[Acute liver damage after using ecstasy].

Ecstasy is a stimulant used mainly by youngsters to get 'high.' There are few reports of acute injury of the liver due to ecstasy. We describe a 37-year-old woman who presented with the clinical picture of recurrent hepatitis following ingestion of the drug. After several months she developed liver cirrhosis shown by biopsy and CT scanning. This case emphasizes the potential danger of ecstasy. Every patient with hepatitis of unknown origin must be questioned about ingestion of the drug.

[Terbinafine-induced cholestatic liver injury].

A 43-year-old man presented with weakness, pruritus, skin rash and jaundice 2 weeks after treatment for onychomycosis with terbinafine (Lamisil) was started. Liver function tests showed combined hepatocellular and cholestatic injury. Ultrasound examination, computerized tomography and ERCP excluded extrahepatic obstruction. Serology was negative for HBV, HCV, HAV, CMV, and EBV. Liver biopsy was consistent with drug-induced cholestatic injury. Since the clinical picture did not improve when terbinafine was stopped, corticosteroids were started and resulted in complete clinical and laboratory recovery; liver function tests were normal 8 months after corticosteroids were discontinued.

[Acute renal failure with hepatic involvement after methylene chloride inhalation].

A 29-year-old man working in a closed room was exposed to methylene chloride. 2 days later he developed acute renal failure and hepato-cellular damage. Despite the fact that methylene chloride is usually considered nontoxic, fatal cases have been described. It should be stressed that a good history, especially in those who work with materials of low toxicity, can explain complex clinical pictures, allowing proper treatment to be started. Our patient was treated by hemodialysis and recovered completely without residual hepatic damage.

Common variable immunodeficiency: a family study and therapeutic trial with cimetidine.

Various immunologic parameters were tested in a family of two patients with common variable immunodeficiency. Both patients had low serum immunoglobulin levels, low peripheral B cell and T4 subclass of lymphocytes, and reversed T4/T8 ratio. One of the patients had excessive suppressor activity. Two of the asymptomatic members of the family (the father and one brother) had also low T4/T8 ratio that was not associated with excessive suppressor activity. No linkage between the disease inheritance to HLA could be observed. A study of the T cell helper activity to an antigen, the response to which is regulated by an HLA-linked gene, suggested a defect in the immune response of the two patients and their asymptomatic brother with immunologic disorders. Treatment with cimetidine of the patient with excessive suppressor activity led to an improvement in his clinical state, reduction in suppressor activity, temporary effect on his proliferative response capacity to mitogens, and an increase in the antigen-specific helper activity.

Chylous ascites and chylothorax as presenting manifestations of stomach carcinoma.

Chylous ascites and chylothorax appeared as the presenting symptoms of metastatic carcinoma of the stomach in a 69-year-old male. Although in the last decade malignancies, predominantly lymphomas, have been responsible for most cases of spontaneous chylous ascites or chylothorax, carcinoma of the stomach was very rarely described as the cause of this entity. The criteria for diagnosis of chylous fluid and the etiology and treatment of this condition are reviewed.

Anti-inflammatory drugs in periarthritis of the shoulder: a double-blind, between-patient study of naproxen versus indomethacin.

Fifty-nine patients were entered into a double-blind, parallel comparison of the efficacy and side-effects of naproxen sodium (825 mg daily) and indomethacin (100 mg daily) in the treatment of periarthritis of the shoulder joint. Assessments were made on entry to the study, at two weeks, and at the end of four weeks when objective and subjective recordings of mobility, loss of function, pain and the presence of absence of side-effects were noted. The two treatment groups were found to be matched for age, sex and duration of disease, and an assessment at the start of the study differed only in respect of the degree of active medial rotation of the shoulder joint and pain. There was an overall improvement from the time of admission to the study in both the naproxen sodium and the indomethacin treatment groups but there was no significant difference between the efficacy of the two groups. One patient from the naproxen sodium group and three patients from the indomethacin group withdrew from the trial because of side-effects which in each case involved the gastro-intestinal tract.

Lymphocutaneous nocardiosis due to nocardia brasiliensis.

A farmer had chaining lymphocutaneous granuloma on the right hand and arm. Clinically the syndrome seemed typical for sporotrichosis. Bacteriological examination revealed Nocardia brasiliensis as the only etiologic agent. Since 1920, eight similar cases of sporotrichoid nocardiosis have been reported from various parts of the world. To our knowledge, isolation of N brasiliensis has not been reported previously in this geographical area.