Carcinoembryonic antigen in basal cell neoplasms in black patients: an immunohistochemical study.

The development of skin cancer in black persons is rare, and basal cell epitheliomas are the most uncommon. Eight tumors were evaluated by routine histochemistry examination and immunoperoxidase staining for carcinoembryonic antigen (CEA). Our results demonstrate that half these tumors showed a positive reaction to this antigen, supporting the adnexal origin/differentiation of these lesions. Sixteen (16/18) similar tumors from white patients failed to show equivalent features. In addition, some of these CEA-positive tumors seem to demonstrate less aggressive behavior.

Treatment of malignant carcinoid syndrome with a long-acting somatostatin analogue.

A patient with malignant carcinoid syndrome was treated with a long-acting somatostatin analogue. The cutaneous and systemic improvement our patient had while receiving this therapy is described.

Use of the kinetic treatment table to prevent the pulmonary complications of multiple trauma.

The kinetic treatment table (KTT) has been developed to prevent and treat complications of immobility. Because atelectasis and pneumonia may be related to immobility, we studied the effect of the KTT on the prevention and treatment of pulmonary complications in a prospective randomized study of 30 patients with severe traumatic injuries. All were receiving mechanical ventilation and were randomly assigned to treatment with a KTT or a conventional bed. Both groups received conventional medical-surgical therapy while pulmonary function, chest roentgenograms, and the presence or absence of lung infection were monitored for one week. In the patients who began the study with a clear chest roentgenogram, atelectasis and pneumonia were significantly less frequent in those treated with a KTT (P less than .05). Thus, the KTT can reduce pulmonary complications in selected patients with multiple trauma. The effect of this benefit on overall outcome is uncertain.

A multipurpose overtube for diagnostic and therapeutic flexible fiberoptic endoscopy.

A newly devised overtube for diagnostic and interventional endoscopy has been used in 140 cases. In 60 cases of acute gastrointestinal bleeding, adequate gastric lavage was completed in 14.1 +/- 1.3 min, using an average of 7.5 +/- 0.69 liters; the volume of fluid recovered was 103.9 +/- 0.58% of the volume infused. This tube also allows simultaneous gastric lavage and esophageal or gastric tamponade, enabling therapeutic intervention with sclerotherapy or bipolar coagulation in the patient with acute massive bleeding. This device can be employed for the removal of bezoars, foreign bodies, and multiple polyps.

Venous lakes of the ears.

Venous lakes of the ears and telangiectasias of the ears and cheeks were seen in older men living in Texas who were known to have had long-term sun exposure. Even though these are benign changes, these patients should be checked routinely for possible skin malignancies, especially basal cell carcinomas.

Atelectasis and neuromuscular respiratory failure.

Atelectasis occurred in 17 of 20 patients treated with assisted ventilation for respiratory failure due to neuromuscular disease. A retrospective review of chest roentgenograms and medical records indicated that atelectasis occurs early in the course of respiratory failure and has a predilection for the lower lobes. Atelectasis was associated with infection and persisted despite therapy, often for more than four weeks. This study demonstrates that atelectasis in this condition still occurs frequently despite modern practices of mechanical ventilatory assistance. Infection, occurring soon after intubation, is identified as the principal cofactor.

Cutis marmorata telangiectatica congenita: a case report.

Cutis marmorata telangiectatica congenita (CMTC) is a rare cutaneous vascular disorder that was first described in 1922 by Van Lohuizen (1). The clinical presentation is one of persistent cutis marmorata, phlebectasia, telangiectasia, and areas of ulcerations. The disorder shows slow clinical improvement over time. Previously, CMTC has also been described as congenital generalized phlebectasia (2-7), congenital phlebectasia (8), nevus vascularis reticularis (9), congenital livedo reticularis (10), and livedo telangiectatica (11). The following is a case report.

Radiologic considerations in the adult respiratory distress syndrome treated wih positive end expiratory pressure (PEEP).

Radiographic changes with ARDS are similar to alveolar pulmonary edema in the typical case, although early changes may also be nodular in a small number of cases. These may last about 4 days. Following early alveolar changes the later ARDS findings evolve into a diffuse interstitial pattern, and if the patient survives without complications, the chest x-ray may eventually clear completely. PEEP therapy may cause no x-ray changes or may manifest an apparent hyperinflation appearance to the chest x-ray. PEEP may result in barotrauma changes to the lungs manifested by vesicular rarefactions, lucent lines streaking toward the hilus, radiolucent halos around vessels, pneumatocele formation, and subpleural emphysema manifested by blebs or lucent lines on the chest x-ray. Barotrauma pulmonary changes preceded more serious complications such as pneumothorax, mediastinal emphysema and extrathoracic gas collection.

Idiopathic familial cirrhosis and steatosis in adults.

A family was studied in which three middle-aged siblings had unexplained cirrhosis and steatosis. Five of nine additional family members had abnormalities of liver function. Liver biopsy in those 5 revealed steatosis in 3, steatosis and fibrosis in 1, and increase in lipofuchsin pigment in another. Detailed investigation revealed no known metabolic defect, adverse environmental exposure, or alcohol abuse. We postulate that this family represents a unique type of idiopathic familial cirrhosis. The role of steatosis in the pathogenesis of cirrhosis in this family remains unsettled. The HLA haplotype A24, B18, DRW 4 X 7 was found in several family members, but the association of the disease with the HLA system remains to be established.

Pulmonary interstitial gas: first sign of barotrauma due to PEEP therapy.

Radiographic identification of pulmonary interstitial gas is a prime indicator of possible further complications in patients treated with PEEP therapy for severe respiratory failure. Records and chest radiographs of 89 adult patients treated with PEEP in a 40-month period were reviewed. Data of 7 were incomplete, 82 cases were analyzed. Of 17 patients who developed interstitial gas, 9 progressed to further barotrauma complications of pneumomediastinum, pneumothorax, and extrathoracic dissection. Interstitial gas is manifested radiographically by vesicular rarefactions (cystic changes), linear streaks along the bronchi and vessels, halos of gas around vessels, and subpleural gas.

Roentgenographic findings in PEEP therapy. Indicators of pulmonary complications.

We reviewed serial chest roentgenograms of 82 patients treated with positive end-expiratory pressure (PEEP) therapy for morbid pulmonary failure. No change was identified in the appearance of the chest roentgenograms in 49 patients. Thirty-three patients showed pulmonary hyperinflation, varying degrees of apparent clearing of alveolar or interstitial disease, and resorption of interstitial and pleural fluid. Lung hyperinflation and interstitial gas generally preceded pneumomediastinum and pneumothorax. These pulmonary complications were identified roentgenographically, often before they became clinically apparent. No consistent correlation was observed between these roentgenographic changes and the ventilatory pressures employed. The radiologist should be informed that a patient is receiving PEEP therapy, as the earliest signs of alveolar rupture--interstitial emphysema--are frequently subtle.

Autoimmune hemolytic anemia in ulcerative colitis: report of three cases, review of the literature, and evaluation of modes of therapy.

Three cases of autoimmune hemolytic anemia in association with idiopathic ulcerative colitis are reported; the literature is reviewed; and therapeutic modalities are considered. Successful treatment is shown to have resulted with steroids alone, steroids and immunosuppressives, splenectomy, and colectomy. It is concluded that moderate or severe hemolysis should be treated first with high-dose corticosteriods; if unsuccessful, immunosuppressive therapy may be added or a splenectomy performed. Finally, total colectomy should be reserved for fulminant colitis and its complications and is not indicated solely for hemolysis.

Pneumoperitoneum and pneumoretroperitoneum. Consequences of positive end-expiratory pressure therapy.

Patients receiving positive end-expiratory pressure (PEEP) therapy should be considered at risk for pneumoperitoneum. In the four patients described, chest roentgenographic demonstration of pulmonary interstitial gas and pneumomediastinum, frequently but not always associated with pneumothorax, preceded the dissection of gas into the abdominal cavity. Neither prompt intubation of the pleural space with reexpansion of the lung in the event of pneumothorax nor decrease in the PEEP applied precluded dissection of gas from the mediastinum into the retroperitoneal and peritoneal spaces. This sequence of roentgenographic events should strongly suggest pneumoretroperitoneum and pneumoperitoneum as a sequela to PEEP therapy rather than a ruptured viscus.