Presentation of CaseA 45-year-old man was admitted to the hospital because of a question of carcinoma of the pancreas.He was well until three weeks earlier, when he began to experience intermittent epigastric pain, which became constant and was accompanied by anorexia and retching. The pain did not radiate to the back and was not relieved by sitting up. He entered another hospital, where x-ray films of the chest and abdomen, an intravenous urographic study, and a barium-enema examination with air contrast were reported to be negative. Gastroscopic examination revealed only mild gastritis. A computed tomographic (CT) scan of . . .

SELENIUM is a trace element that until recently has been considered unimportant in human nutrition, except when ingested in excessive amounts.1 During the past decade, Chinese investigators have shown that selenium deficiency is one of the principal factors responsible for Keshan disease, a "dilated" (congestive) cardiomyopathy that affects persons (mainly children and young women) living in rural areas of a selenium-deficient zone in China.2 3 4 This report describes an Occidental patient in whom selenium deficiency became associated with dilated cardiomyopathy.Case ReportA 43-year-old man had been receiving parenteral alimentation for two years (one liter of FreAmine 11 [an amino acid . . .

Presentation of Case First admission. A 54-year-old woman was admitted to the hospital because of abdominal pain.She was well until seven months earlier, when periumbilical pain developed and was ascribed to nephrolithiasis. The pain soon subsided but recurred four months before admission and was particularly evident 20 to 30 minutes after eating. Diarrhea and back pain developed. The patient was admitted to another hospital. The erythrocyte sedimentation rate was 76 mm per hour. Serum immunoelectrophoresis showed that IgM was 485 mg per 100 ml, and the complement 320 U. A culture of urine yielded Escherichia coli. A . . .

Presentation of CaseA 91-year-old woman was admitted to the hospital because of a mass in the right upper quadrant of the abdomen.The patient was born in Italy and immigrated to this country at the age of 16 years. At 21 years a spontaneous abortion occurred, vaginal bleeding persisted for two weeks, and a laparotomy was performed, with the removal of "a large tumor." Thereafter she was well until four weeks before admission, when she began to have pain in the right upper quadrant of the abdomen, with fever and chills. The pain became diffuse, and four days later . . .

Presentation of CaseA 28-year-old man was admitted to the hospital because of gastrointestinal bleeding.The patient was well until five years earlier, when he sustained an abdominal injury in a motor-vehicle accident. The pyloric canal and liver were repaired, with partial resection of the omentum. Eleven months before entry bleeding per rectum developed, followed by hematemesis. He entered another hospital, where an upper gastrointestinal series showed marked thickening of the gastric folds. Gastroscopic examination revealed a questionable ulcer. An exploratory laparotomy disclosed multiple adhesions, and a planned total gastrectomy was abandoned. He continued to pass tarry stools and began . . .

Presentation of Case First admission (1966). A 47-year-old woman was admitted to the hospital because of diarrhea.She was well until two years earlier, when a cholecystectomy was followed by crampy lower abdominal pain and the urgent passage of loose, watery stools of small volume, often accompanied by mucus, without blood or pus. The attacks lasted for three to four days and were followed by a symptom-free interval during which she passed two to three stools daily. Eight months before entry she traveled to Mexico and noticed exacerbation of the symptoms. Repeated stool cultures gave no growth of pathogenic bacteria. . . .

Presentation of CaseA 42-year-old woman was admitted to the hospital because of abdominal pain.She was well until three weeks previously, when she began to have a constant, sharp pain in the right upper abdominal quadrant that was aggravated by movement or by local pressure and unaffected by food intake or bowel movements. She entered another hospital, where a mass in the right upper abdominal quadrant was found on physical examination. An intravenous pyelographic examination, an oral cholecystographic study, a barium-enema examination and an upper gastrointestinal study were reported to be negative. The pain disappeared spontaneously, and the mass . . .

Presentation of CaseA 53-year-old woman was admitted to the hospital because of fever.She was well until six months previously, when she had a respiratory-tract infection that gradually cleared but left her feeling vaguely unwell. Two months before admission pain developed in the left side of the neck and left shoulder, with radiation to the left arm. Injections into the shoulder joint and a cervical collar gave no relief.One month before entry she came to the Orthopedic Service of this hospital, where examination disclosed that she was afebrile. There was tenderness over the cervical spine, with pain on . . .

Presentation of CaseA 50-year-old man was admitted to the hospital because of fever.Twenty-two years previously bloody diarrhea occurred, and a barium-enema examination showed changes consistent with ulcerative colitis. His symptoms improved but recurred 15 years before entry, and his weight decreased to less than 46 kg. Fourteen years before admission evaluation at this hospital revealed the malabsorption syndrome, and a biopsy of the small intestine disclosed villous atrophy consistent with sprue. A gluten-free diet was prescribed, with control of the diarrhea and a gain in weight. Five years later gastrointestinal bleeding occurred; an exploratory laparotomy revealed no source . . .

Presentation of Case First admission. A 67-year-old man entered the hospital because of fever.Four and a half years previously, after a trip to Mexico, he had a brief episode of fever. Six months later, after a visit to Hawaii, his temperature rose for one day to 104°F, accompanied by shaking chills. A physician performed blood tests and informed him that his liver was abnormal. X-ray films of the gallbladder and the bile ducts failed to show opacification. Three and a half years before admission fever recurred, and he was admitted to another hospital. X-ray films of the gallbladder region . . .

Presentation of Case First admission. A 40-year-old man was admitted to the hospital because of hematemesis.For several years he had experienced occasional belching and an epigastric "empty feeling" associated with nausea after the ingestion of fatty foods. On the morning of admission he abruptly vomited large quantities of coffee-grounds material, accompanied by weakness, dizziness and sweating, and was brought to the hospital.The temperature was 36.6°C, the pulse 96, and the respirations 20. The blood pressure was 115 systolic, 90 diastolic.Physical examination revealed a robust man who appeared pale. No lymph nodes were palpable, and the lungs, heart . . .