Henry Burko

Pheochromocytoma: present diagnosis and management.

In the 25-year period 1950-1975 forty-four patients with pheochromocytoma were observed at Vanderbilt University Affiliated Hospitals. Bilateral adrenal tumors occurred in 3 patients (6.8%) and extra-adrenal tumors occurred in 7 others (16%), 33 patients (75%) had single tumors arising in one of the adrenal glands; in one of these 5 years after operation, a malignant tumor developed in the same renal fossa. Five of the 44 patients (11.3%) proved to have malignant tumors and died with metastases. In 11 patients in the earlier years of this study the clinical diagnosis was not made and the tumor was identified by the pathologist at autopsy. There was a single postoperative fatality among the 33 patients in whom the clinical diagnosis was made. Seventy per cent of all survivors with benign tumors have remained normotensive during followup periods of one to 20 years.

Residual Pulmonary Findings in Clinical Hyaline-Membrane Disease

Abstract Seventy infants who had clinical hyaline-membrane disease as neonates were followed from two to five years with repeated physical examinations and x-ray films of the chest. Nineteen of them had such severe symptoms that they required mechanical ventilatory assistance for periods ranging from 17 to 116 hours. During the follow-up period six of the 19 had radiologic evidence suggestive of pulmonary fibrosis or overexpansion or both. Only two had clinical evidence of frequent infections and expiratory wheezing that failed to respond to bronchodilator therapy; lung biopsies in these two indicated patchy areas of peribronchial and alveolar fibrosis. Subsequently, both showed clinical improvement. The clinical, radiologic and pathologic sequelae that occurred in these infants surviving clinical hyaline-membrane disease appear to result from the reparative process of the lung to the perinatal insult that produces the original disease.

Delayed Radiographic Presentation of Congenital Right Diaphragmatic Hernia

The diagnosis of right-sided Bochdalek hernias is diffucult. Problems encountered in diagnosis include delayed radiographic manifestations and stimulation of inflammatory disease. The case is presented of a neonate in whom a right-sided diaphragmatic hernia masqueraded as inflammatory disease of the chest.

Persistent Localized Intrapulmonary Interstitial Emphysema: An Observation in Three Infants

Persistent intrapulmonary interstitial emphysema confined to a single lobe was observed in 3 premature male infants as a complication of pulmonary hyaline membrane disease. Following resolution of the clinical and roentgen findings of the respiratory distress syndrome, each infant again experienced respiratory distress as a result of enlarging cystic collections of intrapulmonary interstitial air. In each instance, a lobectomy was necessary to alleviate respiratory distress. Age at time of lobectomy was 7 months, 33 days, and 7 weeks, respectively.

Pressure Dressings and Postarteriographic Care of the Femoral Puncture Site

Patient dissatisfaction with prolonged bed rest and the discomfort caused by pressure dressings led to the following evaluation. Alternate application of pressure dressings and band-aids to femoral artery puncture sites was performed in 754 arteriographic examinations. The application of pressure dressings for 16-24 hours, especially in hypertensive patients, was found to be justified by a significant reduction in delayed bleeding requiring further medical attention. A minimum application time of 8 hours is supported because all instances of delayed bleeding occurred within 8 hours of the procedure. Arterial thrombosis is not affected by the use of pressure dressings. The rationale for recommendation of bed rest is largely anecdotal and is supported by almost all experienced angiographers responding to our questionnaire.

Renovascular hypertension secondary to atherosclerosis

Abstract Atherosclerosis is a common cause of renovascular hypertension. However, the association of hypertension and renal artery stenosis does not establish a causal relationship. At present the best methods of determining the significance of a given renal artery stenosis are split renal function studies and differential renal venous renin assays. When these tests indicate a stenosis to be functionally significant our experience suggests that a good result can be expected from surgical treatment in over 90 per cent of the cases. When the tests showed no differences between the two kidneys, surgical treatment has been a failure in every instance.

Diagnostic Criteria of Bilateral Renovascular Hypertension

Thirteen patients with renovascular hypertension and severe bilateral renal artery stenosis were cured or significantly improved at least one year after bilateral revascularization. Preoperative screening tests (excretory urography, split renal function studies, and renal vein renin assays) were positive in most patients. These results were not significantly different from those noted in a group of patients with unilateral renovascular hypertension.

Detergent enema: A cause of caustic colitis

A 5-year-old boy developed acute colitis followed by stricture formation as a result of a detergent enema. The acute phase of the caustic induced colitis was reproduced in the dog and the rat using full strength and diluted detergent enemas. The severity of the experimental colitis was shown to be directly related to the concentration of the detergent.

Unusual bone changes in sickle-cell disease in childhood.

A review of the roentgenograms of 126 children with sickle-cell disease seen over a five-year period (1956–61) at Kings County Hospital Center (Brooklyn, N. Y.) disclosed several unusual skeletal changes which are the subject of this report. The changes to be emphasized here have been included in the excellent discussions of sickle-cell disease by Middlemiss (1) and by Moseley (2). In general, three types of bony abnormalities occur. Marrow hyperplasia, involving the long and short tubular bones and the axial skeleton, frequently results in the roentgen appearance of widened medullary cavities and intertrabecular spaces, with cortical thinning. A second type of osseous lesion results from infarction. The roentgen appearance due to this cause varies according to (a) the site and extent of infarction, (b) the degree of surrounding hyperemia, (c) the state of osteoclastic resorption and osteoblastic repair, and (d) the effect of weight-bearing on compromised bone. A third complication is osteomyelitis, parti...

Diffuse Bilateral Wilms's Tumor Simulating Multicystic Renal Disease

Wilmss tumor (embryonal adenomyosarcoma) is one of the most common malignant neoplasms in children, constituting 20 per cent of all childhood tumors (1). Four of the 96 cases reported by Gross and Neuhauser (6) were bilateral, but Schneider (11) considered that bilaterality was found in approximately 7 per cent of the patients. The purpose of this article is to report an unusual case of diffuse bilateral infiltration of the kidneys by Wilmss tumor. Case Report R. B., a white boy of thirteen months, was admitted on March 15, 1963, because his mother noticed progressive swelling of the abdomen over a two-month period. The child was born at term after an uneventful pregnancy and an uncomplicated delivery. He had no illnesses prior to admission. On physical examination, two large fixed masses were palpated in the right and left sides of the abdomen. The urine analysis was normal; the urea nitrogen level in the blood was 13 mg. per cent. The blood count was within normal limits (hemoglobin 10.1 gm.), and the...