Extradigital glomus tumor as a cause of knee pain.

Although there exists much debate in the dermatohistopathologic literature about the exact characterization of the glomus tumor, this case illustrates what should be considered the sine qua non indications of clinically significant glomus tumors, i.e., exquisite pain and complete relief of pain with surgical excision. One should not, therefore, limit the inclusion of glomus tumors to the differential diagnosis of severe localized pain only in the upper extremity.

Hypoglycemia in a diabetes nurse care coordinator.

A 26-yr-old registered nurse who is employed as a diabetes nurse care coordinator had episodes of symptomatic fasting hypoglycemia associated with hyperinsulinemia and a relatively suppressed plasma C-peptide concentration, arousing the suspicion of self-induced illness. However, using a species-specific radioimmunoassay, the species of insulin during an episode of hypoglycemia was determined to be human in origin. Once the patient's illness was attributed to endogenous insulin hypersecretion, prompt surgical intervention and the diagnosis of nesidioblastosis in an adult was made.

Legionnaires' disease pneumonia: histopathologic features and comparison with microbial and chemical pneumonias.

The histopathologic findings in lung tissue are reported from five cases of Philadelphia Legionnaire's Disease and the results are compared to pneumonias caused by other microbial and chemical agents. Histopathology of lung tissue was similar in all cases, despite the fact that death occurred between the fourth and 14th day of clinical illness. The inflammatory response was almost totally limited to the lower respiratory tract and primarily involved respiratory bronchioles, alveolar ducts and alveoli. Major bronchial branches and pulmonary interstices showed little or no involvement. There was considerable variation in the extent and nature of the consolidation, but the overall reaction pattern was highly characteristic of diffuse alveolar damage. Most involved areas showed intra-alveolar, fibrinocellular mononuclear cell predominant exudates, associated with pneumonocytic hyperplasia and slough. These findings plus the presence of erythroleucophagocytosis by macrophages and paucity of polymorphonuclear leucocytes are commonly associated with psittacine pneumonia, and much less so with classic patterns of bacterial, viral, fungal or rickettsial pneumonias. Of the toxic inhalants, nickel carbonyl, phosgene, nitrous oxide, cadmium oxide and some halogenated hydrocarbons have been associated with this tissue reaction pattern. Bacteria were notably absent in lung tissue stained by methods used to demonstrate the Legionnaires' Disease agent.