Sudden death from pericardial tamponade. Unusual complication of nonbacterial thrombotic endocarditis.

A ruptured myocardial infarct secondary to total coronary occlusion by a fragment of nonbacterial thrombotic endocarditis produced sudden, unexpected death in a nearly asymptomatic 82-year-old man who harbored two malignant neoplasms.

Metastasis of bronchogenic carcinoma to the skin involved by melanoma.

In a 52-year-old man, a cutaneous malignant melanoma developed concurrently with an adenocarcinoma of the right lung. The latter disseminated widely, and autopsy disclosed that it had also metastasized to the dermal tissue involved with the melanoma. Because it was not a metastasis into the substance of the melanoma, it was classified as an unusual type of "collision tumor" rather than a "cancer-to-cancer" metastasis.

Spurious pseudomembranous enteritis in strongyloidiasis.

A fatal case of Strongyloidiasis, unsuspected until postmortem microscopy, is presented. At autopsy, the gross changes in the small bowel of the patient suggested pseudomembranous enteritis. The "membrane" consisted of inspissated barium sulphate from a gastrointestinal series 2 wk before death, nematodes, and proteinaceous material. We believe these findings to be unique. It is possible that bowel hypomotility, known to occur in Strongyloidiasis, favored retention and inspissation of barium sulphate, thus starting a vicious cycle favoring further stasis with increased susceptibility to burrowing worms and augmented auto-infection.

Strongyloidiasis. When to suspect the wily nematode.

Strongyloidiasis is a tenacious soil-transmitted nematode infestation endemic in the south-eastern United States. Thirty-three cases were diagnosed in a series of 1,290 stool examinations in 971 patients at Veterans Administration Medical Center, Mountain Home, Tennessee. Most patients had a concurrent major illness, such as chronic lung disease, serious bacterial infection, or cancer. A minority presented with gastrointestinal symptoms alone. Skin rash was uncommon. Eosinophilia, IgE elevation, and skin anergy were common. Atypical presentations included severe proctitis, colitis, and exacerbation of inflammatory bowel disease. In a patient with the hyperinfection syndrome, the diagnosis was made only at autopsy. Since strongyloidiasis seems to present like an opportunistic illness, all physicians, not just those in endemic areas, should consider its presence in the appropriate setting.

Cavernous hemangioma of the neck simulating thyroglossal cyst.

A rare case of cavernous hemangioma simulating a thyroglossal duct cyst was reported. It is recommended that these be treated by total excision, including hyoid bone, to prevent recurrence.