Transbronchial biopsy of pulmonary alveolar microlithiasis.

A middle-aged woman was initially seen with mild breathlessness and a fine reticulonodular pattern noted on chest roentgenogram. Pulmonary alveolar microlithiasis was demonstrated by transbronchial biopsy. Although microlithiasis calcispherites have been described as appearing in bronchial walls, at necropsy, and in lavage fluid, we have found only one previous report of a case diagnosed by transbronchial biopsy.

Testosterone-secreting adrenal adenoma containing crystalloids characteristic of Leydig cells.

A 49-year-old woman with virilization demonstrated biochemical features traditionally ascribed to virilizing ovarian tumors: marked elevation of serum testosterone level with normal urinary excretion of 17-ketosteroids and normal serum dehydroepiandrosterone level. An adrenal cortical adenoma containing neoplastic cells indistinguishable from Leydig cells, including the demonstration of characteristic crystalloids of Reinke, was shown to be the source of the elevated testosterone level. A review of the literature revealed 13 cases with a similar biochemical profile, and of these, two were reported to contain crystalloids of Reinke. Taking cognizance of the fact that these characteristic crystalloids are only found in 40 percent of Leydig cell tumors of the testis, it is concluded that Leydig cells may be present in, and may be active participants in, the pathophysiology of a number of testosterone-secreting adrenal tumors.

Lung carcinoma by histologic type in coal miners.

Histologic types of lung carcinoma were studied in 171 coal miners in the National Coal Workers' Autopsy Study. These miners had an average underground mining tenure of 29 +/- 14 years and an average smoking history of 31 +/- 23 pack-years. The proportion of carcinomas by cell type were: squamous cell carcinoma, 30%; adenocarcinoma, 27%; small-cell undifferentiated carcinoma, 26%; large-cell undifferentiated carcinoma, 9%; and other carcinomas, 8%. More tumors were observed in the right lung and in the upper lobes of both lungs than in the left lung and in the lower lobes of both lungs, respectively. The majority of the tumors were centered on cartilaginous airways (81%) as compared with the peripheral regions of the lung (19%). Squamous cell carcinomas predominated in the older miners and in larger airways. Adenocarcinomas were more common in the peripheral lung. No significant interaction was demonstrated between cell type and years of underground mining. The data indicate that lung carcinoma in coal miners differs little in its pathologic features from men in the general population who smoke cigarettes. No effect of coal mine dust exposure on lung carcinoma histogenesis was demonstrated.

Burden of mental illness on the family: a critical review.

The burden that a family experiences as a result of one of its members having a chronic mental illness has been the subject of research since the mid-1950s. A review of the findings in the research literature, an examination of the conceptual and operational definitions of burden, and an evaluation of methodological issues are provided. Finally, based on this critical review, suggestions are offered for future research.

An evolution of malignant mixed müllerian tumor.

In an unusual example of malignant mixed müllerian tumor, a tumor originated in the uterine corpus as an endometrial carcinoma consisting of ordinary endometrial adenocarcinoma, papillary adenocarcinoma, mucinous adenocarcinoma, and squamous cell carcinoma. Following hysterectomy, the tumor recurred at the vaginal vault as poorly differentiated papillary adenocarcinoma. During the second recurrence as a pelvic tumor about 3 years after hysterectomy, the tumor evolved into a malignant mixed müllerian tumor with predominance of sarcomatous element. The latter included undifferentiated sarcoma, endometrial stromal sarcoma, fibromyxosarcoma, leiomyosarcoma and rhabdomyosarcoma. These findings support the contention of Sternberg et al. that a malignant mixed müllerian tumor may exceptionally originate in an endometrial carcinoma.

Fine-needle aspiration of head and neck masses in children.

PURPOSE: Head and neck masses in children are common. Suspicious or persistent masses are referred to the otolaryngologist who is faced with the dilemma of deciding which ones require surgical excision. Fine-needle aspiration (FNA) in adults helps distinguish lesions requiring excision from those that do not. Few reports exist of its use in children PATIENTS AND METHODS: Between January 1991 and December 1994, 67 FNAs were performed on children, 29 of which (43%) were for head and neck masses. Based on the FNA findings, 16 patients underwent surgery. RESULTS: In 13 patients, the final pathology was consistent with the FNA findings: granulomatous diseases (3), branchial cysts (3), acute/chronic lymphadenitis (3), thyroglossal cyst, hemangioma, Hodgkin's lymphoma, and Castleman's disease (one each). There was one misdiagnosis, no false positives, and two nondiagnostic specimens. Based on the results of FNA, surgery was not performed in the remaining 10 patients. The cytology was: cervical lymphadenopathy (7), abscess formation (1), lymphangioma (1), and leukemia (1). CONCLUSION: We conclude that FNA in an extremely useful tool in the management of head and neck masses in children. It is very well-tolerated by children, and we did not encounter any complications.

Ectopic decidual cell reaction in para-aortic and pelvic lymph nodes in the presence of cervical squamous cell carcinoma during pregnancy.

Bilateral para-aortic lymphadenectomy is routine prior to radical surgery in cancer of the cervix. A pregnant patient with invasive cancer of the cervix and ectopic decidual cell reaction in para-aortic and pelvic nodes is presented. A decidual cell reaction in frozen sections of para-aortic lymph nodes could be confused with metastatic disease. Pathogenesis of ectopic decidual cell reaction is discussed.

Validating the safety of nurse-health advocate services.

Prior to promoting the use of community health care advocates for home visits, it is necessary to evaluate their ability to safely screen for health problems. This study examined trained maternal-child health advocates (MCHAs) who, supervised by professional nurses, conducted maternal-child home visits consisting of health promotion and problem identification. Problems identified by MCHAs were compared to problems identified by professional, validating nurses, who were not part of the service project, on hypothetical home visit situations and during 213 duplicate home visits. There were no significant differences between MCHAs and professional nurses in their identifications of infant health problems, infant health care deficits, other family members' health problems, prenatal care deficits, emotional problems, and substance abuse on either the hypothetical home visits or the duplicate home visits. The validating nurses identified significantly more women's health problems (p = 0.01) and women's health care deficits (p = 0.02) than the MCHAs on the duplicate home visits. These findings validate the safety of using the model of trained community health advocates teamed with registered nurses to screen for infant health problems during home visits.