Risk management: an overview.

It is not known what the future holds for the health care industry in the way of risk. It is pretty clear that the environment is dynamic with daily, if not hourly, changes. Risk managers must be willing to meet the challenge to improve quality of care, meet the needs and expectations of patients and payors, and reduce the potential for loss.

The current litigation crisis and tort reform.

We live in a litigious society. The resultant liability insurance crisis has had a major impact on almost every area of our lives. This article explores issues concerned with the litigation crisis and suggested reforms to lessen the stress caused to society.

A unique case of sarcoidosis with coexistent collagen vascular disease. Possible result of a compatible disease-sustaining immunologic environment.

A patient presented with dysphagia, arthralgias, and a peculiar skin eruption characterized by histopathologic features of sarcoidal granulomas and lupus erythematosus occurring in the same lesion. Sarcoidal granulomas were also found in skeletal muscle. The unique histopathologic features of this case suggest that coexistence of sarcoidosis with autoimmune collagen vascular diseases may be more than coincidence. A review of the immunologic status of patients with sarcoidosis and autoimmune collagen vascular disorders is presented with speculations on the relevance of potential disease-sustaining immunologic patterns of both groups of diseases.

Clinical and pathologic cutaneous manifestations of malignant histiocytosis.

The clinical and pathologic changes in the skin of five patients with malignant histiocytosis were studied. The clinical signs included papules, nodules, noduloulcers and purpura. The histopathologic changes included exocytosis of inflammatory cells, infiltration of the papillary and reticular dermis with neoplastic histiocytes, and periadnexal and perivascular infiltrates. Phagocytosis of RBCs and nuclear debris by atypical histiocytes was seen in two cases. In one case, the skin lesions were the only initial manifestation of the disease. Skin involvement occurs in about 10% to 15% of all cases of malignant histiocytosis. Hence, it is important to include malignant histiocytosis in the differential diagnosis of patients with such skin lesions, especially when clinical symptoms may be suggestive of this disease.

Giant condyloma acuminatum.

The subtle histologic differences between condyloma acuminatum and giant condyloma acuminatum are presented in the following report.