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.

Liver diseases unique to pregnancy.

Severe liver diseases occur in less than 0.1% of pregnancies. Accurate diagnosis and appropriate therapy are essential to the health and survival of both the mother and fetus. Because of their low incidence and the fact that most pregnant women are cared for primarily by their obstetricians, gastroenterologists only infrequently encounter these diseases. This review is intended to update the practicing gastroenterologist on the complex spectrum of liver diseases unique to pregnancy.

Selected rheumatologic and dermatologic manifestations of inflammatory bowel disease.

This review focuses on the behavior and pathogenesis of selected dermatologic and rheumatologic manifestations of inflammatory bowel disease. Erythema nodosum, the most common skin lesion, correlates with activity of the bowel disease but not with its duration or extent. Resolution occurs with therapy of inflammatory bowel disease. Pyoderma gangrenosum, the most severe skin lesion, bears little relationship to the activity or extent of the colitis. Therapy is usually supportive, but dapsone and steroids appear promising. Immune and vasculitic mechanisms have been postulated for both skin lesions. Peripheral arthritis usually has its onset with or after the development of colitic symptoms. It worsens with exacerbation of bowel inflammation and responds to treatment of the bowel disease. Immune mechanisms are likely. Spondyloarthropathy usually occurs before the onset of overt intestinal disease. Its course is unrelated to the bowel inflammation, it does not respond to treatment of bowel disease, and it is associated with HLA B27.

Pulmonary function in singers and wind-instrument players.

Previous studies suggest that pulmonary function of singers and wind-instrument players may be better than normal control subjects due to breath-control training; however, prior studies were poorly controlled or limited in scope. In the present study, we compare 34 singers and 48 wind instrumentalists with a control group of 31 string or percussion instrumentalists using a pulmonary questionnaire, measurements of inspiratory and expiratory pressures, and spirometry. We found no significant difference between groups in maximum voluntary ventilation, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), mean forced expiratory flow during the middle half of the FVC, the FEV1/FVC, peak expiratory pressure, or peak inspiratory pressure, independently or when corrected for age, sex, height, weight, years performing, smoking, presence or absence of cough, or sputum production. Smoking correlated negatively with measurements of pulmonary function in all groups. There was evidence of a heightened awareness of health among singers, who exercised more and smoked less than their colleagues. The differences in health habits may account in part for the myth of improved pulmonary volumes among singers.