Armin E. Good

Acinar Pancreatic Tumor with Metastatic Fat Necrosis Report of a Case and Review of Rheumatic Manifestations

SummaryThis report deals with a pancreatic tumor associated with metastatic fat necrosis. Our patient displayed the full gamut of nodular panniculitis, polyarthritis, fever, eosinophilia, hyperlipasemia, lytic bones lesions, and marrow fat necrosis. The rheumatologic features are reviewed. Elevated serum lipase is a most helpful laboratory confirmation. The tumor in our patient presented a difficult problem in classification. Although the appearance under light microscopy was most compatible with islet cell carcinoma or islet cell carcinoid, the ultrastructural characteristics were those of acinar carcinoma.

Reiter's Disease: A review with special attention to cardiovascular and neurologic sequellae

T HOUGH not the first description of the tetrad of urethritis, arthritis, conjunctivitis, and rnucocutaneous lesions, Hans Reiter’s report in 19 16 was meticulous and detailed, reintroducing the syndrome into the medical literature.‘= By common usage, Reiter’s disease (RD) is the standard label.2 When discussing late manifestations far afield from the presenting syndrome, it is conceptually useful to set up a distinct, admittedly tentative, disease entity. Diagnosis is based, however, on an acute syndrome including at least three members of the tetrad. Several reviews have appeared. 3*4 The most useful basic reference is Csonka’s study’ containing a comprehensive analysis of the literature up to 1965 as well as contributions from the author’s large experience with the disease. Early publications emphasized the excellent prognosis, reporting that the disease nearly always cleared completely following an attack.6 With follow-up, it became apparent that the majority of patients suffered recurrences and had permanent articular complaints.’ As attention has been directed to sequelae, reports of cardiac and neurologic manifestations have arrived on the scene. A recent leading article in the British Medical Journal concludes with the statement, “While deaths are rare and mostly due to cardiac or neurological lesions or to reactions to treatment, the prognosis for full functional restitution is only fair though still better than rheumatoid arthritis or classical ankylosing spondylitis.“’ This review will concentrate on these cardiac and neurologic lesions, prefaced by a historical overview of the disease.

Four Cases of “Milwaukee Shoulder,” with a Description of Clinical Presentation and Long‐term Treatment

“Milwaukee shoulder” was first described by McCarty et a1.1~2 in 1981. Features of this condition include: 1) an occurrence predominately in older women; 2) shoulder pain and marked limitation of motion; 3) recurrent and large shoulder effusions, with a bland synovial fluid characterized by a low leukocyte count, composed chiefly of mononuclear cells; 4) concomitant glenohuineral osteoarthritis and/or rotator cuff tear; and 5) the presence of liydroxyapatite on crystal analysis of the aspirated synovial fluid. This paper presents four patients with “Milwaukee shoulder” in order to: illustrate the clinical presentation, discuss the treatment, and point out unresolved questions concerning the etiology of this disorder.

Multiple pneumococcal pyarthrosis complicating rheumatoid arthritis.

Pneumococcal pyarthrosis was documented in seven and ten joints, respectively, in two patients with rheumatoid arthritis. The recognition of multiple pyarthrosis superimposed upon rheumatoid arthritis can be difficult. The present cases are compared with eight previously reported cases of pneumococcal arthritis in patients with rheumatoid arthritis.

Fixed Eruption and Fever After Urography

We have described a patient with fixed bullous eruption, usually associated with severe fever, occurring on five occasions after a series of seven intravenous urograms between 1974 and 1979. Diagnosis was initially obscured because the onset of fever and dermatitis was delayed as long as 72 hours. This is only the second report of true ioderma ascribed to urographic contrast media.

HLA Antigens in Migraine

SYNOPSIS

HLA profile and Reiter's syndrome

The analysis of the clinical and HLA profiles of 99 patients with Reiters syndrome is reported. Antigen HLA‐B27, which has previously been firmly associated with Reiters syndrome, predisposes patients to develop disease features which reflect articular involvement. The HLA haplotype A2, B27 was found to be at an elevated frequency in our Reiters syndrome sample, and the latter two antigens are also associated with a general increase in disease severity. Conversely, antigen BW35 appears to be protective against certain features of the syndrome. Patients with certain antigenic profiles (namely A2 and A3 together with B27) tend to develop certain syndrome manifestations earlier in the course of the disease than those with other antigens.