Clinical Characteristics of the Patient with Nonspecific PleuritisThe role of needle biopsy in the evaluation of unexplained pleural effusions is well established. The histologic demonstration of malignancy or granulomatous pleuritis is diagnostic, but the significance of a biopsy which reveals only nonspecific pleuritis is unclear. Carcinoma or tuberculosis may be eventually diagnosed in as many as 40 percent of those individuals who have an initial biopsy consistent with nonspecific pleuritis. Repeat pleural biopsy (closed or open) will increase the diagnostic yield in patients ultimately proven to have cancer or granulomatous pleuritis, but will only add to the expense and morbidity of those with nonspecific pleuritis. The identification of which patients should undergo additional diagnostic procedures is a difficult but important clinical problem. The purpose of this study was to determine if individuals with nonspecific pleuritis could be distinguished from those with malignant or granulomatous pleural disease by clinical criteria. add comment Read the rest of this entry »

Mixed Clinicopathologic Behavior of a Solitary Mesothelioma: DiscussionThe present-day classification of mesotheliomas is based on several clinicopathologic criteria. Grossly the tumor is divided into diffuse and localized types. Microscopically the tumor is judged by the degree of pleomorphism and angiogenesis, and the number of mitoses. Histologically subdivisions are made based on tissue organization: epithelial (carcinomatous), mesenchymal (fibrous), or mixed. Our report describes one of the largest solitary fibrous mesotheliomas that has been curatively resected. A review of the literature shows that such an outcome, despite the tumor size, has been the rule rather than the exception when complete surgical resection is achieved. In general, benign mesotheliomas tend to be fibrous, solitary, noninva-sive, with limited degree of pleomorphism and a small number of mitotic figures. They are not associated with previous asbestos exposure. Case reports have described huge benign mesotheliomas (up to 5 kg) which have been surgically excised with cure. The malignant types, in contrast, tend to be diffuse, invasive (locally and metastatic), and more pleomorphic accompanied by rudimentary angiogenesis. Often their diffuse nature precludes complete surgical resection. Chemotherapy and radiation therapy have been equally ineffective in extending survival time. Read the rest of this entry »

Mesothelioma is a primary tumor of the serosal surface. Although the mesothelium lines various parts of the body, including the peritoneum, pericardium, and genital tract, a primary tumor of this structure most commonly arises from the pleura. Controversy has existed regarding the actual existence of pleural mesotheliomas. Traditionally, tumors in the pleural space were believed to be metastases or to arise from tissues of the chest wall. It was not until the 1940s that studies of these tumors in tissue culture showed they could differentiate into mesothelium, and thus suggested the existence of true mesotheliomas. Until recently, pathologists continued to have difficulty in distinguishing certain mesotheliomas from metastatic adenocarcinomas. The diagnosis of mesothelioma was often only made in the context of a primary adenocarcinoma not being clinically detected elsewhere. We describe here a case of solitary fibrous mesothelioma that exhibits a mixed clinicopathologic behavior and discuss this finding in the context of the continuing evolution of our understanding of mesotheliomas. canadian healthcare mall Read the rest of this entry »

Elevated CK-MB Isoenzyme after Exercise Stress Test and Atrial Pacing in Patients with Ischemic Heart Disease: Atrial Pacing-Induced Ischemia with Elevated CK-MB Isoenzyme LevelAtrial Pacing-Induced Ischemia with Elevated CK-MB Isoenzyme Level
The existence of elevated CK-MB isoenzyme level in the presence of normal total CK is questioned due to the fact that small amounts of CK-MB isoenzyme released from the heart during a myocardial ischemic or micronecrotic event are diluted in the peripheral blood, rendering the detection of such minute elevations highly improbable. Thus, it is reasonable to assume that if samples from the coronary sinus are taken, before the enzyme is released into the peripheral blood, immediately after the ischemic event, the changes in CK-MB isoenzyme levels can be accurately monitored. In order to clarify this topic, blood samples were obtained in this study simultaneously from coronary sinus and from peripheral vein in six patients in whom acute myocardial ischemia was induced by rapid atrial pacing. generic zoloft Read the rest of this entry »

The CK-MB isoenzyme is present in healthy individuals in minute amounts, undetectable by the routinely employed electrophoretic methods. Pathologically elevated CK-MB isoenzyme levels occur in massive skeletal muscular necrosis or myocardial necrosis. The percentage of CK-MB isoenzyme in peripheral blood will be significantly higher when myocardial necrosis occurs than when massive skeletal muscular necrosis occurs due to the relatively high percentage of CK-MB isoenzyme in the heart. Therefore, it is justified, in the everyday clinical setting, to express the amount of CK-MB isoenzyme in blood as a percentage of total CK, and it is generally accepted that more than 4 percent of CK-MB isoenzyme in the blood indicates myocardial necrosis. When estimated by the electrophoretic technique, however, this approach is not sensitive enough to detect small amounts of CK-MB isoenzyme release when the amount of necrotic or ischemic tissue is relatively small causing almost imperceptible changes in total CK. The significance, however, of small amounts of CK-MB isoenzyme in ischemic events may be far-reaching especially in its prognostic value. In the present study, the highly sensitive and specific method of monoclonal antibody against CK-MB molecule was used, allowing detection of minute isoenzyme levels below 3 ng/ml in the subjects studied. read Read the rest of this entry »

Elevated CK-MB Isoenzyme after Exercise Stress Test and Atrial Pacing in Patients with Ischemic Heart Disease: ResultsIn all patients, acute myocardial ischemia documented by ST depressions, horizontal or down-sloping of more than 2 mm (2.7 ±0.5), and thallium reversible perfusion defects were induced. Eight patients had an anteroseptal defect, five patients had apical and septal defects, and two patients had an inferior wall defect. In the 15 patients studied, there was an average elevation in CK-MB isoenzyme levels from 1.5 ±1.1 to 2.8± 1.6 ng/ml (p<0.05) detected within 6 h after exercise-induced ischemia. In ten patients (66 percent) an elevation of more than 2 SD from the baseline values was measured. In contrast, in the 18 normal subjects there was a small and nonsignificant change in the CK-MB isoenzyme level from 1.5±1.7 to 2.0±1.7 ng/ml, p = NS (Fig 1). Read the rest of this entry »

Exercise Stress Test and Thallium 201 Scintigraphy
The subjects from groups 1 and 2 underwent multistage exercise stress testing on supine bicycle ergometry. A 12-lead ECG was obtained for every stage of the exercise and during recovery. Exercise was stopped when the patients complained of severe chest pain, shortness of breath, extreme weakness or when hypotension occurred. A test was considered positive when ST depression of at least 1.5 mm during at least 0.08 s (horizontal or downward in shape) appeared with or without chest pain. A test was considered negative when 80 percent or more of the predicted heart rate for age and sex was achieved without chest pain or any ischemic change on the ECG. Read the rest of this entry »

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