Refusal to eat in the elderly

Refusal to eat by the elderly, and subsequent malnutrition, occurs in both institutional and community settings. Causes include physiologic changes associated with aging, mental disorders such as dementia and depression, and medical, social, and environmental factors. Treatment approaches call for management of these causes while considering the roles that medicine, ethics, and culture play in the process.     

Metastasis of malignant melanoma of the nasal mucosa to the small intestine

Malignant melanoma of the mucous membranes is rare and has a very poor prognosis. When localized in the nose, the tumor becomes apparent late in the course of the disease with nasal obstruction and epistaxis. Distant metastases are uncommon, but any organ of the body can be involved. A case of a malignant melanoma of the nasal mucosa with metastasis to the small intestine is presented, and the natural history of the metastatic disease is discussed.     

Hematuria and sickle cell disorders

To examine the relationship between gross hematuria and sickle cell disorders, all patients admitted to Grady Memorial Hospital with the diagnosis of a sickle cell disorder during a 14-month period were reviewed. Of 115 such patients, 65% had sickle cell disease and 35% had sickle cell trait. None of the former but seven of the latter group had gross hematuria. Mean age of the seven was 30 years. Comprehensive examinations and laboratory studies showed that all were free of concomitant disease. Physical findings, diagnostic modalities, and treatment were reviewed. Findings suggest that conservative therapy (bed rest, hydration, and diuresis) is usually effective.     

Anomalous double blood supply to the lung

We report an unusual case in which an apparently normal upper lobe of the right lung was supplied by major systemic arterial and pulmonary arterial vessels. The anomalous artery arose from the descending aorta. Following interruption of this vessel, the machinery-like murmur previously present disappeared.