A patient with weakness and an abnormal chest radiograph: A case report.

A 40-year-old black male presented to ICU after intubation for airway protection due to rapid onset of neck weakness and swallowing difficulty. His chest radiograph showed an unusual mediastinal opacity for which a computer tomography (CT) scan was done, confirming a mediastinal mass.

Secondary thyroid carcinoma after treatment for childhood cancer.

BACKGROUND: Second malignant neoplasms (SMNs) have become a primary concern in evaluating long-term effects of treatment in pediatric oncology. Thyroid carcinoma has proven to be a common SMN. METHODS: In a multicenter study involving 58 hospitals in Germany, Austria and Switzerland, 18 of 239 (7.5%) SMNs documented following first malignant neoplasm (FMN) in childhood were thyroid carcinoma. RESULTS: The age at diagnosis of FMN ranged from 1 to 15 years. Eleven patients were female. Six children had survived Hodgkin disease, seven acute leukemia, two Ewing sarcoma and three various other tumors. Fifteen of the 18 patients had been treated with radiotherapy to the head and neck region. The time interval between treatment and diagnosis of thyroid carcinoma ranged from 4 to 19 years (median 8 years). The carcinoma was papillary in 17 cases and follicular in one. Eleven patients had metastases in the regional lymph nodes at presentation. DISCUSSION: Radiotherapy appears to be an important risk factor in secondary thyroid carcinoma, but it does not explain all cases. The current data are remarkable for the large proportion of patients who received only prophylactic cranial irradiation for ALL and for the three patients who received no irradiation to the head and neck region. Genetic determinants and chemotherapy must also be considered. CONCLUSIONS: Regular thyroid examination should be included in the long-term follow-up of survivors of childhood malignancy.

Treponema pallidum membrane protein A ELISA: a new test for screening and diagnosis of syphilis.

A new ELISA test system for screening antibodies directed against Treponema pallidum is presented. The ELISA is based on a recombinant DNA-derived T. pallidum membrane protein A (TmpA). It makes the production of the kit easier as it abandons the necessity to culture T. pallidum in living animals. The specificity and sensitivity of the ELISA are comparable with those of the TPHA and FTA-ABS. The test gives only a positive result when there are antibodies against the TmpA antigen and, therefore, it gives in screening (e.g. blood donors) no false-positive reaction in persons who, due to an old well-treated infection, have a so-called serological scar. As these donors are noninfective, they should be concerned as negative in syphilis screening.

Autosomal recessive hereditary congenital aplasia of the vasa deferentia in four siblings.

Congential absence of the vas deferens is a frequently occurring cause of infertility. Such a disorder can be accompanied by renal agenesis and therefore pyelography should be performed. That such a disorder in man could have genetic aspects has not been mentioned in the literature, but there are reports that this disorder is hereditary in some animals. A family of nine children is described in which four of the five sons were infertile as a result of congenital aplasia of the vasa deferentia. Since there was no evidence that these men had cystic fibrosis and since they did not have the mosaic form of Klinefelter's syndrome, an unrelated developmental defect is postulated. The genetic aspects are discussed and the conclusion is made that the inheritance pattern most probably is autosomal recessive. Finally, the therapeutic problems are discussed. At this time, surgical treatment of this disorder is not encouraging.