Men's Health News - Part 2

29 Mar

Pulmonary Sarcoidosis Associated with Leydig Cell Testicular Neoplasm

Pulmonary Sarcoidosis Associated with Leydig Cell Testicular NeoplasmThe association between neoplastic diseases and sarcoidosis is well known. Among many types of tumor, some testicular neoplasms have also been associated with the development of intrathoracic sarcoid lesions. We report here the first case of association between Leydig cell testicular tumor and biopsy-proven pulmonary sarcoidosis.
Case Report
A 33-year-old man came for observation in March, 1985 because of a moderate fever with exertional dyspnea and multiple bilateral opacities on chest roentgenogram (Fig 1). He was submitted in May, 1984 to a left orchiectomy at another hospital because of a painless mass, diagnosed as seminoma on frozen sections. However, the final diagnosis on routinely-processed sections was a Leydig cell tumor. Continue Reading »

28 Mar

Recurrent Pleural Effusion as Manifesting Feature of Primitive Chest Wall Hodgkin’s Disease: Discussion

Tracheobronchial and mediastinal lymph nodes are the most common sites of thoracic HD. Pleural effusion is not frequent and is almost always associated with enlarged thoracic lymph nodes. In a review of 15 cases of primary pulmonary HD defined as restriction of disease to the lung without hilar or mediastinal lymph node involvement, 14 had neoplastic infiltration beneath visceral pleura, but only one pleural effusion was present. This occurrence was explained with the absence of obstructed lymphatic return by swollen lymph nodes in this series. In 18 cases of HD involving breast and chest wall, six of seven cases in which the thoracic wall was involved at initial presentation had mediastinal widening, and in one case, palpable lymph nodes were present in the neck. One case only of pleural effusion was reported. In a series of 44 patients with HD limited to intrathoracic sites, pleural effusion was present in seven, two of whom had cytologic findings consistent with HD and no better defined localization; five cases resulted from direct pleural involvement. No case of isolated pleural localization was evident. We were able to detect one case record only in which thoracic HD had a course very similar to that of our patient, in that recurrent benign pleural effusion and fever were, for a long time, the only clinical manifestations; however, neoplastic involvement of hilar lymph nodes became evident later and finally was proved by autopsy. Continue Reading »

27 Mar

Recurrent Pleural Effusion as Manifesting Feature of Primitive Chest Wall Hodgkin’s Disease

Recurrent Pleural Effusion as Manifesting Feature of Primitive Chest Wall Hodgkin’s DiseaseIt is common opinion that pleural effusion, which accompanies 30 percent of thoracic Hodgkins disease (HD) is secondary to obstructed lymphatic return by enlarged hilar or mediastinal lymph nodes; this hypothesis also explains the common negativity of pleural fluid cytologic examination for malignant cells. We report a very unusual case of recurrent, cytologically benign pleural effusion which for months was the only manifestation of HD localized to the lateral inner thoracic wall as finally demonstrated by thoracic CT scan and closed needle biopsy. There was a remarkable absence of mediastinal or hilar lymph node involvement at any time, both on chest roentgenograms and CT scan. Continue Reading »

26 Mar

The Red Scourge: Pneumocystis carinii

Pneumocystis carinii pneumonitis is a well-known pulmonary infection associated with AIDS. Its symptoms include dyspnea, fever, cough, chills, sweats, and hemoptysis. Interestingly, normal findings on chest x-ray film have been reported. In such instances, transbronchial biopsies and a touch preparation of lung tissue yield a high rate of positive results. It is not unusual to find other opportunistic infections concomitantly with Pneumocystis carinii such as cytomegalic virus, Histoplasma capsulatum, Mycobacterium avi-vum-intercellulare, and Cryptococcus neoformans in immunocompromised patients. Continue Reading »

25 Mar

The Red Scourge

The Red ScourgeA 33-year-old caucasian man was admitted to the Kansas University Medical Center for evaluation of a fever, nonproductive cough and persistent headaches. Physical examination revealed a red asymptomatic nodule present on his right antecubital fossa for six months (Fig 1). His admission chest roentgenogram can be seen below (Fig 2). The patients condition deteriorated during his hospitalization and he ultimately expired. What is the diagnosis? Continue Reading »

24 Mar

The Total Artificial Heart: Conclusion

It is likely that patients will be incapable of directly participating in the final decision to turn off a TAH. Advance termination agreements, like living wills or durable powers of attorney, could be used as part of the consent process to provide “relief from the continued beating of the artificial heart” just as they are now used in other settings. These directives should be constructed to protect health care providers from adverse legal action as they act to carry out the patients wishes. Such agreements should be reviewed periodically with the patient after the TAH has been implanted. Continue Reading »

23 Mar

The Total Artificial Heart: Termination Planning for TAH Patients

The Total Artificial Heart: Termination Planning for TAH PatientsTermination Planning for TAH Patients
The decision to terminate a TAH resembles the decision to discontinue other life-sustaining treatments like respirators or dialysis. It should be based on the patients preferences. Though TAH termination necessarily entails death, this is not, as some suggest, suicide, an analogy that has been rejected in reference to other refusals of life-sustaining therapy by terminally ill persons. Despite improvements in equipment and medical management, TAH implantation will be a hazardous therapy Some TAH recipients will die after an extended course of multiple organ failure similar to that of critically ill intensive care unit patients. Bridge recipients may well experience complications that will render transplantation impossible. These complications and this manner of dying may be anticipated and should be addressed with patients. Continue Reading »

22 Mar

The Total Artificial Heart: TAH Research with Human Subjects

TAH Research with Human Subjects
Research with human subjects is limited in order to protect individuals from being abused by the researchers or society’s pursuit of grander social objectives. In 1982, the FDA granted an investigational device exemption for permanent TAH implantation because of the absence of other life-prolonging therapies for patients with endstage cardiomyopathy or who are unable to come off circulatory assistance after heart surgery. This exemption was justified by these patients’ dire need and by the importance of information about how to treat this class of patients. Annas2 believes that the prognosis with a permanent TAH is so predictably poor that the exceptional authorization for TAH research is not warranted. Continue Reading »

21 Mar

The Total Artificial Heart: TAH Bridges and Patient Choices

The Total Artificial Heart: TAH Bridges and Patient ChoicesTAH Bridges and Patient Choices
The availability of TAH bridges imposes a complex and poignant decision on patients with heart failure. Those electing a TAH bridge incur substantial additional costs without a guarantee that a donor heart will become available. Those wanting a transplant, but declining the costs and burdens of the TAH bridge, might justifiably fear that this decision decreases their chance of receiving a donor heart. This Faustian gamble will have profound emotional and financial consequences for family members as well. Public awareness of such choices might help mobilize additional donor hearts, but it would take a 15-fold increase in the efficiency of donor heart harvesting to meet the projected need for donated hearts for transplantation. Continue Reading »

20 Mar

The Total Artificial Heart: The TAH as Bridge

The TAH as Bridge
Many scientific observers propose that the TAH be employed only as a temporary bridge until a donated heart can be implanted. One quarter of heart transplant candidates die while waiting for a donor heart. The shortage of donor hearts and the increasing success and availability of heart transplantation have led to an eight-fold increase in the waiting time of critically ill patients for a donor heart. Many believe that clinical experience with the TAH as a bridge will lessen the need for further trials of permanent TAH implantations. Critics point out that deployment of the TAH as a bridge increases the pool of persons awaiting transplantation without increasing the supply of donor hearts. The possibility that the limited supply of donor hearts might be preferentially allocated to persons on a bridge in order to minimize TAH-related morbidity has been especially controversial. Continue Reading »

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