Observations on prolonged systemic used of cortico-steroids and ACTH

In a case of systemic scleroderma which has undergone clinical remission after more than 3 years of corticosteroid and ACTH therapy, the unique complication observed was osteoporosis with cystic bone marrow. This cystic bone marrow, which is the first to be observed in such kind of therapy, does not fit any pattern of bone disorderFrom the five cases presented other observations reported are: generalized and localized osteoporosis, moon faces, moderate weight gain, increased abdominal girth, hirsutism, anti-lepra reaction, hyperpigmentation, normoglycemia, normotension, clinical remission of the disease process, normal serum electrolytes, gynecomastia, buffalo hump, low 24 hr. urinary cortocoids, positive Bence-Jones protein in one case, and positive Thorn test in 3 casesThe period of observation ranges from more than 6 months to more than 6 years. Except for the extensive osteoporosis with cystic bone marrow, the rest of the observations noted are not unusual. (Summary)

Streptomycin in dermatitis exfoliativa secondary to dermatitis seborrheica

A case of dermatitis exfoliativa secondary to seborrheic dermatitis presumably also secondary to bilateral fibroid pulmonary tuberculosis is presented. The illness was of over 4 months duration and had received various kinds of treatments which gave negative results when streptomycin was started at the height of the symptoms. After 66 days of streptomycin treatment, in combination with other adjuvant medications, marked improvement was observed and progressed to complete recovery shortly1. Streptomycin (calcium chloride complex) had been found effective in a case of dermatitis exfoliativa secondary to dermatitis seborrheica with tuberculous etiology2. Tuberculous infection or tuberculous toxemia can be considered an etiologic factor in dermatitis exfoliativa, secondary to dermatitis seborrheica in the presence of a bilateral fibroid pulmonary tuberculosis. (Summary/Conclusions)

Ammonium salt of mandelic acid in some cases of urinary infection

The above cases, although few, demonstrate the therapeutic value of ammonium mandelate (mandelium) in certain bacterial infections of the urinary tract. As to what kind of bacterial infection, that the writer cannot state because no effort was made to isolate the causative germ or combination of germs by cultural methods and to identify them morphologically by Gram staining. For lack of foresight, these examinations were unfortunately omitted by the author, since he did not expect to make these cases the subject of a medical paperA few pus cells leucocytes are present in normal urine. In pathological conditions they become abundant. By the phrase " a few puS cells" as used here is meant an average of three to five cells to the field of 6 mm. objective with 6x eyepiece. By "abundant," or four plus, is meant numerous cells in the same fieldUnder normal conditions, urine in the bladder is bacteria-free, but it becomes contaminated in passing through the urethraIn Cases 1,2, and 3 urine samples were not obtained after catheterization, and therefore the possibility of contamination from the urethra and vagina cannot be eliminated. Considering that Cases 1,2, and 3 were free of vaginal and urethral infections, the abundant pus cells and bacteria, and some epithelial cells found in their uncertrifuged urine can be attributed principally to infections above the internal sphincter urethraeIn the absence of cystoscopic examination of the bladder, urethral catheterization of both ureters, kidney-function test, and x-ray examination, it is difficult to arrive at a definite diagnosis in infections above the internal sphincter urethrae. There are so many pathological conditions to consider, namely: cystitis, pyelitis, ureteritis, pyelonephritis,pyonephrosis, renal abscess, paranephritis, perinephritis, calculus, tumorsJudging from the symptoms of high, irregular, continuous fever, occasionally accompanied by chills, some vomiting, restlessness, little or no urinary disturbance, definite pyuria and bacteriuria, the female sex and age of the patients, the short duration and non-recurrence of the illness, it is not wrong to diagnose Cases 1,2, and 3 as acute pyelocystitis of a mild type. According to Griffith and Mitchel, the febrile symptoms and local manifestation may be vague and misleading, so that only by the pyuria can a diagnosis of pyelitis be madeThe finding of hyaline and pus casts plus the pyuria and bacteriuria, not to mention the constitutional symptoms and moderate leucocytosis, was highly indicative of pyelonephritis in Case 4Case 5 was a clear of typhoid fever complicated with pyelocystitis and acute bronchitisCase 6 was more than a pyelocystitis. It was a pyelonephritis or possibly worse, for there were prominent lumbar pains radiating to the abdomen and marked leucocytosis, besides the high continous fever with chills, nausea, and vomiting, intense headache, and the pyuria and bacteriuriaFunctional test of the kidney was not performed in any of the above cases because there were no manifestations of kidney insufficiencyGonococcus and tuberculous infections can be excluded from the above cases, judging from the history and clinical symptomsSince B. coli is the causative agent in 75 per cent of cases of urinary tract infection above the internal sphincter urethrae, and mandelic acid treatment gave effective results in those cases in which the urinary reaction was acidic throughout, it is safe to presume that B. coli was the most probable etiologic agent in the six cases mentionedIn Cases, 1,4 and 6 some kind of known urinary antiseptic had been administered with ineffective results prior to treatment with ammonium mandelate (mandelium)In Case 4,5, and 6, in which hyaline and finely granular casts, besides albumin, were found in the urine before starting treatment with mandelium, it was observed that these signs of renal irritation disappeared after completion of treatment. This rather confirms the findings of workers abroad that mandelic acid is non-toxic and can be safely administered in the absence of urinary obstruction and impaired kidney functionThe exclusion of fruits and fruit juices from the diet and substituting for them food rich in protein and fats and low in carbohydrates, the maintenance of proper acidity in the urine, the administration of adequate dosage, the limitation of fluid intake, and the observance of indications and contraindications, are important factors for a successful treatment.(Discussion, Summary and Conclusions)

Transformation and fate of two cases of secondary dermatitis exfoliativa

Two cases of secondary dermatitis exfoliativa, associated with lipomelano reticulosis with hyperplasia of lymph nodes and generalized negroid-like pigmentation (Case II), terminating in uneventful recovery, are presentedEtiology and pathogenesis are consideredManagement is described and discussedThe remarkable beneficial results of parenteral calcium gluconate-ascorbic therapy in both cases, especially in the second one with the negroid pigmentation, is observed and commented upon. Differential diagnosis of this pigmentation is discussed. (Summary)