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Mutations of one of the two subunits of the amino acid transporter in the kidney leads to defective renal tubular reabsorption of dibasic amino acids such as cystine signs of arthritis in feet and knees generic medrol 16 mg buy, arginine, lysine, and ornithine. Cystine stones are the main complication of this defect due to the low solubility of cystine in urine. The diagnosis of cystinuria is based on a family history of stones, stone formation at a young age, mildly radiopaque stones, and measurement of urinary cystine excretion. Patients with cystinuria excrete 250 to 1000 mg of cystine per day (normal is about 30 mg/day). Treatment must be aimed at decreasing the urinary cystine concentration by increasing urine volume to more than 4 L/day, alkalization of urine (urine pH >6. If the contralateral kidney has no stenosis, the increased systemic blood pressure increases sodium excretion by that kidney. In up to 30% of the population, accessory renal arteries arise from the aorta to provide blood to portions of one or both kidneys, which may become important when evaluating patients for renovascular hypertension. Arcuate arteries course along the corticomedullary junction and give rise to interlobular arterioles, which extend outward into the cortex before branching into afferent arterioles, from which the glomerular capillary tufts arise. The postglomerular efferent arterioles from more superficial glomeruli form a capillary network in the renal cortex, and those extending from glomeruli nearer the cortical-medullary junction. The vasa recta provide the sole blood supply for the renal medulla, making this portion of the kidney particularly susceptible to ischemic injury. Venules from the ascending vasa recta and the cortical capillary network empty into the renal veins. The left gonadal vein also empties into the left renal vein, and a left varicocele may be evident if the renal vein is occluded by thrombosis or tumor involvement. Atherosclerotic renovascular disease is a common form of secondary hypertension, affecting up to 5% of patients with hypertension. Evaluation should always begin with a thorough history and physical examination, including attention to blood pressure and pulse amplitude in each extremity. Urinalysis results are usually normal, although low-grade proteinuria (usually <1 g/day) from longstanding hypertension may be seen. However, renal duplex ultrasonography is technically demanding, particularly in obese patients, and it is best performed by an experienced ultrasonographer at a high-volume center with a proven track record of high diagnostic accuracy. If the arteries to both kidneys are narrowed, pressure natriuresis does not occur, and hypertension is maintained chronically by the resulting intravascular volume expansion rather than by increased total peripheral resistance. However, this may not be detectable by measurement of the serum creatinine level because of the normally functioning contralateral kidney. Chapter 30 VascularDisordersoftheKidney 343 duplex ultrasonography are unknown, and its clinical utility is probably limited. An added advantage of arteriography is that angioplasty and stenting can be performed during the procedure (discussed later) if appropriate. Because of the frequent occurrence of accessory renal arteries, an aortogram must be performed rather than selective renal angiography to ensure that all vessels are visualized.
Syndromes
In most cases arthritis in cats back legs discount medrol 4 mg without prescription, however, patients have a history of progressive dyspnea over hours to days, with increasing bronchodilator use. Treatment of status asthmaticus should be aggressive, including administration of nebulized bronchodilators and intravenous steroids and continuous monitoring of blood oxygen saturation by pulse oximetry, often supplemented by arterial blood gas analysis to evaluate for hypercarbia. A rising Paco2 in a patient with asthma is an ominous sign and may portend need for ventilatory support. Noninvasive ventilation has been used successfully to decrease the work of breathing and avoid the need for endotracheal intubation in patients with exacerbations of asthma, but intubation and mechanical ventilation are necessary for the management of respiratory failure in status asthmaticus. Mechanical ventilation of the patient with status asthmaticus can be extremely challenging and may require the use of paralytic agents to control the breathing pattern or even use of inhaled general anesthesia to relieve bronchospasm. Methacholine, a synthetic form of acetylcholine, is preferred to histamine because there are fewer systemic side effects. Although most patients with or without asthma develop some degree of airflow limitation during bronchoprovocation testing, those with asthma develop airflow limitation at much lower doses. Although a positive bronchoprovocation challenge result is not by itself diagnostic of asthma, a negative result is helpful in ruling out asthma as a diagnosis. Lung volume measurements may show hyperinflation during active disease, but the Dlco is typically normal or even elevated. During acute exacerbations of asthma, analysis of arterial blood gases is useful to determine gas-exchange status. A chest radiograph should be obtained if a concern for pulmonary infection exists, but routine chest radiography is not necessary. Fleeting or migratory infiltrates on chest radiographs in a patient with difficult asthma should suggest the possibility of allergic bronchopulmonary aspergillosis. Skin tests might be useful to identify household products or other antigens that could precipitate asthma attacks in a specific patient. A major differential consideration in patients not responding to typical asthma treatment is vocal cord dysfunction. Treatment the management of asthma requires education and cooperation on the part of the patient. Simple, inexpensive peak expiratory flow meters can be used at home to monitor airflow obstruction. A diary should be maintained, and a clear written plan should be in place for using symptoms and peak flow information to intervene early in exacerbations and to alter long-term therapy for optimal control of symptoms. Short-acting -agonists are used for acute relief of symptoms such as wheezing (level 1 evidence). However, the cornerstone of maintenance therapy in all but mild intermittent asthma is administration of inhaled corticosteroids, which are highly effective in improving asthma control (level 1). Long-acting -agonists may be added for additional symptomatic control as needed (level 1). However, these medications may be added to inhaled corticosteroids to provide additional symptom control. Theophylline preparations may have additional beneficial effects in some patients, but the narrow therapeutic window and modest efficacy of these preparations limit their value.
Glomerular disease (see Chapter 28) decreases Kf by affecting both the surface area for filtration and the hydraulic permeability arthritis in back pinching nerve medrol 16 mg on-line. Major calciotropic hormones include parathyroid hormone, vitamin D, and calcitonin. Renal epithelia directly respond to ionized calcium via the calcium sensing receptor. Responds to systemic acid-base status which can be mediated by direct sensing by the renal epithelia or via hormonal actions. Bicarbonate can also be secreted in the collecting duct when alkali excretion is required. Reabsorption primarily resides in the proximal tubule and is regulated by parathyroid hormone and fibroblast growth factor-23. The proximal tubule reclaims almost all filtered glucose except when the filtered load exceeds reabsorptive capacity. The cortical proximal tubule performs gluconeogenesis from other organic substrates. Major routes of uric acid clearance are (1) renal excretion and (2) intestinal secretion and uricolysis. Handling of both secretion and reabsorption in the proximal tubule is complex, and regulatory mechanisms are unclear. Chapter 25 RenalStructureandFunction 287 can occur within the same nephron segment. Secretion Secretion is an ancient mode of excretion that is found in lowerorder organisms. Although the human nephron is not primarily secretory in nature, a number of solutes are still handled by secretion. For example, the renal excretion of potassium (K+) and hydrogen (H+) ions is largely achieved by secretion. Many organic cations and anions are secreted by the proximal tubule, and so are many exogenous toxins such as xenobiotics. Integrated Models of Excretion the modes of excretion are well coordinated in a precise, complex, and concerted fashion to effect excretion with exquisite accuracy (see Table 25-2). The kidney is capable of a large range of urinary tonicity (<50 to 1200 mOsm), depending on the need of the organism to excrete or conserve electrolyte-free water. Water is filtered at the glomerulus and is handled isotonically in the proximal tubule. At the lumen of the distal convoluted tubule, urine is maximally dilute as a consequence of low water permeability throughout the thick ascending limb of Henle. In the proximal tubule, Na+ reabsorption is also regulated by peritubular physical factors.
Pleomorphic hamartoma of the subcutis: A lesion with possible myogenous and neural lineages rheumatoid arthritis what causes it buy generic medrol 4 mg line. Cutaneous fetal rhabdomyoma: A case report and historical review of the literature. Adult rhabdomyoma: Report of two cases of rhabdomyoma of the lip and of the eyelid. Embryonal rhabdomyosarcoma presenting in an adult: A case report and discussion of immunohistochemical staining. Primary cutaneous epidermotropic alveolar rhabdomyosarcoma with t(2;13) in an elderly woman. Unusual second malignancies following radiation therapy: Subcutaneous pleomorphic rhabdomyosarcoma and cutaneous melanoma. Solid alveolar rhabdomyosarcoma of the hand in adolescence: A clinical, histologic, immunologic, and ultrastructural study. Pleomorphic rhabdomyosarcoma in adulthood: Analysis of 11 cases with definition of diagnostic criteria. Postirradiation cutaneous pleomorphic rhabdomyosarcoma with extracellular collagen deposits reminiscent of so-called amianthoid fibers. Pleomorphic rhabdomyosarcoma in adults: Immunohistochemistry as a tool for its diagnosis. Malignant rhabdoid tumor of the vulva: Is distinction from epithelioid sarcoma possible Congenital disseminated malignant rhabdoid, tumor: A distinct clinicopathologic entity demonstrating abnormalities of chromosome 22q11. Chromosome 22q dosage in composite, extrarenal rhabdoid tumors: Clonal evolution or a phenotypic mimic Malignant rhabdoid tumor beside benign skin mesenchymal neoplasm with myofibromatous features. Rhabdoid tumors of soft tissues: A clinicopathologic study of 26 cases enrolled on the intergroup rhabdomyosarcoma study. Expression of the intermediate filament peripherin in extraskeletal myxoid chondrosarcoma. Subungual exostoses: Clinicopathological and ultrastructural studies of three cases.
Retraction of the left parasternal area can be observed in patients with severe left ventricular hypertrophy arthritis in neck and upper back discount medrol 4 mg with visa, whereas systolic retraction at the apex or in the left axilla (Broadbent sign) is more characteristic of constrictive pericarditis. Palpation of the precordium is best performed when the patient, with chest exposed, is positioned supine or in a left lateral position with the examiner located on the right side of the patient. The examiner should then place the right hand over the lower left chest wall with fingertips over the region of the cardiac apex and the palm over the region of the right ventricle. The right ventricle itself is typically best palpated in the subxiphoid region with the tip of the index finger. In those patients who have chronic obstructive lung disease, are obese, or are very muscular, the normal cardiac pulsations may not be palpable. In addition, chest wall deformities may make pulsations difficult or impossible to palpate. The normal apical cardiac impulse is a brief and discrete (1 cm in diameter) pulsation located in the fourth to fifth intercostal space along the left midclavicular line. If the heart cannot be palpated with the patient supine, a left lateral position should be tried. With volume overload states such as aortic insufficiency, the left ventricle dilates, resulting in a brisk apical impulse that is increased in amplitude. With pressure overload, as in long-standing hypertension and aortic stenosis, ventricular enlargement is a result of hypertrophy, and the apical impulse is sustained. Patients with hypertrophic cardiomyopathy can have double or triple apical impulses. Those with apical aneurysm may have an apical impulse that is larger and dyskinetic. However, in those with right ventricular dilation or hypertrophy, which can be related to severe lung disease, pulmonary hypertension, or congenital heart disease, an impulse may be palpated in the left parasternal region. In some cases of severe emphysema, when the distance between the chest wall and right ventricle is increased, the right ventricle is better palpated in the subxiphoid region. With severe pulmonary hypertension, the pulmonary artery may produce a palpable impulse in the second to third intercostal space to the left of the sternum. This may be accompanied by a palpable right ventricle or a palpable pulmonic component of the second heart sound (S2). An aneurysm of the ascending aorta or arch may result in a palpable pulsation in the suprasternal notch. Thrills are vibratory sensations best palpated with the fingertips; they are manifestations of harsh murmurs caused by such problems as aortic stenosis, hypertrophic cardiomyopathy, and septal defects. The amplitude of the pulse is diminished in low-output states such as heart failure, hypovolemia, and mitral stenosis. Tachycardia, with shorter diastolic filling times, also lowers the pulse amplitude. Aortic stenosis, when significant, leads to a delayed systolic peak and diminished carotid pulse, referred to as pulsus parvus et tardus.
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Cardiac catheterization is indicated when a clinically suggested cardiac abnormality requires confirmation and its anatomic and physiologic importance needs to be quantified diet for psoriatic arthritis management purchase 4 mg medrol otc. Compared with catheterization, noninvasive testing is safer, cheaper, and equally effective in the evaluation of most valvular and hemodynamic questions. Most often, catheterization precedes some type of beneficial intervention, such as coronary artery angioplasty, coronary bypass surgery, or valvular surgery. An important objective during cardiac catheterization is documentation of filling pressures in the heart and great vessels. This task is accomplished through use of fluid-filled catheters that transmit intracardiac pressures to a transducer that displays the computerized data analysis has improved the quality and reproducibility of the data from these studies. During a right ventricular heart catheterization, pressures in the right atrium, right ventricle, and pulmonary artery are routinely measured in this manner. The catheter can then be advanced further until it wedges in the distal pulmonary artery. The transmitted pressure measured in this location originates from the pulmonary venous system and is known as the pulmonary capillary wedge pressure. In the absence of pulmonary venous disease, the pulmonary capillary wedge pressure reflects left atrial pressure, and if no significant mitral valve pathologic condition exists, it reflects left ventricular diastolic pressure. A more direct method of obtaining left ventricular filling pressures is to advance an arterial catheter into the left ventricular cavity. Cardiac output can be determined by one of two widely accepted methods: the Fick oxygen method and the indicator dilution technique. The basis of the Fick method is that total uptake or release of a substance by an organ is equal to the product of blood flow to that organ and the concentration difference of that substance between the arterial and venous circulation of that organ. If this method is applied to the lungs, the substance released into the blood is oxygen; if no intrapulmonary shunts exist, pulmonary blood flow is equal to systemic blood flow or cardiac output. The cardiac output is expressed in liters per minute and then corrected for body surface area. With this method, cold saline is injected into the blood, and the resulting temperature change downstream is monitored. This action generates a curve in which temperature change is plotted over time, and the area under the curve represents cardiac output. Detection and localization of intracardiac shunts can be performed by sequential measurement of oxygen saturation in the venous system, right side of the heart, and two main pulmonary arteries. By using the Fick method for calculating blood flow in the pulmonary and systemic systems, the shunt ratio can be calculated. Noninvasive approaches have largely supplanted catheterization laboratory assessment of shunts. Left ventricular size, wall motion, and ejection fraction can be accurately assessed by injecting contrast into the left ventricle.
Violaceous plaque on the forehead clinically resembling angiosarcoma: Cutaneous metastasis in a patient with prostatic adenocarcinoma arthritis pain.org discount medrol 4 mg buy on line. Metastases to skin from occult malignant neoplasms: Cutaneous metastases from a teratocarcinoma. Metastatic testicular choriocarcinoma of the skin: Report and review of the literature. Testicular choriocarcinoma metastatic to the skin: An additional case and literature review. Umbilical metastasis from gynecologic malignancies: A primary carcinoma of the fallopian tube. A review of the cutaneous paraneoplastic associations and metastatic presentations of ovarian carcinoma. Cutaneous metastasis from an endometrial carcinoma: A case history and review of the literature. Cutaneous metastatic malignant mixed mullerian tumour mimicking cutaneous leiomyosarcoma: A case report. A case of cutaneous metastasis of small-cell neuroendocrine carcinoma of the uterine cervix. Skin metastases from malignant gestational trophoblastic disease: Report of two cases. Infantile choriocarcinoma with cutaneous tumors: An additional case and review of the literature. Cutaneous metastases of follicular thyroid carcinoma: A report of four cases and a review of the literature. Metastatic follicular carcinoma of the thyroid to the skin: A case confirmed by immunohistochemistry. Cutaneous metastasis from papillary carcinoma of the thyroid: Report of two cases. Metastatic Hurthle cell carcinoma of the thyroid presenting as ulcerated scrotum nodules. Metastatic cutaneous lesions in children, and adolescents with a case report of metastatic neuroblastoma. Coexisting metastatic neuroblastoma and dermal erythropoiesis in a blueberry muffin baby. Metastatic melanoma of unknown primary resembles the genotype of cutaneous melanomas.
Despite these considerations rheumatoid arthritis joint pain medrol 16 mg generic, cascade screening or screening of family members for a disease-causing mutation once characterized in a proband has been effectively used to identify mutation carriers. Before ordering genetic testing, patients should be thoroughly informed of the risks, benefits, and limitations of testing. For a deeper discussion on this topic, please see Chapter 65, "Ventricular Arrhythmias," in Goldman-Cecil Medicine, 25th Edition. Ventricular arrhythmias include isolated ventricular premature beats; short, nonsustained runs of tachycardia; and sustained ventricular arrhythmias. Several of these conditions are familial, and genetic testing and family screening have important roles in their management. Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society, Heart Rhythm 9:632. The cardiac cellular action potential is composed of five phases determined by the activity of multiple ion channels, including the rapid sodium channel, several potassium channels, and a calcium current. Disruptions of these currents may lead to abnormal automaticity and triggered activity, which may mediate pathologic tachyarrhythmias. Reentry is the dominant mechanism of clinically significant tachyarrhythmias and requires a functional or fixed obstacle to propagation, an area of slowed conduction, and differential refractoriness for initiation and perpetuation of the arrhythmia. Despite its clinical utility, many antiarrhythmic drugs have multiple effects and do not fit neatly into this framework. Clinical sinus node dysfunction manifests as one of several syndromes, including sinus bradycardia, chronotropic incompetence, exit block, and bradycardia-tachycardia syndrome due to sinus pauses and bradycardia when concomitant atrial arrhythmias terminate to sinus rhythm. This permits asymptomatic patients to be followed clinically for the development of symptoms before intervention. In contrast, second- or third-degree infranodal block at the His bundle, or more commonly at the level of the bundle branches, is potentially malignant and is often not accompanied by stable escape mechanisms. The space between these two layers contains a small amount of fluid (15 to 50 mL), which is a plasma ultrafiltrate. Due to a paucity of randomized trial data and absence of practice guideline statements, the recommendations for assessment and treatment of pericardial disorders in this chapter are largely based on expert opinion and professional consensus. The laboratory findings of acute idiopathic pericarditis are not specific and consist of mild elevation of the white blood cell count, sedimentation rate, and C-reactive protein level. It is difficult to determine the exact incidence of acute pericarditis because a subclinical course is common.
Trichoblastoma and syringocystadenoma papilliferum arising in naevus sebaceous in a 4-year-old boy rheumatoid arthritis rings buy medrol 4 mg cheap. Cystic trichoblastoma (so-called trichoblastic infundibular cyst): A report of three new cases. Combined trichoblastoma and melanocytic nevus: Report of 2 cases widening the spectrum of hair follicle-derived tumors combined with melanocytic nevus. Primary cutaneous neuroendocrine carcinoma within a cystic trichoblastoma: A nonfortuitous association Trichoblastic fibroma: A case report and an immunohistochemical study of cytokeratin expression. Merkel cells are absent in basal cell carcinomas but frequently found in trichoblastomas: An immunohistochemical study. Clear cell trichoblastoma: A clinicopathological and ultrastructural study of two cases. Melanotrichoblastoma: Immunohistochemical study of a variant of pigmented trichoblastoma. Trichogenic trichoblastoma arising on the supraclavicular fossa with an immunohistochemical study of cytokeratin expression. Androgen receptor expression helps to differentiate basal cell carcinoma from benign trichoblastic tumors. Cytokeratins as markers of follicular differentiation: An immunohistochemical study of trichoblastoma and basal cell carcinoma. Immunohistochemical analysis of laminin 5-gamma2 chain expression for differentiation of basal cell carcinoma from trichoblastoma. Cutaneous lymphadenoma: A basal cell carcinoma with unusual inflammatory reaction pattern Immunohistochemical comparison of cutaneous lymphadenoma, trichoblastoma, and basal cell carcinoma: Support for classification of lymphadenoma as a variant of trichoblastoma. Cutaneous lymphadenoma: An adnexal neoplasm with intralobular activated lymphoid cells. Epidermal panfolliculoma: An adnexal proliferation with advanced follicular differentiation confined to the epidermis. Multiple perifollicular fibromas: Report of a case and analysis of the literature. Congenital annular multiple fibrofolliculomas occurring with deformity of the ear and ventricular septal defect.
Silicosis is a lung disease caused by exposure to crystalline-free silica arthritis in my back medrol 4 mg order line, which results in an inflammatory and fibrotic reaction and the formation of the characteristic silicotic nodule. Occupations with a higher likelihood of exposure to silica include mining, stone cutting, carving, polishing, foundry work, and abrasive clearing. Although exposure is usually chronic (over years), accelerated and acute disease manifestations have been described in the setting of heavier short-term exposures. Acute silicosis causes a pulmonary alveolar proteinosis and accumulation of surfactant in the alveolar spaces. Chronic silicosis results in simple nodular silicosis, which is usually asymptomatic unless the patient is also exposed to tobacco, and progressive massive fibrosis, which is characterized by extensive bilateral apical fibrosis resulting from the confluence of many silicotic nodules. Patients with silicosis may have dyspnea or may be relatively asymptomatic but require further evaluation of an abnormal chest radiograph. Pulmonary function tests in simple nodular silicosis may be normal or show a mixed obstructive or restrictive pattern, whereas progressive massive fibrosis is typically associated with severe restriction and hypoxemia. Patients with silicosis are at elevated risk for tuberculosis and should be screened for latent tuberculosis infection; there is also an association between silicosis and rheumatoid arthritis. Chapter 17 InterstitialLungDiseases 235 formation of pigmented lesions in the lung surrounded by emphysema, called coal macules. Most patients have chronic cough, which is usually productive, resulting from bronchitis related to coal exposure or to tobacco. Asbestosis results from chronic exposure to asbestos, which is a fibrous silicate used for insulation, for friction-bearing surfaces, and to strengthen materials. The inhaled asbestos fibers are deposited in the lungs, where the small fibers may be phagocytosed and cleared through lymphatics to the pleural space, but the longer fibers are often retained. Asbestos exposure typically leads to pleural disease characterized by pleural plaques, effusion, and fibrosis, but it does not necessarily affect the lung parenchyma. If it does, it is called asbestosis, with interstitial lung fibrosis resulting from asbestos exposure. As with other pneumoconioses, the risk and severity of disease are related to the extent and duration of exposure. Asbestosis is often diagnosed after exposure has ceased, and disease progression may continue in the absence of ongoing exposure because of the reaction to retained asbestos fibers in the lung. In uncertain cases, the demonstration of asbestos in tissue specimens may be necessary. Asbestos bodies are the characteristic finding and consist of asbestos fibers coated by ironcontaining (ferruginous) material.
Mazin, 60 years: Lymphedematous fibroepithelial polyp of the glans penis non-associated with condom catheter use. Lesions are composed of a proliferation of small blood vessels, some with vacuolated cytoplasm, and a mixed inflammatory cell infiltrate with a predominance of polyclonal plasma cells. Antiarrhythmic drug Macro-reentrant atrial arrhythmias are a consequence of stable reentrant circuits, which encompass large portions of the atria. Under such circumstances, echocardiography can be a safe and helpful noninvasive test to assess cardiac structure and function in the pregnant patient.
Spike, 47 years: In either case, the physical examination reveals a cold, cyanotic (bluish) extremity with absent pulses distal to the site of arterial occlusion and diminished motor and/or sensory function. Early in the course of illness, pain may be perceived in one location and subsequently felt in another; this pattern of progression may be suggestive of specific pain syndromes. Extracutaneous transformation into a high-grade lymphoma: A potential pitfall in the management of patients with Szary syndrome. Focal areas of distention may indicate hernias; notice should also be taken of any scars from prior surgeries.
Hogar, 51 years: Avoidance of Toxic Drug Effects Many drugs that are excreted by the kidney should be avoided, or their doses should be reduced, as shown in Table 32-2. Interstitial eosinophils are characteristic of various parasitic infestations, particularly arthropod bites (p. Giant vascular eccrine spiradenomas: A report of two cases with histology, immunohistology and electron microscopy. Langerhans cell histiocytosis Clinicopathological reappraisal and human leucocyte antigen association.
Vatras, 33 years: Cutaneous extramedullary hematopoiesis following splenectomy for idiopathic myelofibrosis. Determination of urinary indices, including fractional excretion of sodium and urine output 5. After exposure to an antigen, a susceptible individual develops an alveolitis with influx of neutrophils and lymphocytes. Enteroscopy Examination of the small intestine beyond the ligament of Treitz is not feasible with a standard gastroscope.
Pranck, 44 years: Diffuse dermal angiomatosis: A variant of reactive cutaneous angioendotheliomatosis. The social history evaluates past and current use of tobacco products, alcohol, and illicit drugs. Nevus lipomatosus cutaneus superficialis with follicular papules and hypertrophic pilosebaceous units. Anticoagulation is key to prevent thromboembolism in any patient with a previous event or with onset of atrial fibrillation.
Norris, 35 years: Superficial low-grade fibromyxoid sarcoma (Evans tumor): A clinicopathologic analysis of 19 cases with a unique observation in the pediatric population. Lidocaine is more effective in relatively depolarized ventricular tissue due to preferential affinity for inactivated sodium channels; the drug is more potent in ischemic tissue. Unilateral angiolymphoid hyperplasia with eosinophilia involving the left arm and hand. Solid and hematologic malignancies in 60 patients with systemic mast cell disease.
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