Clinical and laboratory parameters in predicting chronic urticaria duration: a prospective study of 139 patients.

BACKGROUND: Despite the disabling nature of chronic urticaria (CU), little is known about the disease's duration or the efficacy of adopting aggressive therapeutic regimens such as cyclosporine A. OBJECTIVES: The aim of this study was to evaluate whether parameters such as angioedema, autologous serum test, anti-thyroid antibodies, and total IgE could predict both CU duration and severity. PATIENTS AND METHODS: One hundred and thirty-nine patients suffering from CU were prospectively followed over a 5-year period for disease duration, severity and the presence of angioedema. Also investigated was the association between these clinical parameters and the subsequent detection of autologous serum test, anti-thyroid antibodies, and total IgE. RESULTS: CU lasted over 1 year in more than 70% of cases and in 14% it still existed after 5 years. Angioedema co-existed or appeared during the course of CU in 40% of patients and was associated with disease duration. Autologous serum test and anti-thyroid antibodies were found positive in 28 and 12% of patients, respectively, compared to none of normal individuals, P = 0.001. CU duration was associated with the presence of both autologous serum test and anti-thyroid antibodies; however, autologous serum test and not anti-thyroid antibodies was found in association with CU severity. CONCLUSION: We demonstrate for the first time that CU duration is associated with clinical parameters such as severity and angioedema, and with laboratory parameters such as autologous serum test and anti-thyroid antibodies. The ability to predict CU duration may facilitate decisions regarding the possible early initiation of cyclosporine A as a means by which to reduce disease severity and duration.

Simultaneous occurrence of systemic lupus erythematosus and coeliac disease-like features.

Involvement of the gastrointestinal tract in systemic lupus erythematosus is well documented but small intestinal malabsorption is a rare event. We report a 27 year old woman with systemic lupus erythematosus who had malabsorption and coeliac-like changes on intestinal biopsy. This is the eighth reported case of this association the significance of which is discussed.

Methyldopa-induced syndrome of inappropriate antidiuretic hormone secretion and bone marrow granulomatosis.

A case of an elderly man who developed severe hyponatremia and bone marrow granulomatosis while taking methyldopa is described. The hyponatremia was found to be due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Bone marrow biopsy revealed granulomas. A MEDLINE search of the English literature was done, yielding only one previous report of methyldopa-induced bone marrow granulomatosis and no previous reports of methyldopa-induced SIADH.

Glucose, insulin and glucagon response to intravenous glucose load in patients on chronic hemodialysis.

We examined the theory that patients with chronic renal failure exhibit glucose intolerance that is not completely corrected by dialysis. I.v. glucose tolerance tests (IVGTT) were performed in 11 uremic patients who were on chronic intermittent hemodialysis therapy for a mean of 33 months, before and 24 h after dialysis. The glucose disappearance constants (K-glucose) were normal in all subjects and were not affected by dialysis. Insulin response was within normal limits, with minimal changes by dialysis. Serum glucagon was higher than normal. The early, middle and late insulin levels were the same as in the normal population. These results indicate that chronic hemodialysis therapy, together with continuous effective control of biochemical impairment, can achieve normal glucose tolerance in uremic patients.

Primary meningococcal pericarditis in a pregnant woman.

Pericardial effusion is an unusual complication of meningitis due to Neisseria meningitidis. Primary meningococcal pericarditis without signs of meningitis is rare. Only 18 cases have been described in the literature. The first case was reported in 1939 and the others since 1971. We report a case of primary meningococcal pericarditis in a pregnant woman. Improvement followed prompt antibiotic therapy. Fetal death necessitated abortion by curettage.