Eli H. Rubin

Nodular pleuropulmonary rheumatoid disease: Report of two cases and review of literature

Abstract Described herein are two patients with nodular rheumatoid pleuropulmonary disease confirmed at autopsy. In neither was there an occupational history to suggest Caplans syndrome. In one, a sixty-two year old man, symptoms and roentgenographic findings of diffuse interstitial pulmonary fibrosis, in keeping with the Hamman-Rich syndrome, were present three years before the onset of joint complaints, the latter evolving into a crippling rheumatoid arthritis. In the other, a seventy-one year old woman, advanced rheumatoid arthritis had been present for more than twenty years before discovery of the pulmonary lesions. The course of the disease in the man was featured by recurrent spontaneous pneumothoraces, and repeated attempts at closure of the bronchopleural fistulas. Thirty-two previously reported cases of nodular, nonpneumoconiotic rheumatoid disease are tabulated and several others cited, with special reference to certain relationships of the manifestations of joint and lung involvement. On the basis of the present study and previous observations it is concluded that in some cases the Hamman-Rich syndrome reflects a rheumatoid disease even in the absence of accompanying symptoms of joint involvement.

Dissecting aneurysm of the aorta treated surgically

Abstract A case is described of a sixty-two year old man with antecedent hypertension, arteriosclerosis, psoriasis and psoriatic arthritis in whom a diagnosis of dissecting aneurysm of the aorta was made. This was subsequently confirmed by angiocardiography. Fenestration to the aorta was performed in which a double-barrelled channel was established to enable the blood from the aneurysm to re-enter the main stream. The patient was discharged ten days after operation in good condition. Two weeks later, because of epigastric pain, blood in the stool, and spitting of bright red blood, he was readmitted to the hospital. However his condition worsened and he died the same day. It was suspected that the cause of death was proximal extension of the dissection, possibly involving the pericardium and causing heart tamponade. Autopsy was not performed. The available case reports on the surgical treatment of dissecting aneurysm of the aorta are reviewed.