Cases reported "Necrosis"

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11/20. Necrotizing sialometaplasia. A review of the literature and report of two additional cases.

    Necrotizing sialometaplasia is a nonneoplastic, inflammatory, variably ulcerated, occasionally bilateral, self-healing lesion of human salivary glands which is often confused clinically and histologically with squamous cell or mucoepidermoid carcinoma. On the basis of thirty-three documented cases, the lesion occurs primarily in the minor salivary glands of the palate (87.9 percent), with 63.6 percent arising in the fifth and sixth decades (average age 46.0 years, range 22 to 68 years). There is a marked predilection for males (ratio of males to females. 2.7:1) and a questionable predominance in Caucasians (60.6 percent). Numerous etiologic factors have been proposed; however, on the basis of previous animal experimentation, the lesion appears to be infarctive in nature.
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12/20. Extensive bone marrow necrosis in patients with cancer and tumor necrosis factor activity in plasma.

    Tumor necrosis factor (TNF), a macrophage secretory protein produced by peripheral blood monocytes from patients with cancer, has been shown to possess cytotoxicity toward tumor cells in vitro. TNF in the blood of individuals with cancer is usually not detectable except with extremely sensitive radioimmunoassay or enzyme-linked immunosorbent assay (ELISA) methods. We have encountered two patients with the rare syndrome of extensive bone marrow necrosis in association with cancer. The first patient presented with marrow failure secondary to necrosis and was found to have adenocarcinoma in thoracic lymph nodes, lung, and marrow lymphatics at autopsy. plasma tested at two dilutions (1:200 and 1:2,000) contained TNF at a concentration of 8.3 ng/ml, or 80 U/ml by a cytotoxicity assay using LM cells. The presence of TNF was confirmed with immunoblotting. The second patient had a poorly differentiated lymphoid tumor involving bone marrow, pancytopenia, and marrow necrosis. The plasma cytotoxicity assay indicated the presence of 0.7 ng/ml or 7 U/ml TNF. TNF was not detectable in plasma from six other patients with untreated cancer involving bone or bone marrow using either of our methods. The levels of TNF in the two patients with marrow necrosis were greater than those previously measured by others in patients with cancer but were comparable to those noted in patients with lethal sepsis. Since large doses of TNF have been shown to cause organ necrosis in animals, the data presented here are consistent with TNF involvement in mediating the observed marrow necrosis in our patients.
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13/20. Necrotizing tracheobronchitis: a newly recognized cause of acute obstruction in mechanically ventilated neonates.

    Necrotizing tracheobronchitis (NTB) is an acute inflammatory lesion of the lower airway which can result in total airway obstruction. While potentially treatable, this lesion has been described predominantly in autopsy or animal studies. We observed clinical symptoms which reflect development of this lesion. Symptoms of acute airway obstruction (hypercarbia, respiratory acidosis, decreased chest wall movement) occurred in eight neonates undergoing treatment with high-frequency jet ventilation; five patients treated with HFJV were studied without signs of obstruction. Emergency bronchoscopy using a rigid bronchoscope was performed in the intensive care unit. The diagnosis of NTB was made by the observation of hyperemia, intraluminal debris, or the appearance of eschar formation. Necrotic debris was removed using forceps and/or suction as necessary. All patients survived treatment. Seven were long-term survivors, all with bronchopulmonary dysplasia. In patients who died, autopsy evaluation of the airway revealed a characteristic picture consisting of necrosis, neutrophil infiltration, epithelial erosion, and intraluminal obstruction.
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14/20. A neoplasm with pancreatic and hepatocellular differentiation presenting with subcutaneous fat necrosis.

    A neoplasm demonstrating both pancreatic and hepatic phenotypes is described. The tumor, from a 53-year-old woman with the syndrome of subcutaneous fat necrosis and arthropathy, was studied histologically, immunohistochemically, ultrastructurally, and biochemically. The clinical features of this case can be explained by the production of large amounts of lipase by the tumor. The hepatocellular properties of the tumor included characteristic morphology and the synthesis of catalase. The pancreatic properties of the tumor included the production of pancreatic lipase. This neoplasm would appear to be analogous to animal models in which the transdifferentiation of pancreatic acinar cells and hepatocytes has been demonstrated. Although the bulk of the tumor was present in the liver, the authors believe the tumor arose from the pancreas. The distinction between differentiation and site of origin of tumors is discussed.
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15/20. shock-related injury of pancreatic islets of langerhans in newborn and young infants.

    Variable degrees of injury of the pancreatic islets of langerhans, with sparing of the acinar pancreas, were observed in three infants (age range, 1 day to 3 months) who died of profound shock. The duration of shock varied from 19 to 48 hours. In two of the infants, the shock stemmed from hypovolemia; in the remaining infant, the shock followed blood loss, sepsis, and heart failure. The islet lesions were devoid of cellular infiltrates, hemorrhage, and fibrin thrombi. Tissue manifestations of shock included acute renal tubular necrosis, massive hepatic centrilobular necrosis, ischemic enteropathy, and "shock" lung. Study of pancreatic sections from 30 children (age range, 13 hours to 15 years) with clinical and/or morphologic evidence of shock showed no additional instances of islet injury. These findings suggest that pancreatic islets in the young may be vulnerable to shock-induced ischemia. Studies are in progress in an animal model to test this hypothesis.
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16/20. Hazards of calcium gluconate therapy in the newborn infant: intra-arterial injection producing intestinal necrosis in rabbit ileum.

    Five infants received 10% calcium gluconate via umbilical artery catheters, which resulted in intestinal bleeding and lesions of the buttock, anus, groin, and thigh. The effects of intra-arterial calcium gluconate in two animal models were investigated. Injection of calcium into the aorta in the region of the posterior mesenteric artery resulted in immediate hyperperfusion of the descending colon; this may be an early hemodynamic response to injury in the area of colon supplied by this vessel. injections into the arterial arcade of the rabbit ileum resulted in intestinal necrosis and villous atrophy. The use of umbilical artery catheters for administration of calcium gluconate is potentially hazardous.
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17/20. Differential response of skin and muscle in the experimental production of pressure sores.

    An experimental model was developed to determine the effects of pressure on skin and muscle in animals. A pressure-time regimen that consistently produced cutaneous ulceration (100 percent) over a bony pressure point was found to produce no ulceration in skin in a location where muscle separated skin and bone. When pressure was applied to skin over a transposed muscle flap and bone, a reduction of the incidence of ulceration (69 percent) was noted, as compared to the corresponding side without a muscle flap between skin and bone (100 percent ulceration). Histologic studies of skin and muscle biopsies demonstrated epidermal breakdown, increased cellularity, and muscle fiber necrosis when cutaneous ulceration occurred. In the animals without ulceration, were normal muscle or a muscle flap was interposed between skin and bone, there were nevertheless significant areas of muscle necrosis in almost every case. Although these data support the supposition that the increased mass of muscle under skin can diffuse pressure and lessen incidence of ulceration, the extremely high incidence of muscle necrosis in response to pressure, despite absence of skin ulceration points to the possibility that muscle is an unsuitable coverage for a pressure-bearing area.
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18/20. hypothyroidism in head and neck cancer patients: experimental and clinical observations.

    Damage to the thyroid gland may occur in patients undergoing treatment for head and neck neoplasms. This injury may result from damage incurred during surgery, from radiation therapy, or a combination of the two. Development of hypothyroidism is often insidious with potential harmful effects. An experimental study was performed to study the effects of hypothyroidism in pigs whose skin closely approximates that of the human. Wound tensile strength and flap necrosis were studied in the hypothyroid animal treated by surgery, radiation, and a combination of the two. The results of this study indicate that hypothyroidism alone has no significant unfavorable impact on wound tensile strengths or flap survival. When combined with preoperative radiation, however, there are statistically significant deleterious effects on both wound tensile strengths and flap survival. Histologically, collagen fibers within the wound appear shorter and thinner, which probably accounts for decreased wound tensile strengths. A clinical review of 62 head and neck cancer patients was also conducted. Within the study group, 10% of patients developed abnormally low thyroxine measurements, whereas 15% developed high thyroid-stimulating hormone levels as the only evidence of early primary hypothyroidism. hypothyroidism was not statistically related to tumor size, nodal status, clinical staging, or treatment group (surgery alone, radiation alone, or combination surgery and radiation). A previously unreported finding is that patients who develop a second primary tumor are significantly at risk for developing hypothyroidism. All patients diagnosed with a head and neck cancer should undergo baseline thyroid function testing, including measurement of TSH, and have serial repeat testing after treatment. Thyroid function determination should be mandatory in patients undergoing oncologic salvage procedures or treatment of a second primary tumor.
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19/20. akinetic mutism with bithalamic infarction. Neurophysiological correlates.

    A 42-year-old man presented with akinetic mutism, caused by bilateral thalamic infarction, resulting in a temporary amnesic syndrome and, finally, selective downgaze palsy. Electroencephalographic recording in the initial phase showed generalized spike- and-wave discharges, similar to those found in animal studies after lesion or stimulation of specific thalamic nuclei. Analysis of magnetic resonance images (MRI) of the head showed that the centre of ischemic necrosis particularly involved the intralaminar thalamic nuclei and a small part of the rostral mesencephalon. The findings support the previously suggested involvement of cortico-thalamo-mesencephalic circuitry in the initiation of motor responses, and the association of the non-specific thalamic nuclei with the appearance of generalized epileptiform phenomena in cases of reduced vigilance.
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20/20. Herb use and necrodegenerative hepatitis.

    Twelve patients with herbally-induced hepatitis are described and the clinicopathological features of their illness, which seem to present a recognisable spectrum, are discussed. The nature and the severity of the histological changes seem to correlate with the clinical manifestations and the immediate prognosis. Laboratory tests, especially liver function studies, are of limited diagnostic and prognostic value. The plants which contain the responsible toxins, have been identified in this country and in other parts of Southern africa. A short list is provided of, apparently, the commonest medicinal plants in lesotho. Many more toxic plants, however, are used in food and in diverse traditional medications. senecio species are the principal source of hepatotoxic alkoloids, especially pyrrolizidines. Experimental studies ann evidence of similar disorders in animals, have thrown some light on the pathogenic mechanisms of these hepatotoxic and possibly hepatocarcinogenic agents. The disease in humans probably results from a combination of factors.
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