Gene V. Ball

Chronic ulcerative colitis, skin necrosis, and cryofibrinogenemia.

Necrotizing skin lesions developed in a man with chronic ulcerative colitis. No evidence of intrinsic disease of medium or small-sized vessels was found. A circulating cryofibrinogen was thought to be responsible for in situ thrombosis leading to skin infarctions. Sodium warfarin in a daily dose of 2.5 to 5 mg appears to have thwarted progression of developing lesions and the occurrence of new ones.

Gamma globulin complexes in rheumatoid pericardial fluid

Cardiac tamponade due to pericarditis occurred in a patient with rheumatoid arthritis. Aspiration afforded us an opportunity to expand the characterization of pericardial fluid. Elevated acid phosphatase levels, decreased whole hemolytic complement and gamma globulin complexes similar to those found in rheumatoid synovial fluid were noted, supporting the concept of a unitary nature of inflammation in rheumatoid disease.

Evaluation of patients with back pain of suspected inflammatory nature.

PURPOSE Detection of early inflammatory back disease is often difficult. Certain clinical characteristics have been reported to increase the likelihood of its detection in referral patients, but the usefulness of these clinical characteristics has not been evaluated in an open population. In our study, we undertook to evaluate the value of the clinical history as a screening test for inflammatory back disease in a general population. PATIENTS AND METHODS Twenty-three male patients with back pain of moderate duration and with clinical characteristics suggestive of inflammatory back disease were recruited by advertising and were studied by various means, including computed tomography (CT), scintigraphy, and radiography. RESULTS One patient had radiographic sacroiliitis. Two had positive results for the B27 antigen, and another had positive results for the cross-reacting HLA antigen B7. Eight patients had abnormal scintiscans of the sacroiliac joints. Twenty-one of 23 patients and 20 of 23 control subjects had abnormalities that were detected by CT. Repeat plain radiographs of the pelvis done 36 months after enrollment into the study did not uncover further evidence of sacroiliitis. CONCLUSIONS These results indicate plain radiographic evidence of sacroiliitis will often not develop in patients with historical features suggestive of inflammatory back disease even with long-term evaluation, thus vitiating the specificity of these historical findings in men with back pain of relatively brief duration.

Acute Renal Failure without Fibrotic Skin Changes in Progressive Systemic Sclerosis

Scleroderma renal crisis (SRC) is defined as sudden development of accelerated hypertension, hyperreninemia, and acute renal failure in a patient with progressive systemic sclerosis (PSS). Although the diagnosis of PSS is generally straightforward because of dermal fibrosis, we report 2 patients who had PSS with SRC without the characteristic fibrotic skin changes of scleroderma. PSS should be considered in the differential diagnosis of unexplained acute renal failure and accelerated hypertension even though the cutaneous fibrotic manifestations of the disease may be absent.