Pheochromocytoma - review and biochemical workup.

A commonly received question in the clinical laboratory is as follows: what is the best test for pheochromocytoma? A widely variable presentation and potentially catastrophic consequence make this a feared neoplasm despite its infrequent encounter. Because various biochemical testing modalities are available, test selection is often confusing. This selection process can be made easier through a better understanding of catecholamine producing neoplasms. The aim of this article is to provide a review of catecholamine producing neoplasms and give recommendations on appropriate test selection.

Comparison of the retrieval of item versus spatial position information.

It has been argued that temporal and spatial position information are represented similarly, but prior research comparing their time course of retrieval with item information has not supported this conclusion. The time course of retrieval was compared for spatial position and item information in 3 response signal experiments, and differences were found in the time course of retrieval that paralleled those found previously for temporal position and item information (B.M. McElree & B.A. Dosher, 1993). The finding was unaffected by restrictions on the degree of relational support, postretrieval decision difficulty, and the elimination of a strategy favoring item recognition. The authors conclude by discussing whether the data indicate that a recall process was contributing to recognition performance.

Polyhydramnios-oligohydramnios in a twin pregnancy complicated by fetal glomerulocystic kidney disease.

Polyhydramnios and oligohydramnios in twin gestation is most often caused by twin-twin transfusion syndrome. Presented is a monozygotic twin pair with polyhydramnios and oligohydramnios, in which both twins had glomerulocystic kidney disease of differing severity. The more severely affected donor twin died of renal failure in the neonatal period. The surviving twin is well following unilateral nephrectomy. This case illustrates the varied spectrum of pathology in glomerulocystic kidney disease.

Incidence of prostate cancer diagnosis in the eras before and after serum prostate-specific antigen testing.

OBJECTIVE: To estimate the incidence of prostate cancer in Olmsted County, Minnesota, from 1983 through 1992 to describe the secular changes that have occurred since the introduction of serum prostate-specific antigen (PSA) testing to the community medical practice in 1987. DESIGN: Population-based, descriptive epidemiological study with ecological and individual level comparisons over time. STUDY SETTING: Olmsted County, Minnesota, where the Rochester Epidemiology Project provides passive surveillance of the population for health outcomes. SUBJECTS: All 511 biopsy-proven incident cases of adenocarcinoma of the prostate diagnosed from 1983 through 1992. The community inpatient and outpatient medical records of all incident cases were reviewed to evaluate the presenting characteristics of men at the time of diagnosis. RESULTS: The age-adjusted incidence of biopsy-proven prostate cancer increased from 64 per 100,000 person-years in 1983 to 216 per 100,000 person-years in 1992. The increase occurred primarily between 1987 and 1988 and was predominately for organ-confined tumors. The age-specific incidence increased dramatically in this same period among men aged 50 years and older. Among men aged 70 years and older, however, prostate carcinoma incidence rates declined after 1990 following the initial increase. This decline among older men contrasted with community-based estimates of PSA utilization rates, which demonstrated consistent increases since 1987 to nearly 50% of the older population in 1992. CONCLUSION: These results support the premise that the recent increase in prostate cancer is due in part to the increased utilization of serum PSA testing. Further, the increased incidence appears to be a transient phenomenon due to the depletion of previously undiagnosed cases from the previous pool. Finally, these data suggest that, in terms of stage at diagnosis, early detection efforts may be effective in identifying more early stage (smaller) cancers.

Cryptosporidiosis: a pathogen more common than appreciated.

Cryptosporidiosis is caused by a protozoan species which can produce an enteritis in humans. Until recently it was thought to primarily infect immunocompromised individuals but is now known to affect immunologically intact persons as well. It is capable of causing a severe diarrhea in small children. Discovery that the organism takes an acid-fast stain has aided greatly in its recognition in the clinical laboratory. There is no effective antimicrobial treatment, thus recognition and careful infection control practices become very important. The authors report stool studies of 247 pediatric age individuals in the Sioux Falls, South Dakota area over a four-month period. Three positive cultures for salmonella were found (1.4%) and four instances of cryptosporidium were identified (1.6%). This is similar to other reports and indicates that this organism is now one of the more frequent non-viral causes of diarrhea in children. It tends to be more common in rural areas.

Intestinal lymphangiomas: a rare cause of intestinal obstruction.

Intestinal obstruction developed in a 4-month-old child in association with an ileal lymphangioma. Intestinal lymphangiomas have only rarely been reported in the literature. This case report documents an additional case and also points out an association with intestinal obstruction. The clinical and pathologic details of lymphangiomas are also reviewed.

Reimbursement issues in clinical oncology.

In this multidisciplinary review, health-care specialists present practical solutions to the dilemma of rising costs v the need for adequate medical care for all Americans. The United States is the only advanced industrial society that makes ability to pay a critical determinant in health care. As the costs of patient care and insurance coverage escalate, the public demands greater value in insurance coverage with enhanced access to adequate care, clinical trials, and experimental therapies. Greater cooperation is needed between third-party payers, business, and government to create a system that provides optimal care today while supporting innovation and emerging technology for the future.

Malignant pleural mesothelioma following radiotherapy in a 16-year-old boy.

A case of diffuse, epithelioid mesothelioma of the right pleura in a 16-year-old boy is presented. Though a history of previous exposure to asbestos could not be elicited, the patient did receive pulmonary irradiation for metastatic Wilms' tumor at the age of 2 years. The authors believe that the development of his mesothelioma was causally related to his prior radiotherapy.