Metastatic Small Cell Carcinoma of the Lung: An Unusual Cause of Acute Fulminant Hepatic Failure.

For patients with acute fulminant liver failure, imaging and histopathologic studies are indicated to reveal the underlying etiology, and metastatic small cell carcinoma should be included in the clinical differential diagnosis when appropriate.

Extranodal Rosai-Dorfman disease arising in the right atrium: a case report with literature review.

Rosai-Dorfman disease is a rare, benign histiocytic proliferative disorder that commonly affects the lymph nodes. Although extranodal involvement has been reported in diverse sites, manifestation in the cardiovascular system is extremely uncommon. Specifically, the involvement of the heart by Rosai-Dorfman disease is an extraordinarily infrequent event. Here, the authors present a case of Rosai-Dorfman disease arising in the right atrium in a symptomatic 61-year-old man who initially presented with pleuritic chest pain and was found to have a large, lobulated, and circumscribed right atrial mass. The lesion exhibited an exuberant histiocytic and chronic fibroinflammatory process with focal emperipolesis within histiocytes. Immunohistochemical studies demonstrated strong S100 positivity in CD68+ CD1a- histiocytes. Although rare, Rosai-Dorfman disease should be considered in the differential diagnosis of a right atrial mass.

Chemical terrorism: a primer for 2002.

Agents of chemical warfare have inflicted mass casualties on military and civilian personnel. Although not yet deployed on populations in the United States, stockpiles exist in countries that view the United States with enmity. There are four groups of such agents. The inhalants, chlorine and phosgene, were the earliest such weapons. Cyanide gases, because of their volatility, exert their lethal consequences in enclosed spaces. The vesicants and nerve agents, currently the most successful agents of chemical mass destruction, are the major focus of this overview. Mustard, the prototype of the vesicants, and its sulfur and nitrogen analogues are aerosolized liquids that linger on victims, incapacitating through their effects on the skin, eye, and respiratory tract. Mortality is low, but morbidity is substantial and mass casualties strain health care resources. Nerve agents, by contrast, are designed to kill. All, including Tabun, Sarin, Soman, and VX, are organophosphates that inactivate acetylcholinesterase. Widespread manifestations of peripheral and central neuronal dysfunction can be fatal without timely administration of antidotes. Decontamination, axiomatic in the management of agents of chemical warfare, is outlined, and therapeutic strategies are summarized in the light of current understanding.

Bioterrorism: a primer for 2002.

The often anticipated, sometimes dismissed, threat of biological terrorism became a reality in the United States in the fall of 2001 with cases of cutaneous and inhalation anthrax. As the public health sector is rapidly focusing on enhancing awareness and preparedness, this overview is intended as a primer for clinicians. The more probable events, their most prominent characteristics, and currently available management strategies are summarized. The biowarfare characteristics of plague, tularemia and botulism are summarized. The more problematic anthrax and smallpox are presented in greater detail. Epidemiological clues to a biological attack are outlined with reference to the recent literature.