Aortic dissection in a patient receiving chemotherapy for Hodgkin's disease--a case report.

Cancer chemotherapy is associated with a wide range of vascular toxicities, which may be related to endothelial cell damage by these agents. The authors describe a patient with Hodgkin's disease who developed an atypical aortic dissection while receiving MOPP/ABV chemotherapy (nitrogen mustard, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine). They would place aortic dissection on the list of potential vascular complications associated with antineoplastic agents.

Barrett's esophagus: the changing management.

An estimated 700,000 persons in the United States currently have this disease, which is often preceded by gastroesophageal reflux and may progress to adenocarcinoma. Questions posed in management include: Which patients merit endoscopic surveillance? And in which is medical therapy or surgery appropriate?

Clinical implications of Barrett's esophagus.

Barrett's esophagus is a medical condition in which the squamous mucosa that normally lines the distal esophagus is replaced by a columnar type of epithelium. Most definitions that have been used for inclusion of patients in studies have indicated that columnar mucosa must extend 3 cm or more above the gastroesophageal junction. The precise length refers to the distance above the manometrically defined lower esophageal sphincter. This measurement is somewhat cumbersome to make on a routine basis for all patients at the time of endoscopy and thus is generally not done. It is important to realize that the gastroesophageal junction can be visually identified at the area where the esophagus tapers, in the region of the lower esophageal sphincter. The tapering of the esophagus in the region of the lower esophageal sphincter may be difficult to determine when lower esophageal sphincter pressures are low; thus, we commonly say that Barrett's esophagus is defined as columnar mucosa 3 cm above the region where the gastric folds end.

An unusual presentation of Sjögren's syndrome.

A 44-year-old woman presented with a long history of nausea and vomiting and was found to have hypokalemic metabolic acidosis with elevation of the urine bicarbonate level consistent with the new onset of renal tubular acidosis, type I. Her laboratory findings and histologic picture of a buccal biopsy sample of two minor salivary glands were consistent with Sjögren's syndrome. Treatment with steroids markedly improved her symptoms.

Visual loss in cytomegalovirus retinitis caused by cystoid macular edema in patients without the acquired immune deficiency syndrome.

PURPOSE: Although serous macular exudation has been described in patients with the acquired immune deficiency syndrome (AIDS) with active cytomegalovirus (CMV) retinitis, cystoid macular edema (CME) is not encountered in this clinical setting. In contrast to these findings, we describe vision loss due to CME occurring in immunosuppressed patients without AIDS treated for CMV retinitis. METHODS: Three patients (four eyes) with systemic immunodeficiency presenting with vision loss underwent ophthalmologic examination, including fundus photography and fluorescein angiography. Systemic evaluation was performed to establish the etiology of immunodeficiency and to rule out human immunodeficiency virus infection. Patients were treated with topical corticosteroid and nonsteroidal anti-inflammatory medications for CME. RESULTS: All patients had severe generalized immune deficiency, related either to drug-induced immunosuppression or primary immunodeficiency. Laboratory studies confirmed the presence of systemic CMV infection. Affected eyes had mild reduction of central vision (range, 20/40 to 20/60). Three of four affected eyes had resolving CMV retinitis outside the posterior pole with mild panuveitis. These eyes showed CME on clinical examination and fluorescein angiography. The CMV lesions regressed after reduction of immunosuppressive agents or after systemic antiviral treatment. Response of CME to topical anti-inflammatory medication was variable. CONCLUSIONS: Cystoid macular edema can occur in the setting of resolving CMV retinitis in patients with immunodeficiency other than AIDS. This entity is distinct from serous macular exudation, which can occur in patients with AIDS with active CMV retinitis involving the posterior pole. The disparity between patients with and without AIDS in the development of CME may be important in understanding the pathogenesis of CME.

Long-term enteral access in aspiration-prone patients.

Aspiration pneumonia is a serious complication of enteral feeding. Many critically ill patients are particularly at risk for aspiration. Few studies have rigorously compared various access devices. Risk factors for aspiration and studies examining aspiration associated with enteral feeding devices are reviewed. We recommend a surgical jejunostomy for all patients at high risk for aspiration who require more than 3 weeks of enteral nutrition support.

Oral manifestations of disseminated Cryptococcus neoformans in a patient with acquired immunodeficiency syndrome.

A palatal lesion was the initial manifestation of disseminated cryptococcosis in a patient with acquired immunodeficiency syndrome (AIDS). The diagnosis was initially verified with cytologic smears in situ and later confirmed with pathologic findings from an excisional biopsy specimen. As cryptococcosis is one of the major opportunistic infections in persons with AIDS, an increased incidence of oral manifestations of cryptococcosis can be expected.

Test-of-cure analysis by direct immunofluorescence for Chlamydia trachomatis after antimicrobial therapy.

The direct immunofluorescence assay (DFA) was compared with culture for test-of-cure analysis for Chlamydia trachomatis in patients 7 to 10 days after antimicrobial therapy was given. DFA test-of-cure results correlated with culture results in 79.5% of 39 patients. Of DFA-negative patients, 97% had negative cultures. Six of seven patients with borderline DFA results had negative culture results.

Vascular smooth muscle cell kinetics: a new assay for studying patterns of cellular proliferation in vivo.

A new quantitative assay for studying the kinetics of vascular smooth muscle cells in vivo is reported. The assay was used to determine the specific activity of DNA from rabbit aortic smooth muscle cells stimulated to grow by removal of the endothelial layer. The specific activity of the DNA was correlated with the rate of tritiated thymidine incorporation as measured by autoradiography and with the rate of DNA synthesis as estimated by direct measurement of cellular proliferation. Smooth muscle cells exhibit a 24-hour latent period in vivo prior to DNA synthesis; the synthesis peaks at 48 hours and then rapidly declines. The decline in DNA synthesis is not related to endothelial regrowth, and may be of homeostatic significance in limiting luminal stenosis. The assay offers a rapid and reliable alternative to autoradiographic and morphometric techniques for evaluating growth kinetics and growth regulation in vivo.