Congenital syphilis in Nebraska: a case report.

In the United States, the incidence of acquired syphilis has increased thirty four percent in the last decade with young, black, urban dwelling, drug dependent females representing the highest risk group. Concomitantly, congenital syphilis has increased causing spontaneous abortions, stillbirths, and neonatal morbidity and longterm neurologic sequela. Because physicians are no longer familiar with the disease, it is estimated that only twenty-five percent of neonatal syphilis is diagnosed during the first year of life. This report describes the first reported case of congenital syphilis in Nebraska. Our patient demonstrates the typical clinical findings of lethargy, extremity swelling and the pseudoparalysis of Parot, while laboratory evaluation showed anemia, abnormal hepatic enzymes, hypoproteinemia, and confirmatory positive neonatal VDRL and FTA-ABS. The plain film radiographic survey illustrated the characteristic findings of periostitis, metaphyseal banding and cortical erosion. By relying upon the relatively inexpensive and easy to obtain radiographic long bone survey a prompt diagnosis can be made and immediate treatment instituted while awaiting confirmatory serology. We must reacquaint ourselves with the increasing incidence of acquired and congenital syphilis. This will enable us to make a timely and cost-effective diagnosis of cogenital syphilis and prevent its devastating complications.

Cholesterol embolism: experience with 22 histologically proven cases.

The records of 22 patients, aged 61 to 85 years, with histologically proven cholesterol embolism (CE) were reviewed. All had one or more risk factors. Twenty-one patients had preexisting symptomatic or recognized atherosclerotic disease. Twenty patients had one or more identifiable precipitating factors, including warfarin administration (4), angiography (15), angioplasty (2), intra-aortic balloon pump placement (2), vascular surgery (11), aortitis (2), and cardiopulmonary resuscitation (1). These preceded the onset of symptoms by as many as 3 months, but usually by less than 3 weeks. Eight patients had peripheral CE alone. Fourteen patients had visceral CE. All 14 had renal CE that was characterized by abrupt deterioration of renal function after a precipitating event (13), evidence of concurrent CE to the lower extremities or other organs (10), accelerated hypertension (9), gross hematuria (6), or flank and back pain (3). Unusual presentations included one case each of spinal cord infarction, penile gangrene, adrenal insufficiency, and symptomatic splenic infarct. If patients with visceral CE survived after initial hospitalization, they often required dialysis and later hospitalizations because of complications. Premortem diagnoses were made in 18 patients: nine from surgical specimens and nine from biopsies (one kidney, eight muscle and skin). Attempts at definitive vascular surgery were possible in only two patients and successful in one. The challenges encountered in managing these patients' conditions are reviewed.

Subphrenic abscess: a pulmonary presentation.

A patient with subphrenic abscess can present with pulmonary or abdominal symptoms because of the location of the abscess adjacent to the diaphragm. This thoracoabdominal clinical complex has been described previously and, if chest symptoms predominate, may obscure the diagnosis of subphrenic abscess. The case of a patient with occult abdominal pathology who presented with respiratory complaints is discussed.

Spontaneous splenic rupture in infectious mononucleosis.

Spontaneous splenic rupture occurs in association with infectious mononucleosis. Three cases of serologically proven infectious mononucleosis complicated by spontaneous splenic rupture are described. In two, the diagnosis was confirmed preoperatively by abdominal computerized tomographic (CT) scan. Treatment by splenectomy was curative in all three patients. Infectious mononucleosis patients who have acute abdominal pain must be considered for potential splenic hemorrhage.