Mayo Clin Research Articles

Chronic Necrotizing Pulmonary Aspergillosis: Approach to Management

We read with interest the article by Saraceno and associates 1 Saraceno JL Phelps DT Ferro TJ et al. Chronic necrotizing pulmonary aspergillosis: approach to management. Chest. 1997; 112: 541-548 Abstract Full Text Full Text PDF PubMed Scopus (153) Google Scholar in the August 1997 issue of CHEST. These authors describe their clinical experience with six cases of chronic necrotizing pulmonary aspergillosis (CNPA). Though the clinical features and radiographic findings associated with this disorder have been well described by others, 2 Gefter WB Weingrad TR Epstein DM et al. “Semiinvasive” pulmonary aspergillosis: a new look at the spectrum of Aspergillus infections of the lung. Radiology. 1981; 140: 313-321 Crossref PubMed Scopus (231) Google Scholar , 3 Binder RE Faling LJ Pugatch RD et al. Chronic necrotizing pulmonary aspergillosis: a discrete clinical entity. Medicine. 1982; 61: 109-124 Crossref PubMed Scopus (307) Google Scholar this series is remarkable in that half of the cases (3 of 6) were diagnosed antemortem by transbronchial lung biopsy (tbbx). In two instances, tbbx showed fungal invasion, while in a third the biopsy grew Aspergillus species. In contrast, of the three CNPA patients in our series, 4 Caras WE Pluss JL Chronic necrotizing pulmonary aspergillosis: pathological outcome after intraconazole therapy. Mayo Clin Proc. 1996; 71: 25-30 Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar only one was histologically diagnosed antemortem by transthoracic needle biopsy. In the remaining two, the disease was pathologically confirmed at autopsy. Though not commented upon specifically, tbbx may deserve a larger role in the diagnosis of CNPA. Patients with compatible histories, radiographic findings, and positive precipitin bands for Aspergillus species may benefit from tbbx. This is because a biopsy showing fungal invasion or growing Aspergillus species is more meaningful diagnostically than positive cultures of sputum or bronchial washings; the latter may represent saprophytic colonization. Indeed, this concern often leads to needless delays in effective treatment.

Chronic Ventilator Unit Admission Criteria

The Health Care Financing Administration (HCFA) ventilator weaning demonstration projects for which data are available, 1 Criner GJ Kreimer DT Pidlaoan L Patient outcome following prolonged mechanical ventilation via tracheostomy [abstract]. Am Rev Respir Dis. 1993; 147: A874 Google Scholar , 2 Gracey DR Ventilator care beyond the intensive care unit. Mayo Clin Proc. 1995; 70: 595-597 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar clearly show that a high percentage of carefully selected patients that have become ventilator dependent can be weaned using the principles of rehabilitation medicine. I believe the location of such a unit, inside or outside of an acute care hospital, is less important than the multidisciplinary rehabilitation approach.

The Management of Hepatic Hydatid Cyst Cavity By Overlapping

The obliteration of the cyst cavity after evacuation is a controversial procedure in hepatic hydatid disease. There is no ideal surgical technique which can be used in all hydatid cyst cavities. Since 1989 we have been using a new technique, which we call overlapping, in the treatment of suitable cases of hepatic hydatid cyst cavities. The technique depends on the obliteration of the cavity without drainage. After evacuating the hydatid material from the cavity, instillation of the cystic cavity is performed with scolecidal agent (silver nitrate solution, 0.5%). The cavity is opened along its long axis. The pericyst is prepared, and the upper edge is sutured to the bottom of the cavity with absorbable stitch (modified external collapse). Before doing this, if there is no possibility of operative ultrasonography, the cavity is punctured with a fine needle to evaluate any dangerous areas. Then the other edge of the pericyst is laid down beside the collapsed one and sutured to the former with the same technique. The term “overlapping” stems from this second procedure. During the operation, we decide which pericyst will collapse and which one will overlap. Before overlapping, openings between the cavity and biliary tree should be found and if there are any, they should be secured. In cases of large and multiple openings, T-tube choledochostomy is necessary. We applied overlapping to 31 of 43 hepatic hydatid cysts (ranging from 5 to 17 cm in diameter, with a mean of 12 cm) in 19 patients. Twenty-four of 31 cysts had partial pericystectomy before overlapping. Three cystic cavities were connected to the biliary tree. Because of a large connection, T-tube choledochostomy was added in one case. We have not seen any complications, either infection or biliary fistula. The results of the obliteration of cavities were excellent in 15 cysts. There were no residual cavities

Venting percutaneous gastrostomy in the treatment of refractory idiopathic gastroparesis

Gastroparesis is a common disorder characterized by chronic gastric stasis. 1 Kang YW Kim CH. Gastroparesis: diagnostic and therapeutic strategies. Dig Dis. 1992; 10: 181-189 Crossref PubMed Scopus (7) Google Scholar , 2 McCallum RW. Motor function of the stomach in health and disease. in: Gastrointestinal disease: pathophysiology, diagnosis, management. WB Saunders, Philadelphia1989: 675-713 Google Scholar Patients with gastroparesis usually present with symptoms of nausea, vomiting, and abdominal bloating or pain without demonstrable mechanical or mucosal abnormalities in the upper gut. Intractable symptoms may lead to significant weight loss and malnutrition in adults or a failure to thrive in children. Causes of gastroparesis may include diabetes mellitus, prior gastric surgery such as vagotomy or partial gastric resection, anorexia nervosa, connective tissue disorders, and Parkinsonism. However, the underlying etiology remains unexplained in a substantial subset (up to one third) of patients with gastroparesis. 2 McCallum RW. Motor function of the stomach in health and disease. in: Gastrointestinal disease: pathophysiology, diagnosis, management. WB Saunders, Philadelphia1989: 675-713 Google Scholar Severe idiopathic gastroparesis is associated with significant morbidity and is often resistant to medical therapy. Similar symptoms stemming from postoperative ileus are often relieved by use of nasogastric tube suction. Drawing on this analogous situation, we hypothesized that placement of a venting percutaneous gastrostomy (VPG) tube to decompress the distended stomach may be useful in alleviating symptoms in patients with idiopathic gastroparesis. This approach has proven successful in gas-bloat syndrome and various post-surgical or malignant conditions resulting in obstruction. 3 Cannizzaro R Bortoluzzi F Valentini M Scarabelli C Campagnutta E Sozzi M et al. Percutaneous endoscopic gastrostomy as a decompressive technique in bowel obstruction due to abdominal carcinomatosis. Endoscopy. 1995; 27: 317-320 Crossref PubMed Scopus (54) Google Scholar , 4 Herman LL Hoskins WJ Shike M. Percutaneous endoscopic gastrostomy for decompression of the stomach and small bowel. Gastrointest Endosc. 1992; 38: 314-318 Abstract Full Text PDF PubMed Scopus (76) Google Scholar , 5 Moulis H Vender RJ. Percutaneous endoscopic gastrostomy for treatment of gas-bloat syndrome. Gastrointest Endosc. 1993; 39: 581-583 Abstract Full Text PDF PubMed Scopus (9) Google Scholar , 6 Larson DE Burton DD Schroeder KW DiMagno EP. Percutaneous endoscopic gastrostomy: indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology. 1987; 93: 48-52 Abstract PubMed Google Scholar , 7 Stellato TA Gauderer MWL. Percutaneous endoscopic gastrostomy for gastrointestinal decompression. Ann Surg. 1987; 205: 119-122 Crossref PubMed Scopus (50) Google Scholar , 8 Dozois RR Lewis DJ. Gastrostomy: scalpel or scope. Mayo Clin Proc. 1983; 58: 138 PubMed Google Scholar To our knowledge, a long-term decompressive approach has not been reported in patients with gastroparesis. We now report our experience with VPG in patients with refractory idiopathic gastroparesis.

Ophthalmic Eponyms From the Mayo Clinic

Ophthalmic Eponyms From the Mayo Clinic

Roentgenographically occult small-cell lung cancer: Case report and review of the literature: Sekine I, Sasaki Y, Noguchi M, Ono R, Saijo N. Division of Oncology/Hematology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-City, Chiba 277. Mayo Clin Proc 1996;71:481–484

Roentgenographically occult small-cell lung cancer: Case report and review of the literature: Sekine I, Sasaki Y, Noguchi M, Ono R, Saijo N. Division of Oncology/Hematology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-City, Chiba 277. Mayo Clin Proc 1996;71:481–484

Familial prevalence of gallstone in first-degree relatives of patients with gallstones

HepatologyVolume 23, Issue 6 p. 1708-1708 Book ReviewFree Access Familial prevalence of gallstone in first-degree relatives of patients with gallstones S K Sarin, S K SarinSearch for more papers by this author S K Sarin, S K SarinSearch for more papers by this author First published: June 1996 https://doi.org/10.1002/hep.510230659AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Romero Y, Phillips SF. Familial prevalence of gallstones in first-degree relatives of patients with gallstones (Letter). Hepatology 1996; 23: 1285. 2 Sarin SK, Negi VS, Dewan R, Sasan S, Saraya A. High familial prevalence of gallstones in the first degree relatives of gallstone patients. Hepatology 1995; 22: 138– 141. 3 Jackson CE, Gay BC. Inheritance of gall bladder disease. Surgery 1959; 46: 853– 857. 4 Van der Linden W, Lindenof G. The familial occurrence of gall stone disease. Acta Genet Stat Med 1965; 15: 159– 164. 5 Van der Linden W, Simonson N. Familial occurrence of gall stone disease. Incidence in parents of young patients. Hum Hered 1973; 23: 123– 127. 6 Gilat T, Feldman C, Halpern Z, Dan M, Bar-Meir S. An increased familial frequency of gall stones. Gastroenterology 1983; 84: 242– 246. 7 Van der Linden W, Westlin N. The familial occurrence of gall stone disease II. Occurrence in husbands and wives. Acta Genet Basel 1966; 16: 377– 382. 8 Danzinger RG, Gorden H, Schoenfield LJ, Thistle JL. Lithogenic bile in the siblings of young women with cholelithiasis. Mayo Clin Proc 1972; 47: 762– 766. Volume23, Issue6June 1996Pages 1708-1708 ReferencesRelatedInformation

Is formaldehyde an important cause of allergic respiratory disease?

Is formaldehyde an important cause of allergic respiratory disease?

Smoking status as the new vital sign: Effect on assessment and intervention in patients who smoke: Fiore MC, Jorenby DE, Schensky AE, et al. Mayo Clin Proc. 1995;70:209–213

Smoking status as the new vital sign: Effect on assessment and intervention in patients who smoke: Fiore MC, Jorenby DE, Schensky AE, et al. Mayo Clin Proc. 1995;70:209–213

Cascade testing for autoantibodies in connective tissue diseases: Homberger HA. Mayo Clin Proc 1995;70:183-4

Cascade testing for autoantibodies in connective tissue diseases: Homberger HA. Mayo Clin Proc 1995;70:183-4

Aneurysmal Bone Cyst: the Role of Fibular Graft in its Treatment

Aneurysmal bone cyst is a relatively uncommon benign bone lesion for which curettage and cancellous bone grafting is a widely accepted method of treatment. This paper presents a report of eight patients with aneurysmal bone cysts; four in the humerus, three in the femur and one in the proximal phalanx of the index finger. Seven patients were treated by curettage and cancellous bone graft and one by autogenous fibular graft combined with cancellous allograft. Patients treated by cancellous bone grafting developed recurrence within a year. Three of these recurrent cysts were then treated by autogenous fibular graft combined with allograft. All four patients treated by fibular graft showed satisfactory healing of the cysts with no recurrence at three years' follow-up. Analysis of these patients suggests that recurrence of the aneurysmal bone cyst is very frequent after curettage and cancellous bone grafting. It is recommended that where total excision of the cyst is not feasible, the treatment of choice should be curettage and autogenous fibular bone grafting combined with cancellous bone graft. Removal of the fibula form its middle third does not cause any disability and the fibula regenerates completely within a period of three months.

64-Year-Old Woman With Chest Pain and Presyncope

64-Year-Old Woman With Chest Pain and Presyncope

Clinical effects of intravenously administered dantrolene: Wedel DJ, Quinlan JG, Iaizzo PA. Mayo Clin Proc. 1995;70:241–246

Clinical effects of intravenously administered dantrolene: Wedel DJ, Quinlan JG, Iaizzo PA. Mayo Clin Proc. 1995;70:241–246

Antithrombotic Therapy in Atrial Fibrillation

Atrial fibrillation (AF) is a common arrhythmia that is an important independent risk factor for stroke. AF is present in over 2 million people in the United States. 1 Feinberg WM Blackshear JL Laupacis A et al. The prevalence of atrial fibrillation: analysis and implications. Arch Intern Med. 1995; 155: 469-473 Crossref PubMed Scopus (1950) Google Scholar The prevalence of AF begins to increase after age 40 and rises rapidly after age 65 2 Wolf PA Abbott RD Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke. 1991; 22: 983-988 Crossref PubMed Scopus (5655) Google Scholar , 3 Lake FR McCall MG Cullen KJ et al. Atrial fibrillation and mortality in an elderly population. Aust NZ J Med. 1989; 19: 321-326 Crossref PubMed Scopus (225) Google Scholar , 4 Phillips SJ Whisnant JP O'Fallon WM et al. Prevalence of cardiovascular disease and diabetes in residents of Rochester, Minnesota. Mayo Clin Proc. 1990; 65: 344-359 Abstract Full Text Full Text PDF PubMed Scopus (229) Google Scholar , 5 Furberg CD Psaty BM Manolio TA et al. Prevalence of atrial fibrillation in elderly subjects (The Cardiovascular Health Study). Am J Cardiol. 1994; 74: 238-241 Abstract Full Text PDF Scopus (1026) Google Scholar (Fig 1). AF is particularly common in the elderly, occurring in 7 to 14% of such individuals. 2 Wolf PA Abbott RD Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke. 1991; 22: 983-988 Crossref PubMed Scopus (5655) Google Scholar , 3 Lake FR McCall MG Cullen KJ et al. Atrial fibrillation and mortality in an elderly population. Aust NZ J Med. 1989; 19: 321-326 Crossref PubMed Scopus (225) Google Scholar , 4 Phillips SJ Whisnant JP O'Fallon WM et al. Prevalence of cardiovascular disease and diabetes in residents of Rochester, Minnesota. Mayo Clin Proc. 1990; 65: 344-359 Abstract Full Text Full Text PDF PubMed Scopus (229) Google Scholar , 5 Furberg CD Psaty BM Manolio TA et al. Prevalence of atrial fibrillation in elderly subjects (The Cardiovascular Health Study). Am J Cardiol. 1994; 74: 238-241 Abstract Full Text PDF Scopus (1026) Google Scholar The median age of patients with AF is approximately 75 years. 1 Feinberg WM Blackshear JL Laupacis A et al. The prevalence of atrial fibrillation: analysis and implications. Arch Intern Med. 1995; 155: 469-473 Crossref PubMed Scopus (1950) Google Scholar AF is more prevalent in men than in women. 3 Lake FR McCall MG Cullen KJ et al. Atrial fibrillation and mortality in an elderly population. Aust NZ J Med. 1989; 19: 321-326 Crossref PubMed Scopus (225) Google Scholar , 4 Phillips SJ Whisnant JP O'Fallon WM et al. Prevalence of cardiovascular disease and diabetes in residents of Rochester, Minnesota. Mayo Clin Proc. 1990; 65: 344-359 Abstract Full Text Full Text PDF PubMed Scopus (229) Google Scholar , 5 Furberg CD Psaty BM Manolio TA et al. Prevalence of atrial fibrillation in elderly subjects (The Cardiovascular Health Study). Am J Cardiol. 1994; 74: 238-241 Abstract Full Text PDF Scopus (1026) Google Scholar However, because there are more women than men in the older age groups, the absolute number of women and men with AF is approximately equal. 1 Feinberg WM Blackshear JL Laupacis A et al. The prevalence of atrial fibrillation: analysis and implications. Arch Intern Med. 1995; 155: 469-473 Crossref PubMed Scopus (1950) Google Scholar Antithrombotic Therapy in Atrial FibrillationCHESTVol. 109Issue 6PreviewWe are writing in response to the article on “Antithrombotic Therapy in Atrial Fibrillation” (CHEST 1995; 108(suppl):352S–59S). In that article, Laupacis and colleagues describe our original report on the use of transesophageal echocardiography (TEE) to guide early cardioversion without the use of chronic warfarin among patients with atrial fibrillation.1 Unfortunately, while the initial description of our patients correctly lists the use of heparin anticoagillation in almost 90% of patients and warfarin in 70%, the text later inappropriately states that of the patients who were cardioverted after a negative TEE, that “None received warfarin.” It is important for the medical community to be aware that the use of TEE to guide early cardioversion has only been proved safe when performed with a therapeutic prothrombin time/intemational normalized ratio or partial thromboplastin time at the time of TEE and extending through cardioversion to 1 month after cardioversion. Full-Text PDF

Lung cancer complicating pregnancy: Case report and review of literature: Van Winter JT, Wilkowske MA, Shaw EG, Ogburn PL Jr, Pritchard DJ. Department of Obstetrics/Gynecology, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905. Mayo Clin Proc 1995;70:384–387

Lung cancer complicating pregnancy: Case report and review of literature: Van Winter JT, Wilkowske MA, Shaw EG, Ogburn PL Jr, Pritchard DJ. Department of Obstetrics/Gynecology, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905. Mayo Clin Proc 1995;70:384–387

Urothelial Extension of Wilms Tumor Presenting as a Prolapsing Urethral Mass

We report a unique case of Wilms tumor presenting as a urethral mass in a patient with bilateral ureteral duplication. The prolapsing urothelial component was contiguous with the intrarenal Wilms tumor and consisted of fetal skeletal muscle free of blastemal or tubular elements.

Diagnosis and Management of Urethral Sarcoidosis

We report on a woman with urethral sarcoidosis with obstructive urinary symptoms and previously known systemic sarcoidosis. The diagnosis of this rare lesion and management are discussed, and the genitourinary manifestations of sarcoidosis are reviewed.

A Case of Unique Communication Between Blind-Ending Ectopic Ureter and Ipsilateral Hemi-Hematocolpometra in Uterus Didelphys

Uterus didelphys with double vagina and hemi-vaginal atresia is a rare syndrome of congenital anomalies. A 17-year-old girl had a right blind-ending ectopic ureter, the proximal end of which communicated with the ipsilateral uterine cervix of uterus didelphys. The patient presented with vaginal urinary incontinence after incision of the vaginal wall for right hemi-hematocolpometra. Following various examinations, the ipsilateral kidney was found to be absent. The ectopic ureter and communicating duct were resected, and the fistula was closed. The genesis of malformation of the female genitalia and urinary tract resulting in such a unique communication is discussed. The importance of preoperative meticulous examinations, including cysto-genitography, pelvic magnetic resonance imaging and panendoscopy with the patient under anesthesia, is emphasized.

Current treatment of unresectable lung cancer : Jett JR. Thoracic Dis./Internal Medicine Div., Mayo Clinic Rochester, Rochester, MN. Mayo Clin Proc 1993;68:603–11

Current treatment of unresectable lung cancer : Jett JR. Thoracic Dis./Internal Medicine Div., Mayo Clinic Rochester, Rochester, MN. Mayo Clin Proc 1993;68:603–11

Ancillary therapies in the management of lung cancer: Photodynamic therapy, laser therapy, and endobronchial prosthetic devices : Edell ES, Cortese DA, McDougall JC. Thoracic Diseases/Internal Med. Div., Mayo Clinic Rochester, Rochester, MN. Mayo Clin Proc 1993;68:685–90

Ancillary therapies in the management of lung cancer: Photodynamic therapy, laser therapy, and endobronchial prosthetic devices : Edell ES, Cortese DA, McDougall JC. Thoracic Diseases/Internal Med. Div., Mayo Clinic Rochester, Rochester, MN. Mayo Clin Proc 1993;68:685–90