摘要:

Metastatic breast carcinoma to the esophagus most often presents with a midesophageal stricture. Involvement of the gastroesophageal junction by breast carcinoma is distinctly unusual. The authors report the case of a 78-year-old woman who presented with clinical and radiologic features of achalasia secondary to breast carcinoma, metastatic to the gastroesophageal junction. Metastatic breast cancer to the gastroesophageal junction should be added to the list of conditions mimicking achalasia.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The authors describe a 31-year-old woman of British Isle ancestry who developed a syndrome resembling familial dysautonomia in her early teenage years. Predominant manifestations included achalasia, severe orthostatic hypotension, and abnormal sweating. The study included resting and stimulated fractional catecholamines, which were almost nonexistent in both situations, and urinary catecholamines, demonstrating an increase in dopamine degradation products. Immunohistochemistry of saphenous vein was negative for dopamine betahydroxylase (DBH), serotonin (5-HT) and several vasoactive neuropeptides. The only neuropeptide detected at levels thought to be physiologically relevant was calcitonin gene-related peptide (CGRP), a vasodilator. This was in contrast to control veins, all of which had DBH and neuropeptide Y immunoreactive fibers but few CGRP fibers. Also in contrast to controls, electron microscopy of the saphenous vein indicated a close to total absence of terminals with norepinephrine containing vesicles. Sural nerve biopsy showed, on electron microscopy, a considerable reduction in the number of myelinated fibers, while unmyelinated fibers appeared to be in the normal range. The authors suggest, from the above findings, that the autonomic fibers were undergoing some form of distal axonal degeneration. Their findings differ from most biopsies performed in dysautonomic children, and they believe their patient has a different neurologic entity.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Pathogenesis of hypertension in Cushing's syndrome has remained controversial. A 56-year-old Japanese man with Cushing's syndrome due to adrenal carcinoma has been followed up for more than 6 years. During the followup period, left adrenalectomy and hemi-hepatectomy due to metastatic lesion were performed. Blood pressure, serum cortisol, and urinary excretion of 17-OHCS, as well as other routine biochemicals, have been measured periodically. These data revealed that there is a marked correlation between the levels of blood pressure and serum cortisol or urinary excretion of 17-OHCS. This finding suggests that cortisol production by tumor is a determinant factor in hypertension in Cushing's syndrome.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Cocaine use is escalating in the United States. Cocaine produces sympathomimetic effects and causes generalized vasocon-striction involving multiple organ systems. Its cardiovascular complications may be life-threatening and include myocardial infarction, myocarditis, cardiomyopathy, arrhythmias, and aortic dissection. Accurate diagnosis and prompt management can be life-saving. This review focuses on the current information available on the cardiovascular complications of cocaine and suggests guidelines regarding their management strategies.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The decision to operate in patients with aortic stenosis is based on the presence of symptoms and hemodynamically significant valvular obstruction. The strengths and limitations of cardiac catheterization and Doppler echocar-diography are compared, and the concept of “critical” aortic stenosis is discussed. The recommendation of aortic valve replacement must take into account the symptom status, the hemodynamic significance of the lesion, and the size and type of valve to be implanted.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID