Dendritic fibromyxolipoma: clinicopathologic study of a distinctive benign soft tissue lesion that may be mistaken for a sarcoma.

Twelve cases are described of a distinctive benign soft tissue lesion that may be mistaken for a sarcoma. The tumors occurred in 11 men and a woman aged 33 to 81 years (mean, 64 years), and measured from 2 to 11 cm in greatest diameter (mean, 6 cm). They were grossly described as soft, well-circumscribed, yellow-gray, with a mucoid cut surface.

The modified Steiner stain: a new use for an old stain? Staining cytomegalovirus-infected cells in gastrointestinal biopsies.

The modified Steiner stain is a non-specific silver stain for identifying bacteria in formalin-fixed, paraffin-embedded tissues. The principle behind its use is that bacteria are first sensitized using uranyl nitrate solution, making them able to precipitate silver from a silver nitrate solution. It is used routinely for staining gastric biopsies to identify Helicobacter pylori.

Gastrointestinal stromal tumors.

Stromal tumors of the gastrointestinal tract represent relatively rare lesions that are thought to arise from connective tissue elements located along the entire length of the gut. For many years these tumors have been the subject of much controversy and debate in the literature regarding their histogenesis, criteria for diagnosis, prognostic features, and nomenclature. Only a minority of these lesions, mainly those confined to the esophagus and rectum, have been shown to correspond to mature, well-differentiated types of neoplasms such as leiomyoma or leiomyosarcoma of the conventional type.

Clear cell tumors of the skin.

Clear cell tumors of the skin represent a heterogeneous group of lesions of diverse histogenesis that share as their common denominator the presence of cells containing abundant clear cytoplasm. The phenomenon of cytoplasmic clearing may be observed focally or represent the dominant feature in a variety of tumors originating from the epidermis or in tumors within the dermis showing well-defined features of eccrine, sebaceous, and follicular lines of differentiation. In addition to the aforementioned conditions, melanocytic lesions derived from the epidermis characterized by a prominent or predominant clear cell component as well as metastases to the skin from clear cell tumors of internal organs may enter the differential diagnosis and will also be discussed.

Malignant glomus tumor. A case report of widespread metastases in a patient with multiple glomus body hamartomas.

Glomus tumors are characteristically benign solitary tumors. A few cases of malignant glomus tumors have been reported; however, they are usually only locally invasive, and metastases are exceedingly rare. We report a case of widespread metastases of a malignant glomus tumor involving the skin, lungs, jejunum, liver, spleen, and lymph nodes in a 63-year-old man with end-stage chronic renal failure.

Determinants of operative mortality in octogenarians undergoing coronary bypass.

Background: The elderly segment of the population is increasing rapidly, and surgeons are being asked to consider patients more than 80 years old as candidates for coronary bypass. The objective of this study was to identify risk factors that may adversely affect mortality as well as analyze functional outcomes and survival in octogenarians undergoing coronary bypass.

Methods: From July 1989 through February 1994, 300 consecutive patients 80 years of age and older underwent coronary artery bypass grafting.

Primary sarcomas of the lung.

Primary pulmonary sarcomas are rare tumors. Because the lung is one of the favored metastatic sites for soft tissue sarcomas, care must be taken when evaluating these lesions to rule out the possibility of an alternate primary source by means of thorough clinical history and radiographic evaluation. In addition to the difficulties involved in separating primary from metastatic tumors, pulmonary sarcomas must be distinguished from a number of sarcomalike primary lung neoplasms, including spindle and giant cell (pleomorphic) carcinoma, and from mixed epithelial/mesenchymal lesions such as pulmonary blastoma and carcinosarcoma.

Morning report revisited: a new model reflecting medical practice of the 1990s.

Given the changes that are taking place in medical practice, it is important to reexamine traditional teaching methods in internal medicine residencies. One such component is morning report, which usually focuses exclusively on patients recently admitted to the hospital by the housestaff. A new morning report format described here adds several new components, including the review of patients who have been recently discharged from the hospital.

Hyalinizing spindle and epithelioid cell nevus. A study of five cases of a distinctive histologic variant of Spitz's nevus.

Five cases are described of a distinctive histologic variant of benign spindle and epithelioid cell nevus characterized by extensive and prominent stromal hyalinization. The lesions consisted of a proliferation of spindle or epithelioid nevocytes scattered singly or in small clusters in the dermis and surrounded by abundant paucicellular hyalinized or collagenous stroma. Three patients were men and two were women.

Research in medical education: the challenge for the next decade.

As we enter a very turbulent period for medicine and medical education, it is essential that the importance and value of medical education research be demonstrated. Despite the billions of dollars that our society invests annually in medical education, medical education research, the "R & D" of medical education, is best with many problems. These include a low priority for academic medicine, underfunding, and insufficient consensus on goals and directions.

The generalist health care workforce: issues and goals.

The generalist health care workforce in the United States is best characterized as those practitioners who deliver primary care services. These include most family physicians, general internists, general pediatricians, nurse practitioners, osteopathic family physicians, and physician assistants. Based on a variety of factors, including health care needs, managed care/HMO hiring practices, international comparisons, and health care costs, the case for increasing the amount and proportion of generalist providers is compelling.

Gastric syphilis. Primary diagnosis by gastric biopsy: report of four cases.

Gastric involvement in secondary or tertiary syphilis is rarely recognized clinically, and its diagnosis by examination of endoscopic biopsy specimens has been reported infrequently. We report four cases of gastric syphilis with the primary diagnosis made by gastric biopsy. The patients, all male, ranged in age from 38 to 78 years and presented with gastric complaints, the most common being upper gastrointestinal tract bleeding (three of four).

Artifactual distortion of cells simulating metastatic small cell carcinoma in the bone marrow.

Artifactual distortion of hematopoietic elements in histologic preparations and smears of bone marrow aspirates simulating metastatic small cell carcinoma has been recently described. The clinical, pathologic, and immunohistochemical features in 12 such cases have been studied by us. In all these cases, bone marrow smears and histologic sections showed multiple small clusters of atypical, hyperchromatic cells suspicious for metastatic small cell carcinoma.

Histopathology of the heart in tetanus.

Despite modern intensive care, the mortality rate for systemic tetanus intoxication remains high. The prevention of deaths attributable to respiratory muscle spasm has made apparent a clinical syndrome of cardiovascular instability characterized by labile blood pressure and heart rate and associated elevated plasma catecholamine levels. A 60-year-old man treated at our hospital demonstrated this clinical problem and was shown by echocardiography to have a left ventricular ejection fraction of only 8%.

Resident education in surgical endoscopy.

Under the auspices of the Resident Education Committee of the Society of American Gastrointestinal Endoscopic Surgeons, 158 of 298 (53%) of surgical training program directors responded to a survey on the current status of endoscopy in residency programs. Although 100 per cent claim that gastrointestinal endoscopy is provided by their program, only 76 per cent have formal endoscopy training, usually centered around the PGY 3 level, with only 23 per cent having didactic lectures in endoscopy. Directors claim to have trained nearly all of their residents by the completion of residency, averaging 44 esophagogastroscopies, 37 colonoscopies, and 46 flexible sigmoidoscopies per resident.

Doppler echocardiography.

In the past year, Doppler echocardiography has continued to transform the "echo laboratory" into a "cardiac imaging and hemodynamics laboratory." Evaluation of blood flow through the cardiac chambers and great vessels is moving from semiquantitative to quantitative. The potential for measuring mitral regurgitant flow more precisely has been demonstrated by evaluating the zone of flow acceleration that occurs on the left ventricular side of the mitral valve.

Ambulatory-based residency education: improving the congruence of teaching, learning, and patient care.

Residency education in internal medicine should be based in the ambulatory setting. The challenge in ambulatory education lies not only in the unique opportunities afforded by the setting but also in the careful implementation of a program based on sound educational principles. We have designed a new ambulatory-based model of internal medicine residency that adheres to the principles of adult learning theory.

Congenital self-healing reticulohistiocytosis. Report of a case with 7-year follow-up and a review of the literature.

A case of congenital self-healing reticulohistiocytosis in an otherwise healthy newborn boy is presented. Histological, immunohistochemical, and ultrastructural findings are described and the nosologic position of this entity is discussed.

Laparoscopic treatment of acute cholecystitis.

Retrospective review of the first 210 patients treated by laparoscopic cholecystectomy revealed 55 patients (26%) with acute cholecystitis diagnosed preoperatively or intraoperatively. Average age was 52 years amongst 38 women and 17 men. Cardiac history was present in 4%, pulmonary disease was noted in 9%, and other significant medical history was found in 10%.

Laparoscopic approach to gallstones in the morbidly obese patient.

Obesity has been suggested to be a contraindication to laparoscopic cholecystectomy (LC). In our center, in which all patients presenting with symptomatic gallstones are considered to be candidates for LC, 24 of the first 325 LC candidates were retrospectively found to be morbidly obese. In all, 20 were women and 4 were men.

Thymic hyperplasia. A clue to the diagnosis of hyperthyroidism.

The association of simultaneous abnormalities of the thyroid and thymus is well documented, particularly in the case of Graves' disease. We present a case of a natural death following thyroid storm in which marked thymic hyperplasia was present. This finding can be helpful in determining the cause of death.