RESUMO
Extramedullary hematopoiesis of the bronchus is rare. The case of a 72-year-old man in whom the right lower lobe bronchus was obstructed by extramedullary hematopoiesis is presented. Ten months after the initial presentation, Philadelphia chromosome-negative chronic myelogenous leukemia was diagnosed. Such findings have not been reported previously. The various anatomic locations of extramedullary hematopoiesis are reviewed, with an emphasis on intrathoracic and pulmonary presentations. The clinical and pathologic features and the differential diagnosis in the present case are discussed.
Assuntos
Brônquios/patologia , Neoplasias Brônquicas/complicações , Coristoma/complicações , Hematopoese , Leucemia Mieloide/fisiopatologia , Adenocarcinoma , Idoso , Broncopatias/etiologia , Calcinose/etiologia , Humanos , Masculino , Neoplasias Primárias Múltiplas , Neoplasias da PróstataRESUMO
With the use of a microcomputer, the authors prospectively stored the bronchoalveolar lavage (BAL) cell differential counts from 208 patients undergoing initial evaluation for chronic interstitial lung disease. Sarcoidosis subsequently was diagnosed in 46% of these patients; the remainder had several other etiologies of their lung disease. The BAL lymphocyte count did not allow for clear separation between these two groups. To facilitate the interpretation of the BAL percent lymphocyte data, the authors applied a modification of Bayes' theorem to calculate likelihood ratios for the differential diagnosis of sarcoidosis versus other interstitial lung disease. These values ranged from 0.15 for patients with less than 6% lymphocytes to 3.5 when more than 40% lymphocytes were found. Similar results were obtained with a subsequent, independently analyzed group of 46 patients. To provide a more meaningful interpretation of the BAL fluid lymphocyte count, the authors designed a reporting scheme that includes both a written description and a graphic representation of the likelihood ratio. Prospective collection of data using microcomputers should extend this useful form of reporting to additional laboratory studies.
Assuntos
Brônquios/patologia , Diagnóstico por Computador , Contagem de Leucócitos , Alvéolos Pulmonares/patologia , Fibrose Pulmonar/diagnóstico , Sarcoidose/diagnóstico , Teorema de Bayes , Diagnóstico Diferencial , Humanos , Microcomputadores , Fibrose Pulmonar/etiologia , Sarcoidose/complicações , Irrigação TerapêuticaRESUMO
Neurological complications of malignant carcinoid are infrequent. Only 11 cases of central nervous system metastasis are documented, and neurological symptoms may be the initial or only manifestation of this tumor. We describe the case of a 60-year-old man with no known primary tumor who presented with spinal cord compression by a thoracic epidural tumor. After laminectomy, the diagnosis of carcinoid was made by light and electron microscopic demonstration of neurosecretory granules in tumor cells. Urine 5-hydroxyindole acetic acid and plasma serotonin levels were subsequently found to be elevated. Carcinoid tumors should be considered in the differential diagnosis of lesions metastatic to the spinal cord and brain.
Assuntos
Tumor Carcinoide/secundário , Compressão da Medula Espinal/cirurgia , Neoplasias da Medula Espinal/secundário , Tumor Carcinoide/cirurgia , Espaço Epidural , Humanos , Masculino , Pessoa de Meia-Idade , Mielografia , Neoplasias da Medula Espinal/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Demographic and trend analysis of 881 consecutive suicides in blacks and whites is presented. For the years 1975 through 1984, the suicide rate was 15.1/100 000 and did not significantly change. White males were overrepresented in all age groups, had an overall suicide rate of 34.9, and showed a small but statistically significant increase in rate which was not accounted for by any specific age group. White females, in general, were represented in proportion to their prevalence in the population, and those ages 20 to 24 demonstrated an increasing suicide rate which was small. Black males were at highest risk in their twenties, showed no significant trends, and were also represented near their prevalence in the population. Black females of all ages were underrepresented, and had low suicide rates which decreased with time. No significant rate changes were noted for teenagers or the elderly. Firearms was the method of choice in all groups, although methods varied with age, race, and sex, and male children preferred hanging. Small but significant increases were noted for the prevalence of nondrug methods in females and carbon monoxide deaths in white males. Similarities and differences to larger scale studies are discussed. Suicide may have characteristics unique to given geographical areas and pervasive to all areas. The authors advocate study and publication of local data to clarify further the nature of suicide.
Assuntos
Suicídio/epidemiologia , Adolescente , Adulto , Negro ou Afro-Americano , Fatores Etários , Idoso , Criança , Feminino , Georgia , Humanos , Masculino , Pessoa de Meia-Idade , Estações do Ano , Fatores Sexuais , População BrancaAssuntos
Hospitais Psiquiátricos , Transtornos Mentais/diagnóstico , Encaminhamento e Consulta , Adulto , Idoso , Arritmias Cardíacas/diagnóstico , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Hospitalização , Humanos , Hiponatremia/diagnóstico , Masculino , Pessoa de Meia-Idade , North Carolina , Pancreatite/diagnóstico , Pneumonia/diagnósticoRESUMO
A senior pathology resident recounts the circumstances of his search for a post-residency forensic pathology training program. If some of his episodes sound familiar, your ailing application and interview process may need improvement.
Assuntos
Educação de Pós-Graduação em Medicina/organização & administração , Medicina Legal/educação , Candidatura a Emprego/normas , Patologia/educação , Gestão de Recursos Humanos/normas , Estudos de Avaliação como Assunto , Estados UnidosRESUMO
We analyzed the blood of homicide victims for the presence of cocaine's major metabolite, benzoylecgonine. During 1989 in Fulton County, Georgia, 81% of 275 homicide victims were tested for benzoylecgonine; 40% tested positive. The proportions of blacks and victims of firearm injuries who tested positive for benzoylecgonine were significantly larger than the respective proportions for whites and victims of injuries not involving firearms. The data show overall proportions of benzoylecgonine positivity much larger than those previously reported in the literature. The relationships between homicide, race, firearms, and cocaine use deserve further study.
Assuntos
Cocaína/análogos & derivados , Homicídio , Negro ou Afro-Americano , Cocaína/sangue , Feminino , Georgia/epidemiologia , Homicídio/estatística & dados numéricos , Humanos , Masculino , Vigilância da População , Estudos Retrospectivos , Ferimentos por Arma de Fogo/sangue , Ferimentos por Arma de Fogo/etnologiaRESUMO
Cardiac diverticula have been documented in approximately 80 patients. In over 70% of cases, this lesion is associated with midline thoracoabdominal defects or other congenital malformations of the heart. The diverticulum is thought to occur early in embryogenesis from an outpouching of the endomyocardium through a weak region in the left ventricular wall, but its exact etiology is uncertain. The case of a 6-year-old white boy who died suddenly while playing is presented. Autopsy revealed a ruptured diverticulum of the left ventricular apex with massive hemopericardium and cardiac tamponade. No other abnormalities were found. The pertinent literature is reviewed.
Assuntos
Morte Súbita/etiologia , Divertículo/congênito , Cardiopatias Congênitas/patologia , Criança , Morte Súbita/patologia , Divertículo/patologia , Humanos , Masculino , Ruptura EspontâneaRESUMO
A 29-year-old homosexual man died as a result of cocaine inserted into his rectum by his sexual partner. The apparent purpose of this form of drug abuse is to relax the anal sphincter muscles. However, as in this case, cocaine administered in this fashion has a high potential for toxicity. The possible legal and medical ramifications of death resulting from this practice are discussed.
Assuntos
Cocaína/intoxicação , Administração Retal , Adulto , Cocaína/administração & dosagem , Medicina Legal , Homossexualidade , Humanos , Masculino , Transtornos Relacionados ao Uso de Substâncias/legislação & jurisprudência , Estados UnidosRESUMO
So-called "typical" autoerotic fatalities are the result of asphyxia due to mechanical compression of the neck, chest, or abdomen, whereas "atypical" autoeroticism involves sexual self-stimulation by other means. We present five atypical autoerotic fatalities that involved the use of dichlorodifluoromethane, nitrous oxide, isobutyl nitrite, cocaine, or compounds containing 1-1-1-trichloroethane. Mechanisms of death are discussed in each case and the pertinent literature is reviewed.
Assuntos
Cocaína , Hidrocarbonetos Halogenados , Óxidos de Nitrogênio , Transtornos Parafílicos/patologia , Transtornos Relacionados ao Uso de Substâncias/patologia , Adulto , Clorofluorcarbonetos de Metano , Cocaína/sangue , Humanos , Masculino , Nitritos/sangue , Óxido Nitroso/análise , Transtornos Parafílicos/complicações , Solventes , Transtornos Relacionados ao Uso de Substâncias/sangue , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/urina , Tricloroetanos/análiseRESUMO
Three patients initially diagnosed with Hodgkin's disease developed non-Hodgkin's lymphoma 1.5, 7, and 16 years later, respectively. Combined modality therapy had been employed in one patient; the other two had received combination chemotherapy. All three of the second neoplasms were morphologically characterized as peripheral T-cell lymphomas. Cell surface marker studies performed on two of these tumors confirmed their T-cell origin. Second lymphoproliferative malignancies are an increasingly recognized complication in patients with Hodgkin's disease. Further immunologic phenotyping is needed to more conclusively define the origin and frequency of occurrence of these tumors.