Atypical multicentric reticulohistiocytosis with paraproteinemia

Two women had multiple subcutaneous nodules that showed features of multicentric reticulohistiocytosis (MR). Neither had joint symptoms. Both had a raised erythrocyte sedimentation rate, an immunoglobulin G paraproteinemia, and raised levels of nonhepatic serum alkaline phosphatase. The skin lesions have been followed up, using light and electron microscopy, immunoperoxidase, and histochemical methods. The material in the giant cells stained positively for gamma heavy chain determinants: the light chain type in each case was that of the paraprotein. An attempt to reproduce the skin lesions in one patient by intradermal injection of her paraprotein failed.     

Infantile psoriasis

We report 14 infants younger than 2 years of age with psoriasis vulgaris in order to call attention to the existence of infantile psoriasis. Three of the patients were noted to have psoriasis in the neonatal period; the onset may have been prenatal in one. In 13 of the 14 patients the site of onset was determined by the isomorphic effect (K?bners phenomenon). Although nail pitting is usually said to be infrequent in childhood psoriasis, 11 (79%) of our patients had typical psoriatic nail changes. Psoriasis must be considered in the differential diagnosis of papulosquamous disorders in infants.     

Diagnosis and management of colovesical fistulas

Diagnosis and management may present difficult problems in patients with colovesical fistulas. Symptoms in the urinary tract are most common, and cystoscopy, and cystography are the most valuable diagnostic procedures. It may not always be possible to demonstrate the fistula by diagnostic tests, and a high index of suspicion should be maintained in patients with inflammatory or neoplastic disease of the rectosigmoid area or bladder with recurrent cystitis. Definitive treatment should include resection of the fistula and diseased segment of the intestine. Both one stage and multistage procedures have their place in the treatment of this condition. There are specific criteria for success for a one stage procedure.