Pitfalls in the computed tomographic diagnosis of toruloma.

A case of multiple intracerebral mass lesions is presented in which significant "improvement" in the computed tomographic appearance was noted following steroid and radiation therapies. Nonetheless, the patient's clinical course was one of rapid deterioration, and an autopsy revealed multiple torulomas. It seems that the computed tomographic appearance of torulomas can mimic those of other intracranial mass lesions and can be greatly altered by steroid and radiation therapies, either singly or in combination.

Death and injury caused by methyl bromide, an insecticide fumigant.

Methyl bromide (MeBr) is used as an insecticide fumigant. Four deaths and three recent hospitalizations have resulted from exposures to MeBr in Dade County, FL. Six cases occurred during burglaries of tented houses over a nine-month period. In four lethal exposures, the symptoms of nausea, vomiting, and malaise preceded fulminant respiratory failure. Two of these also had seizures, delirium, and agitation. Serum or plasma bromide ion levels ranged from 40 to 583 mg/L. Pulmonary edema, hyaline membranes, and hemorrhagic alveolitis were present at autopsy along with varying degrees of cerebral edema. The nonlethal exposures resulted in symptoms of conjunctival irritation, headache, or nausea. Plasma bromide concentrations varied between 17.5 and 321 mg/L. Methyl bromide characteristics, use, morbidity, and mortality in Florida during the past 25 years are reviewed. Remedies for illegal entry are proposed.

Manifestations and therapeutic considerations in pineal yolk-sac tumors. Case report.

A 20-month-old patient with a paraventricular and parapineal yolk-sac tumor was treated with subtotal excision and total neuraxis irradiation. She has done well in the 3 1/2 years since surgery. A comparative review of similar pineal and gonadal yolk-sac tumors suggests role for surgery combined with radiotherapy and chemotherapy. Additional experience with these unusual germ-cell neoplasms should establish the need for aggressive extirpation, not only to determine the exact diagnosis, but also to provide the basis for subsequent adjunctive therapy. The latter may include specific combination of antineoplastic drugs in addition to radiation.

A neuropathologic approach to human disease: the intracranial mass effect.

This review describes insults to the brain which result in either an increased or decreased mass effect. These mechanisms produce certain derangements in the central nervous system, which can lead to the patient's death. Increased intracranial mass effect characterized by brain tumors may produce lethal brain-stem ischemia. On the other hand, decreased intracranial mass effect as seen in Alzheimer's disease leads to aspiration pneumonia and terminal sepsis.

A free clinic for youth in an academic department of pediatrics.

The Gainesville Youth Clinic was organized to meet a community need for medical care of nonuniversity youth and to provide experience in adolescent medicine to pediatric house officers. Demographic and clinical data were gathered in three studies spanning the first 15 months of operation. The clinic sees 2,200 patients (3,000 visits) annually; two thirds are girls, 98% are white, and 90% are 15 to 25 years old. The population was not predominantly transient; parental occupations were mostly professional or skilled. Educational level was consistent with age; one third of the patients are students at present. Genitourinary problems, principally venereal infection, account for nearly one third of all visits and suspected pregnancy or birth control another one fourth. The clinic experience has emphasized the youth cultural influences on health, increased the participant's insight into the emotional turmoil of adolescence, and has suggested a style and design for providing primary care to this population consistent with the academic objectives of a pediatric department.