ABSTRACT
We report on 2 patients with catamenial pneumothorax and one patient with catamenial hemoptysis. The pathogenesis of these diseases is not clear, and intrathoracic endometriosis is often assumed. Catamenial pneumothorax is rare and differs from primary spontaneous pneumothorax in its prevalence in the fourth decade and in mainly multiparous women, its recurrent and almost exclusively right-sided occurrence within 72 hours of the beginning of menstruation, and the generally small size of the pneumothorax. About 5% of women under 50 presenting with primary pneumothorax have catamenial pneumothorax. Prevention of recurrence is difficult, as the recurrence rate is high, treatment duration is potentially long, and residual thoracic pain during menstruation is sometimes seen. The combination of medication (Gn-RH analogues, danazol, possibly hormonal contraceptive drugs or progestagens) with efficient pleurodesis (e.g. thoracoscopic talc application preferentially performed during menstruation) seems so far to be the most efficient, although no controlled studies have yet been performed. Catamenial hemoptysis is very rare and hormonal treatment alone is frequently successful in the long term. In the event of relapse, resection of the implicated endometriotic or angiomatous lesion localized by computed tomography can be performed.
Subject(s)
Hemoptysis/physiopathology , Menstruation , Pneumothorax/physiopathology , Adult , Chest Pain/physiopathology , Female , Hemoptysis/drug therapy , Humans , Hysterectomy , Lynestrenol/therapeutic use , Pleurodesis , Pneumothorax/therapy , Progesterone Congeners/therapeutic use , RecurrenceABSTRACT
A case of angiosarcoma of the liver and the spleen following vinyl chloride exposure is described. The main symptoms in clinical diagnosis were microangiopathic hemolysis, disseminated intravascular coagulation, hepatosplenomegaly and exposure to vinyl chloride thirty years ago. It is the first case in which liver and spleen are involved in angiosarcoma due to vinyl chloride exposure. The tumor cells showed angioformative and solid histiocytoid growth with erythrophagocytosis.
Subject(s)
Anemia, Hemolytic/chemically induced , Disseminated Intravascular Coagulation/chemically induced , Hemangiosarcoma/chemically induced , Liver Neoplasms/chemically induced , Vinyl Chloride/adverse effects , Vinyl Compounds/adverse effects , Aged , Environmental Exposure , Erythrocytes , Female , Hemangiosarcoma/pathology , Humans , Liver Neoplasms/pathology , PhagocytosisABSTRACT
Pathogenesis of nodule formation was studied in over 100 nodular goiters from a subendemic area. 60 surgical specimens were autoradiographed. Only one classical, well-encapsulated adenoma was detected. All other nodules were incompletely encapsulated and consisted of follicles that were morphologically and functionally identical to those of nonnodular parenchyma. Most characteristic was the tremendous interfollicular heterogeneity appearing on autoradiographs. Nodular goiters contain multiple foci and strands of fibrous tissue, which result from scarring of multiple hemorrhagic necroses occurring during goiter growth. Therefore, the slowly growing number of newly formed follicles has to squeeze into the meshes of an inelastic network of connective tissue. Nodular growth pattern is the inevitable consequence. Some particular nodules expand because of excessive accumulation of colloid. We conclude that most thyroid nodules in long-standing goiters consist of ordinary, polyclonal goiter follicles which expand in nodular fashion because they replicate within a mold made out of a poorly extensible network of connective tissue.