Mesenteric adenitis caused by Yersinia pseudotuberculosis presenting as an abdominal mass.

Infection by Yersinia pseudotuberculosis has become of increasing pathological importance. Patients normally present with symptoms similar to those of appendicitis, due to mesenteric adenitis. We present the case of 3 patients infected by Yersinia pseudotuberculosis who in addition to fever and abdominal pain had a palpable abdominal mass, so great was the enlargement of the mesenteric nodes. In 2 patients a laparotomy was carried out, followed by biopsy of a mesenteric lymph node. The diagnosis of Yersinia infection was confirmed by bacterial culture of the biopsied material and also by serology. In the third patient, serological studies and ultrasonic imaging of the abdomen led to early diagnosis and surgery was avoided. We suggest that a diagnosis of mesenteric adenitis due to Yersinia pseudotuberculosis should now be considered in all patients presenting with an abdominal mass, and in whom there is an appropriate clinical and epidemiological history. The diagnosis should be confirmed by abdominal ultrasound (alternatively Computerised Axial Tomography or Magnetic Resonance Imaging) and serological studies. In this way, unnecessary surgery can be avoided.

Sodium in hand and pump expressed human breast milk.

Sodium content was analysed in the expressed breast milk from 30 mothers. Measurements were taken up to 24 days postpartum, during which time the mothers expressed manually or by means of a pump. Statistical analysis has confirmed not only the known decline in sodium levels postpartum but has also shown a significantly higher sodium content in manually expressed milk compared to that from pump expressed milk. This finding suggests that the method of expression may alter the sodium concentration in human breast milk, thus potentially reducing the amount of sodium supplementation required by some preterm infants.

Prolonged cutaneous herpes zoster in acquired immunodeficiency syndrome.

We described the development of prolonged disseminated cutaneous herpes zoster in two patients with acquired immunodeficiency syndrome. Both patients developed hyperkeratotic, verrucous lesions that progressed despite acyclovir therapy. The biopsy specimens were typical of herpes infection. The development of acyclovir-resistant varicella-zoster virus during therapy was suspected clinically in the first patient and documented in vitro in the second patient. The inability to mount an effective cell-mediated immune response contributed to the prolonged course of cutaneous zoster in our patients. The hyperkeratotic nature of the skin lesions may reflect their chronic nature. Treatment with inadequate doses of acyclovir, allowing viral persistence and the selection of resistant strains of virus, may also be implicated. We recommend prolonged high-dose intravenous acyclovir therapy in the initial management of herpes zoster in patients with acquired immunodeficiency syndrome.

The MAGIC syndrome (mouth and genital ulcers with inflamed cartilage).

We describe a 42-year-old man with features of both Behçet's disease and relapsing polychondritis. The term MAGIC syndrome (mouth and genital ulcers with inflamed cartilage) has previously been used to describe similarly affected patients. We discuss the diagnostic criteria and pathogenetic mechanisms.

Prolonged apnea and cardiac arrhythmias in infants discharged from neonatal intensive care units: failure to predict an increased risk for sudden infant death syndrome.

Twenty-four hour recordings of respiratory wave form and ECG were made on low-birth-weight and/or premature infants within one week of discharge from eight neonatal intensive care units. Eight infants (0.7%) had episodes of apnea greater than 30 seconds in duration, all of which were accompanied by bradycardia less than 100 beats per minute; 25 infants (2.3%) had a total of 36 apneic episodes between 20 and 30 seconds in duration, 29 of which were accompanied by bradycardia less than or equal to 100 beats per minute; and 19 infants (1.7%) had episodes of bradycardia less than or equal to 50 beats per minute without prolonged apnea (as shown by a lack of breathing movement). Five infants had ventricular premature beats (including one with ventricular tachycardia). Eleven infants had supraventricular premature beats (including two with supraventricular tachycardia and one with preexcitation). Four infants had both supraventricular and ventricular premature beats. Two infants had preexcitation. Eleven infants who underwent 24-hour recordings died. Five infants were victims of sudden infant death syndrome. One infant death was sudden and unexpected and was attributed to bronchopneumonia. Two deaths were associated with congenital heart disease and three were associated with major cerebral disorders. None of the six babies who died suddenly and unexpectedly had apnea greater than or equal to 20 seconds, bradycardia less than or equal to 50 beats per minute, or cardiac arrhythmias on their 24-hour recordings.

Perforation of the bowel in the newborn as a complication of exchange transfusion.

Spontaneous perforation of the bowel without evidence of intestinal obstruction is reported in six infants who had exchange transfusions for rhesus incompatibility, and in a seventh who had prolonged intravenous fluids via the umbilical vein. The pathological findings resemble those found in acute necrotizing enterocolitis in adults, which is known to be associated with arterial hypotension. The cause in these infants may also be due to a period of hypotension during the transfusion, and hypoxia and superimposed infection may also play an important part.