Asbestos related interstitial pneumonitis associated with glomerulonephritis and lymphomatoid granulomatosis.

We report a case of pulmonary asbestosis in a patient who also developed glomerulonephritis and lymphomatoid granulomatosis. The pulmonary reaction was unusual, characterized clinically by an acute onset of symptoms after a prolonged latent period and morphologically by an interstitial pneumonitis with prominent desquamative features and a paucity of fibrosis. The association of pulmonary asbestosis with glomerulonephritis and lymphomatoid granulomatosis has been hitherto unreported.

Smoking and peptic ulcer in rheumatoid arthritis.

The prevalence of chronic peptic ulcer among 152 out-patients with rheumatoid arthritis attending a district general hospital was found to be 16.4% (25 patients), as against 6.6% (10 patients) among an equal number of matched control out-patients with other diagnoses. There was no evidence that any form of anti-inflammatory treatment increased ulcer risk, but smoking was significantly associated with a higher prevalence of ulcer. This relationship was shown to be quantitative and to depend upon an increased frequency of duodenal ulcer in women who smoked. It is possible that greater numbers would have shown the effect of smoking to apply to both sexes, and that for all patients with rheumatoid arthritis abstention from smoking could diminish the high risk of peptic ulceration associated with this disease.

Ectopic adrenocorticotrophic hormone production and neoplasm.

Three patients presented with severe hypokalaemic, hypochloraemic alkalosis, muscle weakness and later cutaneoud pigmentation. There were few signs of Cushing's syndrome. Two had bronchial and one pancreatic neoplasm. Plasma cortisol and urinary steroid metabolites were extremely elevated and synacthen stimulation showed significant adrenal capacity even with adrenal metastases. Aminoglutethamide reduced plasma cortisol in two patients.