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Lymphomas are tumors of the lymphatic tissues and may occur in many places within the body. Lymphoma of the heart is rare, and has a particularly poor prognosis; in many cases the patients die before the condition is diagnosed and in other cases within two or three weeks despite prompt treatment. In such cases, however, it might be imagined that the aggressiveness of this tumor is only part of the reason for the poor outcome; delay in diagnosis seems likely to have played an important part as well. A case has now been seen in which early diagnosis may have helped a patient with lymphoma of the heart to enjoy longer survival. The patient was a 64-year-old woman who developed chest pain, nausea, shortness of breath, and profuse sweating. Physical examination revealed nothing unusual, but electrocardiographic examination revealed heart abnormalities and a temporary pacemaker was required after the patient developed compete heart block. When ultrasound imaging was used to examine the patient's heart, signs of fluid collecting in the pericardium surrounding the heart were seen. This finding was confirmed with CT scan, which also showed a vague mass next to the heart. The pericardial fluid was sampled and malignant cells were discovered. Imaging techniques revealed no indications of lymphoma elsewhere in the body, and bone biopsies uncovered no signs of lymphoma. The patient was treated with the chemotherapeutic drugs cyclophosphamide, doxorubicin, vincristine, and prednisone, and CT scan revealed a reduction of about 75 percent in the mass by the heart. The patient remains alive more than 18 months after completion of therapy. The characteristics of the lymphoma in this patient were similar to those in other patients who died rapidly. The initiation of chemotherapy, which in this case began within three days of the patient's presentation, is most likely responsible for the long survival of this patient. At present, this woman seems to be the longest survivor of lymphoma of the heart. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dilated cardiomyopathy is disease of the cardiac muscle causing abnormal enlargement of the heart ventricles and other associated problems. One major complication of this disease is the threat of blood clot development and consequent blockage of heart vessels (embolism). Embolisms can occur at any time, sometimes being the first symptom of the disease and sometimes occurring long after the disease has been diagnosed and producing no clinical symptoms. These clots tend to be rather large and affect other organs besides the heart. The case is reported of a 37-year-old woman with dilated cardiomyopathy who had arterial microembolization (very small clots) in the arteries of her toes as her initial symptom. The patient, who had no previous heart problems, complained of painful and discolored toes that had appeared one month before she came for examination. Examination of the heart found left ventricular enlargement and decreased left ventricular function, but no coronary artery disease or other heart disease. The vessels to the affected toes were found to be occluded by microemboli, but no vascular disease was found. The patient was treated with drug therapy for cardiomyopathy and the problems with her toes resolved and her heart functioning improved. The case was unusual in that the initial symptom was arterial microemboli in the periphery (arms and legs) rather than larger emboli in the trunk or brain and there were no symptoms of congestive heart failure. Cardiomyopathy should be considered when patients are suffering from peripheral microembolization. (Consumer Summary produced by Reliance Medical Information, Inc.)

A 72-year-old woman with the Ramsay Hunt's syndrome subsequently experienced brainstem and cerebellar encephalitis and the syndrome of inappropriate antidiuretic hormone secretion. REPORT OF A CASE The patient complained of a three-day history of slurred speech, left-sided facial drooping, pain in the left ear, and left parietal headache. There was a left peripheral seventh nerve paralysis with a crusting eruption in the left external auditory canal and on the left pinna. Taste was intact. Lymph nodes were not palpable.Normal laboratory determinations included a 12-factor chemical analysis, urinalysis, serum electrolytes, and the rapid plasma reagin test. The WBC count was 15,300/cu mm and the hemoglobin level was 14.2 g/dL. Chest roentgenogram showed unremarkable features. The eruption of the left ear was dry, and fluid was not obtainable for study.Three days after admission, the patient became lethargic with paresis of the left sixth and eighth nerves, bilateral pyramidal tract signs