Roentgenograms of the thorax in certain cardiovascular conditions may simulate those associated with diseases of the lungs, bony thorax, or mediastinum. It is important to be aware of these similarities, which may be remarkable. Roentgenographic shadows may be produced that look very much like those characteristic of a different disease. The recognition of the real cause of these roentgenologic changes may allow treatment of an apparently hopeless condition or prevent an unnecessary operation. This exhibit presents examples of such misleading roentgenograms under the following categories: shadows produced by abnormal aortic contours; shadows suggesting intrathoracic tumor; shadows produced by intrathoracic fluid, and shadows of diverse origin and complexity. Shadows Produced by Abnormal Aortic Contours (Figs. 1-5) Abnormalities in the shape of the aorta can cause confusion. Abnormal roentgenographic shadows may be produced directly by the aorta or indirectly by its effect on contiguous structures. These variations may be due to
Introduction Exophthalmos is the ocular abnormality most often described in Graves' disease. Repeated emphasis on this aspect of the disease has diverted attention from other ocular disturbances. In fact, most synonyms emphasize this focus—Graves' disease with exophthalmos, exophthalmic goiter, malignant exophthalmos, endocrine exophthalmos, exophthalmic ophthalmoplegia, and exophthalmic ophthalmopathy. Inspection of the eyes in patients with thyroid disease, however, enables us to see a great variety of lesions causing many symptoms. Indeed, exophthalmos may not exist at all in an eye with grossly disturbed function. We have studied the elements of the eye disease associated with thyrotoxicosis and have described them under the termendocrine eye lesion. Hitherto the etiology, pathogenesis, and response to treatment have been studied in highly selected patients with severe eye lesions. In a comprehensive review of endocrine exophthalmos Wybar makes the point that "there is still no true understanding of the basic nature of the exophthalmic
Duffy and Fitzgerald,1in 1950, first called attention to the frequent association of x-ray therapy to the thymus gland of infants to the later appearance of thyroid carcinoma. Subsequently many clinical reports have appeared, not only substantiating this association2-8but enlarging it to include any early irradiation received about the head and neck. Although these subsequent data have not provided definitive proof that a causal relationship exists between the two, they have indicated a sufficiently high frequency of occurrence to imply guilt by association. A history of previous irradiation, however, has not been found in all children with thyroid cancer,9-13and the possible fallacies of drawing too strong inferences of cause and effect between the one and the other have been pointed out.13Duffy14has recently summed up his experiences, and the present study, although not supplying unequivocal proof, is in agreement with his conclusion that the bulk of evidence
Introduction Macroglobulins have, in recent years, been identified as normal constituents of human blood serum. Macroglobulinemia has been recognized in association with neoplastic, collagen, and chronic infectious diseases. There remains, however, a group of patients with the findings of macroglobulinemia unassociated with these entities. Ultracentrifugal, immunophoretic, and viscosity studies have provided further clarification of this disorder. The patients below illustrate two clinical types of primary macroglobulinemia. Of interest is the fact that the disease developed while both patients were under medical observation. In both, the macroglobulinemia was of the uncommon cryogelglobulinemia variety. Report of Cases Case 1. —A 55-year-old Turkish-born white American seaman was admitted to the U.S. Public Health Service Hospital, Galveston, Texas, on Sept. 17, 1957, with weakness, dyspnea, and cough of one month's duration. There was no associated hemoptysis or pedal edema. There was a past history of asthma and a subtotal gastrectomy and gastrojejunostomy performed in
There are many reported cases of leukemia with involvement of the central nervous system.1-5In the majority of these, however, there has been insufficient clinical or pathological material for detailed analysis. Reported series of cases have usually included both acute and chronic forms of the leukemias, and have given only a rough approximation of the frequency of leukemic involvement of the central nervous system. As a pathological study of the central nervous system in 117 consecutive cases of acute leukemia, the present paper will deal with three broad aspects of neurological involvement; (1) hemorrhages, (2) leukemic infiltrations, and (3) infections. No reference will be made to cranial or peripheral nerve infiltrations, to nerve root or ganglionic infiltrations, or to degenerations. The association of "blastic crisis" in patients with acute leukemia with the presence of intracerebral leukostasis, leukemic nodules, and fatal intracerebral hemorrhage has been previously reported.6In another
When Thannhauser and Stanley 1,2 fed I 131 -labeled olive oil and followed the appearance and disappearance of the radioactivity in the blood of their patients, they introduced a new, simple, and very valuable technique for the study of neutral fat metabolism in health and disease. Numerous reports soon followed 3-6 in which I 131 -labeled neutral fat was used as a diagnostic tool in various malabsorptive syndromes. The fruitfulness of this field of investigation probably led to a delay in the use of this technique in studying hyperlipemic states, although the original workers reported abnormal curves in nephrotics and idiopathic hyperlipemia as well. 1,2 Recent studies by others as well as in our laboratory 7-9 have demonstrated that individuals with proven myocardial infarction display elevated levels of blood radioactivity following ingestion of a radioactively labeled fat meal. Since it is well known that patients with diabetes mellitus have a tendency to develop atherosclerotic lesions at an
The diagnosis and treatment of acute meningitis is a challenge for the primary care physician. Differentiating between bacterial meningitis and aseptic meningitis is not always straightforward. The aseptic meningitis syndrome is usually viral in origin, and enteroviruses account for most cases. The aseptic syndrome also may be caused by unusual bacterial organisms such as Mycobacterium tuberculosis, Leptospira species, Brucella species, Borrelia burgdorferi and others. The classic presentation consists of the acute onset of meningismus, headache, fever, malaise with pleocytosis and normal glucose and slightly elevated protein in the cerebrospinal fluid. Cerebrospinal fluid lactate and serum C-reactive protein measurements may be helpful in differentiating aseptic meningitis from treatable bacterial meningitis. Aseptic meningitis of viral origin usually responds to expectant care. Other causes of aseptic meningitis must be searched for and treated if present.
Pulse volume and changes in perfusion flow pertaining to a segment such as the arm or leg may easily be followed by radiofrequency impedance plethysmography. Volume varies directly with electrical conductance and inversely as the resistive electrical impedance of the conductor. The method is sketched briefly in Figure 1 and defined in its legend. Thus, we propose by this type of study (1) to measure pulse volume and blood flow on the basis of electrical properties of tissue and blood; (2) to calculate pulse volume and blood flow from such electrical data, and (3) to apply the electrical impedance method to physiological and clinical flow problems. Electrical impedance to radiofrequency current through tissues is capacitative as well as resistive in nature. The former is less than three per cent of the latter in value and may be regarded as insignificant when volume pulses are derived from the limbs. A
It is now recognized that bone-marrow failure rather than hyperhemolysis underlies the crises in sickle-cell disease.1,2Bonemarrow failure has been reported in Cooley's hemolytic anemia,3hereditary spherocytosis,4and paroxysmal nocturnal hemoglobinuria.5Maturation arrest of the neutrophil polymorphonuclear leukocytes has been noted in sickle-cell disease.6Infection has been thought to precipitate bone-marrow aplasia in sickle-cell disease1,2and in hereditary spherocytosis.7The occurrence of "aplastic crisis" in several members of a family has been recorded in hereditary spherocytosis7and in sickle-cell disease.17Erythroblastopenia has been noted during the course of viral pneumonia in patients without hemolytic blood diseases,8and the same communication records eosinophilia in patients who had erythrocytic aplasia after exposure to allergens. The association of chronic hemolytic anemias with megaloblastic arrest of the bone marrow has been documented. Some of these responded to vitamin B12therapy,9some were associated with pregnancy,10and in others dietary deficiency of folie acid
Since the entity known as aseptic meningitis was described by Wallgren over a quarter of a century ago, 1 considerable progress in the recognition of some of the multiple etiologic agents of this syndrome has been made. Wallgren's basic criteria for the diagnosis of aseptic meningitis were: (1) acute onset with obvious signs and symptoms of meningeal involvement; (2) alteration of cerebrospinal fluid typical of meningitis; (3) absence of bacteria in cerebrospinal fluid; (4) relatively short benign course of illness; (5) absence of local parameningeal infection or systemic disease which might present meningitis as a secondary manifestation; (6) absence from the community of epidemic disease of which meningitis is a feature. In general, with the exception of the last named feature, these criteria remain valid. In addition, it should be recognized that the cellular elements of the cerebrospinal fluid are frequently predominantly lymphocytic, although early in the disease there may
Scant attention was paid to graded degrees of severity of infectious diseases in the past. Study was impeded by undeveloped knowledge, lack of exact methods of diagnosis, rigid clinical criteria of the "typical" case, and, during epidemics, by the pressure of the emergency. Inapparent infections were undetectable, and victims of mild attacks usually were ignored or regarded as having some other ailment. After 1868, for example, according to Wunderlich's dictum, typhoid was not typhoid unless fever reached 39.5 C (103.1 F) between the fourth and sixth days. During an epidemic of cholera as late as 1944, victims not dehydrated or in a shock-like state were not regarded as having cholera. Yet brief typhoid was known to Louis, and Koch had described mild cholera in 1892. Sydenham recognized trivial smallpox, in 1676; mild yellow fever was observed by Nott, in 1848, and Ghon, in 1916, demonstrated specific pulmonary lesions as sequels
Introduction Earlier communications from this laboratory reported abnormalities in carbohydrate metabolism in various psychotic states.1,2Among the most important of the changes noted in patients was an excessive rise in lactate and pyruvate after ingestion of glucose or fructose; similar changes in α-ketoglutarate and citrate have also been observed. Since it seemed possible that excessive rises of lactate and pyruvate observed after ingestion of glucose in psychotic patients might also be reflected in abnormal utilization of lactate itself, studies with intravenous lactate were undertaken. Preliminary work,3in fact, had suggested that lactate was removed somewhat more slowly by psychotic patients and further examination of this phenomenon was in order. Materials and Methods A total of 17 patients and 8 control subjects were studied. There were eight acutely psychotic patients, and nine chronically psychotic patients, five of whom had been lobotomized. All patients were schizophrenic, except for two patients
Despite concerted efforts in the laboratory and clinic to combat the staphylococcus, this organism remains the most important bacterial pathogen. The ability to produce deep-seated infections in almost any tissue of the body and to develop resistance to the majority of antimicrobials makes it particularly difficult to eradicate. To date no antibiotic has been uniformly successful in inhibiting its growth. A previous report from this laboratory described the use of tube-dilution sensitivity tests to evaluate the activity of 10 antibiotics against 200 strains of hemolytic staphylococci.1One hundred of these strains were isolated from patients with serious infections and the remainder from carriers hospitalized for other reasons. The majority of cultures were obtained in 1955. The studies to be reported here consist of antimicrobial sensitivity tests performed on 300 additional strains of staphylococci isolated between July 1, 1958, and April 1, 1959. The same tube-dilution technique which measures bacteriostatic
A young woman was followed at Duke Hospital through the course of a rapidly fatal illness which was diagnosed at autopsy as visceral Kaposi's sarcoma. The patient is reported here because of the rarity of this neoplasm in women and because of the occurrence during life of an unusual physical finding. Two other cases are included in this report where similar neoplasms were found at autopsy: one had had thorium dioxide study of the liver 18 years prior to death, and a striking correlation existed between the sites of tumor involvement and the still-radioactive thorium deposits; another patient suffered from visceral lesions as well as typical Kaposi cutaneous lesions. Report of Cases Case 1. —A 27-year-old white female factory worker was admitted to Duke Hospital in December of 1957 with a rapidly progressing illness characterized by extreme emaciation and an enlarging abdominal mass. She had been well until two months
