Spontaneous regression of small cell carcinoma of lung associated with severe neuropathy.

This is a case report of small cell lung cancer (SCLC) that underwent spontaneous regression. This was associated with severe neuropathy, which was unresponsive to therapy, including corticosteroids and plasmapheresis. We present here the case report and a brief review of the literature.

Hageman factor deficiency presentation and implications for management.

One of the more fascinating aspects of patient management arises when dealing with coagulation disorders. Factor XII deficiency, first described by Ratnoff in 1968, is one such coagulation disorder which provides some interesting challenges in management. Factor XII deficiency has been shown to be an inherited autosomal recessive disorder. The presence of Hageman factor abnormality trait can be clinically suspected in a patient with a prolonged activated partial thromboplastin time (APTT), normal prothrombin time (PT), normal bleeding time, and no clinical history of bleeding. Once suspected, the deficiency can be confirmed by normalization of partial thromboplastin time (PTT) with normal aged plasma and by factor assay. The importance of understanding the mechanism of factor XII deficiency has clinical significance when attempts are made to heparinize individuals who have this deficiency. Three methods can be used to monitor therapy: the chromogenic heparin assay, the citrated thrombin time, and the recalcified thrombin time. Two cases are presented.

Hepatic angiosarcoma.

A patient with hepatic angiosarcoma is described. The significant aspects of this malignancy are delineated. This tumor constitutes only 2% of all primary tumors of the liver. The association with exposure to vinyl chloride and other carcinogens is reviewed. Diagnostic and therapeutic modalities are discussed.

The case of Valentine Shortis--yesterday and today.

Valentine Shortis, a young Irish immigrant, was convicted of murder in Quebec in 1895. His insanity defence was unsuccessful in spite of psychiatric evidence given by the leading psychiatrists in Canada. Shortis spent the next 42 years in custody. The case provides a good vehicle for exploring a number of aspects of the history of psychiatry, the insanity defence, and the treatment of the criminally insane in Canada. Comparisons are made with the insanity defence and the treatment of the criminally insane today.

Hepatic abscess following hepatic arterial infusion chemotherapy with an implantable pump.

A patient with an intrahepatic abscess associated with an implantable pump for hepatic arterial infusion for metastatic colonic tumor is described. In view of the increased use of this device, clinicians should be aware of this complication.

Reversible deficiency of serum high density lipoproteins in Hodgkin's disease.

An elderly woman with Hodgkin's disease and hepatic involvement but without cholestasis presented with markedly depressed levels of serum esterified cholesterol and high density lipoproteins (HDL). Within five days of her first cycle of chemotherapy her serum HDL-cholesterol rose from 8-10 mg/dl to 88 mg/dl, and levels of the major HDL-apoprotein, apoA-I, rose from 60 to 138 mg/dl. The proportion of unesterified serum cholesterol fell from 60-80% to 27-30%. These observations suggest a relatively specific effect of the hepatic lymphoma on synthesis or release of lecithin:cholesterol acyltransferase.