Obama Lands An Endorsement.

April 17, 2008

Powerline reports that at least one group of bitter people clinging to guns, religion, antipathy to people who aren’t like them and an anti-immigrant sentiment, likes Barak Obama:

On Sunday, Aaron Klein and John Batchelor interviewed Ahmed Yousef, chief political adviser to the Prime Minister of Hamas, on WABC radio. The interview produced a scoop which, for some reason, has not been widely publicized: Hamas has endorsed Barack Obama for President. Yousef said, “We like Mr. Obama and we hope he will win the election.” Why? “He has a vision to change America.” Maybe Yousef has some insight into what Obama means by all these vague references to “change.”

When a terrorist organization that wants to see the United States turned into an Islamic state backs a US presidential candidate….. well, that is something to consider. I mean, can the Hezbollah endorsement be far behind?

Sudden Death of a Patient With Pulmonary Langerhans Cell Histiocytosis

Archives of Pathology & Laboratory Medicine June 1, 2005 | Nakhla, Hassan; Jumbelic, Mary I We report a case of sudden death due to bilateral pneumothorax in a previously healthy 16-year-old adolescent white girl. She presented with sudden onset of shortness of breath followed by loss of consciousness. Postmortem chest radiograph showed bilateral pneumothoraces. Autopsy confirmed the bilateral pneumothorax and additionally showed emphysematous changes and bullae throughout the lung tissue. Microscopic sections of the lungs showed Langerhans cell histiocytosis. To the best of our knowledge, this is the first reported case of fatal presentation of pulmonary Langerhans cell histiocytosis. this web site langerhans cell histiocytosis

(Arch Pathol Lab Med. 2005;129:798-799) Pneumothorax is one of the known presentations of pulmonary Langerhans cell histiocytosis (PLCH). We report a case of sudden death due to bilateral pneumothorax in a previously healthy 16-year-old adolescent white girl. To our knowledge, this is the first case of fatal bilateral pneumothorax complicating PLCH.

REPORT OF A case The decedent was a previously healthy 16-year-old girl with no previously known medical problem. She was a cigarette smoker, and her only complaint was seasonal allergy, with no history of drug allergy. On the day of her death, she had dyspepsia and vomiting and took an antacid. Shortly thereafter, she complained of sudden shortness of breath, and then she collapsed. When paramedics arrived, she was pulseless and apneic. She was intubated and transferred to the hospital, where resuscitation efforts failed. A postmortem chest radiograph showed bilateral pneumothoraces with collapse of both lungs (Figure 1). An autopsy confirmed the bilateral pneumothoraces and the lung collapse. In addition, 2 burst visceral blebs were seen, 1 on the posterior aspect of the right upper lobe and 1 on the posterior aspect of the left upper lobe. Multiple intact blebs, ranging from 1 to 5 mm in greatest dimension, were present elsewhere on the visceral pleural surfaces. Cut sections of the lungs revealed emphysematous changes in both lungs and areas of nodularity. The tracheobronchial tree was without lesions, and there was no evidence of pulmonary embolism. Postmortem serum ?^sub 1^-antitrypsin level was normal. The remaining autopsy results were unremarkable. Microscopic examination of the lung sections showed peribronchial nodular infiltrates of Langerhans cells. The latter were characterized by moderate eosinophilic cytoplasm and grooved nuclear membrane (Figures 2 and 3). In addition, eosinophils and lymphocytes were also noted admixed with the Langerhans cells. Respiratory bronchiolitis and pigmented intraalveolar macrophages were seen in the surrounding parenchyma. No fibrosis was seen within the infiltrates. No evidence of organizing pneumonia was seen. The Langerhans cells stained positive for S100 and CD1a.

COMMENT Pulmonary Langerhans cell histiocytosis is a lung disorder characterized by nodular interstitial infiltration of the lung by Langerhans cells. Pulmonary Langerhans cell histiocytosis may affect the lung, either in isolation or in addition to other organ systems, as part of what is known as histiocytosis X.

Cases where the lung is the only organ affected are described in literature.1,2 Pulmonary Langerhans cell histiocytosis can affect both sexes, with the highest incidence in the second and third decades of life. Smoking appears to be the most important risk factor. Rare cases have been reported in children.3,4 Nonproductive cough and dyspnea are the usual presenting symptoms, although 23% of patients are asymptomatic, and biopsy is usually performed for various abnormal radiologic findings.2 Early radiologic features are usually multiple bilateral nodules predominantly affecting the upper lobes. The size of these nodules ranges from millimeter sized to more than a centimeter in diameter. Linear or irregular nodular lesions are also common.2 Late in the course of the disease, honeycomb and interstitial fibrosis of the lung may develop.5 The median survival rate of adults with PLCH, 12.5 years, is shorter than the survival rate for healthy adults, and death is most often caused by respiratory complications.6 Poor respiratory physiologic function at the time of diagnosis of PLCH predicts a poor prognosis.6 Spontaneous pneumothorax is a known presenting symptom of PLCH. It is more common in the young age group, with an overall incidence of pneumothorax in patients with PLCH of 11%.2 Tanaka et al7 found PLCH to be responsible for less than 2% of spontaneous pneumothorax cases caused by underlying lung disease. The pathogenesis of pneumothorax is not fully understood, but it is attributed to destructive changes in the lung parenchyma resulting from the disease.8 In many cases, spontaneous pneumothorax was the presenting symptom of PLCH, but to our knowledge, this is the first case of fatal bilateral pneumothorax. go to website langerhans cell histiocytosis

We thank Anna-Luise Katzenstein, MD, from the Department of Pathology, State University of New York, Upstate Medical University, Syracuse, for editing and reviewing this case report.

[Reference] References 1. Chatkin JM, Bastos JC, Stein RT, Gaiger AM. Sole pulmonary involvement by Langerhans cell histiocytosis in a child. Eur Respir J. 1993:6:1226-1228.

2. Friedman PJ, LiebowAA, SokoloffJ. Eosinophilic granuloma of lung: clinical aspects of primary histiocytosis in the adult. Medicine (Baltimore). 1 981 ;60:385-396.

3. McDowell HP, Macfarlane Pl, Martin J. Isolated pulmonary histiocytosis. Arch Dis Child. 1988;63:423-426.

4. Aftimos S, NassarV, Najjar S. Primary puimonary histiocytosis in an infant. Am I Dis Child. 1974;128:851-852.

5. Powers MA, Askin FB, Cresson DH. Pulmonary eosinophilic granuloma. Am Rev Respir Dis. 1984;129:503-507.

6. Vassallo R, Ryu JH, Schroeder DR, Decker PA, Limper AH. Clinical outcomes of pulmonary Langerhans cell histiocytosis in adults. N Engl J Med. 2002; 346:484-490.

7. Tanaka F, ltoh M, Esaki H, IsobeJ, UenoY, lnoue R. secondary spontaneous pneumothorax. Ann Thorac Surg. 1993:55:372-376.

8. Mendez JL, Nadrous HF, Vassallo R, Decker PA, Ryu JH. Pneumothorax in pulmonary Langerhans cell histiocytosis. Chest. 2004;125:1028-1032.

[Author Affiliation] Hassan Nakhla, MD; Mary I. Jumbelic, MD [Author Affiliation] Accepted for publication February 10, 2005.

From the Department of Pathology, State University of New York Upstate Medical University, Syracuse (Dr Nakhla); and Onondaga County Medical Examiner’s Office, Syracuse, NY (Dr Jumbelic).

The authors have no relevant financial interest in the products or companies described in this article.

Nakhla, Hassan; Jumbelic, Mary I


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