[The treatment of ptyalism in children with cerebral lesions (author's transl)]

The cytotoxic and alkylating substance, mustard gas, causes both acute poisoning and also damage to numerous organs following chronic exposure. Especially important is the carcinogenic effect, also confirmed in humans. 34 years after occupational exposure to mustard gas with many intoxication episodes, a former munition-worker died of a glioblastoma; two years before his death a neurofibroma was detected in the thorax and removed by operation. The causal connection between the mustard gas exposure and the development of two neurogenic tumors rests on the statistically significantly raised frequency of malignant tumors and the established psychic changes in former workers with mustard gas and especially on the production of malignant tumors of the central nervous system in experimental animals with alkylating nitrosamines.

Medullary carcinoma of thyroid gland in a girl aged 10 years

A healthy girl of 10 years presented with lumps on her tongue, shown on biopsy to be neuromas. She had had operations to her feet for pes cavus and was relatively long-limbed but had no other 'Marfanoid' features. She had a high plasma calcitonin level. At operation a normal sized thyroid gland was totally removed. It contained two discrete masses of malignant C-cells and diffuse foci elsewhere. The plasma calcitonin fell slowly to normal on follow-up but was noted to be rising 2 1/2 years later. We stress the importance of making this diagnosis as early as possible and mention briefly another child aged 15 months, similarly diagnosed and operated upon.

Spinal neurofibromatosis

Neurofibromatosis is a congenital abnormality due to maldevelopment of the neurectoderm and mesoderm. Spinal abnormalities are a frequent occurrence and the roentgenological changes observed in 21 patients are presented. These include scoliosis, posterior scalloping of vertebral bodies, and the roentgenological features associated with intraspinal tumors and thoracic meningoceles.

The occult intrasacral meningocele

Three cases of occult intrasacral meningocele, one of them with an intrasacral and presacral neurofibroma, are reported. The literature is briefly reviewed. Pathogenesis, clinical picture, radiological findings and surgical treatment are discussed.

[Complications in primary tumors of the small intestine]

Of 112 000 patients undergoing surgery between 1952 and 1973, 67 had a primary tumor of the small intestine. 22 patients had a benign tumor, 8 a carcinoid, 21 carcinoma and 15 sarcoma. Benign tumors were more frequent in the duodenum and ileum, carcinoids in the terminal ileum and carcinomas in the duodenum and jejunum. Sarcomas were found equally in all parts of the small intestine. The most common symptom for all types of the tumor was variable pain in the abdomen. Loss of weight occurred only in patients with carcinomas and sarcomas; heavy intestinal blood loss was most common in patients with benign tumors. Benign tumors often show invagination, while sarcomas cause occlusive ileus or perforation. All duodenal tumors show heavy intestinal bleeding but hematemesis is rare. Emergency surgery was necessary in 42% of patients with benign tumors or sarcoma and in 30% of patients with carcinoma. Five-year survival in patients with benign tumors is excellent (100%). Compared to this, five-year survival in patients with carcinoma, sarcoma or carcinoids is only 15%.

Intrathoracic vagus nerve tumours

Strickland, B. and Wolverson, M. K. (1974).Thorax, 29, 215-222. Intrathoracic vagus nerve tumours. Three new cases of intrathoracic vagus nerve sheath tumour are presented. Two were neurofibromas associated with generalized neurofibromatosis, the third a neurilemmoma. All three presented as tumours of the superior middle mediastinum on the left in close association with the aortic arch. Previously reported cases are reviewed with special reference to the anatomical position and mode of clinical presentation. The tumours most often occur on the proximal part of the nerve close to the aortic arch and more often on the left than the right. They usually present as an incidental finding on a chest radiograph. To explain this anatomical localization it is suggested that the tumours tend to occur on the bulkiest part of the nerve which is in the upper thorax and where there is room for growth which is below the thoracic inlet. Proximal vagal tumours are more easily seen on a chest radiograph than those occurring distally and are therefore more likely to be detected. Symptoms occur only with proximal lesions.