Biomedical subjects
Publications and source records attributed to R A DeRemee.
Five patients with Wegner's granulomatosis were found to have significantly raised serum immunoglobulin E (IgE) levels. The rise in IgE was not related to the extent of clinical involvement, was not part of a generalized serum immunoglobulin rise, and was not associated with eosinophilia. Raised serum IgE may be a clue to the pathogenesis of this disease.
Confusion surrounds the entity known as "lethal midline granuloma". Partly responsible is the lack of specificity in this term. "Polymorphic reticulosis" has been used as a term to describe the morphology of the disease. Thirty-two cases illustrate the protean features of this disease. Although it commonly presents in the head and neck, other sites such as the lungs, kidneys, skin, and gastrointestinal tract may be involved, either alone or in conjunction with lesions of the head and neck. Clinically, it is easily confused with Wegener's granulomatosis. Histopathologic differentiation, however, is both feasible and important. Wegener's granulomatosis is treatable with steroids with or without cyclophosphamide; polymorphic reticulosis confined to one site responds to irradiation. In polymorphic reticulosis, thhe best results of treatment are obtained in localized lesions of the upper airway treated early with irradiation; a poorer outcome is associated with multifocal involvement, which necessitates systemic therapy.
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Fifty-five-degree oblique hilar tomography is an accurate and simple means of evaluating hilar anatomy and pathology. It is of most value in proving the hilum to be normal in cases in which plain chest roentgenograms suggest a hilar lesion. It is accurate in differentiating hilar adenopathy from hilar masses and in both of these it is helpful in determining the extent and bilaterality of the disease process. Unfortunately, granulomatous infiltrates within the hilum cannot be differentiated from tumor. The procedure is of limited value in the presence of diffuse perihilar pulmonary fibrosis, and at this time caution must be advised in the interpretation of small, unilateral, ill-defined hilar densities as tumors.
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