the patient). No eggs or parasites were detected by microscopic examination in stools or in urine, although both sedimented and centrifuged urine specimens were studied and filtration techniques were used. After transthoracic aspiration of 100 mL of pleural effusion, cytologic examination showed an eosinophil count of 5,800/L without parasites. Bacterial culture, including mycobacteria, was negative. On day 4, the patient was afebrile and was discharged. On admission, results of a first set of examinations involving reactivities to schistosomiasis, paragonimiasis, strongyloidiasis, cysticercosis, trichinosis, gnathostomiasis, filariasis, and toxocariasis were negative. One month later, the eosinophil count of our patient had decreased to 1.8 x 109/L. He was afebrile, and his only complaint was asthenia. A new set of serologic examinations was conducted. The Western blot assay for gnathostomiasis conducted at the Swiss Tropical Institute (Socinstrasse 57, CH-4002, Basel, Switzerland) was positive, showing immunoglobulin G reactivity to four specific bands including the 24-kDa band, considered pathognomonic for the diagnosis of Gnathostoma infection (1). The seroconversion confirmed the diagnosis of gnathostomiasis. All other serologic tests remained negative, except an increase of antibodies against Acanthocheilonema vitae used as antigen for unspecific serologic screening for filariasis (Laboratoire Marcel Merieux, Lyon, France). After a 21-day course of albendazole and a single dose of ivermectin, the eosinophil count of our patient decreased to 0.8 x 109/L. Three aspects of gnathostomiasis as an emerging imported disease can complement the findings of Moore et al. (1). First, the clinical findings in our case are very unusual. Hemospermia is often benign with predominant causes including prostatic and seminal vesicle disease. Infections, including mainly schistosomiasis and tuberculosis, have been associated with these symptoms (2). Although our patient had a prostatic adenoma, this is the first time that hemospermia has been associated with gnathostomiasis. Because of the anxiety hemospermia caused, this symptom was the main reason that our patient consulted our center. Secondly, eosinophilic pleural effusion is also unusual in gnathosthosmiasis. Although reported as a potential cause in reference books (3), a MEDLINE search (key words: gnathostomiasis and eosinophilia and pleural effusion or pleuritis or lung) disclosed only two references to pleural effusion as the main symptom of gnathostomiasis (4,5). The eosinophilic pleural and pulmonary response may be elicited by the larvae of helminths carried hematogenously into lungs and pleura in an aberrant fashion (3). The last point we stress is that, as shown by Moore et al. (1), patients returning from disease-endemic areas, mainly Southeast Asia and Central and South America, should be tested systematically for gnathostomiasis. Although some patients show a typical cutaneous form of gnathostomiasis associated with eosinophilia (6,7), most atypical forms are probably underdiagnosed, and severe neurologic involvement may occur if treatment is not given (1). However, until recently specific serologic tests for gnathostomiasis were available only in Asia, mainly in Thailand and Japan. Some laboratories in Europe currently provide testing for gnathostomiasis, which would be a valuable aid in evaluating patients returning from the tropics.

Clenched fist syndrome with palmar lichen planus

A 16‐year‐old girl had a 4‐year history of hyperkeratosis and fissures on the palm. The skin lesions had gradually progressed to thick hyperkeratosis with mild pruritus, diffusely covering the right palm, and leading to flexion contractures of the fingers with mild pain. There was no family history of similar lesions. Her father had died 4 years previously. Dermatologic examination revealed hyperkeratosis, scaling, a mild yellow color, fissures, and maceration on the palm and volar surface of the fingers of the right hand (Fig. 1). There was an approximately 3 cm × 4 cm hyperkeratotic lesion on the palm of the left hand.Hyperkeratosis with a mild yellow color, scaling, fissures, maceration on the palm and palmar surface of the fingers, and flexed fingers of the right handimageFlexion contractures were found at the metacarpophalangeal and proximal interphalangeal joints of the three fingers of the right hand (Fig. 1). There was no pain, tenderness in the joints of the fingers, or palpable nodular lesions on the palmar surface of the hand. Forced extension was difficult, and there was pain with passive extension. Radiography of the patient's hands revealed no abnormality, other than the clenched fingers. Electromyography of the upper extremities was normal.There were no lesions of the oral mucosa. The nails and scalp were normal. The patient showed very poor eye contact, and responded tersely and somewhat reluctantly to questions about her medical history.The patient was evaluated by psychiatry, but did not meet the diagnostic criteria for any mental disorder. There was a schizoid personality characteristic on both the structured clinical interview for DSM‐IV personality disorders (SCID‐II) and the Minnesota Multiphasic Personality Inventory (MMPI). In addition, there was an increase in scores on the hostility and resentment/aggression subscales of the MMPI.The results of routine laboratory tests were within normal limits or negative, including the venereal disease research laboratory (VDRL) test.A skin biopsy specimen showed histopathologic changes of lichen planus (orthokeratotic hyperkeratosis, focal hypergranulosis, acanthosis, papillomatosis, and vacuolization with dense lymphocytic reaction at the dermo‐epidermal junction) (Fig. 2).Hyperkeratosis, acanthosis, papillomatosis, and vacuolization with dense lymphocytic reaction at the dermo‐epidermal junction (hematoxylin and eosin, × 100)imageThe patient was treated with topical 5% salicylic acid and 0.1% methylprednisolone aceponate ointment. Static splinting plus stretching was used for hand therapy. Active assisted motion was employed. The treatment produced a remarkable reduction in the skin lesions (Fig. 3), but no improvement in the flexion posture of the hand. The psychiatric and clinical findings were thought to be consistent with clenched fist syndrome and lichen planus.Normal appearing left hand after treatmentimage

Polyarthritis following vaccination in four dogs

SummaryThe purpose of this study was to describe four dogs that developed polyarthritis (PA) shortly after vaccination.Between 1996–1999, 27 dogs were admitted to the Clinic for Small Animals, University of Berlin with clinical signs of PA. Based on the history, clinical findings, results of routine laboratory tests, radiography and ultrasonography, synovial fluid analysis, serum titers for rheumatoid factors, infectious disease and immunological serum titers nine dogs were diagnosed with idiopathic PA type I and 14 dogs with other forms of polyarthritis. Vaccine-associated PA (VAPA) was suspected in four dogs of different breeds (1.3–2.4 years old) which showed a sudden onset of lameness with several painful and swollen joints three – 15 days (mean 11) after vaccination. Synovial fluid analysis revealed nucleated cell counts ranging from 4,000-72,000/μl (mean 30,000) with 30–90% (mean 80) neutrophils. Treatment consisted of NSAIDs and doxycycline. The VAPA dogs quickly recovered in one to two days, three had not experienced a recurrent arthritic episode, one dog developed arthritic signs 12 days after revaccination. An accurate vaccination history is important on all dogs presenting with PA. In accordance with anecdotal reports the signs of disease in VAPA can spontaneously resolve.

Use of laboratory evaluation and radiologic imaging in the diagnostic evaluation of children with sensorineural hearing loss.

Laboratory testing and radiologic imaging are commonly used to delineate syndromic from nonsyndromic sensorineural HL (SNHL). The aim of this study was to examine the yield of laboratory tests and radiologic imaging commonly used in the diagnostic evaluation of SNHL in children. Retrospective analysis of 114 (54 female, 60 male) consecutively investigated children with SNHL between 1998 and 2000 at a tertiary-care university hospital. Results of routine laboratory testing to assess autoimmunity, blood dyscrasias, endocrine abnormalities, renal function, infection, and cardiac testing were reviewed. Results of radiologic evaluation were also reviewed. In general, computed tomography (CT) was obtained in patients with symmetric SNHL, whereas magnetic resonance imaging (MRI) with or without CT was obtained in asymmetric SNHL. Laboratory evaluation of the blood did not yield the etiology of SNHL in any patient. Blood tests for autoimmune disease were often positive but did not correlate with clinical disease. Nonspecific elevation of erythrocyte sedimentation rate (ESR) and antinuclear antibody (ANA) was present in 22% of cases. An abnormal electrocardiogram with a prolonged QT interval resulted in the diagnosis of Jervall and Lange-Nielsen syndrome. In the 97 patients who underwent radiologic studies, abnormalities were present in 38 of 97 studies (39%). Isolated inner ear malformations were twice as common as multiple abnormalities with large vestibular aqueducts as the most common isolated finding. In the evaluation of children with unexplained SNHL, routine laboratory evaluation should be reconsidered given its low diagnostic yield. However, radiologic abnormalities of the inner ear are common. Identification of inner ear malformations has direct impact on management of these children, suggesting that all children should undergo radiologic imaging as an integral component of evaluation of SNHL.

Cases from the Osler Medical Service at Johns Hopkins University

Presenting featuresA 57-year-old man was seen because of an acutely painful middle finger. For 2 months he had had intermittent pain and numbness in the fingers of both hands that led him to stop operating a printing press at work. His medical history was remarkable only for a 40-year history of cigarette smoking. He was afebrile. Examination revealed an exquisitely tender third finger, cool beyond the proximal interphalangeal joint, with rubor and distal pallor (Figure 1). This and other digits demonstrated nailbeds with splinter hemorrhages (Figure 2). No Janeway lesions or Osler nodes were noted. Pulses were intact at the wrist. The results of initial routine laboratory tests, including an erythrocyte sedimentation rate, were normal. Transesophageal echocardiography revealed no source of embolization.What is the diagnosis?

Using the World Wide Web to enhance the problem-solving skills of third-year veterinary students.

A Web site was created for the small animal problem-solving elective at Virginia Tech. In addition to signalment, history, physical examination findings, and results of routine laboratory tests, students were able to view images of cytologic and histologic specimens, radiographs, and endoscopic findings and hear examples of breath and cardiac sounds. Students commented that the availability of Web-based case materials allowed them increased opportunities to practice problem-solving skills.

Community-acquired pneumonia in the elderly: a practical guide to treatment.

The incidence of community-acquired pneumonia (CAP), an infectious disease, sharply increases among the elderly and the main risk factor for CAP in this age group is chronic comorbidity. The use of the term CAP in the elderly population should be reserved for pneumonia acquired outside of the nursing home setting, since nursing home-acquired pneumonia differs from CAP in terms of its aetiology and clinical manifestations. The main aetiology for CAP is Streptococcus pneumoniae, but atypical pathogens also play an important role as causative agents. The clinical presentations of CAP in the elderly can be different from those in younger patients, and therefore it is important to be aware of and familiar with these differences to avoid unnecessary delays in reaching the correct diagnosis. Imaging is essential to diagnose CAP and to assess its severity. Clinical and laboratory indices can be used to identify elderly patients with CAP who are at low risk for mortality and who can be treated as outpatients. The decision not to hospitalise elderly patients with CAP is contingent on a good clinical condition and the existence of home support systems. The aetiology of CAP cannot be determined on the basis of clinical manifestations, imaging or routine laboratory test results, and the initial antibiotic therapy for elderly patients with CAP should be empirical, based on accepted guidelines. In the light of developments in recent years, elderly patients with CAP, except those who are severely ill, can be treated empirically with once-daily antibiotic monotherapy in the initial phase, using a third-generation fluoroquinolone preparation, such as sparfloxacin, levofloxacin or moxifloxacin, or a new macrolide such as clarithromycin, azithromycin or dirithromycin. In addition to antibiotic therapy, it is critically important to identify and treat the physiological disturbances that accompany CAP as well as decompensation of chronic comorbid conditions. As soon as the patient's condition permits, oral antibiotic therapy should replace intravenous therapy and early discharge from the hospital should be considered. Since influenza and pneumococcus immunisation can reduce morbidity and mortality from CAP, it is important to implement regular immunisation programmes in the primary care setting.

Serum concentrations of soluble adhesion molecules in patients with colorectal cancer.

The concentrations of the soluble adhesion molecules E-cadherin, E-selectin, intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) were investigated in 48 patients with colorectal cancer before treatment, and their relation to clinical, histological and routine laboratory parameters was examined. Data were collected on tumour stage at presentation, presence and sites of metastatic disease, tumour pathology and results of routine laboratory tests. Serum concentrations of ICAM-1 and VCAM-1 were significantly elevated in the patients with colorectal cancer in comparison with a group of healthy subjects (P < 0.00001). Levels of circulating ICAM-1 and VCAM-1 were increased both in patients with local and those with metastatic disease. Although elevated in some patients soluble E-cadherin and E-selectin concentrations were not significantly elevated compared with the control group (P = 0.71 and P = 0.052 respectively). The levels of circulating ICAM-1 were significantly correlated with those of VCAM-1 and E-selectin. A correlation was also found between the serum concentrations of E-selectin and ICAM-1 and alkaline phosphatase, total white cell count and platelet count. VCAM-1 was positively correlated with age and negatively with degree of tumour differentiation and haemoglobin concentration. The biological implications and possible clinical relevance of these findings are discussed.

Circulating soluble adhesion molecules E-cadherin, E-selectin, intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) in patients with gastric cancer.

The concentrations of the soluble adhesion molecules E-cadherin, E-selectin, intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) were investigated in 45 patients with gastric cancer before treatment and their correlation with clinical, histological and routine laboratory parameters was examined. Data were collected on tumour stage at presentation, presence and sites of metastatic disease, tumour pathology, survival and results of routine laboratory tests. Serum concentrations of ICAM-1 and VCAM-1 were significantly elevated in the patients with gastric cancer in comparison with the group of healthy subjects (P < 0.00001 and P < 0.0001 respectively). Increased serum concentrations of VCAM-1 were associated with locally advanced and metastatic disease whereas ICAM-1 was significantly elevated both in local and in advanced/metastatic disease. Soluble E-cadherin and E-selectin concentrations did not show any significant elevation in gastric cancer patients. Concentrations of soluble adhesion molecules showed significant correlation with each other (except E-selectin and VCAM-1) and with alkaline phosphatase. Soluble ICAM-1 and VCAM-1 were significantly associated with an elevated total white cell count. Patients with elevated VCAM-1 had significantly poorer survival in comparison with patients with normal serum levels (P = 0.0361).

Measurement of serum total thyroxine, triiodothyronine, free thyroxine, and thyrotropin concentrations for diagnosis of hypothyroidism in dogs

Objective To determine whether measurement of baseline serum concentrations of total thyroxine (T4), triiodothyronine (T3), free T4, and thyrotropin (thyroid-stimulating hormone; TSH) would aid in the diagnosis of hypothyroidism in dogs. Design Prospective case series. Animals 54 dogs with hypothyroidism, 54 euthyroid dogs with nonthyroidal disease initially suspected to have hypothyroidism, and 150 clinically normal dogs. Procedure In the 54 dogs with hypothyroidism, diagnosis was established on the basis of clinical signs, results of routine laboratory and TSH stimulation tests, exclusion of concurrent nonthyroidal disease, and a good clinical response to treatment with l-thyroxine. Blood samples were collected from all dogs and were tested for thyroid hormone and TSH concentrations. Reference ranges for hormone concentrations were established on the basis of results for the 150 clinically normal dogs. Results Of the 54 hypothyroid dogs, 48 (89%) had low total T4 concentrations, 3 had low-normal concentrations, and 3 had high concentrations because of T4 autoantibodies. In contrast, only 10 (18%) euthyroid dogs had low total T4 concentrations. Only 3 of 31 (10%) hypothyroid dogs had low T3 concentrations; 23 had concentrations within the reference range, and 5 had high concentrations because of T3 autoantibodies. Only 3 of 38 euthyroid dogs had low T3 concentrations. Of the hypothyroid dogs, 53 (98%) had low free T4 concentrations and 1 had a low-normal concentration. Only 4 (7%) euthyroid dogs had low free T4 concentrations. Of the hypothyroid dogs, 41 (76%) had high TSH concentrations, and 13 had TSH concentrations within the reference range. Of the euthyroid dogs, only 4 (8%) had high TSH concentrations. Of all single hormone measurements evaluated, measurement of free T4 concentration had the highest sensitivity (0.98), specificity (0.93), and accuracy (0.95) as a test for hypothyroidism; measurement of total T4 concentration had a lower sensitivity (0.89), specificity (0.82), and accuracy (0.85). Compared with measurement of total or free T4 concentration, measurement of TSH concentration had a lower sensitivity (0.76) and accuracy (0.84) but specificity (0.93) equal to that for measurement of free T4 concentration. When T4 (total or free) and TSH concentrations were evaluated together, specificity was higher than when T4 or TSH concentration was evaluated alone. Only 1 euthyroid dog had low T4 (total and free) and high TSH concentrations. Clinical Implications Results indicate that measurement of serum free T4 and TSH concentrations is useful for diagnosis of hypothyroidism in dogs. About a quarter of the dogs with confirmed hypothyroidism, however, will have serum TSH concentrations within reference limits. (J Am Vet Med Assoc 1997;211:1396–1402)

Renal Cell Carcinoma: Diagnosis Based on Metastatic Manifestations

Renal Cell Carcinoma: Diagnosis Based on Metastatic Manifestations

Laboratory diagnosis of anemia and related diseases using multivariate analysis

To establish a simple computer program for the laboratory diagnosis of anemia and related diseases, multivariate analyses were applied to the results of routine hematological laboratory tests obtained from 48 patients and 51 healthy volunteers. The patients studied were limited to those who had not been treated hematologically by the time of their first visit to our hospital, and their first data obtained in our laboratory were analyzed. Final diagnoses were aplastic anemia (AA) in 21, myelodysplastic syndrome (MDS) in 14, iron deficiency anemia (IDA) in 3, polycytemia vera (PV)in 3, and idiopathic thrombocytopenic purpura (ITP) in 7. Eight parameters, WBC, RBC, Hb, Ht, MCV, MCH, MCHC, and PLT, were transformed to normal distribution and then applied to principal component analysis to evaluate their independence. Very close relationships were observed between Ht and Hb, and between MCV and MCH. One each of these pairs was selected by discriminant analysis and two sets, RBC, MCH, Hb, PLT, and WBC, and RBC, MCV, Ht, PLT, and WBC, were obtained. Two canonical components gave good discrimination of these five diseases and also of normal subjects. When disease prediction was made using this analysis, 37 of 48 patients (77.1%) were predicted correctly, and furthermore, when two disease predictions were allowed, all patients were diagnosed properly. Some overlaps were observed in this two-dimensional coordinate system, especially of AA and MDS, and also with normal subjects. To improve the system further, the additional parameters of age and sex were added to construct a three-dimensional analysis which resulted in much clearer discrimination. The whole procedure described is being developed with subjects who are not taking medication. Subsequently, the general application of this analytical procedure should be limited to only those not on medications. In conclusion, this is in essence a demonstration project; however, this trial of laboratory diagnosis using routine hematological laboratory results appears to be promising. Further extension of the study by increasing numbers of patients and disorders studied, including secondary anemias, will allow the design of diagnostic software for use with personal computers at the sites of primary care. Am. J. Hematol. 54:108–117, 1997 © 1997 Wiley-Liss Inc.

Laboratory diagnosis of anemia and related diseases using multivariate analysis.

To establish a simple computer program for the laboratory diagnosis of anemia and related diseases, multivariate analyses were applied to the results of routine hematological laboratory tests obtained from 48 patients and 51 healthy volunteers. The patients studied were limited to those who had not been treated hematologically by the time of their first visit to our hospital, and their first data obtained in our laboratory were analyzed. Final diagnoses were aplastic anemia (AA) in 21, myelodysplastic syndrome (MDS) in 14, iron deficiency anemia (IDA) in 3, polycytemia vera (PV)in 3, and idiopathic thrombocytopenic purpura (ITP) in 7. Eight parameters, WBC, RBC, Hb, Ht, MCV, MCH, MCHC, and PLT, were transformed to normal distribution and then applied to principal component analysis to evaluate their independence. Very close relationships were observed between Ht and Hb, and between MCV and MCH. One each of these pairs was selected by discriminant analysis and two sets, RBC, MCH, Hb, PLT, and WBC, and RBC, MCV, Ht, PLT, and WBC, were obtained. Two canonical components gave good discrimination of these five diseases and also of normal subjects. When disease prediction was made using this analysis, 37 of 48 patients (77.1%) were predicted correctly, and furthermore, when two disease predictions were allowed, all patients were diagnosed properly. Some overlaps were observed in this two-dimensional coordinate system, especially of AA and MDS, and also with normal subjects. To improve the system further, the additional parameters of age and sex were added to construct a three-dimensional analysis which resulted in much clearer discrimination. The whole procedure described is being developed with subjects who are not taking medication. Subsequently, the general application of this analytical procedure should be limited to only those not on medications. In conclusion, this is in essence a demonstration project; however, this trial of laboratory diagnosis using routine hematological laboratory results appears to be promising. Further extension of the study by increasing numbers of patients and disorders studied, including secondary anemias, will allow the design of diagnostic software for use with personal computers at the sites of primary care.

Efficacy and Safety of Cetirizine and Oxatomide in Young Children With Perennial Allergic Rhinitis: A 10-Day, Multicenter, Double-Blinded, Randomized, Parallel-Group Study

This study was designed to compare the efficacy and safety of cetirizine and oxatomide in young children who have perennial allergic rhinitis. During this 10-day multicenter, doubleblinded, randomized, parallel-group study, 102 children aged 2-6 years received orally administered cetirizine (5 mg once daily) or oxatomide (12.5 mg twice daily). Sneezing, rhinorrea, nasal obstruction, nasal itching, and ocular itching were evaluated by means of symptom scores by investigators and, on daily record cards, by parents. Tolerability was assessed on the basis of adverse events and on the results of routine laboratory tests performed before and after treatment. Compared to baseline both cetirizine and oxatomide improved symptoms significantly. No significant difference in efficacy was found between the two drugs. Both products were well tolerated. Mild sedation was only occasionally reported and no patient withdrew from treatment because of an adverse event. In clinical practice cetirizine may be preferable because of its long action and convenient single daily dose.

Kaposi's Sarcoma on a Lymphedematous Arm After Mastectomy

Two patients with Kaposi's sarcoma developing in an area of lymphedematous arm postmastectomy are reported. The Kaposi's sarcoma occurred after latent periods of 26 and 7 years following radical and modified-radical mastectomy, respectively, in the edematous tissue of the ipsilateral arm. The cutaneous nodules were purple in color and ranged in size from a few millimeters to > 1 cm in diameter. The results of routine laboratory tests were all within normal limits. Human immunodeficiency virus (HIV) antibody and cytomegalovirus (CMV) antigen, using enzyme-linked immunosorbent assay (ELISA), were negative.

Interleukin-6 in cerebrospinal fluid of patients with central nervous system infections.

Interleukin(IL)-6 levels were measured in cerebrospinal fluid (CSF) and serum samples from pediatric patients with central nervous system (CNS) infections by means of an enzyme-linked immunosorbent assay. Mean IL-6 concentrations in CSF samples from patients with bacterial meningitis (49,017 +/- 44,730 pg/ml) were significantly higher than those in patients with aseptic meningitis (1076 +/- 1572 pg/ml) or encephalitis (409 +/- 835 pg/ml). In aseptic meningitis and encephalitis, IL-6 levels in serum were within the lower ranges (< 100 pg/ml), in contrast with the highly elevated levels found in bacterial meningitis (14,332 +/- 18,385 pg/ml). In 5 of the 15 patients with encephalitis, elevated levels of IL-6 were observed in the initial CSF samples despite normal findings of routine CSF examinations. Also, sequential CSF samples revealed that there was an increase in the CSF cell count in two of the five patients. These results validated the potential of measuring IL-6 in CSF samples for the purpose of providing additional information on routine laboratory test results.

Cerebellar Purkinje's cell degeneration and coat color dilution in a family of Rhodesian Ridgeback dogs.

A syndrome of cerebellar Purkinje's cell degeneration and coat color dilution was diagnosed in a family of Rhodesian Ridgeback dogs. One male and 1 female from the same litter and 1 female from a different litter were evaluated for growth retardation, inability to ambulate, and progressive ataxia. On physical examination, lateral recumbency, severe ataxia, tremors, and diluted coat color were identified. Littermates with nondiluted coat color were neurologically normal. Results of routine laboratory tests, urine metabolic screenings, and karyotype analyses were normal. Histopathologic abnormalities at necropsy included cerebellar Purkinje's cell degeneration, reduced granular cell layer thickness, and uneven distribution of macromelanosomes within hair shafts. Pedigree analysis suggested an autosomal recessive mode of inheritance. This is the first description of a genetic syndrome affecting the central nervous system and associated with coat color dilution in dogs.

Fluctuant Nodules and Alopecia of the Scalp

REPORT OF A CASE A 21-year-old white man was seen because of a patch of alopecia on the vertex of his scalp. He had had acne during his adolescence; 2 years before he had undergone an incision of a cyst on his occiput. Scarring alopecia had ensued. Physical examination showed a nonscarring alopecic patch over a fluctuant nodule that was 2 cm across. Application of pressure disclosed numerous follicular openings draining pus. On his back were a number of comedones, furuncles, and old acneic scars. The nodule was incised and drained pus and bloody exudate. Erythromycin (1200 mg/d) was given, but in the following weeks two more nodules developed (Figs 1 and 2). A biopsy specimen was taken and revealed horny plugs in the infundibula of the hair follicles (Fig 3) and a polymorphous infiltrate around their deep portion (Fig 4). Routine laboratory test results were noncontributory. What is your