Myron E. Rubnitz

Heparin as a Therapy for Atherosclerosis: Preliminary Observations on the Intrapulmonary Administration of Low-Dose Heparin in the Morning Versus Evening Gauged by Its Effect on Blood Variables

Reports on clinical trials with subcutaneous and intrapulmonary administration of low-dose heparin suggest that it may be an attractive therapeutic modality for the treatment of coronary artery disease because of unprecedented reduction in mortality of treated subjects. As a preliminary to a clinical trial with low-dose intrapulmonary heparin, a pilot study was conducted on three subjects. It compares overall circadian responses of 37 blood variables following intrapulmonary administration of heparin (10,500-18,800 U) in the morning (0800 h) and in the evening (2000 h). After each of these times, blood samples, mostly at 3 h intervals for the ensuing 27 h, were analyzed for heparin, APTT, TT, functional fibrinogen, CBC, enzymes, lipids, electrolytes, and hormones. Each time series was analyzed for circadian rhythm by the least-squares fit of a 24 h cosine and circadian mesors were compared by the Bingham test of rhythm parameters. Following heparin in the evening, but not in the morning, a statistically significant increase in circulating heparin levels, as well as directional increases in APTT and TT and decreases in fibrinogen, were observed in all three subjects. Same direction changes in several other variables were also observed. It is concluded that inhalation of heparin in low-dose levels results in variable circadian effects on blood parameters measured, ranging from no changes in their levels to minimal within normal range changes, and that these effects are dependent upon the timing of dose administration. It is suggested that the timed self-administration of low-dose heparin by inhalation be seriously considered for long-term clinical trials in the treatment and prevention of atherosclerosis.

Tissue response to intraperitoneal asbestos with preliminary report of acute toxicity of heat-treated asbestos in mice

Abstract Intraperitoneal asbestos not only produced fibrosis, but a special and peculiar type of fibrosis which was proliferative, granulomatous and invasive, and histologically similar to mesothelioma, although morphologic evidence of actual malignancy was not obtained. Further, asbestos fibers exposed to high temperature produced a high degree of toxicity in experimental animals; this resulted in a 60% mortality rate.

Industrial Lung Disease: Report From Veterans Administration Hospital Hines, Illinois

Silicosis associated with asbestosis has been found in several investigations, and the association of asbestosis and mesothelioma is well known. A foundry worker was treated intermittently for chronic obstructive pulmonary disease with superimposed infections. Six years later, a rapidly growing, friable mass appeared in the left lung. Such rapid growth suggested a mesothelioma; however, asbestos bodies were not found in the biopsy specimen.

Chronic Arthritis, Vasculitis and Cutaneous Histoplasmosis

This is an unusual case of histoplasmosis apparently confined to skin and subcutaneous tissue. The pathologist calls it an example of the adage, “You find what you look for.” The patient was given steroids, first for skin rash and later for rheumatoid arthritis. Leg ulcers were diagnosed as thromboangiitis obliterans and the limb was amputated.

Lymphoma and Macroglobulinemia: Report From Veterans Administration Hospital Hines, Illinois

On the basis of clinical and laboratory studies alone, malignant lymphocytic lymphoma may be indistinguishable from Waldenstroms macroglobulinemia. In the case reported here, immunologic data and the presence of multiple infections related to immunoglobulin deficiency suggested macroglobulinemia, but pathologic material and extensive lymphocytic infiltrations were compatible with lymphoma.

Abdominal Mass and Hypoglycemia

A 73 year old man was hospitalized three times in a semicomatose condition but responded each time to intravenous glucose. X-rays showed a large soft-tissue mass in the abdomen, displacing the bowel and ureters, and nodular and linear densities in both lung fields. At laparotomy, extensive hemorrhage during biopsy precluded removal of the mass, but resection was undertaken later on the assumption that the tumor was benign. The mass was difficult to remove and proved to be a large retroperitoneal neurofibrosarcoma of low-grade malignancy.

Painful Chest Wall Mass

A 46 year old man was hospitalized with a tender, growing mass on the left side of the chest wall, ocular and thigh pain, and a mucoid draining sinus over the right hip. Certain findings and laboratory data supported a diagnosis of neoplasm, fungal infection, or typhoid fever, but the total clinical picture was not consistent with any of these. Examination of the excised mass showed encysted larval forms of Trichinella spiralis.

Progressive Pulmonary Insufficiency and Malignant Lymphoma

At onset of illness, the patient had enlarged cervical and inguinal lymph nodes and indications of systemic illness, diagnosed as malignant lymphoma. Later symptoms were compatible with this diagnosis; however, the lung biopsy specimen and negative skin tests suggested sarcoidosis. The major question in this case was whether lymphomatosis was the sole cause of the illness.

Problems With Prosthetic Valve Surgery: Report From Veterans Administration Hospital Hines, Illinois

A 38 year old salesman with rheumatic heart disease had his mitral valve replaced with a Starr-Edwards valve prosthesis in 1963 and his aortic valve replaced with a Hufnagel valve prosthesis in 1968. After the second procedure, he experienced the following complications: hemiparesis, hemolytic anemia, aortic insufficiency, and profound heart failure. What are the diagnostic considerations?

Functioning Adrenocortical Carcinoma: Report From Veterans Administration Hospital Hines, Illinois

Functioning adrenal carcinoma is an unusual condition. In this case it produced Cushings syndrome that lacked many of the usual characteristics. Hypokalemic alkalosis and associated myopathy were the most striking features. The microscopic picture of a metastatic lesion in the neck differed sufficiently from that of the primary tumor to prevent an early definitive diagnosis.