Liquefaction necrosis of mitral annular calcification (LNMAC): review of pathology, prevalence, imaging and management: proposed diagnostic imaging criteria with detailed multi-modality and MRI image characterization.

Liquefactive necrosis within a large spheroid zone of mitral annular calcification (LNMAC) is an atypical but increasingly recognized variant of mitral annular calcification (MAC). Proposed MRI, echo, and CT imaging criteria for diagnosis of this unusual disease entity are discussed along with a review of the prognosis, histopathology, and management implications. A comprehensive ECHO, CT, and MRI imaging approach to diagnostic differentiation from other cardiac masses, allowing characterization of the differing components of this unusual lesion is emphasized.

A longitudinal view of laboratory re-engineering in a community hospital group.

Starting with a traditional community hospital laboratory system in one medium-sized and two small community hospitals and with a modest plan for reorganization, the CHS laboratories have embarked on a successful 6-year run of re-engineering.

Degenerative changes in normal femoral heads in the elderly.

Unipolar hemiarthroplasty and bipolar hemiarthroplasty are frequently chosen for treating subcapital hip fracture; however, clinical outcome varies substantially. Although total hip arthroplasty is indicated for subcapital hip fracture in patients with degenerative hip disease, there is a lack of data on the incidence and extent of degenerative change in patients with subcapital hip fracture without obvious degenerative hip disease. This investigation evaluated articular cartilage in 25 consecutive femoral heads removed from elderly patients who sustained acute femoral neck fracture.

Direct right atrial catheter insertion with video-assisted thoracic surgery.

Chronic gastrointestinal disorders may require support with long-term total parenteral nutrition via a central venous catheter. Central venous access may be problematic because of infection or thrombosis of previous catheters. We report a case where video-assisted thoracic surgical catheter insertion directly into the right atrium provided a successful and safe method of long-term central venous access for parenteral nutrition.

Software regression testing and quality assurance.

Inadequacy and inefficiency of manual validation and regression testing present major problems for users of clinical laboratory information systems (LIS). This article examines the history of LIS regression testing, typical examples of related problems, and possible approaches to improving system QA through partial or complete automation of the process.

Long-term palliation of pulmonary artery sarcoma by radical excision and adjuvant therapy.

The case of an extensive pulmonary artery sarcoma managed by radical excision and homograft reconstruction followed by aggressive chemotherapy and irradiation with prolonged survival is presented. Pulmonary artery sarcomas are reviewed with emphasis on the diagnosis and management of these usually fatal tumors.

Improved food intake and reduced nausea and vomiting in patients given a restricted diet while receiving cisplatin chemotherapy.

Administration of cisplatin alone or in combination with other cytotoxic agents commonly produces intractable nausea and vomiting, which is currently controlled through high-dose antiemetic drugs. However, patients often refuse continued therapy because of suboptimal control of nausea and vomiting and substantial decline in nutritional status. In this pilot study, 19 patients receiving cisplatin were evaluated for nausea and vomiting, amount of food intake, and subjective assessment of well-being.

Pharmacy drug error awareness program.

Medication errors are a major concern in hospital pharmacy practice. The prevention of medication errors involves mainly the departments of pharmacy and nursing. Though there are many safeguards used to prevent medication errors, they still occur, posing potential harm to patients.

Cyanide toxicity from acetonitrile-containing false nail remover.

A patient presented without symptoms 30 minutes after ingesting acetonitrile, also known as methylacyanide. He had prompt gastric lavage and activated charcoal administration. Hours later, the onset of clinical toxicity was heralded by mental status abnormalities and vomiting prior to a generalized seizure.

Urachal signet-ring cell carcinoma.

A case of urachal signet-ring cell carcinoma is reported and compared with the 18 previously reported cases. This tumor appears aggressive, with a five-year survival rate of 27 percent. Only 1 patient achieved a five-year disease-free survival.

Preliminary results of concurrent radiotherapy and chemotherapy in advanced cervical carcinoma: a phase I-II prospective intergroup NCOG-RTOG Study.

Thirty-eight patients with advanced carcinoma of the cervix were prospectively treated with a concurrent combination of radiotherapy (RT) and chemotherapy (CT) using the drugs 5-fluorouracil (5FU), mitomycin C and cis-platinum as part of a Northern California Oncology Group (NCOG) and Radiation Therapy Oncology Group (RTOG) intergroup study. RT consisted of 36.00 Gy to the pelvis in 4 weeks followed by a 9.

Radiotherapy alone and chemoradiation for nonmetastatic esophageal carcinoma. A critical review of chemoradiation.

Sixty-five patients with nonmetastatic (Stages I, II, and III) esophageal cancer (EC) were treated with radiotherapy (RT) alone (56.00 to 61.00 Gy in 6 to 7 weeks) or synchronous combinations of radiotherapy and chemotherapy (RT-CT).

Malignant Brenner tumor of the ovary.

Three cases of stage III malignant Brenner tumor of the ovary in which chemotherapy or radiotherapy favorably altered the clinical courses are reported, and the literature is reviewed.

Extragenital malignant mixed müllerian tumor.

A case of extragenital malignant mixed müllerian tumor that appeared to represent a second primary tumor in a patient previously treated for disseminated ovarian serous papillary carcinoma is reported and compared with other reported cases of extragenital malignant mixed müllerian tumor.

Clinical potential of synchronous radiotherapy and chemotherapy for advanced squamous cell carcinoma.

The equivocal results of past treatment regimens in which concurrent radiotherapy and chemotherapy were used may have resulted from a lack of site-specific active drugs that were also true radiation sensitizers. This report demonstrates an experience with 3 chemotherapeutic agents, 5-fluorouracil, cisplatin, and mitomycin, given simultaneously with radiation for locally advanced squamous cell carcinomas of such diverse sites as the anal canal, cervix, and esophagus. Early results show that the toxicity of these combination regimens is generally acceptable and indicate that such synchronous combination treatments may be superior in local control and survival to radiotherapy alone.

Renal-limited polyarteritis nodosa.

A case of classic (large vessel) polyarteritis nodosa in which the disease was apparently confined in the kidneys is described. The findings in this case support the concept of renal-limited polyarteritis nodosa.

Preliminary results of concomitant radiotherapy and chemotherapy in advanced cervical carcinoma.

Ten patients with advanced and previously untreated squamous cell carcinoma of the cervix were treated with a synchronous course of radiotherapy (RT) and chemotherapy (CT). RT consisted of 3600 to 4500 cGy external pelvic treatments on a 6-MeV linear accelerator followed by two intracavitary applications administering a total of 4000 mg hr of radium equivalent cesium. CT consisted of a course of mitomycin C (10 mg/m2 iv bolus) and 5-fluorouracil (5FU; 1000 mg/m2/24 hr for 96 hr) during the second week of external RT and another course of cis-platinum (CDDP; 75 mg/m2, 1-6 hr infusion) and 5FU (1000 mg/m2/24 hr for 96 hr) during the first intracavitary cesium application.

Carcinosarcoma of the salivary gland.

A 59-year-old woman had carcinosarcoma of the salivary gland. Salivary gland tumors of this type are aggressive and rare. Most patients die of the tumor, but surgical cure has been reported in one case.