Four synchronous primary tumors in a male patient.

Multiple primary malignancies are defined as two or more primary malignant tumors diagnosed in one individual; they are further classified to synchronous or metachronous based on the period between each cancer diagnosis and the other. The diagnosis of four synchronous cancers is exceedingly rare. We report a case of a 72-year-old man, diagnosed with synchronous quadruple cancers, Hurthle cell carcinoma and papillary carcinoma of the thyroid, as well as squamous cell carcinoma and carcinoid tumor of the lung.

Cancer pain management and the JCAHO's pain standards: an institutional challenge.

Unrelieved pain is a major medical problem. In response to this problem, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) launched new standards for pain management in 1999. A review was conducted in five hospitals of 117 charts of 80 inpatients and 37 outpatients with cancer who had pain documented in their medical records to determine whether application of these JCAHO standards was documented.

A data-driven approach to improving clinical outcomes in cardiac care.

The performance improvement department at The Queen's Medical Center (QMC) in Honolulu, has been monitoring the outcomes of cardiovascular interventional procedures and cardiothoracic surgical procedures. By using an institution-wide database as well as participating in national cardiac databases, a set of clinical indicators is tracked, and quarterly reports are provided to the cardiovascular medicine (CV) and thoracic and cardiovascular surgery (TCV) services. After reviewing the data, a combined CV/TCV/anesthesia morbidity and mortality committee meets monthly to further evaluate the data, review cases, and formulate action plans based upon the findings.

Home treatment of mild to moderate bleeding episodes using recombinant factor VIIa (Novoseven) in haemophiliacs with inhibitors.

Objective: To assess the safety and efficacy of a fixed dose of recombinant activated factor VII (rFVIIa; NovoSeven) in the home setting for mild to moderately severe joint, muscle; and mucocutaneous bleeding episodes in patients with haemophilia A or B with inhibitors.

Design: Multicentre, open-label, single arm, phase III study of one year duration. METHODS; Patients or their caregivers administered up to three doses of rFVIIa (90 microg/kg i.

Subacute (acute, persistent) thrombotic microangiopathy.

Six patients with prolonged acute courses of thrombotic microangiopathy are reviewed. These patients had in common courses of acute disease requiring plasma support for more than 3 months, with subsequent complete remission. Plasma support requirements may be prodigious, and the acute course may require more than 100 plasma exchanges before a stable remission is achieved.

An ultrastructural study of the renal juxtaglomerular apparatus and extraglomerular mesangium in patients with systemic lupus erythematosus.

Experimental studies have indicated that the glomerular mesangium may function by phagocytosis of various circulating substances which are then processed and flow to the juxtaglomerular apparatus (JGA) region and into the intercellular spaces of the macula densa. An electron-micrographic study of the juxtaglomerular apparatus and extramesangial region in systemic lupus erythematosus (SLE) was undertaken. In only five of 39 cases (13%) of SLE were discrete electron-dense "immune-type" deposits noted in the JGA region.

Long-term survival after bone marrow transplantation: a 15-year follow-up report of a patient with Wiskott-Aldrich syndrome.

In 1968 a 2-year-old boy with Wiskott-Aldrich syndrome was extremely ill with eczema, a series of life-threatening infections, and repeated hemorrhages into his skin, lungs, brain, and other internal organs. He was given high-dose cyclophosphamide therapy for immunosuppression, followed by bone marrow cells from his histocompatible, healthy sister. In the 15 years since bone marrow transplantation, he has had full T cell, partial B cell, and no hematopoietic engraftment.

Therapeutic apheresis.

Therapeutic applications using semiautomated blood cell separators have improved the clinical management of several disorders through cellular or plasma depletion, or by rapid erythrocyte or plasma replacement. Cytapheresis procedures may remove large numbers of platelets or leukocytes in proliferative disorders, or induce and maintain a lymphopenia in "autoimmune" diseases. Rapid reductions in circulating paraproteins, autoantibodies, and immune complexes can be achieved to augment longer-term cytotoxic or immunosuppressive therapy.

Malignant clear cell hidradenoma: a case report.

A 73-year-old man developed a malignant clear cell hidradenoma on the nose. Although it was treated solely with diathermy and curettage it did not recur. These rare tumours are histologically malignant but do not always behave aggressively.

Generalized morphoea successfully treated with salazopyrine.

A patient with active, generalized morphoea was treated successfully with salazopyrine on two occasions. The first time the trunk was involved and most of the skin softened after the drug therapy was started. After salazopyrine was discontinued, morphoea developed in the thighs but recommencement of therapy resulted in complete resolution.

Thrombotic thrombocytopenic purpura and dose of plasma exchange.

Four patients with thrombotic thrombocytopenic purpura (TTP) were treated by plasma-exchange transfusion, three of whom recovered completely. Because previous reports in the literature describing exchange transfusion as treatment for TTP have demonstrated variable success rates, particular attention was given to "dose" and frequency of plasma exchange. Evans blue dye studies established a measure of "dose" under conditions of varying efficiency.

Comparison of acid phosphatase isoenzymes of human seminal fluid, prostate, and leukocytes.

We used ion-exchange column chromatography and electrophoresis on polyacrylamide gel to compare the acid phosphatase isoenzymes of prostate and leukocytes. The major isoenzyme of the prostate is band 2A; only a trace of band 2B was observed. However, the major isoenzymes of leukocytes are band 4 and band 2B, and only a small amount of band 2A was observed.

Biochemical characterization of an aryl acetic ester hydrolase isolated from human monocytes.

A carboxylic-ester hydrolase was isolated from the leukocytes of a patient with myelomonocytic leukemia. Its relative molecular mass as estimated by sucrose density-gradient sedimentation is about 70 000. The purified enzyme is specific for acetyl esters of aromatic alcohols.

Plateletpheresis in the management of thrombocytosis.

Acute thrombotic and hemorrhagic manifestations of thrombocytosis associated with myeloproliferative disorders may be life threatening. Conventional therapy with radioisotopes and/or cytotoxic drugs may require weeks for effective control of platelet counts. In five patients, plateletpheresis by discontinuous-flow (Haemonetics) or continuous-flow (Aminco Celltrifuge) centrifugation was used as a means of reducing platelet counts acutely.