Mondor's disease mimicking a Spigelian hernia.

Superficial thrombophlebitis of the thoracoepigastric veins (also known as Mondor's disease) is an uncommon disorder that typically affects middle-aged women and classically involves the chest wall including the breasts. Only one previously published, non-operative case of the disease, describes how the condition can resemble a strangulated Spigelian hernia. Herein we describe another similar case in which the diagnosis was made intra-operatively. The extremely unusual and similar clinical findings we observed demonstrate that Mondor's disease can occur in the Spigelian hernia belt and cause diagnostic confusion.

Trace elements in head and neck cancer patients: zinc status and immunologic functions.

In this study we have assessed zinc status and zinc-dependent cell-mediated immune functions (interleukin-2 production by mononuclear cells, natural killer cell lytic activity, and interleukin-1 beta production by mononuclear cells) in adult patients with squamous cell carcinoma of the upper aerodigestive tract at diagnosis and before any therapy was instituted. Inasmuch as significant interactions between zinc, copper, and iron exist, we also assayed the plasma copper level, serum iron level, and total iron-binding capacity in our patients. We recruited 30 cancer subjects and 21 control subjects. On the basis of cellular zinc criteria, we diagnosed a mild deficiency of zinc in 53% of cancer subjects. The plasma zinc level was not decreased in our subjects. A univariate analysis was applied by use of one-way analysis of variance comparing study variables among the three study groups (controls and zinc-deficient and zinc-sufficient cancer patients) and Tukey's multiple comparison test, and we showed that interleukin-2 production and natural killer lytic activity were decreased in zinc-deficient cancer patients. Interleukin-1 beta production (ELISA assay) was increased in both zinc-deficient and zinc-sufficient groups. Plasma copper level was not different, but the iron utilization was decreased in both groups of cancer subjects. We conclude that zinc deficiency and zinc-dependent immunologic dysfunctions are present in more than half of the patients with head and neck cancer in the Detroit area.

Scintigraphic assessment of swallow efficiency postlaryngectomy.

There have been reports of a high incidence of hypopharyngeal stenosis in total laryngectomy patients when the surgery requires a partial pharyngectomy for pyriform sinus involvement. In this study, three groups were compared: total laryngectomy patients without partial pharyngectomy, total laryngectomy patients with partial pharyngectomy, and normal controls. All patients had received radiation therapy following surgery. All were maintaining oral nutrition, and none complained of dysphagia. Patients were tested between 1 and 7 months postradiation therapy, with a mean of 3 months. Measures of swallowing efficiency were based on scintigraphic data for a liquid swallow. Patients with partial pharyngectomy had abnormally long oropharyngeal transit times and low efficiency scores. For a subgroup of patients with partial pharyngectomy, swallowing data were available postsurgery and postradiation therapy. Postsurgery this patient group did not differ significantly from normal patients in swallowing efficiency, and swallowing efficiency deteriorated in postradiation therapy. This scintigraphic methodology is shown to be a sensitive method of assessing swallowing function in this patient population.

Gangrenous cholecystitis in an urban VA hospital.

Gangrenous cholecystitis is an advanced form of acute cholecystitis associated with increased morbidity and mortality. We sought to determine the incidence of gangrenous cholecystitis in an urban VA hospital patient population and identify any distinguishing characteristics that may aid in its preoperative diagnosis. We retrospectively reviewed all urgent admissions that underwent cholecystectomy (n = 65) over the past 7 years at the Allen Park VAMC. Using histologic criteria, 17 (26%) of these patients had gangrenous cholecystitis. As a group compared to patients with nongangrenous cholecystitis, patients with gangrenous cholecystitis were statistically older (64 vs 54) and had an elevated WBC (15.4 vs 11.5) and increased serum glucose levels (203 vs 141). Preoperative imaging studies (ultrasound and cholescintigraphy) correctly identified only 31% of the gangrenous cholecystitis patients. We conclude that in an urban VA hospital patient population, the diagnosis of gangrenous cholecystitis cannot be accurately made or ruled out among urgent admissions with acute biliary disease. Considering the high incidence (26%) and difficulty confirming the diagnosis of gangrenous cholecystitis in this setting, we recommend early surgical intervention for this and similar patient populations.

Bone and liver imaging in regionally advanced melanoma.

The clinical records of 94 patients with regionally advanced melanoma (nodal disease or regional satellites) were reviewed to determine the value of preoperative bone and liver imaging. Of 68 bone scans obtained, none were suggestive of metastases. of 97 liver imaging studies (computed tomography, scintiscan, or sonography) in 88 patients, only two were found to have demonstrable metastases. Liver enzyme elevation was present in both of these patients. Bone and liver imaging in the absence of signs or symptoms of dissemination by history, physical examination, chest x-ray, and enzyme determination for regionally advanced melanoma appears to be of little value unless the patient is involved in a protocol study.