Sebaceous adenoma of the parotid gland: a case report with fine needle aspiration findings and histologic correlation.

Background: Sebaceous adenoma of the salivary gland is an extremely rare, benign neoplasm that predominantly involves the major salivary glands. The major problem in dealing with sebaceous adenoma is the recognition of this entity to avoid confusion with other more aggressive neoplasms, such as mucoepidenmoid carcinoma. In particular, recognition of this entity in cytologic specimens is important to avoid radical surgery.

Single-operator duodenoscope-assisted cholangioscopy is an effective alternative in the management of choledocholithiasis not removed by conventional methods, including mechanical lithotripsy.

Background And Study Aims: The widespread use of cholangioscopy in the management of difficult choledocholithiasis has been limited by the need for two expert operators. This report describes the use of a technique of single-operator duodenoscope-assisted cholangioscopy (SODAC) in the successful management of 75 patients with choledocholithiasis.

Patients And Methods: The single-operator technique, allowing simultaneous control of both the duodenoscope and cholangioscope, was prospectively studied between June 1999 and June 2001 in the diagnosis and treatment of choledocholithiasis.

Phase II trial of irinotecan in combination with amifostine in patients with advanced colorectal carcinoma.

Background: Irinotecan is effective in patients with advanced colorectal carcinoma in both first-line and salvage settings but its use can be limited by serious side effects. Amifostine has been shown to reduce the incidence of cisplatin-induced cumulative renal toxicity in patients with advanced ovarian carcinoma and nonsmall cell lung carcinoma. In the current pilot Phase II trial, the authors examined the potential role of amifostine as a protective agent against irinotecan-induced diarrhea and myelosuppression and evaluated an every-2-weeks regimen as an alternative schedule for the administration of irinotecan in patients with previously treated metastatic colorectal carcinoma.

Magnetic resonance imaging--guided fine-needle aspiration biopsies of retropharyngeal lesions.

Objective: The retropharyngeal space is a deep neck space susceptible to a host of disease processes. Surgical access to this space is technically difficult and associated with potential morbidity. An image-guided fine-needle aspiration (FNA) biopsy, if proven accurate and safe, would be of great benefit as an alternative diagnostic approach to this space.

Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage.

Background: Although endoscopy is often used to diagnose and treat acute upper gastrointestinal bleeding, its role in the management of diverticulosis and lower gastrointestinal bleeding is uncertain.

Methods: We studied the role of urgent colonoscopy in the diagnosis and treatment of 121 patients with severe hematochezia and diverticulosis. All patients were hospitalized, received blood transfusions as needed, and received a purge to rid the colon of clots, stool, and blood.

Precursor lesions for cancer of the cardia.

This article gives the rationale for the likelihood that the precursor lesion for cancer of the cardia is either short segments of Barrett's esophagus or even intestinalized (globlet cell change) mucosa at a normally located squamo-columnar junction. Intestinal metaplasia of the cardia is likely a wear and tear phenomenon in many individuals without gastroesophageal reflux disease (GERD). Markers that stratify risk further are required before routine biopsy specimens of the Z-line can be obtained in the clinical evaluation of patients with GERD.

Overinterpretation of gastroduodenal motility studies: two cases involving Munchausen syndrome by proxy.

Two children were thought to have an atypical gastroduodenal motility disorder because of the history and clinical course; both had received parenteral alimentation because of claims of inability to tolerate enteral feedings, and both continued to have unusual medical problems during parenteral alimentation. Both children had motility studies that were interpreted by a pediatric gastroenterologist to be "abnormal" and "diagnostic" of a motility disorder, but each was eventually shown to have a behavioral abnormality related to Munchausen syndrome by proxy.

Deep vein thrombosis. Diagnosis and management.

In at least 50% of patients with suspected deep vein thrombosis, the diagnosis is not confirmed by objective testing. The addition of impedance plethysmography and real-time B-mode ultrasound with color-enhanced Doppler imaging to the available diagnostic modalities has altered the approach to clinical evaluation. Pharmacologic treatment has evolved to place emphasis on the use of subcutaneous heparins of greater efficacy and the reduction of hemorrhagic risk with the use of the INR system when warfarin is recommended for long-term therapy.

Radical hysterectomy after pelvic irradiation in patients with high risk cervical cancer or uterine sarcoma: morbidity and outcome.

Background: The optimal treatment of patients with "high risk" cancer involving the uterine cervix has not been defined. These patients include those with "bulky" or barrel shaped cervical tumors, individuals with adenocarcinomas or sarcomas, and those who respond poorly to radiation. As these patients are at high risk of failure if treated with radiation, it has been proposed that radical hysterectomy be performed in combination with radiation to improve local control of disease.

The Effects of Temperature upon Contraction and Ionic Exchange in Rabbit Ventricular Myocardium : Relation to control of active state.

The mechanical responses (active and resting tension, dP/dt, TPT) and ionic exchange characteristics (Ca(++), K(+), Na(+)) which follow upon a variation in temperature, rate, and [K(+)](o) were studied in the rabbit papillary muscle and arterially perfused rabbit interventricular setpum. Abrupt changes in temperature provided a means of separating the contributions of rate of development (intensity) of active state and duration of active state to total active tension development (approximated by isometric tension). Threefold changes in duration of active state with proportional changes in active tension can be induced without evidence for alteration of Ca(++), K(+), or Na(+) exchange.