Effect of sphincteroplasty on gallbladder function and bile composition.

The effect of sphincteroplasty on bile concentration and composition and on gallbladder function was investigated in the dog. Gallbladder and hepatic bile samples were analyzed for cholesterol, phospholipid (lecithin), bile salt concentration and individual bile salt content. Motor function was studied by cholecystokinin-cholecystography with changes in gallbladder volume computed from the radiographs. All bile samples were cultured and at the conclusion of the experiments, the gallbladders were histologically examined. Sphincteroplasty did not alter biliary cholesterol concentration but the concentration of lecithin and bile salts decreased in gallbladder bile and increased in hepatic bile (p less than .001). These changes depict a trend toward greater lithogenicity for gallbladder bile and lesser lithogenicity for hepatic bile. Postoperative analysis of individual bile salts in gallbladder bile showed an increase in monohydroxy and dihydroxy bile salts and a decrease in trihydroxy bile salts (p less than .001). This tendency has been shown to be conducive to gallstone formation. The concentrating ability of the gallbladder was partially eliminated by sphincteroplasty but gallbladder filling and motor response to stimulation by cholecystokinin was not affected. All gallbladders demonstrated histologic changes of chronic inflammation and all developed a significant bacterial flora following sphincteroplasty. It is concluded that cholecystectomy should always be performed following transduodenal sphincteroplasty not because of any resultant abnormality of motor function, as has previously been held, but because of the resultant abnormality of gallbladder pathophysiology.


Primary Crohn's disease of the appendix: report of 14 cases and review of the literature.

Fourteen patients with primary Crohn's disease of the appendix have been seen in a 12 year period. These patients represent 12.8% of the total number undergoing surgical resection because of Crohn's disease. Twenty-three cases of appendiceal Crohn's disease have been previously reported in the literature. A correct preoperative diagnosis is rarely made; the usual diagnosis is that of acute appendicitis or appendiceal abscess. The removed appendix in twelve of our 14 cases had marked thickening of the wall with transmural fibrosis and often with granulomatous inflammation. The enlarged appendix had an external appearance similar to that of ileal Crohn's disease, and we consider a correct surgical diagnosis might be possible with better awareness of its existence. The diagnosis might be suspected earlier when the clinical course of apparent appendicitis is protracted or atypical. Contrary to the previous estimation of high recurrence rate, this series and the cumulative evidence in the literature show a relatively low rate at 14%. The feared fistula formation following the removal of the appendix has not been seen in either our series or the literature. These patients, however, merit long-term follow-up.


Abdominal wound dehiscence in gastroenterological surgery.

The occurrence of complete wound dehiscence is analyzed in a group of 4538 patients treated with abdominal surgery. All possible measures for the prevention of wound dehiscence should be taken at the time of operation, especially when two or more of the following predisposing factors are present: male, more than 64-years-old, complicated neoplastic and inflammatory diseases, as well as bleeding and noncomplicated inflammatory diseases (except appendicitis), as well as emergency interventions. The use of Ventrofil plates for the prevention of wound dehiscence is recommended in these cases. It is demonstrated that the incidence of complete wound dehiscence in cases with predisposing factors in significantly decreased when extrapreventive measures are taken at the time of wound closure, what results in a decrease of the frequency by which wound dehiscence after gastrointestinal operations occurs.


A study of secretory proteins, cytology and tumor site in pancreatic cancer.

Pure pancreatic fluid was aspirated at the time of endoscopic retrograde cholangiopancreatography (ERCP), after Secretin stimulation, and was analyzed for protein in eight patients with proven adenocarcinoma of the pancreas and in 16 subjects of the same sex ratio and approximately matching ages, who had normal pancreatograms and pancreatic cytology, who served as controls. The albumin concentration, IgA, IgG, were all significantly greater in the pancreatic fluid of the cancer group, and the IgM and transferrin increase was of borderline significance. Many zymogen bands present in controls were either faintly present or absent in the cancer group at matching zymogen concentration. Cytology was positive or suspicious in eight of 11 cancer patients. The secretory protein abnormalities and cytology results in the cancer group did not depend on a particular tumor site or size, the smallest being 3 cm lesions. Hence, secretory abnormalities and gross tumor size and location are independent entities to a certain extent. It is possible that secretion changes may precede the development of gross tumor. Further study will be necessary before the actual significance of these findings for early diagnosis is known.


Splenorenal arterial anastomosis for renovascular hypertension.

In properly selected patients, the benefits of renal artery reconstruction for renovascular hypertension have been clearly established. Disagreement remains, however, regarding the optimal technique. For most types of left-sided lesions, a splenorenal arterial anastomosis offers decided advantages. Only a single suture line is required and autogenous arterial tissue is employed. Difficulties with a diseased aorta are avoided. The procedure is particularly suitable for a staged approach to bilateral disease or in reoperation for failed prior reconstructions. Our experience with this procedure in 19 patients is reviewed and indications for selection of a splenorenal anastomosis are discussed. There were no deaths, and a single failure due to graft occlusion (5%). Of the remaining 18 patients, 7 are cured and 11 are improved. There were no instances of postoperative renal failure, and renal function improved in all four patients with preoperative renal failure. We conclude that in properly selected patients this procedure is of great usefulness and deserves wider application.


Intrapericardial diaphragmatic hernia in adults.

Intrapericardial diaphragmatic hernia (IDH) is the rarest type of adult diaphragmatic hernia. Only 28 cases have been reported. Indirect blunt trauma has been implicated in most cases, but one resulted from a stab wound to the anterior chest. Patients presented immediately or up to 20 years following trauma with symptoms of intermittent bowel obstruction, including one with strangulation, or cardiac dysfunction, including dyspnea, palpitations, and two patients with cardiac tamponade. Physical findings included bowel sounds in the chest, decreased heart and lung sounds, and an absent point of maximal cardiac impulse. Chest roentgenography usually revealed supradiaphragmatic gas shadows suggestive of bowel in the chest. Thorough examination of both anteroposterior and lateral chest roentgenograms and barium gastrointestinal series may provide positive diagnosis of anterior diaphragmatic hernia, and fluoroscopy after induced pneumoperitoneum may establish its pericardial involvement. Celiotomy is the preferred approach to surgical repair of IDH. Since the symptoms referable to adult IDH can be incapacitating or life threatening, herniorrhaphy should be performed promptly upon diagnosis, with expectation of an uneventful recovery and negligible recurrence rate.


The danger of hemolysis in shock.

Intravascular hemolysis is sometimes harmful and often fatal. Other times it is harmless. Dogs were paired and subjected to hemorrhagic shock. One of the pair was given 2 ml/kg of autologous hemolyzed blood before bleeding. The other of the pair was given 2 ml/kg of heparinized autologous blood. All of the animals given heparinized blood survived, whereas, all of the animals given hemolyzed blood died. The animals given hemolyzed blood developed coagulation changes indicative of Disseminated Intravascular Coagulation (DIC), whereas, the dogs given nonhemolyzed blood did not. It is concluded that hemolysis in the presence of shock (slow capillary flow) causes DIC and death. Hemorrhagic shock alone or hemolysis alone was harmless.


Diagnostic value of tests of fibrin metabolism in patients predisposed to pulmonary embolism.

Blood tests for fibrinogen/fibrin degradation products (FDP/fdp) and soluble fibrin complexes (SFC) were performed in 100 patients at high risk for thromboembolism in order to assess the diagnostic value of these determinations in patients suspected to have pulmonary embolism. Tests were positive significantly less often in high-risk patients, and mean values were significantly lower, when compared with patients with established pulmonary embolism (P less than .001). However, no significant differences existed between high-risk patients and patients with deep venous thrombosis of the legs. Positivity rates and mean values were significantly higher in the presence of pulmonary embolism than in patients with deep venous thrombosis alone (P less than .05). Elevated FDP/fdp and SFC values are useful in the diagnosis of pulmonary embolism in high-risk patients; moreover, positive results in a patient with deep venous thrombosis suggests that pulmonary embolism has occurred.


Empiric therapy for infections in granulocytopenic cancer patients: continuous infusion of amikacin plus cephalothin.

A combination of amikacin sulfate given by continuous infusion (800 mg/sq m/24 hr) plus cephalothin sodium (2 g every four hours) was used as initial empiric therapy for the treatment of 65 evaluable febrile (greater than 38.5 degrees C) episodes in 54 granulcoytopenic (neutrophils, less than 1,000/microliter) adult cancer patients. Carbenicillin disodium (5 g every four hours) was substituted for cephalothin in patients with Pseudomonas infections and in patients in whom the initial regimen was unsuccessful. Thirty-two of the 38(84%) identifiable infections responded to therapy, including all of the eight septicemias and eight of 11 pneumonias. Three additional infections responded to the substitution of carbenicillin for cephalothin, for a total response rate of 92% (35/38). Nephrotoxicity occurred in five patients (7.1%), most commonly in patients over 60 years of age. Ototoxicity, highly correlated with a duration of greater than 19 days and a total dosage of greater than 25 g of amikacin sulfate, occurred in four patients (5.6%). Amikacin given by continuous infusion plus cephalothin is a safe and efficacious empiric therapy for infections in granulocytopenic cancer patients.


Long-term granulocyte transfusion in patients with malignant neoplasms.

Thirty-eight episodes of culture-documented antibiotic-resistant bacterial or fungal infection in patients with malignant neoplasms were treated with daily granulocyte transfusions until the infection improved or the patient died. Cumulative summation temperature plotting allowed easier interpretation of recipient fever response. Seventy-one percent of recipients had a favorable response to transfusion. There was no difference in mortality between patients treated with cells collected by filtration (FL) or intermittent flow centrifugation (IFCL) leukapheresis techniques. Transfusion reactions were more than twice as common with FL than IFCL collected cells. Seventy-four percent of recipients were alive 21 days after completion of transfusions; of the ten deaths, five could be classified as granulocyte transfusion failures. This study suggests that long-term granulocyte transfusion may be required in infected recipients when autologous granulocytes do not return after chemotherapy.


Benign mass lesions after therapy for Hodgkin's disease.

Two patients with stage 2A Hodgkin's disease were treated with chemotherapy followed by radiation therapy. After treatment, both patients had mass lesions. Resection and histologic examination of these lesions showed only fibrosis, necrosis, and inflammation. Benign mass lesions occurring after therapy for Hodgkin's disease have not been previously described.


Drug dependence, a possible new risk factor for tuberculosis disease.

A study was performed to assess the risk of drug-dependent persons for developing tuberculosis. Tuberculosis prevalence was 3,740/100,000 drug-dependent inpatients compared with 584/100,000 non-drug-dependent discharges. In another program, prevalence was 3,750/100,000; in the New York Methadone Program, prevalence was 2,652/100,000 patients in Harlem and 1,372/100,000 city-wide. The city-wide prevalence rate in the entire population was 86.7/100,000 in 1971 and 64.7/100,000 in 1973. Similar elevations in incidence also were found in drug-dependent vs non-drug-dependent populations. Our data show that disease rate is elevated in drug-dependent populations, suggesting that drug dependency reflects a high-risk situation for tuberculous infected individuals developing tuberculosis disease. We suggest that infected drug-dependent persons (tuberculin positive) be considered for preventive therapy with isoniazid, which can be piggybacked onto a drug treatment program.


Nelson's syndrome and spontaneous pituitary tumor infarction.

Large, adrenocorticotrophic hormone-secreting pituitary tumors (Nelson's syndrome) developed in four of 12 patients treated with a bilateral adrenalectomy for Cushing's disease. Two of the patients with Nelson's syndrome suffered spontaneous pituitary tumor infarctions. One patient improved under close observation and subsequent radiation therapy, although she ultimately died from her locally invasive tumor. The condition of the other patient-which had stabilized-appeared to be worsened by surgical intervention. The high incidence of these tumors after bilateral adrenalectomy, their large and agressive nature, and their apparent propensity to undergo spontaneous infarction supports the position that initial therapy for Cushing's disease should be directed to the pituitary gland.


Isolated ultrafiltration in the treatment of fluid overload in cardiogenic shock.

Dramatic improvement in measured hemodynamic values, arterial blood gas values, and renal function was quickly achieved by the use of isolated ultrafiltration in a patient with cardiogenic shock refractory to medical management. Swift venous access was obtained by femoral catheterization, and the rapid removal of 3,500 mL of ultrafiltrate was well tolerated. This technique may afford another mode of therapy in patients with refractory cardiogenic shock associated with severe volume overload.


Apparent quinidine-induced digoxin toxicity after withdrawal of pentobarbital: a case of sequential drug interactions.

Accelerated quinidine metabolism was observed in a 94-year-old woman also receiving daily doses of digoxin and pentobarbital sodium. Discontinuation of pentobarbital produced a sharp increase in serum digoxin concentrations coupled with symptoms highly suggestive of digoxin toxicity. Associated with these findings was 3.8-fold increase in quinidine half-life. These data seemed consistent with an interaction between quinidine and digoxin that was precipitated by pentobarbital withdrawal.


Liver disease in early syphilis.

Atypical manifestations of early syphilis, although uncommon, may represent diagnostic difficulties and delay therapy. We describe two cases of hepatitis complicating early syphilis. Clues to the diagnosis of early syphilitic hepatitis include the presence of perianal lesions and disproportionate increases in the serum alkaline phosphatase level. Biopsy results were nonspecific. The major differential diagnostic consideration is hepatitis B with false-positive serologic findings. The abnormalities of liver function respond to standard therapy for secondary syphilis. Follow-up of patients and their contacts is essential.


Fatal benign phenytoin lymphadenopathy.

A 71-year-old man had status epilepticus and was treated with phenytoin (Dilantin) sodium. Subsequently, an absolute eosinophilia developed, which increased and reached its zenith immediately before the patient died. At autopsy, anasarca and an interstitial nephritis characterized predominantly by eosinophils and occasional focal necrotizing arteriolar glomerular lesions were found. Portal areas also contained an eosinophilic infiltrate. It has been previously stressed that exfoliative dermatitis is often the initiating sign of an allergic hypersensitivity reaction with phenytoin therapy. In view of this, we would suggest that a potential first sign of such an underlying reaction may be the development of an otherwise unexplained absolute eosinophilia.


Effect of early plasmapheresis and immunosuppressive therapy on natural history of anti-glomerular basement membrane glomerulonephritis: report of a 22-month follow-up.

A patient with anti-glomerular basement membrane (GBM)-mediated necrotizing and proliferative glomerulonephritis with crescents was treated with plasmapheresis, cyclophosphamide, and steroids. Treatment resulted in decreased circulating anti-GBM antibody and prompt improvement of renal function that remained stable for 15 months after all treatment was discontinued. Renal biopsies were performed initially, at seven and 17 months. Immunofluorescent examination showed that anti-GBM antibody continued to be present on GBMs although light and electron microscopic findings demonstrated a transformation to a form of sclerosing glomerulonephritis. To our knowledge, this patient's course is the first demonstration that early treatment with plasmapheresis and immunosuppressions may transform the histologic findings in anti-GBM-induced rapidly progressive glomerulonephritis, thereby altering the natural history of this disease.


Traumatic cardiac hemolytic anemia: a late complication of a Starr-Edwards mitral valve prosthesis.

Severe, traumatic, cardiac, hemolytic anemia developed in a patient nine years after mitral valve replacement with a Starr-Edwards model 6120 prosthesis. Cardiac catheterization failed to demonstrate a perivalvular leak or prosthetic malfunction. Transfusion on two occasions resulted in accelerated hemolysis and failed to maintain an appreciable elevation of the hemoglobin level. At operation, a perivalvular leak was found. Replacement of the valve led to complete resolution of the hemolytic problem. The case demonstrates that cardiac hemolysis may be a good indicator of valve dysfunction.


Growth yield and energy generation in anaerobically-grown Campylobacter spec.

An anaerobic continuous culture study was made with Campylobacter spec. to determine growth yields under various growth conditions. The growth media contained 0.1% (w/v) yeast extract as carbon source. When grown in an aspartate-limited culture Ymaxasp was 4.6. Inclusion of formate in the culture medium hardly affected the true growth yield. The number of ATP equivalents generated in the fumarate-reductase system was 0.66 and the YmaxATP was 7.0. In the nitrate reduction with formate 1.7 ATP equivalents were generated, and a YmaxNO3- of 12.2 was observed. The true growth yield obtained with a mixture of lactate and aspartate was lower than that found with aspartate alone.


Competition for L-glutamate between specialised and versatile Clostridium species.

Clostridium cochlearium could be reproducibly enriched in an L-aspartate- and L-glutamate-limited, anaerobic chemostat inoculated with anaerobic sludge. L-glutamate, L-glutamine and L-histidine were the only fermentable substrates. Less specialised clostridia of the C. tetanomorphum type could only be isolated from batch enrichments with L-glutamate and L-aspartate as energy sources. Competition experiments with C. cochlearium and C. tetanomorphum in a L-glutamate-limited chemostat resulted in the selective elimination of the latter species. Addition of glucose to the medium resulted in coexistence of both species. The molar growth yields for L-glutamate at different dilution rates at 30 degrees C were determined for both species. The maximum specific growth rates on L-glutamate were 0.55 h-1 for C. cochlearium and 0.35 h-1 for C. tetanomorphum.


Studies on the macroconidia of Microsporum canis. Characteristics of in vitro amino acid incorporating system.

The characteristics of an in vitro polyuridylic acid dependent amino acid incorporating system prepared from germinating macroconidia of Microsporum canis are described. The incorporation of 14C-phenylalanine into polyphenylalanine is dependent on S-30 extract, adenosine triphosphate, magnesium ions and polyuridylic acid. Incorporation is slightly enhanced by yeast transfer ribonucleic acid and pyruvate kinase. The system is highly sensitive to ribonuclease, puromycin and miconazole (an antifungal agent), moderately sensitive to sodium fluoride and much less sensitive to phenethylalcohol, cycloheximide, chloramphenicol and deoxyribonuclease. Cell-free extract from ungerminated conidia has less capacity to synthesize the protein and during germination a marked increase in the protein synthetic activity is observed. The results from experiments wherein ribosomes and S-100 fraction from germinated and ungerminated spores are unterchanged, revealed that the defect in the extract from the ungerminated spore is in the ribosomes.


Ferredoxin degradation in growing Clostridium pasteurianum during periods of iron deprivation.

Clostridium pasteurianum was grown in batch cultures on media with an initial iron concentration of 10 micron. The uptake of iron and the synthesis of ferredoxin was followed. All the iron present in the medium was taken up by the cells before 50% of the final cell density was attained. The bacteria then continued to grow in the complete absence of exogenous iron. Ferrodoxin was synthesized during growth until the exogenous iron concentration dropped below 1 micron. During growth in the absence of iron ferredoxin was degraded with the result that at the end of growth the cells did not contain ferredoxin. The specific activity of the iron sulfur protein, pyruvate synthase (E.C. 1.2.7.1), remained constant during growth of C. pasteurianum in the absence of exogenous iron. This finding suggest that ferredoxin was used as an endogenous source of iron for the synthesis of essential iron proteins during periods of iron deprivation.


On the formation of crystal proteins during sporulation in Bacillus thuringiensis var. thuringiensis.

The processes of sporulation and crystal formation in Bacillus thuringiensis could be desynchronized, using short term temperature shift-up conditions or addition of chloramphenicol at the beginning of sporulation. Isolation of a Sp-, Cr+ mutant, blocked at early stage of sporulation further confirmed that crystal formation can occur in the absence of sporulation. The presence of one of the two antigenic subunits of the crystal protein in chloramphenicol treated cultures and both of them in cultures shifted up to 37 degrees C was demonstrated. The insect toxicity was exhibited by both the extracts.


Life changes. Do people really remember?

The question, "How well do people remember life changes?" was approached in a longitudinal study of nearly 400 healthy men in a responsible profession. Three scales for assessing life changes were administered by questionnaire at two examinations nine months apart. The subjects were asked to report life change events occurring during a specific six-month period--that which immediately preceded the first examination. For all three life change scales there was substantial forgetting over the interval between reports, with  a second report yielding total scores 34% to 46% less than those from the first report for the same period. The amount of change over time varied greatly across persons. These findings raise serious questions about the validity of retrospective studies of life change and illness when the period being reported is greater than six months in the past. They do not, however, jeopardize the potential of the method for prospective studies.


Physicians' concordance with consultants' recommendations for psychotropic medication.

Physicians' concordance with the recommendations of psychiatric consultants regarding the use of psychotropic medications in a general hospital was retrospectively examined in an outcome study. Using medical records in a series of 200 consecutive consultations, the authors found 68% of all psychotropic recommendations resulted in physician responses rated concordant and 24% nonconcordant. Resultant concordance ratings are presented according to category of recommendation (that is, start, adjust, continue, or discontinue) and drug groupings. The data suggest that drug group is not a critical variable in physician concordance. Responses did differ by category of recommendation. Further study of physician concordance is desirable. The work suggests both the potential of and need for outcome studies in consultation work.


"Adherence" and the negotiated approach to patienthood.

A study was conducted on adherence to treatment referrals made in the psychiatry walk-in clinic of a general hospital. One hundred thirty patients were administered the patient request form, a general information questionnaire, and a postinterview evaluation questionnaire. Information on adherence was obtained from the hospital records. Forty-one percent of the patients adhered to the treatment referral. Adherence was significantly related to negotiation, as predicted. Another significant predictor of adherence was the patient's getting the plan he wanted. Adherence was not found to be related to demographic measures or scores on the patient request form. The index of negotiation also correlated significantly with the patient's evaluation of the interview, replicating previous findings. The relationship of adherence and negotiation is discussed.


Patients' requests of an outpatient clinic.

Three-hundred-twenty-five consecutive predominantly lower-class new patients at a psychiatric outpatient clinic rated the importance they attached to each of 14 categories of treatment needs or requests. Psychiatric residents subsequently rated the importance of each request for each patient at the conclusion of their initial assessment interview. Requests reflecting needs for intrapsychic therapy, clarification, and control of feelings were considered very important by approximately two thirds of the patients; needs for institutionalized contact, advice, and community triage by one half; and other requests for medication, reality contact, succorance, ventilation, confession, social intervention, administrative requests by a minority (one fourth to one third). Residents significantly underestimated the importance their patients attached to 10 of 14 requests. Factor analyses confirmed several systematic sources of disparity between patient and therapist perception of lower-class patient needs.


Psychiatric referrals in general practice.

A major option available to the nonpsychiatric physician in dealing with patients who have psychiatric problems is to refer them to psychiatrists. A group of 93 nonpsychiatric physicians indicated that they have positive attitudes toward making such referrals where appropriate, and make extensive use of this mechanism with psychiatric patients. There are, however, great differences of opinion with respect to the appropriateness of psychiatric referrals for neurotic patients, those with alcohol and addiction problems, and those with other personal problems (marital, vocational, etc).


Morbidity and rate of undiagnosed physical illnesses in a psychiatric clinic population.

Major medical illnesses remain undiagnosed and patients' ailments are being labeled "psychosomatic" at an alarming rate. A careful screening of 2,090 psychiatric clinic patients showed that 43% of this population suffered from one or several physical illnesses. Almost half of the physical illnesses (46%), remained undiagnosed by the referring source. Morbidity in the psychiatric clinic patients far surpassed the expected rate found in the general population. Among others, diabetes mellitus was a frequently overlooked diagnosis and proved, particularly, to produce emotional disturbances. Physicians other than psychiatrists missed one third and psychiatrists one half of the major medical illnesses in patients they referred. Self-referred and social agency--referred patients almost always had undiagnosed physical illnesses. The causes for failing to recognize medical illnesses are discussed. Based on the obtained data, the necessity for a medical orientation on the part of psychiatrist in evaluating all patients is stressed.


Influence of experience on major clinical decisions. Training implications.

We studied 779 walk-in psychiatric patients presenting to 32 first- or second-year residents and 772 patients presenting to 25 third-year residents or attending physicians as to the decision to admit to the hospital or to administer medication to those not admitted. There were no significant demographic or clinical differences between patients presenting to the two groups. The more experienced staff admitted half as many patients and treated serious depression with tricyclics twice as frequently. Inexperienced psychiatrists used hospitalization more frequently when these patients suffered from suicidal ideation, hallucinations, delusions, and inability to cope. When the training procedure was modified and second-year residents were introduced into a more structured setting, their decision-making quickly approached that of third-year residents and attending physicians. We suggest that specific training can modify decision-making, where general clinical experience may not. Implications for resident and medical student training are discussed.


Evaluation of nocturnal penile tumescence in the differential diagnosis of sexual impotence. A quantitative study.

Nocturnal penile tumescence (NPT) was assessed in 30 impotent patients for the purpose of differential diagnosis. In 11 psychogenic cases, with several exceptions, NPT was found to be normal, with a marked discrepancy between the NPT findings and the patients' estimates of their daytime erectile capacity. In 19 organic patients, maximal NPT corresponded closely to and mirrored the patient's subjective estimate of his impaired waking performance. Statistically, the figures for frequency, degree, duration, and amount of NPT were found to be significantly and markedly greater in the psychogenic group. Statistical significance was maintained when the 11 psychogenic patients were closely age-matched with 11 of the 19 organic cases. The method is not 100% accurate; some 15% of impotent patients without organic findings have reduced NPT, several of whom were shown to be psychogenic, but others in this group may have undetected organic pathology. The NPT method is very promising, but beset by a number of methodological problems.


Male genital self-mutilation.

Men who intentionally mutilate or remove their own genitals are likely to be psychotic at the time of the act, to have a number of goals and aims relating to conflicts about the male role, and to be vulnerable to sociocultural and psychological forces in a causal network as yet unknown. However, from a review of the cases of 53 male self-mutilators, it appears that a significant number involve individuals not psychotic at the time of the act but rather having character disorders and rageful feelings toward themselves or women, and transsexual males who premeditate their own gender conversion surgery. The psychiatric consultant's role in the management of such an individual in the general hospital setting includes not only care of a patient with a psychotic or impulse disorder but also involves support of the house staff, who are distressed by the fear, guilt, hopelessness, anger, and revulsion that the patient's act of genital self-mutilation causes.


Newer experimental methods for classifying depression. A report from the NIMH collaborative pilot study.

A total of 83 patients receiving diagnoses of major depressive disorder in the pilot phase of the National Institute of Mental Health Collaborative Study of the Psychobiology of Depression were used to evaluate two newer methods of classifying depressive disorders on the basis of family history or course. A third subtype based on family history, nonfamilial depression, was compared with the two subtypes originally proposed by Winokur and colleagues, pure depression and depression spectrum diseases. The system for classifying depressions on the basis of course and antecedent disorder, primary vs secondary depression, was also compared. These data from the pilot study indicate that two newer systems for classification have some predictive, construct, and content validity, but both are in need of further investigation before they become accepted methods for the classification of depressive disorders.


The erythrocyte lithium-plasma lithium ratio in patients with primary affective disorder.

Increasing attention has been given to the significance of intra-cellular concentrations of the lithium ion in patients treated with this drug. The erythrocyte has been the most common cell investigated because of its accessibility and certain similarities between the ion transport mechanisms of this cell and the neuron. Intraerythrocyte lithium is expressed as the ratio of lithium in the cell to the plasma lithium concentration (lithium ratio). The lithium ratio has been reported to be related to a number of clinical variables, including treatment response, clinical state, side-effects, toxicity, diagnosis, and electrophysiological effects. We have investigated the lithium ratio in a large series of patients with a primary affective disorder and in a smaller control group. We found a significantly higher mean lithium ratio in the bipolar diagnostic group than in the unipolar and control groups. There was a trend, not statistically significant, in the unipolar and bipolar groups for females to have higher lithium ratios than males. While not diagnostic, the lithium ratio appears to be another biological variable where bipolar patients, as a group, differ from normals and others with an affective disorder.


Identification of heparin resistance during cardiac and vascular surgery.

An investigation of the response of the activated clotting time to systemic heparinization during cardiopulmonary bypass and peripheral vascular surgery was prompted by the death from clotting of a patient with endocarditis while undergoing valve replacement. The activated clotting time during cardiopulmonary bypass was thereafter maintained at 300 to 400 seconds. Consumption of heparin sodium, derived from an individual dose-response curve, was 0.01 to 3.86 units/kg/min. There was no correlation between initial heparin resistance and the subsequent rate of consumption. Some patients undergoing peripheral vascular surgery required additional heparin after an initial standard dose of 8,000 units so as to maintain their activated clotting time at twice the control values. These data are discussed in relation to previous articles, and recommendations are made for adequate intraoperative heparinization.


Dacarbazine and melphalan. Enhancement by dosage scheduling of the effect in combination treatment on the Harding-Passey melanoma in C3D2F1 mice.

The best combination and schedule for dacarbazine and melphalan with the Harding-Passey melanoma in C3D2F1 mice is achieved when dacarbazine is administered first, followed by melphalan, given on either the day of dacarbazine therapy or the first three days after dacarbazine is given. When dacarbazine is given first, followed by melphalan on day 0, 1, 2, or 3, the effect of the two drugs is considerably more than additive. Other schedules reduce the outcome to a simple additive effect, or to an outcome that is less than additive, in which the combination is less effective than melphalan used alone. The effect of variations in the order and schedule of drug administration should be investigated in future trials of cancer chemotherapeutic agents, since profound effects may occur with these variations.


Wound dehiscence. Pathophysiology and prevention.

A review of 32 abdominal wound dehiscences in a five-year period shows an incidence of 0.51%. Important factors are preexisting pulmonary disease, "malnutrition," intraoperative contamination (often minimal), gastrointestinal distention, and aggressive tracheobronchial toilet in the postoperative period. Incision direction and type of closure have little influence on dehiscence rates. Wound dehiscence results in a substantial prolongation of hospital stay. Promptly recognized and treated, wound dehiscence is no longer a highly lethal complication.


Bacteriologic and systemic effects of intraoperative segmental bowel preparation with povidone iodine.

A technique for intraoperative segmental preparation of the large bowel, using 10% povidone iodine, was evaluated in 25 patients undergoing elective colon resection. Qualitative and quantitative bacteriology was obtained from the normal bowel content and from segments of colon treated with povidone iodine or normal saline. Forty-five of 50 segments treated with povidone iodine demonstrated no growth, whereas the segments injected with normal saline maintained bacterial counts of 3.5 x 10(8) colony forming units per milliliter. There were no septic complications in this group of patients and the levels of triiodothyroninc and thyroxin remained unchanged despite a substantial absorption of iodine, as demonstrated by protein-bound iodine determinations. Intraoperative segmental preparation of the colon with 10% povidone iodine is a simple technique that may be useful in the enhancement of other methods of bowel preparation by further reducing the endogenous bacterial inoculum at the time of transection of the colon.


Periorbital ultrasound findings. Hemodynamics in patients with cerebral vascular disease.

The direction of supraorbital and frontal artery flow and its response to compression of the superficial temporal, facial, and angular arteries were measured in 250 carotid arteries in 114 patients. All patients had arch and/or selective carotid arteriography. The carotid arteries were placed into the following three groups: hemodynamically normal, greater than 60% occlusion of the internal carotid artery, and total occlusion of the internal carotid artery. The test's accuracy was 94.5% in the hemodynamically normal group, 68.8% in the totally occluded group, and only 51.4% in the group with hemodynamically significant stenosis. Although the carotid Doppler examination is not reliable in detecting hemodynamically significant lesions of the internal carotid artery, it is valuable in assessing the adequacy of collateral cerebral circulation.


Diagnosis and surgical treatment of colonic endometriosis.

Endometriosis is sufficiently common that it should always be considered in the differential diagnosis of colon lesions of women of childbearing age. Seven selected cases illustrate problems in diagnosis and management of endometriosis of the colon. Characteristic of colon endometriosis are large bowel symptoms frequently associated with gynecologic complaints, usual sigmoid and rectosigmoid location, extramucosal radiologic appearance, and difficult diagnosis by endoscopic biopsy. Suspicion of malignancy and presence of a symptomatic colon lesion are indications for bowel resection, which is an effective form of therapy.


Transduodenal sphincteroplasty.

We report on the results of elective sphincteroplasty for benign stenosis of the sphincter of Oddi in a prospective study of 32 consecutive cases. All patients underwent combined supraduodenal exploration of the common bile duct and transduodenal sphincteroplasty. All patients were followed up clinically and biochemically for from one to four years. Seventeen patients underwent a barium meal examination a year after surgery and of these patients, ten showed retrograde filling of the common bile duct and four had air in it. The intrabiliary pressures in six patients were abnormal, ranging from 210 to 230 mm H2O (normal, 80 to 130) intraoperatively before the exploration of the common bile duct, but were found to be normal after the sphincteroplasty. The mortality was 0% and no serious complications were observed.


Risk assessment of pulmonary embolism by multivariate analysis.

A prospective study of 6,527 hospitalized patients was performed to evaluate the effectiveness of multivariate analysis of risk factors to correctly designate risk for pulmonary embolism. History of previous pulmonary embolism was the single most important factor. In patients without prior history, five factors emerged: inactivity, congestive heart failure, Doppler ultrasound evidence of deep-vein occlusion, female sex, and black race. Used together, these factors permitted a discrimination of risk such that 68.7% of pulmonary embolization was found to occur in 32.2% of the population designated as showing increased risk. Multivariate analysis of clinical factors improved assessment of risk, compared to the use of lower extremity findings alone, and proved to be useful in identifying individuals at increased risk for pulmonary embolism.


Late appearance of intra-abdominal abscesses after total colectomy for inflammatory bowel disease.

Intra-abdominal abscesses after colon surgery usually appear within eight weeks. Over the past few years, we have observed nine patients who underwent colectomy for inflammatory bowel disease in whom large and relatively asymptomatic abscesses developed, requiring surgical drainage as long as three to five years after the operation. In five patients, there was no report of intraoperative complications such as perforation or fecal spillage. At the time of discharge from the hospital, all patients were afebrile. In three of these patients, abscesses were discovered when they were readmitted to the hospital for elective abdominal procedures; most of the others had localized abdominal pain.


Presplenectomy transcatheter occlusion of the splenic artery.

Transcatheter splenic artery occlusion can be performed rapidly and safely prior to splenectomy. This procedure reduces splenic bulk and decreases intraoperative bleeding. Patients not operated on after transcatheter splenic artery occlusion have had high mortality, and therefore the procedure should probably not be considered unless splenectomy is contemplated. An illustrative case is reported.


Meckel's diverticulum of the proximal jejunum.

There are no well-substantiated reports, to our knowledge of a Meckel's diverticulum arising outside the limits of the terminal ileum. We saw a diverticulum located in the proximal jejunum that fulfilled the anatomic and histologic criteria for the diagnosis of a Meckel's diverticulum. This was an incidental finding during the treatment of a sliding esophageal hiatus hernia and caused no apparent difficulty to the patient.


Portalization of venous blood of kidneys and adrenal glands. Effect in experimental vasorenal hypertension.

The study concerns the effect of angiotensin II when infused into the systemic and portal blood flow on the general and renal hemodynamics in normal dogs and in hypertensive dogs, as well as the effect of the operation of portacaval transposition (PCT) on the course of renovascular hypertension. When peptide is infused at a rate that causes a moderate pressor effect into the systemic blood flow of normal dogs, an antidiuretic and antinatriuretic effect is obtained, whereas in hypertensive dogs an increase of diuresis, natriuresis, and a less distinct pressor effect are obtained. When angiotensin II is infused into the portal flow, a less distinct pressor and renal effect is seen in dogs with renovascular hypertension. The operation of PCT of the vessels results in a hypotensive effect in the dogs with renovascular hypertension.


The biology of human malignant melanoma. Preliminary findings in the nude mouse.

The nude mouse model was explored as a means of predicting the behavior of human cutaneous malignant melanoma. Subcutaneous implants from 20 patients were observed for external growth, microscopic appearance, and autoradiographic analyses following tritiated thymidine labeling. Normal epithelial and dermal components were maintained in the six low-risk primary implants, but none had any external growth or tumor cell preservation. Four of the five metastatic implants grew throughout the observation periods, with 30% of the counted tumor cells taking up the radioisotope. There was a slower growth rate in four of nine high-risk primary implants, with tumor cell preservation in eight. Only 6% of the counted tumor cells incorporated tritiated thymidine. This model appears to be capable of discriminating among the behavior of various forms of human malignant melanoma.


Further studies on a vaccinia virus cytotoxin present in infected cell extracts: identification as surface tubule monomer and possible mode of action.

A vaccinia virus-specific cytotoxic protein (3--10 X 10(4) daltons) had previously been detected in extracts of infected HeLa cells. In this study the protein has been shown to be a late gene product and a virion component--almost certainly the monomer of the surface tubules of the vaccinia virion. The relationship of this cytotoxin to a number of early vaccinia-induced cytopathic effects was examined: it was not the mediator of vaccinia-induced early cell rounding, did not inhibit protein or RNA synthesis in cell-free systems or intact cells (after uptake-induction by hypertonic MgSO4), or cause the release of beta-glucuronidase from a crude preparation of HeLa cell lysosomes. Its possible role in vaccinia-induced cell degeneration, late in infection, is discussed.


Serum interferon assay as a possible test for virus infections of man.

Acute phase serum gave positive results in an interferon assay when collected from 17 out of 45 (38 per cent) patients with proven virus infection, and from none of 43 patients with other disease and none of 61 healthy subjects. Sera from 11 of 43 (26 per cent) patients with suspected virus infection were also positive. Interferon was detected in the sera of volunteers infected with respiratory viruses in strict isolation. It is suggested that the test might be used to supplement conventional tests for virus infections, and with modification may provide a useful diagnostic aid.


Interaction in replication between goose parvovirus strain B and duck plague herpesvirus.

The goose parvovirus strain B was found to replicate only in cells with DNA synthesis. Cells in the stationary phase of DNA synthesis or maintained under 2 mM thymidine (TdR) in excess were refractive to the parvovirus infection. However, stationary phase cells could be rendered to produce progeny paroviruses by herpesvirus superinfection. In reverse, the replication of the herpesvirus was significantly inhibited by parvovirus preinfection of cells.


[Types of cell differentiation in colonic and rectal adenocarcinoma].

The Normal mucous membrane and tumours of the large intestine and the rectum were studied electron microscopically. Five known cell types were found in normal intestinal mucosa: intestinal epitheliocyte with striated border, goblet enterocyte, intestinal argentaffinocyte, enterocyte with acidofilic granules, borderless enterocyte. Adenocarcinoma cells differentiate in the direction of 3 cell types: intestinal epitheliocytes, goblet enterocytes, and borderless enterocytes. The level of differentiation in different cells varies considerably.


[Differential diagnosis of epithelial thymoma and seminoma (histological and electron-microscopic study)].

The paper describes two observations of thymus gland tumours: epithelial thymoma and seminoma. Differential diagnosis of these tumours is very important for the proper selection of the method of treatment as seminoma is more radio-sensitive than epithelial thymoma. Epithelial thymoma is characterized by coarse-fiber stroma, perivascular grouping of cell elements and the lack of glycogen in them. Seminoma consists of light and dark cells containing much glycogen in their cytoplasm. Differences between these tumours are most clearly seen in electron microscopic studies. In epithelial thymoma cells have processes, numerous tonofilaments, desmosomes, and basal membrane. Seminoma cells contain glycogen, no tonofilaments or basal membrane, few desmosomes.


[Malignant tumors of lymphatic vessels in children].

Lymphangiosarcomas were found in 5 out of 82 observations of vascular malignant tumours in children, according to the data of the pathological department of Children's Clinical Hospital No. 1, for 60 years. Differential diagnosis of relapsing lymphangiomas and rarely found malignant lymphangioendetheliomas presents considerable difficulties for morphologists because of poorly manifest cell polymorphism in the primary node of neoplasia and the presence of areas of lymphangioma and malignant hemangioendothelioma among fields of lymphangiosarcoma. Cytological studies assist in specification of the degree of malignancy and histologenesis of the neoplasias.


[Clinical morphology of early breast cancer].

True early forms of mammary cancer include tumours undetectable in routine clinical examinations and histologically presenting intraductal and lobular cancer (cancer in situ and with beginning invasion) in the absence of metastases. Parallel histological and cytological examinations and cytospectrophotometric determination of the DNA content increase the validity of the differential diagnosis between benign displasias and carcinoma in situ. Stages of composite clinico-roentgenilogical and morphological diagnosis of early mammary cancer have been developed. Two mammographic signs: accumulations of finest calcinates and filamentous tumour node less than 10 mm in diameter, permit to diagnose clinically latent cancer which has two forms of growth, diffuse and nodular. The diffuse form in some cases presents a stage preceeding the nodular form.


[Morphological changes in the lung blood vessels in diabetes mellitus].

Examinations of the lung vessels in diabetes of various degrees of severity and duration revealed changes in the vessels similar to diabetic microangiopathy in other organs (kidneys, skin). Manifestations of diabetic microangiopathy in the lungs are most marked in arterioles and capillaries of the alveolar septae. Diabetic microangiopathy in the lungs is characterized by phenomena of plasmorrhagy and insudation, thickening of capillary basal membranes, sclerosis and hyalinosis of capillary and arteriola walls, and accumulation of alveolar macrophages resorbing metabolism products in alveolar lumen. Diabetic microangiopathy leads to the development of alveolar septae sclerosis and to centrilobular pulmonary emphysema. As compared with the involvement of the vessels in the kidneys and the skin, manifestations of diabetic microangiopathy in the lungs lag in their development and are less manifest.


[Morphogenesis of experimental emphysema induced by different circulation disorders in the lungs].

Pulmonary emphysema was reproduced in 126 rabbits by disorders of circulation in the pulmonary artery system with the development of pre- and postcapillary hypertension and hypovolemia of pulmonary circulation. Under conditions of pulmonary circulation hypertension changes in the lungs initially are of the compensatory-hypertrophic nature: hyperplasia and distention of capillaries, myoelastosis of respiratory bronchioles and closing plates of alveoli, hypertrophy of the muscle wall of arteries and veins. At later intervals (4--12 months), processes of atrophy, sclerosis and inflation develop in the lungs; changes in the lungs acquire the nature of emphysema. Anemia, parenchymal atrophy, sclerosis and inflation develop in the lungs due to a considerable reduction of circulation.


[Planning the pathological departments of modern large clinics].

With the increasing importance of pathomorphological research as an integral element of optimization of therapeutic-diagnostic service of a modern hospital, it is important to improve the structure and technical basis of the pathology departments. The experience of pathological service and the analysis of projects of pathology departments included in the current type projects of clinical and other hospitals reveal some unsatisfactory features in architectural planning and in medico-technological aspects. This handicaps the improvement of the pathological service as an element of medical service and the subject of teaching. Recommendations on these problems are presented.


[Electron-cytochemical method of DNA detection with the aid of ammonia silver].

Three prescriptions for the detection of aldehyde groups of deoxyribose with ammoniac silver are proposed. The reaction can be carried out on tissue blocks or imprints; it is useful for DNA identification in the light and electron microscope, gives high contrast and allows to reveal DNA in structures with a relatively low content of DNA, for instance, in nucleoi. The disadvantages of the method include a possibility of nonspecific reduction of silver if the reaction is performed on a plastic-embedded material and damage of ultrastructures if the reaction is done prior to embedding.


[Relationship of focal lesions in the myocardium to coronary arteriosclerosis in sudden death].

Hearts of 12 patients with ischemic heart disease at the age of 42--60 years who had died suddenly were examined. The control consisted of 6 autopsy observations of violent death. A strong positive correlation between the degree of coronary arteries stenosis and the size of focal myocardial lesions was revealed in ischemic heart disease. No similar regularities were found in the controls. The size of myocardial lesions in the control group was minimal.


[Effect of physical overloads on the state of the cardiomyocytes in experimental autoimmune cardiomyopathy].

Morphology and energetic processes in the myocardium of rats suffering from autoimmune cardiomyopathy, and their changes under the influence of physical load were studied. Chronic cardiac insufficiency in autoimmune cardiomyopathy is explained by a decreased level of adenosin triphosphate (ATP) and creatinphosphate (CP), death of some cardiomyocytes, atrophy of contractile myofilaments in the working cells and disorders at the level of micro circulation bed. Physical load resulted in the appearance of ultrastructural signs of acute cardiac insufficiency without significant changes in the initial low content of ATP and CP, but with a high total creatinphosphokinase activity. Such a reaction of cardiomyocytes of the heart to physical load in autoimmune cardiomyopathy is due to the disorders in the process of energy transportation at the level of mitochondrial crystae.


[Abramov-Fiedler myocarditis, the most severe variant of infectious allergic myocarditis in infants].

Seven cases of Abramov-Fidler myocarditis in infants were studied. The heart affection may be considered to be an infectious-allergic process occuring in a presensitized host. The severity of the disease is due to necrotic changes in the myocardium, in some cases to the involvement of the endocardium and pericardium.


[Structure of the alveolar wall in obstructive pulmonary atelectasis in children].

The results of light and electron microscopy and morphometric studies of the alveolar wall in obstructive atelectasis in children with chronic nonspecific lung diseases (materials of 40 biopsies) are presented. Morphological changes in obstructive atelectases of various durations are described. Fresh atelectasis was shown to be characterized mostly by discirculatory and dystrophic changes. In atelectasis of a long duration, inflammatory reactions developed and, besides, regeneration-proliferation processes were activated which in children were manifested mainly by an increase in the number of large alveolar cells and, to a lesser extent, some increase in sclerotic changes. The release of osmiophilic lamellated corpuscules of large alveolar cells was disturbed, which was one of the factors conducive to the lack of a surfactant.


[Changes in the thyroid gland in Itsenko-Cushing's disease and corticosteroma].

Histological and ultrastructural examinations and stereological analysis of the thyroid gland of 16 patients with Itsenko--Cushing disease and corticosteroma with glucocorticoid hyperproduction showed signs of a decrease in its functional activity. An increase in the colloid mass in follicles was accompanied by its irregular staining, flattening of the epithelium, lipomatosis of the stroma and ultrastructural signs of low activity of thyreocytes. The assumption of a spherical shape of the follicles was shown to be unjustified. The accurate quantitative evaluation of the structural changes in the thyroid gland requires information on the spacial organization of its components and shape of individual follicles.


[Chronic pancreatitis from histo- and cytological study data].

Biopsies of pancreatic tissue in 54 patients with chronic pancreatitis were studied histologically and electron microscopically. Pathomorphological criteria of this disease include: dyscomplexation of acini, necroses, hemorrhages, inflammatory reaction, pseudocystosis, lipomatosis, condensation of secretory masses, and formation of concrements, hyperplasia, metaplasia, and increased desquamation of ductular epithelium, hyperplasia of Langerhans islands, damage of the vessels and perineural spaces, fibrosis. The increased permeability of ductal epithelium, increased synthesis of protein substances, formation of concrements and specific antibody are conducive to exacerbation of chronic pancreatitis.


[Morphogenesis of fibromuscular dysplasia of the renal arteries (an ultrastructural study)].

Ultrastructural examinations of 32 cases of various forms of fibrousmuscular dysplasia (FMD) of renal arteries showed the lesions at the subcellular level to be identical in all these forms and to differ only in their intensity and localization. As the disease progresses, smooth muscle cells (SMC) show signs of activation accompanied by an increased collagen synthesis. In this, the cells exhibit large multiblade nuclei, intensive proliferation of the granular endoplasmic reticulum, hypertrophy of the Golgi complex. In cases of intensive fibrous changes, occasional fibroblasts appear in the arterial media. As collagen accumulates in intercellular spaces, signs of involution of various degrees are found in SMC. The number of elastic fibers in the media of the affected arteries decreases markedly as compared with the control. The inner elastic membrane of the arteries is frequently destroyed, particularly in the intimal form of the lesions. The study suggests that all forms of FMD represent a single process in the morphogenesis of which the leading role is played by fibroblast-like transformation of SMC.


[Generalized sarcoidosis with a predominant lesion of the myocardium].

Materials on heart sarcoidosis are presented on the basis of the literature analysis, morphological and electron microscopical examination of an autopsy observation. Heart sarcoidosis is characterized morphologically by granulomatous myocarditis with diffuse infiltration with lymphoid and macrophage cells, and marked destructive changes in muscle fibers. A damaging effect of the infiltrate cells on cardiomyocytes is shown.


[Hamman-Rich syndrome].

An observation of Hamman-Rich syndrome in a man of 47 with an acute, rapidly progressive course due to an immunoconflict situation in the lungs is presented. This situation is characterized by marked changes of the microcirculatory bed of interalveolar septae, with increased permeability, productive-desquamative alveolitis and formation of hyalin membranes, lymphoid-macrophage cell reaction of diffuse fibrosis. The peculiar features of this case include not only the involvement of the lungs but also the occurrence of generalized productive vasculitis with the involvement of the myocardium and the kidneys which, alongside with considerable immune alterations in the spleen and lymph nodes, confirm the hypothesis of the systemic autoaggression nature of this disease.


[Nodular fibrohistiocytosis of the stomach].

The paper described 11 observations of peculiar nodulous formations of the stomach localized in the submucous layer and usually ulcerated. They consist of the connective tissue stroma with abundance of vessels in which polymorph cells of the immune system are deposited and there is an abundant eosinophilic infiltration. The structure of the formation resembles gradually fibrosing granulations. The process goes in waves. In some cases, lesions typical of the scarry tissue at the site of chronic ulcer were observed in the adjacent submucous layer and sometimes in the external muscle layer of the stomach. It is suggested that the described formation is associated with the healed ulcer, possibly under special conditions of the immune system stimulation. The morphological essence of the process is most completely described by the term "fibrohistiocytosis with tissue eosinophilia".


[Adrenal cortex in experimental carcinogenesis of the intestine].

Morphological and histochemical examinations of the adrenal cortex of 150 rats with intestinal carcinogenesis caused by 1,2-dimethylhydrasine, and comparison of the results with control results in 20 intact rats showed the latent period to occur against the background of atrophic changes in the cortical matter consisting in a decrease in the adrenal weight, narrowing of the cortical matter, decreasing diameter of the secretory cells nuclei, accumulation of lipids and cholesterol in zona fasciculata and zona reticulosa, and decreased content of ascorbic acid. In contrast, the period of tumour growth within the intestinal mucosa coincides with hypertrophic changes in the adrenal cortex. In extensive cancer, the intensity of these hypertrophic changes increased, and dystrophically changed cells and micronecroses appeared.


[Ultrastructural analysis of the morphological changes in the lungs and heart in experimental thermal burns of the skin].

The experimental results showed that in severe thermal burns of the skin marked disorders of microcirculation in all parts of the tissue in the lungs and myocardium or rabbits, disorders in permeability of capillary and cell membranes, increased diffusion and filtration processes developed. Alongside with these processes, dystrophic changes of some organoids were observed in cells. Most of these changes were reversible which was conducive to subsequent restoration of the ultrastructure of the affected cells as a result of intracellular compensatory processes.


[Histoautoradiographic study of the heart in experimental myocardial ischemia].

Autoradiographic examinations of the heart muscle in experimental myocardial necroses using 3H-thymidine, revealed a high DNA synthesis in the connective tissue cells in the zone of necrosis in the acute period of infarction and its subsequent decrease. Deviations from this regularity were observed when relapses of necrosis developed. The activation of DNA synthesis occurred to a lesser extent in stromal cells of the periinfarction and remote zones of the heart. Muscle cells incorporated 3H-thymidine extremely rarely. When myocardial infarction was combined with aterosclerosis, relapses of necrosis occurred frequently, and morphological changes in many arteries and veins were accompanied by 3H-thymidine incorporation into the nuclei of the endothelium, smooth cells and adventitial cells. Inhibition of DNA synthesis in connective tissue cells of various heart zones was observed in cases of combined myocardial infarction and aterosclerosis and hypertension.


[Characteristics of the rat heart in experimental atheroclerosis].

The morphological picture of the myocardium of white rats after administration of cholesterol, cholic acid, and vitamin D2 was studied. After four weeks of atherogenic diet the hearts of rats showed severe lesions of intramural vessels in addition to disseminated necroses, granulomatous cell reaction of the stroma which was sometimes of the giant cell nature, and connective tissue proliferation. Non-uniform hypertrophy of the endothelium, edema and defibrilation of the media, proliferation of young connective tissue cells, outgrowth of reticular and collagen fibers, and deposition of calcium salts in the entire thickness of the vessel wall were observed, as well as destruction of the inner elastic membrane and its substitution with newly formed fibers and membranes. These changes may be associated with the toxic effect and sensitizing properties of vitamin D2 which was a component of the atherogenic diet used.


[Embolisms in punctures and catheterization of the subclavian veins in young children].

Observations of thrombic and tissue (skin, muscle) embolism of small branches of the pulmonary artery in two infants of 2 1/2 months suffering from acute respiratory viral diseases and a child of 3 1/2 years who died of scarlet fever are presented. Complications of this kind due to insufficient observations of the rules of puncture and catheterization of central veins, particularly in young infants, are not infrequent. In some cases, they may aggravate the course of the main disease.


[Intrauterine candidiasis of the brain].

Clinical data and morphological pictures of two cases of intrauterine affection of the brain with fungi of the genus Candida are presented. Tissue reactions in the brain were of productive inflammation nature and were accompanied by calcium deposition, focal hemorrhages, and the development of pseudoporencephalia. Changes in resistance of the baby occurred as indicated by hyperplasia of the lymphoid apparatus and the occurrence of nonspecific inflammation in other organs. When calcifications are found in the brains of newborn babies, it is recommended that proper examinations be done to exclude intrauterine mycosis.


[Chronic gastritis and cancer of the stomach].

The paper analyses interrelationships between chronic gastritis and carcinoma of the stomach. It has been recognized that various forms of chronic gastritis preceed carcinoma of the stomach. The source of the carcinoma origin is the epithelium of the gastric pit, intestinal and mixed epithelium. The nearest precursors of the carcinoma are foci of dysplasia of the epithelium developing in pits, intestinal cryptae and mixed glands. Proceeding from the regular emergence of the stomach carcinoma against the background of chromic gastritis, features of carcinogenesis in the stomach, and morphogenesis of chronic gastritis, the authors substantiate the pathogenetic connection between chronic gastritis and carcinoma of the stomach. Secondary changes in the gastric system have been found to develop in the III--IV stages of carcinoma. The main morphological features of carcinoma of the stomach of different histogenesis are characterized.


Influence of rehabilitation on language skills in aphasic patients. A controlled study.

The influence of language rehabilitation on specific language skills (speaking, understanding, writing, and reading) was investigated in 281 aphasic patients (162 reeducated and 119 controls) who were subjected to a second examination no less than six months after the first. The relationship of the following factors to improvement was studied: (a) time between onset of aphasia and first examination; (b) type of aphasia; (c) overall severity of aphasia on first examination; (d) presence or absence of rehabilitation between first and subsequent examination. It was found that rehabilitation has a significant positive effect on improvement in all language skills. Time between onset and first examination and overall severity of aphasia were negatively related to improvement. The relationship of type of asphasia to improvement was not significant. Additional evidence of the efficacy of rehabilitation is provided by experience with patients who began language therapy several months or years after the onset of their language disorder.


Temporal gradients in the retrograde amnesia of patients with alcoholic Korsakoff's disease.

Eleven alcoholic patients with Korsakoff's disease and 15 control subjects were given three tests of retrograde amnesia. The first consisted of photographs of famous faces from the past, the second was a recall test of famous people and events, and the third was a multiple-choice questionnaire. To determine whether previously reported temporal gradients (ie, preservation of remote events) were related to item difficulty, half of the questions dealt with events of transient fame while half concerned subjects that continued to receive public attention for many years. The findings indicate that alcoholic patients with Korsakoff's disease have a marked retrograde amnesia that is characterized by a steep temporal gradient, and that this gradient is not an artifact due to the difficulty of the questions or the method of testing.


Endocrinologic regulation of carbohydrate metabolism. Amyotrophic lateral sclerosis and Parkinsonism-dementia on Guam.

Studies of the endocrinologic control of carbohydrate metabolism were conducted in Guamanians with parkinsonism-dementia (PD) or amyotrophic lateral sclerosis (ALS) and in Guamanian control patients who had various other neuromuscular disorders. Intravenously infused arginine tended to produce a more prolonged elevation in serum glucose levels in PD and ALS patients than in control subjects. On the other hand, the serum insulin response to arginine was significantly less in both PD and ALS patients than in controls. Arginine stimulated the release of growth hormone to a similar degree in all three patient groups. These observations support and extend previous reports of endocrinologic abnormalities in parkinsonism and ALS and might suggest that a defect in pancreatic islet cell function attends these disorders.


Aphasia resulting from occlusion of the left anterior cerebral artery. Report of a case with an old infarct in the left Rolandic region.

A 62-year-old right-handed woman was admitted to the hospital with a cerebrovascular accident in the left hemisphere. She was aphasic as well as hemiplegic on the right. She had had a left cerebrovascular accident 18 years earlier that caused weakness in the right hand, but no grossly detectable speech problems. Autopsy disclosed an old infarct along the left Rolandic area, and a recent infarct in the territory of the left anterior cerebral artery. The clinical picture and pathologic changes are discussed in an attempt to relate the findings at autopsy to the recently developed aphasia.


Alpha-pattern coma in a 2-year-old child.

An EEG of a two-year-old child with Reye's syndrome complicated by prolonged hypoglycemia showed continuous, diffusely distributed, 8- to 9-Hz, well-modulated alpha activity while the patient was comatose. Continuous monitoring of EEG showed gradual reduction of alpha activity and the appearance of moderate-amplitude delta waves within the next 18 hours. Subsequent EEGs showed electrocerebral silence. The EEG features and their evolution resembled those described in postanoxic "alpha-pattern coma" in adults. A diffuse cortical-subcortical insult, possibly due to hypoglycemia, may be responsible for the generation of diffuse alpha activity in our case. Because of its transient nature, immediate and serial EEG studies following the acute cerebral insult may be necessary to demonstrate this pattern in children.


Leukomalacia with ruptured saccular aneurysm.

A 42-year-old woman with a ruptured saccular aneurysm of the internal carotid artery developed large areas of cerebral leukomalacia, resulting in hemiparesis and an obtunded mental state. A significant factor in the development of the white matter lesions was episodic hypotension, leading to reduced cerebral blood flow in a patient whose cerebral circulation was already compromised by vasospasm secondary to the subarachnoid hemorrhage. This case illustrates yet another clinical situation associated with the development of white matter necrosis.


The resolving stroke and aphasia. A case study with computerized tomography.

A 39-year-old man suffered an intracerebral hemorrhage in the region of the left internal capsule deep to Wernicke's area. The location of the lesion was confirmed by computerized tomography (CT) performed two days postictally. Two weeks after admission, the Boston Diagnostic Aphasia Examination (BDAE) diclosed Wernicke's aphasia. We hypothesize that the hematoma exerted pressure on Wernicke's cortical area, thus causing the resulting Wernicke's aphasia at that time. A CT scan three months later showed absorption of the hematoma, with a residual low-density lesion deep to Wernicke's area, in the region of the arcuate fasciculus. At that time, BDAE testing disclosed a mild conduction aphasia. Serial CT scanning combined with discriminating clinical evaluation of aphasia provides a valuable opportunity for study of the processes underlying stroke resolution and aphasia.


Peripheral nerve involvement in familial spastic paraplegia.

A sural nerve biopsy specimen was obtained from a 16-year-old girl affected by a clinically uncomplicated form of familial spastic paraplegia. The electron microscopic study evidenced degenerative changes in some large myelinated fibers. Onion bulb formations and clusters of small myelinated fibers were also observed. Quantitative determinations showed a decreased density of the large myelinated fibers and a mild decrease in the percentage of the endoneural area covered by the myelinated fibers. The unmyelinated fibers were uninvolved except for their participation in onion bulb formations.


The anterior spinal artery collateral in coarctation of the aorta. A clinical angiographic correlation.

A 10-year-old boy had acute flaccid paraparesis with sensory deficits. Attention was drawn to his hitherto asymptomatic coarctation of the aorta. Aniography defined the extent of the dilated anterior spinal artery, and reversal of the flow pattern. The residual deficits consisted of minimal impairment of long motor and lateral sensory tract functions in a unilateral fashion, suggesting a steal syndrome with transient ischemia to the spinal cord. Recovery preceded surgical correction of the coarctation.


Hemiparkinsonism. A human model for studying dopaminergic supersensitivity.

The observation of a patient suffering from a parkinsonian syndrome, almost entirely expressed on the right side, and "on-off" attacks with rotatory movement of the trunk, led us to consider that the rotational model of animals may be reproduced in man. The symptoms presented by our patient may reflect a predominant degeneration in the nigrostriatal pathway of the left side. We suggest that his torsion behavior is due to hypersensitivity phenomenon of the dopaminergic receptors on this side.


Four risk factors for severe visual loss in diabetic retinopathy. The third report from the Diabetic Retinopathy Study. The Diabetic Retinopathy Study Research Group.

The Diabetic Retinopathy Study (DRS) Research Group has so far identified four retinopathy factors that increase the two-year risk of developing severe visual loss. The risk grows as the number of risk factors increases. Eyes with three or more risk factors (eyes with "high-risk characteristics") are at a much higher risk than eyes with two or fewer factors. The DRS protocol was changed in 1976 to require consideration of treatment for these "high-risk" eyes.


Attachment of bacteria to soft contact lenses.

A total of 25 soft contact lenses from 17 asymptomatic contact lens wearers and eight patients with contact lens-associated giant papillary conjunctivitis were examined by scanning electron microscopy. Structures that resembled bacteria were present on the anterior surface of seven lenses. All lenses showed a coating of granular mucus-like deposits. Some bacteria were seen scattered randomly over the surface, with no apparent attachment to the lens, whereas others were attached to the coated surface by thin, flagella-like foot processes, the distal ends of which were unattached. These attached bacteria were cylindrical in shape. Several bacteria showed a constriction centrally. Some bacteria were covered by the surface coating, while others, which were round to ovoid in shape, appeared partially embedded in the coating itself. Aggregations of bacteria were seen around clumps of mucus-like debris.


Orbicularis fatigue: the 'peek' sign of myasthenia gravis.

Three patients with myasthenia gravis demonstrated a distinctive sign of orbicularis fatigue. After momentary opposition on gentle sustained lid closure, the lid margins separated, resulting in widening of the palpebral fissure and scleral exposure. The patient thus appeared to "peek" at the examiner. The "peek" sign was not observed in 200 control patients and in 49 of 50 patients with facial weakness secondary to a spectrum of neuromuscular disorders. Three of 25 patients with myasthenia gravis displayed this sign, and in one patient it was the major diagnostic finding. The presence of the "peek" sign suggests the diagnosis of myasthenia gravis.


Autosomal dominant dystrophy of the retinal pigment epithelium.

This study describes a salt-and-pepper fundus appearance in nine relatives in three generations of a single white kindred. Two of these patients also had subretinal patterned pigment figures by ophthalmoscopy. In another, fluorescein angiography showed a reticular pattern that was not apparent by ophthalmoscopy. This dystrophy was functionally benign, although the electro-oculogram ratio was abnormal in affected patients. This pigmentary dystrophy and fundus pulverulentus, reticular dystrophy of Benedikt and Werner, and pattern dystrophy of Marmor and Byers are indistinguishable. When patterned pigment figures are absent, this autosomal-dominant pigmentary dystrophy of the retinal pigment epithelium can be confused with other disorders such as congenital rubella retinopathy and drug toxicity.


Acuity profile perimetry: description of technique and preliminary clinical trials.

Acuity profile perimetry is a technique that allows visual acuity properties to be rapidly measured at any location in the visual field. This report describes our initial clinical trials with acuity profile perimetry, as performed in combination with standard static perimetry. Preliminary results from patients with cataracts, amblyopia, and central serous retinopathy show, in general, a much greater deficit for acuity profiles than for static sensitivity profiles. In contrast, patients with optic neuritis or other optic neuropathies display approximately equivalent losses for static and acuity profiles. The recovery process in optic neuritis is also about equal for the two functions. Our initial findings suggest that acuity profile perimetry may be a valuable differential diagnostic test, particularly for cases in which optic nerve disease is suspected.


Malignant teratoid medulloepithelioma in an adult.

A malignant teratoid medulloepithelioma (ME) first became symptomatic in a 41-year-old woman. Her eye was enucleated for advanced glaucoma when the patient was aged 43 years, making her the oldest patient known to have had this tumor. The tumor showed little epitheliomatous differentiation, but a large rhabdomyoblastic component and nodules of cartilage. It had extended over the retina, creating a change in macular reflex as an early clinical sign, and eventually produced large retinal contraction folds. The lens was invaded by tumor, and an active phakoanaphylactic uveitis was in progress. Three of the four MEs recognized in adults have been malignant.


Regression of iris neovascularization following panretinal photocoagulation.

A 57-year-old woman with proliferative diabetic retinopathy in both eyes also had iris surface neovascularization with early angle neovascularization in her right eye, which regressed completely following treatment with panretinal photocoagulation. Histopathologic examination confirmed the complete absence of abnormal vessels on the iris surface or in the iridocorneal angle of the right eye; an avascular fibrous membrane persisted on a segment of the posterior iris pigment epithelium near the pupil. There was advanced rubeosis in the untreated left eye.


Fibromatous tumor (desmoid type) of the orbit.

A case of a desmoid tumor originally appeared as an orbital mass lesion in a 63-year-old woman. This is a most unusual location for this tumor and, to our knowledge, only one previous case of this type has been reported in the ophthalmic literature.


The role of Whitnall's ligament in ptosis surgery.

Whitnall's ligament has been described functionally as a check ligament of the levator. Our anatomic dissections and operative findings indicate that this ligament is primarily a support for the upper eyelid and superior orbit. Whitnall's ligament is frequently confused with the levator horns and is unfortunately cut during many ptosis procedures. This is to be avoided because much larger levator resections are required when this ligament's support to the upper lid and the fulcrum effect for the levator are lost. Preserving and enhancing the function of Whitnall's ligament improves the efficiency of the levator, making large levator resections rarely necessary. We have noted no more lid lag than that seen with other forms of levator surgery.


An elastic pouch operation for large retinal tears.

An episcleral pouch operation that uses Dacron-reinforced silicone sheeting for the patch and silicone sponge pellets for the stuffing has been used to extend the localized radial buckling technique to retinal detachments that are caused by breaks that span a circumferential arc between 40 degrees and 70 degrees. Nineteen of 20 retinal detachments responded favorably to the operation, 14 without drainage of subretinal fluid. When the pouch was extended circumferentially to apply to detachments caused by breaks greater than 70 degrees, it failed in six of seven patients because a radial configuration could no longer be maintained. The substitution of transparent silicone sheeting for donor sclera facilitates the fitting and stuffing of the pouch.


Cryotherapy for experimental Pseudomonas keratitis.

The effectiveness of cryotherapy alone and in combination with topical tobramycin sulfate therapy for experimental Pseudomonas keratitis was determined in guinea pigs and rabbits. Results were evaluated quantitatively by determining numbers of viable bacteria surviving in corneas. A brass probe cooled to--79 degrees C and applied directly to infected corneas for six seconds resulted in an immediate 99.9% reduction in bacteria. One freeze-thaw cycle followed by topical tobramycin therapy was significantly more effective than tobramycin therapy alone in five of six strains tested. None of the corneas treated with tobramycin alone demonstrated no growth, whereas 24 of 42 of these infected corneas showed no growth after the combination treatment. We conclude that cryotherapy alone had a rapid bactericdal effect on experimental Pseudomonas keratitis and that it significantly potentiated topical antibiotic therapy for most strains.


The position of the posterior chamber intraocular lens.

Six human cadaver eyes were used for intraocular lens (Shearing) insertion, and the results were photographed. It was found that with the posterior capsule intact, insertion was relatively simple and the feet were found to lie in the ciliary body sulcus with good fixation. Some decentering was common and difficult to correct, but not optically important. With the posterior capsule torn or missing, misplacement was common. After correct insertion, the lens was well fixated without pseudophakodonesis, and there was still found to be room for an additional 1.5 to 2.0 mm of movement.


Combined amphotericin B and rifampin treatment of experimental Candida albicans keratitis.

In a model of experimental Candida albicans keratitis in rabbits, treatment with a combination of amphotericin B and rifampin was compared with treatment with amphotericin B alone. Both modes of therapy substantially reduced the number of organisms in the cornea below the number in untreated control corneas. In the group treated with combined therapy, there were significantly fewer organisms in the cornea after three days of therapy than in the group treated with amphotericin B alone. The results of this study indicate that the treatment of C albicans keratitis in rabbits with combined amphotericin B and rifampin is more effective than treatment with amphotericin B alone.


Ocular effects in normal rabbits of topically applied labetalol: a combined alpha- and beta-adrenergic antagonist.

The ocular effects in rabbits of topically applied labetalol hydrochloride, a new alpha- and beta-adrenergic receptor blocking agent, were studied. A dose-related reduction in intraocular pressure (IOP) followed treatment with 0.01% to 1% solutions. Labetalol at a 1% concentration had no effect on pupil diameter. The same dose blocked an increase in IOP after water loading but did not significantly alter the coefficient of aqueous outflow facility. Mydriasis induced by phenylephrine hydrochloride was competitively inhibited.


The morphology of human conjunctival mucus.

Normal human conjuctival mucus was examined by permeable membrane filter (Millipore) surface biopsy and instillation of India ink. It exists in solution in the tear film, as clusters of granules, as granular sheets, and as strands, the latter often arranged as a network. This mucus network entraps exfoliated epithelial cells, miscellaneous surface debris, carbon particles (from the India ink) and bacteria, and stains positively for lipid. Blinking causes both collapse of this mucus network into a single strand and movement of this strand to the medial canthus, where it compacts and is pushed onto the skin surface. There it dries and either falls off or is removed by rubbing. It is suggested that the formation and collapse of this mucus network represents a system for removing exfoliated surface cells and debris, infection and foreign particles, and lipid-contaminated mucus from the surface of the normal eye.


Experimental double-perforating injury of the posterior segment in rabbit eyes: the natural history of intraocular proliferation.

A reproducible model of double perforating injury of the posterior segment of the rabbit eye was developed. Immediately after injury, a viterous condensation was visible between wounds. The scleral exit wound was sealed by fibroblastic proliferation of probable episcleral origin by the fourth day and the entrance similarly by the seventh day. Cellular proliferations originating in the wounds crossed the vitreous cavity following the vitreous injury tract or condensed vitreous to the disc or to the vitreous base. The earliest intraocular proliferations, composed of spindle-shaped, fibroblast-like cells, were seen at day 4. Occasional pigment epithelia were present in and on these proliferations. Other proliferations occurred directly on the retinal surface adjacent to the wounds. The transvitreous proliferations employed the vitreous as a scaffold, while the surface proliferations used the retinal surface for contact guidance.


Vitrectomy for injury: the effect on intraocular proliferation following perforation of the posterior segment of the rabbit eye.

Perforating injuries were produced in the posterior segments of rabbit eyes. A control group had no surgery; a second group underwent closed vitrectomy immediately after injury; and a third group had closed vitrectomy delayed two weeks following injury. The eyes were then observed for four weeks. Transvitreal proliferation, which was found in each of the control eyes, was effectively prevented in the eyes that underwent immediate vitrectomy. Established transvitreal proliferation was removed and its recurrence prevented by delayed vitrectomy. These results establish the principle that vitreous acts as a scaffold for proliferation. Removal of the vitreous eliminates the structures along which proliferation can occur and thus effectively prevents transvitreal proliferation. Early removal of vitreous in severely injured eyes with vitreous damage is recommended.


Conjunctival capillary fragility: a preliminary study.

Conjunctival capillary fragility (CCF) and skin capillary fragility (SCF) were studied by a negative-pressure suction cup method in 25 normal subjects and 38 diabetic patients with diabetic retinopathy. The CCF was significantly higher (P less than .001) in patients with diabetic retinopathy than in normal subjects; there was no significant difference in the SCF.


A new test of visual acuity using a holographic phase grating and a laser.

A new visual acuity testing device is able to determine a specific visual acuity of the retina even in the presence of opacities of the ocular media, such as a cataract. This is achieved by forming two spatially coherent, quasimonochromatic point sources near the nodal point of the eye. The two spherical waves that emanate from the point sources interact to produce a pattern of stripes on the retina. The intensity of the pattern is easily varied. More importantly, the pattern can be projected over different-sized retinal areas corresponding to visual fields of 0.5 to 15 degrees in diameter. The device may be useful for vision research and preoperative assessments of visual potential.


Toluidine blue. An aid in the microlaryngoscopic diagnosis of glottic lesions?

The value of toluidine blue staining in vivo in the diagnosis of glottic lesions was examined by comparing the results obtained in a series with the histological findings. This material included 272 biopsy specimens from the vocal cords (202 microlaryngoscopic examinations). In 148 of these, the changes were classified as "malignant" (moderate and severe dysplasia and carcinoma) and in 124 as "benign." The sensitivity of the staining test in detection of malignant lesions was 91%. Among 13 false-negative results (9% of the malignant group), there was keratosis in 11. The overall specificity of the staining tests was 52%. The false-positive lesions displayed "benign" pathological alterations, such as inflammation and ulceration. False-positive findings were more common after radiotherapy. A correct diagnosis of malignancy on the basis of positive staining was more frequent the greater the intensity of staining.


Neuroleptanesthesia for the guinea pig. An ideal anesthetic procedure for long-term physiological studies of the cochlea.

The guinea pig is notoriously difficult to anesthetize with conventional agents. Cardiorespiratory depression by general depressant anesthetic agents can render the cochlea abnormal. I report a technique that uses the specific neuroleptic and analgesia properties of the agents droperidol and phenoperidine, respectively, in combination with small doses of pentobarbital sodium, which is required only to produce unconsciousness. These agents can be given intraperitoneally, intramuscularly, or intravenously. The regimen allows performance of substantial surgery (including intracranial) and long-term (minimum, six to ten hours) physiological studies, such as those on the cochlea, with excellent cardiorespiratory stability. The method has been in continuous use in this laboratory since 1974 for single-fiber recordings from the cochlear nerve of normal and kanamycin-treated guinea pigs. This method has proved to be substantially more effective than use of pentobarbital, thiopental sodium, urethan, chloralose, or ketamine alone.


Carcinoma of the lip.

We reviewed 250 patients with carcinoma of the lip who were treated with radiation therapy during a 30-year period. Although radiation techniques underwent continued refinement, the radiation dose delivered to the tumor remained relatively constant. Nearly all tumors were squamous cell carcinoma (247/250) and located on the lower lip (240/250). Only 9% initially manifested lymph node metastases. The median survival was 13.8 years. Treatment failure occurred in 11% of patients. Surgery salvaged half of these patients. Eighteen patients died from carcinoma of the lip, and six others had persistent tumor when last seen. Our experience would support the work of others. Early lesions can be successfully managed by either surgical or radiation treatment. The intermediate tumors and those near the commissure are better handled by radiation. Late lesions and those with lymph node metastases challenge the best surgical and radiation techniques.


Squamous cell carcinoma of the buccal mucosa. A review of 85 cases.

Of 85 cases of squamous cell carcinoma of the buccal mucosa, 61 were treated primarily and 24 secondarily. Sixty-one percent (39) were T3 lesions, and 59% (38) had regional metastases. Nearly half of the patients were more than 70 years of age. Thirty-one percent (19) of the primary patients were treated by surgery alone, 25% (15) by irradiation alone, and 36% (22) by various combinations. The absolute five-year cure rate was 45% for the whole group, and 54% for the primarily and 40% for the secondarily treated patients. For each individual T and N category, the results of surgery were superior over those of radiotherapy. Intra-arterial chemotherapy followed by radiotherapy is to be considered in advanced cases, where composite resection on general grounds is not contemplated. There was a 14% incidence of second primary cancers; these were mainly located in the oral cavity.


Bilateral sudden hearing loss and metastatic pancreatic adenocarcinoma.

We report a rare case of bilateral sudden and profound hearing loss caused by bilateral temporal bone metastasis from a primary adenocarcinoma of the tail of the pancreas. The hearing loss was the patient's only reason to seek medical care. Seventh nerve involvement was very minimal, when compared with that of the eighth nerve.


Detection of foreign bodies with computerized tomography.

Computerized tomography scanning has been proven useful in defining complex anatomical areas of the head and neck and in delineating soft-density foreign bodies. This was helpful in a child in whom all other modalities, including surgical exploration, had failed to localize a foreign body.


Agnogenic myeloid metaplasia with a parotid mass.

Agnogenic myeloid metaplasia, one of the entities in the myeloproliferative syndrome, usually initially appears with splenomegaly, hepatomegaly, and a normocytic, normochromic anemia. Extramedullary hematopoiesis is also a common finding, but is exceedingly rare in the major salivary glands. We report a case of extramedullary hematopoiesis in the parotid gland and discuss the differential diagnosis and characteristics of the disease.


Osteogenesis imperfecta. A study of 160 family members.

Osteogenesis imperfecta, a genetic disease characterized by blue sclera, fragile bones, and hearing loss, was studied in 160 descendants of a single, affected individual. One hundred twenty family members in four generations were at risk of inheriting the gene for osteogenesis imperfecta. Fifty-six percent (68/120) had blue sclera, and, of this group, 66% had fragile bones, and 47% of those tested had hearing loss. The onset of hearing loss was usually in the second or third decade, and was primarily of the conductive type. The incidence of sensorineural hearing loss was only slightly less than the incidence of conductive hearing loss. To out knowledge, this is the largest reported kindred study of osteogenesis imperfecta. The genetic transmission of this disease as an autosomal dominant was confirmed.


Rhinocerebral mucormycosis.

Rhinocerebral phycomycosis is a serious and commonly fatal fungal infection. The causative organism, ordinarily a saprophyte, becomes pathogenic in persons who are made susceptible by coexisting, debilitating disease. We report a well-documented case of rhinocerebral phycomycosis where early diagnosis led to successful treatment, and we discuss important aspects of the clinical evaluation and management of such cases.


Neurilemoma of the trachea.

Neurilemomas of the tracheobronchial tree are exceedingly rare. In this article we report what is, to our knowledge, the 12th case--the third such case of tracheal origin. Clinical features are referable to airway obstruction and local pressure effects. The gross appearance is of an encapsulated lesion. Histologically, there is a proliferation of Schwann cells that are found in either an ordered, palisaded configuration (Antoni type A), or a disordered, loosely textured configuration (Antoni type B). The two types may coexist in a single lesion. Endoscopic removal of nonvascular tracheobronchial masses with follow-up, including periodic chest x-ray films, is advocated. Major surgery is reserved for malignant disease or benign disease not amenable to endoscopic excision.


Rare congenital syndrome associated with profound hearing loss.

In this communication, we describe the otologic and audiometric findings of a rare congenital syndrome associated with profound hearing loss. We offer a hypothesis of the possible inner ear pathologic condition. The major anomalies of this syndrome represent features of an ectodermal dysplasia syndrome.


Histopathology of 30 non-operated acoustic schwannomas.

Thirty of 1720 temporal bones from the Wittmaack's Collection contain nonoperated acoustic neuromas, 22 of them large tumors. Histologically, each tumor has to be considered as an individual. Most of the tumors show a mixture of Antoni type A and B. Tumor vascularization is pronounced in half the cases. Vessels of the internal acoustic meatus are found in all cases. Protein contents of the perilymphatic spaces is medium to pronounced in 23 of 30 cases in comparison to the small protein contents of the healthy side. Ganglion geniculi is invaded in 11 cases (9 von Recklinghausen's disease), Ganglion Scarpae in 26 cases (9 von Recklinghausen's disease), and Ganglion spirale in 9 cases (7 von Recklinghausen's disease). Cochlear and vestibular nerve fibers within the internal auditory meatus were affected by the tumor in 28 of 30 cases, the facial nerve only in 11 cases, among them 9 cases of von Recklinghausen's disease. Twenty-six of 30 schwannomas have a portion within the cribriform area of the cochlea fundus, which explains the limitation to radical tumor surgery without damage of the cochlear nerve. These histological findings explain the site of damage of hearing to expand between the cochlea to the auditory brain stem nuclei, and support the audiological experience that a correlation of "acoustic neuroma" and "retrocochlear lesion" is often not correct.