Recurrent hypoglycemia occurred in a 48-year-old woman with a localized pleural mesothelioma. During hypoglycemia, serum high molecular weight insulin-like growth factor II (IGF-II) was elevated. The tumor also contained a high level of high molecular weight IGF-II. We propose that the primary cause of the hypoglycemia in this patient was the high molecular weight IGF-II produced by the tumor.

A patient presented to the emergency department with tachypnea, fever, a right pleural effusion, and lung consolidation. The computed tomographic guided thoracentesis yielded a greenish fluid with bilirubin. The ultrasound examination demonstrated a distended gallbladder with stones, positioned on the ventral face of the liver and a free communication between the fundus and the pleural cavity. The cholecystopleural fistula was confirmed at operation.

A man with chronic obstructive lung disease presented to the hospital with respiratory failure and a chest x-ray indicated complete radiopacity of the left hemithorax. An endobronchial malignancy was suspected, but unexpectedly left-main bronchial occlusion was found secondary to compression between a descending thoracic aortic aneurysm and an enlarged right pulmonary artery.

Two cases of a Greenfield inferior vena cava (IVC) filter being dislodged during central venous catheter placement are described. This event appears to be related to J-tip guidewire use during venous catheterization. To our knowledge, this occurrence previously has not been reported. One of the two filters was dislodged from the IVC to a new position in the right atrium. Dislodging of the filter in these two particular cases did not give rise to clinical signs or symptoms.

Runaway pacemaker occurred in a patient undergoing high-energy neutron radiation therapy despite adherence to published safety guidelines. The very low estimated dose of 0.9 Gy received by the pacemaker demonstrates the extreme sensitivity of integrated circuits to this new modality of radiation therapy.

We report the case of a 29-year-old woman who died of massive hemoptysis due to hemorrhage from an intralobar pulmonary sequestration into the tracheobronchial tree. The sequestration had been diagnosed in childhood but had been managed nonoperatively. This case emphasizes the need for early surgical treatment of pulmonary sequestration.

A 38-year-old woman with end-stage kidney disease presented with a pleural effusion and profound edema of the ipsilateral arm and breast. A patent hemodialysis arteriovenous fistula access was present in the involved extremity. Brachiocephalic vein stenosis, as a result of previous dialysis catheter placement in the subclavian vein, was demonstrated by ultrasound imaging and Doppler analysis. Takedown of the arteriovenous fistula in the edematous arm along with living-related kidney transplantation caused immediate resolution of the breast and arm edema and rapid clearing of the effusion. An anatomic explantation for the findings is offered.

Pulmonary sequestration is an uncommon anomaly for which the arterial supply is usually derived from the aorta or its major branches. A 66-year-old man is described with a pulmonary sequestration that received its arterial supply from a coronary artery.

Head-up tilt test was done in a 27-year-old man with recurrent syncope of unexplained cause. Severe sinus bradycardia and hypotension accompanied by light-headedness, cold sweating, and nausea occurred at 80 degrees head-up position during 4 micrograms/min isoproterenol infusion. Oral propranolol, 160 mg/d, in four divided doses, effectively prevented the above-mentioned abnormal vasovagal reflexes; diltiazem was only partially effective while disopyramide, aminophylline, or atropine was ineffective in preventing the abnormal vasovagal reflexes induced by head-up tilt with isoproterenol infusion. However, the patient experienced ten episodes of syncope in 2 weeks after he was discharged from the hospital on a regimen of atenolol, 50 mg/d. His symptoms ameliorated immediately after discontinuation of atenolol therapy and he became free of severe symptoms while receiving fludrocortisone. Thus, we have documented a patient with worsening of vasovagal syncope after beta-blocker therapy.

Melioidosis was diagnosed in a diabetic sailor who presented with a history and chest radiograph that suggested tuberculosis. Melioidosis is a tropical disease with protean manifestations: from asymptomatic infection to chronic cavitary lung disease to overwhelming sepsis. The diagnosis is easily made, even in nonendemic areas when duly considered by the clinicians and microbiology laboratory. Ceftazidime has dramatically improved outcomes in hospitalized patients with severe melioidosis.

To contribute to the current debate about the relative merits of meta-analysis of the literature (MAL) and of individual patients data (MAP).

The purpose of this report is to describe an association between bronchogenic carcinoma and HIV. Three HIV-seropositive patients are described who developed bronchogenic cancer (two large cell, one adenocarcinoma) before developing an AIDS-defining illness. A critical review of the literature revealed 22 other patients in which the association of HIV infection and lung cancer is reported. These patients are characterized by a relatively young age at diagnosis (median, 43 years) and prevalence of the adenocarcinoma subtype (13 of 25 patients). Twenty of 21 patients had a history of smoking. Among 21 patients for whom data were available, 6 patients (28 percent) had AIDS at time of diagnosis of lung cancer while 11 patients (55 percent) did not have AIDS or AIDS-related complex at diagnosis.

An 8-year-old girl with moderately severe cystic fibrosis and right upper lobe bronchiectasis developed a cerebellar abscess caused by Blastomyces dermatitidis. To our knowledge, this is the youngest child with cystic fibrosis and a brain abscess, and the first documented case caused by a fungus.

The medical complications of cocaine abuse are being encountered by clinicians with increasing frequency. The cardiovascular manifestations of cocaine abuse include chest pain, myocardial ischemia and infarction, congestive heart failure, arrhythmias, infective endocarditis, and aortic dissection. The pathogenesis of these cardiovascular complications has not been fully elucidated but may be related to a combination of the sympathomimetic and membrane anaesthetic effects of cocaine. We present these concepts in a case discussion format.