Unusual cause of yellow skin.

Abstract

lactation is usually suppressed with stilboestrol to a total dosage of 110 mg. In the years 1961-6 inclusive there were 14,018 deliveries, and among the 44 cases of significant thrombdembolism requiring anticoagulants, in no fewer than 19 (43.2%) of these cases the complication occurred during pregnancy. The relatively large number of venous thrombotic episodes in pregnancy, also noted in one of the Liverpool hospitals, appears to be a recent phenomenon. We are convinced that this high incidence represents a change in the pattern of the disease, rather than an improvement in diagnosis.The incidence of puerperal thromboembolism is 1.6 per thousand births, which is very close to that found in Liverpool. We have formed a control group by selecting at random 1 % of all case records during the period under study. There is every reason to believe that this group is representative of the population as a whole, and one can calculate that the incidence of thromboembolism in women who lactated was 0.5 per thousand, compared with an incidence of 3.0 per thousand in women whose lactation was suppressed. Although our numbers are small certain tentative conclusions are possible. Rare Cause of Precordial Pain SIR,-A 57-year-old male was admitted urgently to the cardiac department of the Evangelismos Medical Center because of severe constricting retrosternal pain. This was of abrupt onset, although two to three weeks earlier he had experienced weakness, low-grade fever, mild dyspnoea, and cough.On admission he was in a shocked state, blood pressure being 80/60 mm. Hg and pulse rate 140/min. There was dullness on percussion and greatly diminished breath sounds in the lower half of the left lung. W.B.C. were 22,000/ cu.mm., with 88% polymorphs and E.S.R. 88 mm. in the first hour. Aspartate transaminase was 33 units, alanine transaminase 27 units, and serum amylase 120 Somogyi units %. Chest x-ray showed stippled densities throughout the left lower lobe due to alveolar infiltration and small amount of fluid in the left pleural cavity. E.C.G. showed sinus tachycardia, with negative or biphasic T waves in I, II, AVL and ST depression in V,-V,. The patient's condition continued to deteriorate rapidly, and he died 12 hours after his admission to the hospital.Necropsy showed the middle portion of the oesophagus infiltrated by a soft tumour mass which had ruptured into the mediastinum and to a lesser extent into the main bronchus of the left lung. Microscopic examination of the turnour showed squamous cell carcinoma. The heart was of normal size without any occlusion of the coronary arteries.The object of describing this case is to draw attention to this rare cause of praecordial pain that may simulate acute myocardial infarc-. tion.Contemporary investigators have accepted between 86 and 200 cases of spontaneous perforations of the oesophagus reported in the literature.' On the other hand, spontaneous perforation of an oesophageal tumour without being previously subjected to radiotherapy seems to be extremely rare. Actually we were unab...

Salicylazosulphapyridine-Induced Heinz Body Anemia

“…The drug is effective in at least a proportion of pa tients with ulcerative colitis. The side effects described include nausea, vomiting, skin rash, fever, joint pains, agranulocytosis [22], pancreatitis [4] and yellow pigmentation of the skin [24]. Only a few cases of hemo lysis have been described [5-7, 9-12, 18, 20, 22], In these cases, the ane mia appeared soon after the commencement of treatment and in those pa tients examined, a deficiency of red cell G6PD was found.…”