Fortuitous imaging of a primary adrenocortical carcinoma with Tc-99m HDP.

The importance of evaluating nonfunctional adrenal masses in the right clinical setting is discussed. A 60-year-old man was initially diagnosed of having a localized lung carcinoma. Metastatic work-up showed an adrenal mass that was not deemed to be related to the lung primary. Although biochemical testing revealed that the adrenal mass was nonfunctional, adrenal scintigraphy was not performed. On resection, the lung neoplasm was shown to be a poorly differentiated adenocarcinoma. Radiologic follow-up of the adrenal finding was recommended. A year later, the patient presented with an abdominal mass that was visualized by bone scintigraphy and, on resection, proved to be adrenocortical carcinoma. In retrospect, the lung mass was a metastasis of an adrenocortical carcinoma.

Exploratory thoracotomy for nonresectable lung cancer.

We sought to evaluate the effect of new diagnostic modalities on patients explored surgically for inoperable lung cancer. From July 1983 to February 1992, 335 patients underwent thoracotomy for lung cancer. Thirty-three of the 35 patients with nonresectable disease had sufficient data for analysis and underwent chest radiography (CXR), CT scan, and bronchoscopy. The study was terminated when video-assisted thoracoscopy (VAT) was introduced at the institution. Causes of nonresectability included significant N2 disease not diagnosed preoperatively (n = 11), tumor invasion of contiguous mediastinal structures (n = 8), and insufficient pulmonary function (n = 4). Four patients were left with unresected disease because of thoracic metastasis. Two patients had technically unresectable disease; three patients were explored surgically because diagnoses could be obtained by no other means. One patient was found to have small cell cancer. Data analysis demonstrated that 19 of 33 thoracotomies could potentially have been avoided or resulted in resection with current techniques. Refinement of imaging criteria, a judicious surgical approach to N2 disease, and VAT may significantly reduce thoracotomies for nonresectable lung cancer.

Effects of cryoprecipitate on the healing of chronic wounds.

Basic research has promise for clinical wound healing. Purified wound healing growth factors are not available for clinical use, but they are present in plasma and platelets and have been used in patients. Chronic wounds would seem to be good for study since the wound surface is easily measured and the patient is anxious for progress. We have done a double-blinded pilot study using autologous cryoprecipitate on chronic wounds. Three of six patients showed wound healing progress; but only one patient's wounds healed permanently. One patient developed new diabetic ulcers, and one patient failed to keratinize epithelialized skin. Cryoprecipitate may promote wound healing, but further work awaits more purified healing factors. Simple measurement of the surface area of a chronic wound may not be adequate to describe all the processes of healing.

Lightning strike to the head: case report.

A case is presented of a teen-aged athlete who sustained a direct lightning strike to the head while wearing a football helmet. The helmet, the presence of sweat, and aggressive resuscitation were instrumental in his survival and complete recovery. This appears to be the first documentation of a lightning strike to an individual wearing protective headgear.

MR findings in extracranial cysticercosis.

A patient with disseminated cysticercosis involving orbit, tongue, parotid glands, epicardial fat, muscle, and subcutaneous tissues is presented. Magnetic resonance findings are described with emphasis on intraorbital and extracranial lesions.

Meckel's cave epidermoid with trigeminal neuralgia: CT findings.

An epidermoid tumor of Meckel's cave was found in a middle-aged woman with trigeminal neuralgia. On CT the lesion had negative attenuation numbers of fat and extended from an expanded Meckel's cave through the porous trigeminus into the ambient and cerebellopontine angle cisterns. Surgical excision provided relief of the patient's trigeminal neuralgia.

Spontaneous pneumothorax from bronchogenic carcinoma.

Spontaneous pneumothorax secondary to bronchogenic carcinoma is an unusual occurrence. Reported here is a patient with adenocarcinoma of the lung whose presenting symptom was spontaneous pneumothorax. A brief review of the literature is presented.