Biomedical subjects
Publications and source records attributed to K G Torrington.
We have reported the first described case of idiopathic simultaneous chylopericardium and chylothorax and discussed its diagnostic and therapeutic considerations. Efficacy of thoracic duct ligation, pericardiectomy, and pleurodesis for this entity is established.
Blind nasogastric intubation was attempted in a chronically debilitated patient. The nasogastric tube entered the trachea and was advanced through the left lower lobe bronchus into the left pleural cavity. During the subsequent two days of dietary supplement (Isocal) infusion, the patient developed fever, chills, decreased responsiveness, and left shoulder pain. This complication ultimately led to the patient's death. We have reviewed the known complications of nasogastric intubation and recommend that difficult intubations in weak or debilitated patients be followed by chest roentgenogram in order to confirm the correct placement of the tube.
A patient with acute myelocytic leukemia who had a chronic febrile illness during the induction of remission of leukemia developed asymptomatic discrete pulmonary infiltrates which rapidly evolved into cavities containing homogeneous opacities. Over the next five weeks, the cavities resolved without specific treatment. The patient subsequently passed large fungus balls in the urine, and the diagnosis of disseminated aspergillosis was made. A course of intravenous amphotericin B therapy was completed without complications. This case demonstrates the importance of culturing urine specifically for fungal organisms in the immunosuppressed host.
A patient presenting with the clinical and radiographic picture of pulmonary sarcoidosis was found to have a testicular nodule. Orchiectomy was done, and the pathologic specimen revealed only granulomatous inflammation. The involvement of the testis in sarcoidosis is reviewed, and recommendations are made regarding surgical diagnosis and medical treatment.
The records of patients who had transbronchial lung biopsy at Walter Reed Army Medical Center between January 1974 and September 1977 were retrospectively reviewed. Nine patients were found whose clinical and radiographic presentations were compatible with lymphangitic carcinomatosis. In five patients in lymphangitic spread of carcinoma was diagnosed from transbronchial lung biopsy specimens. A single patient had a false-negative biopsy, proven at autopsy three weeks later. The other three patients with negative biopsies are alive and receiving chemotherapy 12 months later (two patients) or are lost to follow-up (one patient). Transbronchial lung biopsy is an accurate procedure for diagnosing lymphangitic carcinomatosis. In addition, aggressive chemotherapy should not be used in these patients without a tissue diagnosis.
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