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Pulmonary dirofilariasis caused by Dirofilaria immitis, the dog heartworm, is a rarely reported pulmonary lesion. It appears as a solitary pulmonary nodule, and the diagnosis is not established until thoracotomy and subsequent histologic examination of the specimen are performed. Sporadic reports of pulmonary dirofilariasis in the United States total only 70 cases. The six resections of pulmonary dirofilariasis at the Ochsner Clinic represent the largest reported series of cases originating at a single institution. We present an overview of the pathogenesis of this disease, its clinical manifestations, pathologic and epidemiologic features, and geographic distribution. The prevalence of pulmonary dirofilariasis appears to be increasing; hence, thoracic surgeons and pathologists need to be alert to this cause of granulomatous pulmonary lesions.

We reviewed 161 patients operated upon for renal cell carcinoma between 1945 and 1978. Life table and survival analyses were computed to compare the effects of stage, tumor differentiation, cell type, surgical technique, renal vein involvement and sex on the years of survival. Patients with stage I and well differentiated tumors had the best prognosis. All patients surviving 10 years or more had well differentiated tumors. The type of nephrectomy did not affect survival and lymphadenectomy was only of value in staging the disease. The stage and differentiation of the tumor were more important to outcome than choice of therapy.

• Cushing's disease developed in a 5-year-old girl with acute lymphoblastic leukemia 18 months after her last therapeutic exposure to adrenal glucocorticosteroids. Obesity, hyperpigmentation, striae, osteoporosis, and hirsutism were accompanied by elevated levels of plasma cortisol. These showed no diurnal fluctuation and they were not suppressed by dexamethasone. At autopsy, the adrenal glands were enlarged and the pituitary gland showed increased numbers of basophils of the adrenocorticotropic hormone (ACTH)/melanocyte-stimulating hormone secreting type. Leukemic infiltrates in brain tissue were prominent in the hypothalamus and in the limbic system. It is postulated that the destructive leukemic infiltrate of the limbic system removed a restraining influence on pituitary function, with basophilic hyperplasia, ACTH hypersecretion, adrenocortical hypertrophy, and clinical Cushing's disease the consequences.(Am J Dis Child 132:888-892, 1978)

CENTRAL nervous system involvement by trichinosis has been recognized since the early part of this century.1 The reported incidence of trichinosis in the United States now averages less than 150 cases a year.2 Because only a small percentage of infected patients have CNS involvement, many physicians might fail to recognize this entity. We report the case of a patient who died of CNS trichinosis.Report of a CaseA 50-year-old woman from southwestern Louisiana was in excellent health until late April 1980, when intermittent diarrhea and nausea developed. On May 13, she noted headache, photophobia, myalgias, and periorbital edema. She was admitted to a local hospital with a temperature of 39.5 °C and a WBC count of 12,800/cu mm, with 10% eosinophils. Dexamethasone therapy for a presumed allergic reaction resulted in improvement. When the dexamethasone administration was discontinued after ten days, fever and myalgias returned. Seizures and a

ACETAZOLAMIDE, a carbonic anhydrase inhibitor, has well-established teratogenic potential in rats, hamsters, and mice.1,2 According to a July 17, 1975, letter from L. Lizabeth Monroe, MD, of the Lederle Laboratories, Pearl River, NY, there is only one known case of an infant with congenital anomalies (including congenital glaucoma, microophthalmia, and patent ductus arteriosus) born to a mother treated throughout pregnancy with acetazolamide.Report of a CaseA 22-year-old woman, gravida 2, para 0, abortus 1, was admitted to the National Naval Medical Center at 27 weeks' gestation, with spontaneous rupture of the membranes. The patient had had glaucoma since an episode of bilateral uveitis at age 13 years. She had been treated with acetazolamide, 750 mg daily, continuously since that time and had required enucleation of the left eye at age 17 years. Acetazolamide therapy was discontinued at 19 weeks' gestation. Other medications were ones without known teratogenic effects