Subclinical hypothyroidism during potassium iodide therapy for lymphocutaneous sporotrichosis.

This report describes a high school football player with an unusual ulcerative lesion on the upper leg that was treated initially as pyoderma gangrenosum, but later proved to be due to Sporothrix schenckii. His treatment with potassium iodide solution was complicated by the occurrence of subclinical hypothyroidism.

Spontaneous arteriovenous fistula between the left common iliac artery and iliac vein.

A left lower quadrant bruit, reduced left dorsalis pedis pulse, and left leg edema were found in an elderly male presenting with chest pain, hypotension, heart failure, and azotemia. Measurement of cardiac output, 12.3 1/minute, systemic vascular resistance, 349 (normal, 770-1500), and arterial-mixed venous oxygen differential, 1.3 (normal, 10-20) confirmed the suspicion of AV fistula, which was shown by arteriogram to be left common iliac artery to iliac vein. Repair was accomplished without incident and the patient made an excellent recovery. This patient's AV fistula is an excellent example of a treatable cause of high output congestive heart failure. Further, his rapid recovery after fistula repair undertaken in the setting of hypotension, renal failure, and refractory heart failure emphasizes the need for aggressive surgical intervention.

Ileal carcinoid tumor complicated by retroperitoneal fibrosis and a prolactinoma.

A patient with mid-gut carcinoid tumor and the unusual complication of retroperitoneal fibrosis was also found to have a prolactinoma. This case brings the number of reported mid-gut carcinoid tumors complicated by a second endocrine neoplasm to five. Three of the second tumors were parathyroid in origin, and the fourth was an insulinoma. In view of the rarity of second tumors and in the absence of documented familial occurrence, it is inappropriate to exhaustively study each person with mid-gut carcinoid tumor, or their families, for a second endocrine neoplasm; however, physicians caring for patients with mid-gut carcinoid should be aware that second tumors are possible. Retroperitoneal fibrosis is also a rare complication of carcinoid, but can be associated with renal failure that can be prevented by surgical intervention. Thus, physicians caring for patients with the carcinoid syndrome should also be aware of this complication.

Relief of sleep apnea in acromegaly by bromocriptine.

A patient with longstanding acromegaly complicated by sleep apnea was treated with bromocriptine prior to surgery. In addition to a significant reduction of the plasma growth hormone concentration and measurable decrease in acral overgrowth, a dramatic improvement of the sleep apnea was observed. After three months of therapy, the amount of sleep time occupied by apneic episodes fell from 48 to 12%. The response indicates: (a) that the sequelae sleep apnea in acromegaly can be improved even when ablative therapy of the pituitary is impossible and (b) bromocriptine may prevent perioperative complications caused by clinically significant airway obstruction in patients with acromegaly.

Rationale behind the periodic health examination in adults.

We have outlined a comprehensive approach to the periodic examination of adults. We do not discuss reasons for excluding specific practices. The approach outlined eliminates many practices that have become part of the "routine examination" and focuses on specific key areas. Our recommendations are practical and somewhat more inclusive than those of the others. We have not addressed mass screening, but have instead defined a periodic health examination applicable to the unique physician-patient relationship.