Fatal acute pancreatitis caused by valproic acid.

We describe a case of a 31-year-old woman with cerebral palsy who developed fatal acute hemorrhagic pancreatitis while being treated with valproic acid to control her seizure activity. Acute pancreatitis is usually due to alcohol ingestion or biliary tract disease, and unusual causes include trauma, metabolic diseases, or drugs. Valproic acid is considered a safe drug, although rare cases of severe toxicity such as hepatitis and acute pancreatitis, including two fatalities, have been reported.

Risk factors for breast cancer in women undergoing mammography.

To determine risk factors for carcinoma of the breast, we compared women with cancer on screening and diagnostic mammography with those in whom cancer was not detected. For 39 months, medical histories were collected by mammography technologists on 3492 women having routine screenings or diagnostic mammograms at our institution. Potential risk factors of women with biopsy-proved breast cancer were compared with those in women who had normal findings on mammograms or negative biopsy results (control subjects).

Dipstick evaluation of hematuria in abdominal trauma.

Urine microscopic evaluation of hematuria has traditionally been used to determine the need for an intravenous pyelogram (IVP) in individuals with blunt abdominal trauma. An IVP is generally advocated in cases where greater than 5-10 red blood cells per high power field (RBC/HPF) are identified. Various laboratories have advocated the use of dipstick examination of these urine specimens as a replacement for microscopic examination.

Risk management enhances quality care and protection from liability.

Two externally imposed economic pressures that grip the health care industry are on a collision course: tightening reimbursement and exploding costs of malpractice litigation and insurance. Physicians practice defensive medicine to cope with the latter, but regulatory agencies are no longer willing to pay for this habit. Pathologists must be aware of the laboratory's liability exposure, which is likely to increase in the future.

Quality assurance programs cope with today's demands.

Pathologists face new demands resulting from malpractice litigation, health regulations, increased competition, and heightened consumer activism. Yet despite the concerns about quality and cost that beset the field, the pathologist's mission remains the same: the provision of quality care. Against the backdrop of current pressures, the authors describe the benefits and organization of a quality assurance program to help achieve this goal.

Acute febrile neutrophilic dermatosis (Sweet's syndrome) associated with lymphoma.

A case of Sweet's syndrome (acute febrile neutrophilic dermatosis) in a patient in whom lymphoma subsequently developed is presented. The literature concerning Sweet's syndrome in association with malignancy is reviewed. Awareness of this potential association is imperative for the early detection of the neoplasm and for the institution of appropriate follow-up care.

The effect of time and cholecystectomy on experimental biliary tree dilatation. A multi-imaging evaluation.

The changes of the biliary tree following distal bile duct obstruction and its release were confirmed by biliary scintigraphy and monitored by serial ultrasonography, computed tomography, and values of serum bilirubin and alkaline phosphatase in 14 mongrel dogs. The degree and rate of biliary dilatation were independent of cholecystectomy. The most rapid rate of extrahepatic dilatation occurred within the first 48 hours, while dilated intrahepatic ducts were first recognized three to six days after obstruction.

Studies on the pathogenesis of atherosclerosis. I. Adhesion and emigration of mononuclear cells in the aorta of hypercholesterolemic rats.

In rats with diet-induced hypercholesterolemia, two concomitant changes began to occur within 1 week and persisted for 1 year: an increase in total plasma cholesterol and an increase in the number of mononuclear cells adhering to the aortic intima (up to values 50 times normal). Adherent cells were approximately 90% monocytes and approximately 10% lymphocytes. Adhesion was focal, with some preference for ostia of aortic branches; it was followed by migration into the subendothelial space.

Diagnosis of peritoneal mesothelioma: computed tomography, sonography, and fine-needle aspiration biopsy.

The diagnosis of peritoneal mesothelioma was made prospectively and noninvasively in four patients with the use of sonography, computed tomography, and sonographically guided fine-needle aspiration biopsy. The imaging methods revealed information similar to the operative findings, with clear superiority of computed tomography over sonography. These noninvasive methods may be used as screening tools, especially among groups or in regional areas with a high risk for asbestos exposure.

Inflammatory polyp of the renal pelvis simulating transitional cell carcinoma.

An inflammatory polyps of the renal pelvis that caused a mass effect at excretory urography simulated transitional cell carcinoma. In the differential diagnoses of intracalyceal masses, therefore, inflammatory polyp must be considered.

Two agarose electrophoretic systems for demonstration of oligoclonal bands in cerebrospinal fluid compared.

Demonstration of oligoclonal bands by electrophoresis of cerebrospinal fluid is an important aid in establishing the diagnosis of multiple sclerosis. Electrophoretic systems vary in their effectiveness in doing so. We compared two systems in this respect.

Serum sialic acid levels in lung cancer patients.

The levels of N-acetyl neuraminic acid (sialic acid) in normal men and pre-and post-menopausal women were determined. Smoking post-menopausal estrogen therapy, oral contraceptives, and refreezing had no effects on sialic acid levels. Pre-treatment values from patients with lung carcinoma showed markedly elevated levels of sialic acid (0.