Biomedical subjects
Publications and source records attributed to V W Weedn.
Unexplained retinal hemorrhages in infants are usually indicative of child abuse. We present the case of an infant with retinal hemorrhages following cardiopulmonary resuscitation, who had not been abused. Cardiopulmonary resuscitation should be added to the list of causes of retinal hemorrhages in infants and children.
A national survey reviewing patient injury litigation against US dermatology residency programs revealed that 50% of the respondents had experienced at least one lawsuit between 1964 and 1988. The northeast region reported the most legal activity. Fifty percent of the lawsuits related to therapeutic or surgical complications. Plaintiffs were successful in 37.9% of the lawsuits. The mean award was $26,505, and the largest reported award of $200,000 was for failing to diagnose herpes simplex in an immunocompromised patient. In view of several recent trends in dermatology, the amount of litigation against dermatologists may increase.
We report our second case of chronic eosinophilic pneumonia (CEP) (Carrington's pneumonia) with elevated serum IgE values and present a review of the literature on this subject. Our present patient, a 55-year-old woman, had classic symptoms of dry cough, weight loss, malaise, dyspnea, night sweats, and fevers. Significant peripheral blood eosinophilia and a right upper lobe infiltrate were present. Glucocorticoid therapy caused prompt resolution of symptoms, as well as disappearance of blood eosinophilia, elevated serum IgE levels, and pulmonary shadowing. The diagnosis of CEP should not be neglected in the classification of the eosinophilic pneumonias with increased serum IgE levels. The increased serum IgE levels, when present in CEP, seem nonspecific and thus may not be useful as a diagnostic adjunct. However, measurement of IgE may be helpful in CEP, as it has been in allergic bronchopulmonary aspergillosis, to guide the dosage and duration of corticosteroid therapy.
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A woman with unresectable squamous cell carcinoma of the thymus was treated with combination chemotherapy consisting of cyclophosphamide, adriamycin, cisplatin, and prednisone. Rapid tumor response and hyperuricemia occurred within 10 days after the first course of chemotherapy. Mediastinal irradiation was given after two courses of chemotherapy. Chemotherapy was continued until the total dose of adriamycin reached 450 mg/m2. The patient is alive and well in remission more than 111 weeks after therapy was begun and more than 63 weeks after treatment was discontinued. Further study of this chemotherapeutic regimen in squamous cell carcinoma of the thymus is needed. Monitoring of serum uric acid levels may be required.
Three cases of documented sarcoid meningoencephalitis were reviewed. Computed tomography (CT) showed enhancing, perivascular, linear, and nodular areas along the subarachnoid space, extending deep into the white matter. In one case the perivascular granulomatous infiltration, which caused small vessel periangiitis, gave rise to a CT pattern closely resembling that of arteriovenous malformation or infarction with gyral enhancement. This infiltrative pattern might be seen in other chronic meningeal processes. The pathophysiology responsible for the unusual CT appearance and the differential diagnosis are discussed.
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Bronchioloalveolar carcinomas (n = 45), intravascular bronchiolo-alveolar tumors (n = 8), and sclerosing hemangiomas of the lung (n = 2) were stained for surfactant apoprotein by the immunoperoxidase method. Of the bronchiolo-alveolar carcinomas, 12 were found to be carcinomas of type II pneumocytes and the remaining 33 tumors were designated as nontype II pneumocytic bronchiolo-alveolar carcinomas. Twenty-five of these tumors displayed trapped benign type II pneumocytes within the tumor masses. In the case of intravascular bronchioloalveolar tumors, none of the tumors demonstrated staining of tumor cells for surfactant apoprotein. In the two cases of sclerosing hemangiomas, the type II pneumocytes were exuberant and numerous, and in one case contained intranuclear inclusions of surfactant apoprotein. This article discusses the implication of the presence of benign type II pneumocytes in pulmonary tumors.
Stud guns (powder-actuated fastening tools) are a commonly used construction tool. Accidental injuries and fatalities are no longer frequent, presumably because of current safety features and practices. A case of an intentional fatal wound (suicide) is described. A literature review of stud gun injuries is also presented.
Fine needle aspiration of a lung nodule in an immunosuppressed adult man revealed numerous dematiaceous (pigmented) fungi with both hyphal and spherical forms. Multiseptate bodies ("muriform" cells) were also present in small numbers. Fonsecaea pedrosoi was cultured from the aspirate. The cytomorphologic features of the fungus in tissue are described, and the significance of finding fungal cells that divide both by budding and fission is discussed.