Pulmonary involvement in rheumatoid arthritis.

Pulmonary involvement is one of the extra-articular manifestations of rheumatoid arthritis (RA) and includes pleurisy, parenchymal nodules, interstitial involvement, and airway disease. Rheumatoid pulmonary vasculitis is rare. Pulmonary disease also may be observed as a toxic event consequent to treatment for RA. Although RA is more common in women, rheumatoid lung disease occurs more frequently in men who have long-standing rheumatoid disease, positive rheumatoid factor and subcutaneous nodules. Pleural involvement, usually asymptomatic, is the most common manifestation of lung disease in RA and may occur concurrently with pulmonary nodulosis or interstitial disease. The clinical features and course of pulmonary fibrosis in RA are similar to those of idiopathic pulmonary fibrosis. Bronchiolitis obliterans organizing pneumonia (BOOP), which has been recently described in RA patients, has nonspecific clinical features. The histological patterns correspond to proliferative bronchiolitis in the airway and organizing pneumonia in the alveoli. Obstructive lung disease in RA includes obliterative bronchiolitis (OB) and bronchiectasis. OB is an acute illness characterized histologically by a constrictive bronchiolitis. It may be idiopathic or induced by D-penicillamine or intramuscular gold compounds. Methotrexate (MTX)-pneumonitis is an uncommon complication of MTX treatment. Its clinical presentation is not specific, and diagnosis must be made after exclusion of other causes of pulmonary diseases. It is uncertain if preexisting lung disease predisposes RA patients to MTX-pneumonitis. Treatment of lung disease in RA is empirical. Corticosteroids are usually administered and immunosuppressive drugs are often added when pulmonary disease progresses and/or steroid side-effects appear.

Alveolar cell carcinoma complicating sickle cell anemia: a chance occurrence?

Alveolar cell carcinoma, a neoplasm associated with pre-existing inflammatory lung disease, has not been reported previously in patients with sickle cell disease. We present such a patient and suggest that chronic pulmonary scarring in this setting predisposed to development of his malignancy. As survival increases in individuals with sickle cell disease, alveolar cell carcinoma must be considered in these differential diagnosis of otherwise unexplained chronic pulmonary infiltrates.

Geographic pathology of latent prostatic carcinoma.

Prostates obtained at autopsy from black and white males in the United States of America, from Colombians, from Japanese migrants in Hawaii, and from Japanese in Japan (all over 50 years old) were serially step-sectioned and examined microscopically using identical techniques and diagnostic criteria. The age-adjusted overall prevalence of latent carcinoma was significantly higher in US blacks (36.9%), in US whites (34.6%) and in Colombians (31.5%) than in Japanese in Japan (20.5%). There was no significant difference in prevalence between Japanese migrants in Hawaii (25.6%) and Japanese in Japan. When the carcinomas were subdivided into latent infiltrative type (LIT) and latent non-infiltrative type (LNT), the LIT component reflected upon the overall prevalence of latent carcinoma. There was an increase in the overall prevalence of latent carcinoma and in the prevalence of LIT tumors with age in Japanese migrants to Hawaii and in Japanese of Japan but only a suggestive increase in blacks and whites in the United States. There was no significant relation between age and prevalence in Colombia. In LNT tumors, there was no consistent trend related to race or age. The size of LIT tumors was significantly greater than that of LNT tumors in all races or in each decade of total material. There were many large LIT tumors in blacks and whites in the United States. These results suggest that the prevalence of LIT tumors shows a race variation similar to the incidence of clinical carcinoma of the prostate, and that LNT tumors probably remain latent during the individual's life span.

Suppression of centrineurogenic shock lung by Dilantin (DPH) administered early in established hemorrhagic shock.

Centrineurogenic shock lung following acute hemorrhage was prevented by Dilantin (DPH) given preshock. Nineteen anemia (Hct = 30 +/- 5%) dogs were divided into five groups: one control (no anesthesia, no shock); one of three with 4 hours of anesthesia alone; and of 15 dogs with hemorrhagic shock, eight were without DPH, two with preshock DPH, and five received DPH 15 min after shock was established. Shock animals were rapidly bled to 40 mm Hg which was maintained for 2 hours, and all shed blood was reinfused. One hour later, all animals were sacrificed, the lungs fixed with formalin instilled at 15 cm H2O intratracheal pressure, the trachea cross-clamped, the lungs excised, photographed, and sent for gross and histopathologic study. Shock animals without DPH had grossly hemorrhagic lungs with diffuse interstitial and alveolar congestion, hemorrhage, and edema. Neither of the DPH-treated groups developed gross changes and showed minimal to no histopathology. Dilantin given early in established hemorrhagic shock prevents shock lung.

Benign hepatocellular tumors: a regional survey.

A survey of benign hepatocellular tumors in a metropolitan area included six cases of hepatocellular adenoma, eight of focal nodular hyperplasia, and two of nodular transformation. Two thirds of the adenomas occurred in women using oral contraceptives; two had life-threatening complications. The focal nodular hyperplasias were generally asymptomatic tumors occurring in patients over a wide age range and apparently not related to oral contraceptive use. The two cases of nodular transformation were incidental findings in patients having abdominal surgery. One of them had used oral contraceptives.

Prevalence of latent prostate carcinoma in two U.S. populations.

The prevalence of latent prostate carcinoma, the suspected precursor of invasive carcinoma, was studied in 500 autopsy specimens from New Orleans, Louisiana, and found to be similar in both whites and blacks. The tumors were subdivided into latent infiltrative type (LIT) and latent noninfiltrative type tumor was measured by photographic techniques. A good correlation between size and histology was found: The mean size of LIT tumors was significanty greater than that of LNT tumors. Age-versus-size plots revealed a subset of large LIT lesions in blacks that was not found among whites of the same ages. This subset may account for the excess of invasive carcinomas in blacks. These results suggest that many latent carcinomas lack promotional stimuli to become invasive.