Jonathan Halevy

The Sign of Leser-Trélat in Association with Lymphocytic Lymphoma

The sign of Leser-Trélat was observed in a patient with multiple seborrheic keratoses and hemangiomata. The increase in these lesions of the skin preceded the development of a poorly differentiated lymphocytic lymphoma, a type of malignancy which has not yet been reported in association with this sign.

Functional adaptation of rat remnant colon after proximal hemicolectomy

Functional adaptation of the remnant intestine after extensive resection of small bowel is well documented. The effects of partial resection of large bowel on the remaining colon have not been characterized. Transepithelial potential (VT),tissue resistance (RT),and short-circuit current (Isc) were measuredin vitro across distal colonic tissue of rats three weeks after proximal hemicolectomy with ileotransversotomy and compared to the same parameters measured in the distal colon of control animals. In a second series of experiments, anin vivo perfusion technique was used to measure changes in sodium, potassium, and water transport in distal colon following proximal hemicolectomy. A 2.5-fold increase inVT (P<0.01), a 62% increase inRT (P<0.001), and a 35% increase inIsc (P<0.05) were observed three weeks following hemicolectomy when compared to control animals. A 64% increase in net sodium absorption (P<0.025), no significant change in net potassium transport, and a 115% increase in net water absorption (P<0.01) were demonstrated in hemicolectomized animals when compared to control. It is concluded that in the rat the distal colon is capable of functional adaptation to increase net sodium and water absorption within three weeks after proximal hemicolectomy. The mechanism responsible for this adaptive process has yet to be defined. Our findings may explain the lack of chronic diarrhea in patients undergoing right hemicolectomy.

Infectious mononucleosis in hospitalized patients over forty years of age.

ABSTRACT: Clinical and laboratory features of 17 patients over 40 years of age (mean age: 55 years) admitted with infectious mononucleosis were compared with those of 17 adolescents (mean age: 13 years) hospitalized with this illness. Elderly patients with infectious mononucleosis were found to run a longer febrile course (13 vs. 7 days, p < 0.01) and to have a lower peak total white blood cell count (6,600/mm3 vs. 11,000/mm3, p < 0.001) and a lower incidence of splenomegaly (50% vs. 76%, p < 0.05), lymphadenopathy (25% vs. 94%, p < 0.001), and pharyngitis (25% vs. 47%, p < 0.05), compared with young patients with infectious mononucleosis. Patients in both groups had a high prevalence of abnormal liver function tests. It is concluded that infectious mononucleosis in patients over 40 years of age is not as uncommon as previously reported, and that clinical and laboratory features differ between young and older patients suffering from this disease.

The Stomach and Duodenum

1. The stomach has a volume of 150 ml (adult); the cardia is located 1 inch (2.5 cm) left of the midline at the level of T9. The greater curvature is 4–6 times longer than the smaller curvature and is more mobile; the pyloric channel is 1 inch long; the pylorus is 1 inch to the right of the midline at the level of L1.

The Small and Large Intestine

1. The jejunum has been defined rather arbitrarily as the proximal two-fifths of the small intestine.

The Biliary Tract

1. The gallbladder capacity is 30–50 ml. Wall thickness while fasting is up to 3.5 mm. Maximal diameter of common bile duct is 7–8 mm in intravenous cholangiography (IVC) or ultrasonography, 10–11 mm on ERCP or percutaneous transhepatic cholangiography (PTC).

Macrophage migration inhibitory activity in the sera of patients undergoing peritoneal dialysis for psoriasis

SummaryA study of macrophage migration inhibitory activity (MIA) in serum was carried out in four psoriatic patients with normal renal function who were undergoing peritoneal dialysis (PD) as a method of therapy. Before weekly PD treatment, the MIA was negative in these patients, whereas immediately thereafter it was positive. In two of these patients the appearance of MIA paralleled the clinical improvement observed. The increase in MIA observed after each PD was of short duration, usually being followed by a subsequent decrease prior to the next PD. Seven uremic patients who were similarly studied for the presence of MIA before and after PD did not show this pattern of response. It is suggested that the appearance of MIA in psoriatic patients undergoing PD as a method of therapy reflects the extraction of a “dialysable serum factor”, which may be associated with cell-mediated immunity as well as with the clearing of skin lesions observed in these patients.