Biomedical subjects
Publications and source records attributed to I Rubinstein.
We describe 4 previously healthy patients with non-cavitated pulmonary sarcoidosis, whose presenting symptom was hemoptysis. Despite the presence of pulmonary involvement in about 90% of patients with sarcoidosis, hemoptysis as the presenting symptom is very rare and was described previously, to our knowledge, in only 5 patients.
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Chest roentgenograms of 85 Jewish patients with biopsy-proven pulmonary sarcoidosis were reviewed. In 25 cases (29%), the initial chest roentgenogram showed one of the following unusual manifestations: large pulmonary nodules in 11, an acinar pattern in 10, right hilar lymphadenopathy in 3 and a large pericardial effusion in one patient. Diagnostic biopsy specimens were obtained by an open lung biopsy in 13 patients, by anterior mediastinoscopy in 4, by transbronchial lung biopsy in 3, by skin biopsy in 3 and by liver and splenic tissue examination in 2 patients. Complete roentgenographic resolution occurred only in 4 out of 20 patients who were followed for more than two years (20%), but the majority of them (83% - 15 out of 18 symptomatic patients), improved clinically irrespective of corticosteroid administration. One patient died in the course of follow-up from a cause attributed to sarcoidosis (5% - one out of the 20 patients who were followed for more than two years).
A case of histologically proven intramedullary spinal cord sarcoidosis diagnosed antemortem is presented. The patient manifested symptoms referable only to the spinal cord simulating a tumor--progressive tetraparesis. The histologic diagnosis of sarcoidosis was established through exploratory laminectomy. Surgical intervention is the only way to rule out a malignant process in case of sarcoidosis limited to the spinal cord.
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We present a case of pulmonary sarcoidosis associated with serum and secretory IgA deficiency. This association has only previously been reported in 6 patients and may be coincidental. However, in light of current knowledge of the immunoregulatory defects postulated for sarcoidosis and for patients with selective IgA deficiency, 2 other possible explanations for the association of sarcoidosis and selective IgA deficiency are presented.
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1. The activity of dopamine-beta-hydroxylase (DBH) was assayed in the serum of 102 patients, mostly with varying degrees of hepatic dysfunction. 2. DBH activity was not elevated in those with liver disorder and did not correlate with serum bilirubin, transaminase, lactic dehydrogenase, alkaline phosphatase or creatine phosphokinase. 3. It is concluded that the liver is not necessarily involved in the inactivation of DBH.
Between 1966 and 1970 we reviewed 46 consecutive patients undergoing resection for primary carcinoma of the lung, in whom mediastinal lymph node metastases were found at operation. There was one operative death. Five of the remaining 45 patients survived five years--one of 10 cases of large cell carcinoma, one of 19 cases of adenocarcinoma, and three of 12 cases of epidermoid carcinoma. We believe that mediastinal lymph node metastases are not per se a contraindication to resection of epidermoid carcinoma of the lung.
We studied 202 cases of bronchogenic carcinoma treated surgically between January 1, 1966 and December 31, 1970. Over all, adenocarcinoma was the most common cell type (36.1 per cent). Of 151 patients whose carcinomas were successfully resected, and who lived for at least 30 days postoperatively, 88 had lymph nodes free of cancer. Not surprisingly, 5-year survival was related to lymph node metatases and cell type. The best over-all 5-year survival rate was for large cell carcinoma; it was 52.0 per cent without nodal involvement. Similar figures for epidermoid carcinoma were 29.0 per cent over all, and 26.3 per cent without lymph node involvement; for adenocarcinoma, 19.3 per cent over all, and 32.0 per cent without nodal involvement. For the entire group of 151 patients, the 5-year survival rate was 27.8 per cent over all, and 36.4 per cent without nodal metastases. Among resected patients with mediastinal lymph nodes positive for cancer, the 5-year survival rates were 1 of 10 patients with large cell carcinoma, 1 of 19 patients with adenocarcinoma, and 3 of 12 patients with epidermoid carcinoma. This suggests that in patients with epidermoid carcinoma, the presence of mediastinal lymph node metastases is not, in itself, an absolute contraindication to resectional therapy.
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The effect of indomethacin as an antagonist to prostaglandin was evaluated on a series of 16 women during spontaneous labour in the ninth month of pregnancy. The evaluation of the effect of indomethacin on the progression of labour was determined by the deviation from the normal curve of Friedman. In 8 cases there was complete cessation of labour from 3 to 192 hours and in 8 additional cases there was protraction of the active phase from 3 to 17 hours. In 2 cases there was no effect. Seven births terminated spontaneously and in 9 cases it was necessary to administer pitocin intravenously to strengthen or renew contractions in order to terminate the pregnancy. There is no correlation between the obstetric state (the degree of cervical dilation, or effacement or rupture of membranes) at the time of indomethacin administration and the uterine response, or the speed of return to the normal curve of Friedman. The effect of indomethacin, as an antagonist to prostaglandin, at the time of labour was studied.
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One hundred ten individuals were divided into patients with digoxin intoxication; patients treated with digoxin; patients treated with digoxin and diuretics; patients treated with diuretics; and control subjects. Measurement of salivary potassium and calcium levels showed that 81% of the patients with digoxin intoxication had noticeable elevation of the salivary calcium level. In 22%, elevation of the salivary calcium level preceded clinical manifestations of intoxication. The high calcium level in the saliva was not accompanied by changes in serum or urinary calcium levels. The elevation of salivary calcium levels can be used not only as an additional indicator of digoxin intoxication but also for detecting impending intoxication in patients treated with this drug.