Biomedical subjects
Publications and source records attributed to A Yellin.
We present a case of pulmonary sarcoidosis associated with Hashimoto's thyroiditis. This association has been reported previously and may be purely coincidental. However, in light of current knowledge about the immunoregulatory defects postulated for sarcoidosis and for Hashimoto's thyroiditis, three other possibilities that may explain this association in our patient, are discussed.
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Bilateral, simultaneous visual loss usually indicates vertebral-basilar insufficiency. We report the case of a patient who experienced transient, bilateral, simultaneous, asymmetrical visual loss. Arteriography revealed flow-restrictive lesions in both internal carotid arteries. The most likely cause for this symptom is bilateral ophthalmic artery hypoperfusion distal to high-grade stenotic lesions of the internal carotid arteries.
Fifty-one men and 7 women greater than 70 years of age (mean 72.3) underwent pulmonary resection over a 5-year period. Fifty-two of these patients had a malignancy, of which 48 were primary lung neoplasms, including 42 cases of non-small-cell lung cancer. The overall operative mortality rate was 10.3%. Mortality was correlated with several preoperative factors, including pulmonary function tests, arterial blood gas tension, age, extent of surgery, stage of disease, and additional systemic diseases. Only the extent of surgery (mortality of 36.4% for pneumonectomies compared with 4.3% for less extensive resections, P less than 0.01) and FEV1/VC (the ratio of forced expiratory volume in 1 sec to vital capacity) (P less than 0.05) had statistical significance. The 5-year survival rate for patients with primary lung malignancies was 40%. In view of the aggressive nature of lung tumors in any age-group, the life expectancy of greater than 10 years at age 70, and the reasonable operative risk compared with the high mortality rate in patients not operated upon, we advocate surgical treatment for most patients greater than 70 years of age with a curable disease.
The occurrence of papilledema in a patient with progressive spastic paraparesis due to herniation of the T11-12 intervertebral disc is reported. The papilledema resolved following discectomy. The association and possible pathogenetic mechanisms between spinal cord lesions and signs of raised intracranial pressure are reviewed.
A case of leiomyoma of the lung was described by our department 17 years ago. We now report three new cases of smooth muscle tumours of the lower respiratory tract: a leiomyoma of the lung, a leiomyosarcoma of the right main bronchus, and a leiomyoma of the trachea. Whereas in the previous case the tumour was bronchoscopically removed, all the recent tumours were surgically resected. All the patients have done well, including the one with the leiomyosarcoma who underwent surgery 7.5 years ago. One hundred and eighty cases of leiomyoma and leiomyosarcoma of the lung and trachea have been reported to date. Pulmonary leiomyoma most commonly presents as an asymptomatic solitary lung nodule. The endobronchial variety may cause cough, haemoptysis, or shortness of breath. Most of these tumours were dealt with by major pulmonary resection, although a lesser resection would have sufficed in many cases if a histological diagnosis had been established prior to surgery. Pulmonary leiomyosarcoma may occur at any age, and is much more common in females. The majority of the patients have thoracic symptoms. These neoplasms seem resistant to chemotherapy or radiotherapy and should be treated by radical resection whenever possible, which results in a 45% 5-year survival rate. Only seven cases of leiomyosarcoma and 12 cases of leiomyoma of the trachea have been reported. These usually cause respiratory obstruction and/or haemoptysis. The malignant as well as the benign tumour is probably best treated by complete surgical resection.
We report an unusual case of unnoticed aspiration of an oat head by a healthy 19-year-old male. The foreign body migrated to the right pleural cavity and caused a severe persistent empyema, which resolved only after a thoracotomy . The lodging of a grass head in the pleura is a very rare event, almost never reported in an adult.
A policy of obtaining a routine chest radiograph in every young patient with unexplained chest pain or dyspnoea led to the diagnosis of 14 cases of spontaneous pneumomediastinum within four years, whereas only two cases from former years could be found retrospectively. One patient had recurrent spontaneous pneumomediastinum, the first case so far reported. Analysis of admission data suggested that this entity may be much more common than is generally believed, and may be second only to spontaneous pneumothorax as a cause of admission of young, healthy individuals experiencing sudden chest pain or shortness of breath. After reviewing the published reports we propose the following definition of spontaneous mediastinal emphysema: the non-traumatic presence of free air in the mediastinum in a patient with no known underlying lung disease. When it occurs without associated pneumothorax it is benign. The incidence of spontaneous pneumomediastinum for the four-year period under study was 1 per 12 850 admissions.
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A primary chondrosarcoma of the right main bronchus was removed by pneumonectomy in a 74-year-old woman. The presenting symptoms were dyspnea and cough with a lung mass evident for 18 months. She is well and free of tumor 16 months later. Only eight established cases of primary chondrosarcoma arising from the lung, and four originating from the tracheobronchial tree have been previously described. The long preoperative history and the outcome so far confirm the relatively less aggressive character of the tracheobronchial as compared to the lung subdivision of primary pulmonary chondrosarcoma.
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Fourteen infants, all under 6 months of age, underwent surgery for the relief of severe valvar pulmonary stenosis. A modified Brock (transinfundibular valvotomy) procedure was performed in all cases. Dilatation of the pulmonary valve with a mosquito clamp and biliary dilator is the basis of the modified operation. All infants survived the operation. In two patients there is residual, significant pulmonary stenosis, and in two additional cases pulmonary regurgitation is present.
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