Extrahepatic manifestations of hepatitis B virus infection: Addison's disease and myelofibrosis in a patient with persistent hepatitis B surface antigenemia.

A 60-year-old white male patient was admitted to the hospital with acute abdominal pain, seemingly a self-limited ileus. He was found to be hepatitis B surface antigen (HBsAg)-positive. Previous dental treatment was suspected to be the initial source of the infection with hepatitis B virus. Five months later he was re-admitted with a diagnosis of adrenal insufficiency (Addison's disease) which responded well to steroids. Four years later he developed fever and leucocytosis. A bone marrow biopsy revealed myelofibrosis. He had several episodes of pyrexia during his lifetime. After a 12-year period the patient suffered a fatal myocardial infarction. At autopsy the adrenal glands were reduced to scarred remnants and HBsAg was found to be present in the residual adrenocortical cells by immunoflouresence methods. Bone marrow at autopsy revealed myelosclerosis as well HBsAg (via immunofluoresence). Hepatitis B virus was therefore closely correlated with the development of Addison's disease and myelofibrosis in this case.

Mycobacterium szulgai: an unusual pathogen.

Mycobacterium szulgai is an unusual pathogen that accounts for less than 1% of all cases of non-tuberculosis mycobacterial infection. Infections with this organism usually involve the lung but may involve soft tissues. Although similar to tuberculosis in its clinical presentation, infection due to M. szulgai requires different management, and it is therefore important to distinguish disease caused by M. szulgai from that caused by M. tuberculosis. Isolation of M. szulgai implies the presence of clinical disease, and when the organism is identified, treatment based on sensitivity testing should be initiated. Although no standard recommendations for treatment exist, most infections due to M. szulgai have been treated with combined high doses of isoniazid, ethambutol, and rifampin for 18-24 months. M. szulgai has been isolated worldwide; the first case of infection reported from Canada is described, and the clinical presentation, microbiologic diagnosis, and therapeutic management of M. szulgai infections are reviewed.

Malignant histiocytosis.

The clinical features, therapy, and hospital course of ten consecutive patients with malignant histiocytosis (MH) are presented. The value of bone marrow aspiration for the diagnosis is discussed. The patient's performance status as described in this report by the organ dysfunction score may predict survival and response to chemotherapy. The literature on chemotherapy in this disease is reviewed. Combination chemotherapy may be the best approach to treatment, but there is little experience with single agents. There is a great need for better characterization of the malignant cell in this disorder.

A comparison of membrane and bubble oxygenation as used in cardiopulmonary bypass in patients. The importance of pericardial blood as a source of hemolysis.

A prospective clinical study involving more than 500 patients was designed to compare the Landé-Edwards membrane oxygenator and the Bentley bubble oxygenator. First, the importance of exposure of blood to the pericardium as the major source of hemolysis during open-heart surgery was confirmed. Because of this finding, we included in this study only those patients in whom the blood spilled into the pericardium was not returned to the pump. Under these circumstances, we found that hemolysis was relatively low in patients oxygenated with the membrane oxygenator.

Gastric lymphosarcoma and pseudolymphoma: reappraisal of 12 cases of gastric lymphosarcoma.

Lymphoma localized to one organ is known to have a good prognosis. After a study of 131 cases of lymphosarcoma of the stomach Smith and Helwig(3) reported that 42 were in reality a benign lymphoproliferative disorder which has been termed pseudolymphoma of the stomach. Of our series of 12 cases, six are now thought to be pseudolymphoma. Jacobs(7) has enumerated the differentiating criteria. We have found a polymorphic cellular infiltrate, in nodular or diffuse pattern, associated with a fibrotic reaction located in the submucosa, muscularis or serosa, to be the most helpful criterion. The "good prognosis" associated with gastric lymphoma may be due partly to the difficulty in differentiating these two conditions and to the inclusion of cases of pseudolymphoma in any large series of these lymphomas.