Biomedical subjects
Publications and source records attributed to I Avidor.
A case of haemangioma of the zygomatic bone is presented. The presenting symptoms and signs of this case, unlike those of the other five cases described in the English literature, were of an antral tumour. The treatment comprised surgical removal through a Caldwell-Luc approach. Clinical and histopathological considerations are discussed.
Heterotopic salivary tissue and branchial sinuses occur not infrequently (Goodman et al., 1981; Stingle and Priebe, 1974), caused probably by heteroplasia within remnants of the second cleft (Stingle, 1974). Bilateral lesions which presented clinically as branchial cleft sinuses have been removed from a patient's neck; both of them proved to be branchial cleft sinuses with elements of salivary tissue. The paper describes salivary tissue and branchial sinuses along the anterior border of the sternocleidomastoid muscle on both sides of the neck and bilateral preauricular fistulae occurring in a boy and probably in his sister.
A 37 year old man with Behçet's disease who was maintained on prolonged corticosteroid therapy, developed diabetic ketoacidosis and pneumonia. Secondary infection with mucor intervened with abscess formation cured by pneumonectomy. The association of Behçet's disease and mucormycosis has not been previously reported, although diabetes mellitus was almost certainly the predisposing cause. Surgical treatment offers the best chance of survival in similar cases.
A rare case of two concomitant primary uterine neoplasmas in a 64-year-old patient who had received conjugated estrogens for the 3 preceding years is presented. Müllerian adenosarcoma, heterologous type, with stromal components suggestive of rhabdomyosarcoma, and adenocarcinoma of endometrium, were localized in different sites of the endometrium with no intermingling between them (combination tumor). The diagnostic and therapeutic problems are discussed.
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Persistent lymphocytosis as a presenting sign in sarcoidosis is described in a 61-year-old man. Lymphocytosis is an unusual finding in sarcoidosis. The case presented seems to suggest that sarcoidosis should be considered in the differential diagnosis of lymphocytosis.
The diagnosis of isolated tuberculosis of the Achilles tendon was made in a 50-year-old man by excision of the lesion and histologic examination. The patient was free of other systemic symptoms or other foci of infection. The wound healed without complication with the aid of antituberculous chemotherapy. The lesion recurred after nine years, at which time it was again excised and the diagnosis confirmed. Eight years later, the patient remains symptom-free with no signs of recurrence.
Spontaneous perforation of the small intestine in the newborn is rare. In most cases the etiology is unknown. Three cases of perforation in preterm newborn infants are described. The clinical diagnosis was necrotizing enterocolitis (NEC), and an urgent laparotomy was performed. The histologic examination was compatible with the diagnosis of a congenital defect of the intestinal musculature. All three infants survived.
In a 77-year-old man with dysphagia, x-rays demonstrated an irregular stenotic process in the lower third of the esophagus, suggesting malignancy. Endoscopy disclosed moderate narrowing of the lumen and several ulcers separated by bulges. Serial biopsies revealed Barrett's mucosa. Cimetidine 1 g/day led to prompt improvement and endoscopically there was a disappearance of the lesions after 3 months of therapy. Reduction of the drug to 400 mg/day 3 months later with supplements of antacids and metoclopramide was followed by reappearance of symptoms and recurrence of a deep ulcer. Raising the dose of cimetidine to 1 g/day again resulted in healing and since then a maintenance dose of 600 mg cimetidine with antacids and metoclopramide has been successful in preventing recurrence. This long-term study in a patient with Barrett's esophagus showed 1) that cimetidine can be effective in treating such patients; 2) the prophylactic value of multitherapy as a maintenance regimen, and 3) the importance of careful follow-up.
Three patients presented with liver granulomas and fever. An intensive investigation was initially negative. Corticosteroids were administered with dramatic clinical improvement. Ten months to 3 years later, upon tapering the corticosteroid dose, the initial manifestations reappeared. In two patients Hodgkin's lymphoma was discovered and in a third histiocytic lymphoma. Thus, the diagnosis of lymphoma should be considered in patients with idiopathic liver granulomas, fever, and hepatosplenomegaly without lymph node enlargement, who respond initially to steroid administration but relapse upon tapering the dose.
We report a patient with massive hemoptysis due to benign lymphocytic angiitis and granulomatosis complicated by reactivated tuberculosis. There was remarkably good response to treatment with chlorambucil, corticosteroids and antituberculous drugs.
Postoperative phytobezoars (duration from 2 months to 46 years) after surgery for duodenal ulcer disappeared in seven patients, by both x-ray and gastroscopy, on conservative approach aimed at the major role of delayed gastric emptying in phytobezoar formation. During a 3-day period, metoclopramide was given by drip infusion, 40 mg/24 hours, and the patient received only a copious clear diet, with no solid food. In one patient, two courses of treatment were necessary for complete elimination of the phytobezoar. None of the patients had any underlying disease. All but one had good dentition. "Disruption" of the bezoars allowed the discovery upon endoscopy of unusual etiological features such as carcinoma of the stoma and stomal polypoid hypertrophic gastritis (so-called gastritis cystica polyposa ) in one patient, and a retained suture narrowing the stoma in another.
The macrophage migration inhibition factor (MIF) test toward extracts of choroidal melanoma was repeated four times in a patient with ocular malignant melanoma. In the initial stage, when there was only an ocular finding, the MIF test result was positive. It remained so for a period of two years, even when intrasinusoidal hepatic diffusion developed concomitantly with a nonspecific reactive hepatitis. These histologic findings can be interpreted as evidence of the presence of an immune reaction at a particular moment in the disease process. Several months later, when the patient's condition went into an abrupt decline and showed extensive nodular spread, the results of MIF test were found to have become negative.
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Two cases of intravascular leiomyomatosis are described. In 1 case, a 66-year-old woman was seen with an extension of the tumor to the myometrium, cervix, and left parametrium and with radiologic evidence of tumor extension to the left external and common iliac veins and the inferior vena cava; subsequently, the tumor invaded the left renal, suprarenal and ovarian veins, hepatic veins, and the right atrium, causing severe heart failure and death. The second case is that of a 28-year-old woman with an advanced tumor in the interior vena cava, right atrium, and ventricle who died during cardiac surgery. Review of the literature is presented, with special comment on the management of this disease entity.
Synovitis has been infrequently reported in eosinophilic fasciitis. We report on a patient whose condition conformed to the general features of the syndrome, in whom synovitis was a prominent histological finding. The clinical, laboratory and histopathological features of this disease are reviewed.
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