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A patient with a history of a small-bowel transplant that was subsequently resected required total parenteral nutrition for nutritional supplementation. While receiving therapy, he developed chest tightness, shortness of breath, and fever. The chest radiograph showed bilateral reticulonodular opacities, and the high-resolution CT scan demonstrated diffuse, poorly marginated micronodular opacities in a miliary pattern. Pathology specimens obtained by transbronchial biopsy revealed amorphous material obstructing the pulmonary microvasculature. Microvascular emboli secondary to precipitated crystals is a potential complication of total parenteral nutrition. An awareness of the factors that influence crystal solubility may prevent adverse interactions in patients who require parenteral nutrition.

Background Metastatic neck nodes in patients with squamous cell carcinoma of the head and neck are most commonly managed by surgery, radiotherapy, or combined-modality therapy. For combined-modality cases, the sequencing of surgery and radiotherapy is generally guided by which modality is considered preferable for treatment of the primary tumor. A postradiotherapy neck dissection is often considered for those patients with >N1 disease in which the primary is treated with radiotherapy alone. Methods Between February 1991 and October 1995, 25 patients with node-positive squamous cell carcinoma of the head and neck were treated with planned unilateral (n = 22) or bilateral (n = 3) neck dissection following high-dose radiotherapy. The primary tumor sites included: tongue base (n = 11), tonsil (n = 6), nasopharynx (n = 3), pyriform sinus (n = 2), supraglottic larynx, (n = 1), soft palate (n = 1), and unknown head and neck primary (n = 1). The specific nodal stage breakdown of the 28 individual neck dissections (25 patients) was N1 (n = 1), N2A (n = 5), N2B (n = 15), N3 (n = 7). Results Nineteen of the 28 neck dissections (68%) demonstrated no evidence of residual carcinoma. Of the nine positive neck dissections, six revealed malignant cells in a single nodal echelon. The 1- and 2-year rate of neck control in all 25 patients was 100% and 93%, respectively. The 1- and 2-year disease-specific survival for all 25 patients was 83% and 60%, respectively. With a minimum follow-up of 2 years, 64% of the 25 patients remain alive with no evidence of disease or dead of non-cancer causes. Conclusion In this series of postradiotherapy neck dissections, two thirds of the dissections demonstrated no evidence of residual tumor (19/28, or 68%). However, there was not a direct correlation between pretreatment nodal size (neck staging), radiation dose delivered, and the likelihood of achieving a cancer-free neck dissection. Only one of 28 postradiotherapy neck dissections identified tumor outside of nodal stations II–IV. The predictable pattern of residual disease in pathologically positive cases suggests that a selective neck dissection encompassing levels II–IV may be appropriate in a majority of patients. © 1998 John Wiley & Sons, Inc. Head Neck20: 132–137, 1998.

Background This case report illustrates the need to consider temporal arteritis in the differential diagnosis of jaw or tooth pain. This disease affects the cranial arteries, more frequently in women and usually in those older than age 60 years, causing jaw pain, visual symptoms, headache, scalp pain and sometimes blindness. Case Description A 71-year-old man had jaw pain that increased with chewing and speaking, scalp tenderness and dimming vision. A temporal artery biopsy confirmed the diagnosis of temporal arteritis. Treatment with decreasing amounts of oral steroids over 23 months was successful in relieving his signs and symptoms and in saving his vision. Clinical Implications Patients with this disease may seek care from their dentist first. Jaw or tooth pain is the most reliable clinical symptom in the diagnosis of temporal arteritis. Diagnosis and timely referral for treatment with oral steroids can prevent blindness.

Purulent pericarditis caused by Candida species is rare and is associated with very high mortality. Immunosuppressed transplant patients are particularly susceptible to fungal infections. We report a case of Candida purulent constrictive pericarditis in an immunocompromised heart transplant patient who was treated successfully with antifungal agents, surgical drainage, and pericardiectomy.

Primary pulmonary choriocarcinoma is an exceedingly rare clinical entity in men. In this report, we present a man with an asymptomatic pulmonary mass, which was diagnosed as non-small cell lung cancer by the use of percutaneous transthoracic needle biopsy, who underwent left upper lobectomy. Final pathologic examination proved this tumor to be primary choriocarcinoma of the lung. We conclude that surgical resection of incidental primary pulmonary choriocarcinoma, an extremely fatal malignancy, may be an appropriate treatment of choice.

Synopsis A group of scientists and those interested in the sciences, all feminists, has been meeting for six years at the University of Wisconsin-Madison to discuss and define a feminist critique of science. We consider science an important area for feminist investigation for several reasons. Scientific research is funded, conducted, and applied for the goals of those with political power. Patriarchy throughout history has used science to justify itself, for example, assigning sociobiological explanations to class, race, or gender inequalities. Many of the characteristics we value would generally be considered part of “dgood” science. These include sharing of information, availability of funding for projects representing diverse points of view, opportunity regardless of gender, race, religion, and judging work on its merits rather than the status of the authors. Other criticisms are more specifically feminist, examining how patriarchal politics and worldview are played out in science. Some examples include an emphasis on the control of nature rather than understanding, a search for “master” molecules presupposing a hierarchical rather than an interactive model, or reliance on reductionism, quantification, and linear thinking while denegating other modes of obtaining and organizing information. We emphasize ways to bring a feminist commitment and philosophy into the laboratory and outline one possible mechanism for transformation of science to more egalitarian principles. Our group represents for us an example of feminist science in action, in its emphasis on open discussion, support as well as criticism, and awareness of the relationship between means and ends, theory and practice.