1/26. Physiologic tailoring of therapy for resistant hypertension: 20 years' experience with stimulated renin profiling.renin profiling to assist in management of hypertension was first proposed about 27 years ago. However, it is still not widely used, perhaps because it was initially emphasized for management of primary hypertension, which is usually relatively easy to manage. Our experience in more than 4000 patients with referral hypertension screened since 1977 suggests that this approach, which I call "Physiologic Tailoring" of management, is particularly helpful in resistant hypertension, especially in cases of adrenocortical hypertension. Three cases of resistant hypertension spanning the 20 years of the clinic's existence, are presented to illustrate the contribution of renin profiling to the diagnosis and management of adrenocortical hypertension. It is suggested that adrenocortical hypertension is virtually always due to bilateral hyperplasia and that true curable solitary nodules may not exist if patients are followed long enough; and that adrenocortical hyperplasia is much more common in blacks and patients of African origin. A study to test the cost-utility of a renin-based algorithm for management of resistant hypertension is recommended.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
2/26. Fulminant parvovirus infection following erythropoietin treatment in a patient with acquired immunodeficiency syndrome.We report the case of a 41-year-old black man with acquired immunodeficiency syndrome who developed a severe chronic anemia due to parvovirus infection. Bone marrow biopsy revealed erythroid aplasia. The infectious nature of the anemia was not recognized, and the patient was treated with erythropoietin. The patient's reticulocyte response was inadequate, however, and he remained anemic. A second bone marrow biopsy showed erythroid hyperplasia and prominent intranuclear parvovirus inclusions within erythroid progenitors. erythropoietin was discontinued and was followed by a course of intravenous immunoglobulin, which resulted in rapid correction of anemia. To our knowledge, this is the first reported case of fulminant human parvovirus infection exacerbated by erythropoietin administration and documented by sequential bone marrow histologic examination. This case illustrates the critical importance of considering parvovirus in the etiology of chronic anemia with erythroid aplasia in immunocompromised patients.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
3/26. Subcutaneous lymphoid hyperplasia arising at site of ethnic scarifications and mimicking subcutaneous panniculitis-like T-cell lymphoma.The case of a 40-year-old black man, who developed a very unusual tumour-like lymphoid hyperplasia involving primarily the subcutaneous tissue, is reported. The lesion, which arose at a site of tribal scarifications, displayed a deceptive morphology that closely resembled subcutaneous panniculitis-like T-cell lymphoma (SPTCL). An accurate diagnosis could only be made following detailed immunohistochemical and molecular studies. Although SPTCL has been thought to represent a very specific clinicopathologic entity, the present case illustrates that its histological appearance can, however, be closely mimicked by reactive and benign conditions.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
4/26. Nodular hyperplasia, black thyroid, and chronic minocycline ingestion in a teenager.An 18-year-old man with left-lobe thyroid hemiagenesis underwent isthmectomy for management of a nodule that failed to take up radioactive iodine during a nuclear scan. The resected tissue, which demonstrated nodular hyperplasia, and the remaining right lobe, were black. The association between deep staining and chronic minocycline ingestion was subsequently recognized. Twelve years later, the patient remained asymptomatic, suggesting that complete resection of tetracycline-stained thyroid tissue is unnecessary.- - - - - - - - - - ranking = 5keywords = black (Clic here for more details about this article) |
5/26. Juxta-clavicular beaded lines: a subepidermal proliferation of sebaceous gland elements.Juxta-clavicular beaded lines typical arise at puberty as an asymptomatic, linear papular eruption involving the neck and supraclavicular areas. This entity appears to be more common in blacks than caucasians, and a female predominance has been noted. Microscopically, the papules noted clinically appear secondary to sebaceous gland hyperplasia, which is particularly prominent in the immediate subepidermal zone. Mild papillated epidermal hyperplasia may be observed. Whereas many regard this entity as an anatomic variant of normal, it may be confused clinically and histologically with a number of pathologic processes. A case of juxtaclavicular beaded lines in a 14-year-old caucasian girl is presented.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
6/26. Pigmented nail with atypical melanocytic hyperplasia.We report two cases showing black discoloration of the thumb nail which were histologically found to be acral lentiginous melanoma (ALM) in situ. A pigmented subungual lesion is more frequently malignant than benign and it is generally believed that diagnosis of subungual melanoma during the radial-growth phase is very difficult. Our cases are particularly interesting because atypical melanocytic hyperplasia was confined to the epidermis despite the lesion being present for a long time.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
7/26. Exaggerated venous mural hypertrophy in association with metastatic adenocarcinoma of the prostate.A 61-year-old black man presented with metastases to the right groin 5 years after 125iodine treatment for a well differentiated primary prostatic adenocarcinoma. Medium sized veins within and immediately adjacent to the neoplasm showed marked mural thickening due to hypertrophy and hyperplasia of the inner circular and outer longitudinal muscles. There was no histological evidence of radiation effect in the stroma or in the tumor cells. We could find no report in the literature of such changes associated with metastatic carcinoma.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
8/26. Spitz nevi in black children.Four black children with Spitz nevi are presented. The initial clinical diagnosis was pyogenic granuloma for three patients. One child had two Spitz nevi. Histologic examination revealed melanocytic dendritic hyperplasia in all cases.- - - - - - - - - - ranking = 5keywords = black (Clic here for more details about this article) |
9/26. Granular-cell tumors of the vulva: a report of three cases.Three black women were found to have granular-cell tumors on the vulva; in one, there were several additionally in other cutaneous sites. Although this benign neoplasm is uncommon on the vulva, it should be considered in the differential diagnosis of nodular lesions on the vulva. Granular-cell tumors in multiplicity occur frequently and are not a sign of metastatic disease. This lesion has predilection for blacks. Pseudocarcinomatous hyperplasia occurs typically in overlying squamous epithelium and may be misinterpreted as squamous-cell carcinoma.- - - - - - - - - - ranking = 2keywords = black (Clic here for more details about this article) |
10/26. multiple endocrine neoplasia IIA found at autopsy.A case is presented of a 32-year-old black female who died from adult respiratory distress syndrome with disseminated intravascular coagulopathy. At autopsy she was found to have typical multiple endocrine neoplasia IIA, a combination of medullary carcinoma of the thyroid, bilateral adrenal pheochromocytoma and nodular hyperplasia of the parathyroid.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
| | Next -> |