Malignant pleural mesothelioma. Report of 19 cases

Malignant pleural mesothelioma may be composed of sarcomatous, epitheliomatous or mixed cell types. They can be differentiated from localized, benign mesothelioma. Malignant pleural mesothelioma is a rapidly fatal tumor that poses serious diagnostic and therapeutic problems. A series of 19 cases was compiled at the North Carolina Baptist Hospital, and data from these cases were compared to those of other series. The average survival time was 10 months. The most common symptoms were dyspnea, chest pain, pleural effusion, and weight loss. Three patients had a definite history of exposure to asbestos; in 6 more there was a questionable exposure. The most helpful investigative screening tool was the chest roentgenogram, in that it demonstrated an intrathoracic abnormality; however, mesothelioma could not be differentiated from inflammatory reaction or bronchogenic carcinoma with pleural effusion. Sputum cytology as well as pleural effusion cytology was only suggestive of malignancy. Bronchoscopy was not helpful. Needle biopsy yielded malignant cells in 3 of 8 patients. Exploratory thoracotomy was the most accurate means of diagnosis but was frequently followed by seeding into the incision and severe, intractable incisional pain. Therapy proved to be palliative at best. Thoracotomy did not alter the course of the disease; in fact, the production of severe incisional pain was deleterious to the patient's well-being. Cordotomy done in 3 patients brought no relief. Neither radiation therapy nor chemotherapy had a significant effect on survival time or palliation.

Antileukocyte antibody in postpartum and renal transplant subjects. A comparison of capillary agglutination and lymphocytotoxicity reactions

Sera were obtained from 48 gravida II prenatal and 211 multiparous nonpregnant females and examined for leukocyte antibodies comparing a standard lymphocytotoxicity (CY) test with capillary agglutination (CA). Antibody was detected in 41% of the samples in both groups but only CA tests were positive with approximately one-half of the prenatal and three-fourths of the multiparous specimens. Although, CA reactions, when accompanied by positive CY responses, usually correlated with HLA, no correlation with HLA, 5b, or the neutrophil antigens was determined for 35 of the 48 sera reacting only by CA. As a model to test the specificity of CA positive-CY negative antisera, four extensively studied sera were further analyzed in 16 families. Independent segregation from the HLA complex and ABO and Rh antigens was confirmed and two of the sera appeared to detect separate clusters of reactions in conjunction with some of the other reagents. Pre- and postgraft samples obtained from 23 living related and 75 cadaveric renal transplanted patients were investigated and compared for graft function and prospective tissue typing. Although direct crossmatches were negative prior to surgery, 17.9% of the pretransplant samples from living related and 28.0% from cadaveric recipients contained detectable antibody when tested against a cell panel. Similar to the prenatal and multiparous groups, the majority of these responses were detected by CA. Following engraftment, antibody first became evident in 11 of 19 (58%) living related and in 23 of 53 (48.2%) cadaveric hosts. There was a striking association between the development of CA and CY antibody and failure, as contrasted to 100% 9-month or greater survival in 10 of 10 living related and 15 of 15 cadaveric transplants in whom only CA antibodies arose postoperatively. In total, these studies indicate that CA reacts with HLA antigens in common with CY tests. In addition, CA may detect HLA when CY is negative but many other reactions appear to be directed at non-HLA specificities. The relevance of CA-only responses to clinical transplantation remains uncertain, but we may speculate that they have an enhancing effect on the course of renal transplantation and are associated with important histocompatibility determinants.

Molecular mechanisms of ageing. A critique

Two kinds of evidence, taken in conjunction, indicate that Orgel's theory is inapplicable to a wide range of disorders of senescence in man. The age dependence and the anatomical distribution of the lesions of such disorders imply a Burnet type 'forbidden clone' theory of ageing. We describe the difficulty of establishing Orgel's theory for any disorder of ageing in man.

Preformed cytotoxic antibody in patients subjected to thoracic duct drainage

1. Patients subjected to TDD prior to transplantation had a 4-yr graft survival rate of 65% compared to a comparably HL-A-matched group in which the survival rate was 35%9 2. Patients classified as non-responders to tissue antigens have a much higher graft retention rate than responders. Responders subjected to TDD have a 1 yr graft survival rate of 62% compared to a comparably HL-A-matched group with a survival rate of 28%. 3. Individuals with a positive crossmatch or receiving second or third transplants and subjected to TDD do much better than such individuals not subjected to TDD.

Human middle ear corpuscles -- A light and electron microscopic study

The human middle ear corpuscles originally described by von Troeltsch are examined by means of light microscopy in 124 subjects, and electron microscopy in 27 subjects. While the corpuscles are not observed in all 19 individuals under age six, and in all 20 adults who had a history of suppurative otitis media, an average of six corpuscles per temporal bone is found in 98 percent of 83 adult subjects who had no history of middle ear disease. Two-thirds of the corpuscles are located in the mastoid, and the remainder in the middle ear. Often, they become bifurcated or trifurcated. Although light microscopy shows that the corpuscle is formed by lamellar capsules and a central core resembling pacinian corpuscles, electron microscopic study failed to confirm that this structure is a typical pacinian corpuscle. Subsequently, possible physiological significance of this corpuscle is discussed.

Thyrotrophin estimation in diagnosis and treatment of childhood thyroid disorders

Serum thyrotrophin (TSH) was estimated by double-antibody radioimmunoassay in 200 children aged 2 months to 16 years with normal thyroid function. There was no apparent variation in TSH with age or sex and only 4 children had TSH levels greater than 5 muU/ml. High TSH values were obtained in 9 children with primary hypothyroidism, in 3 children with thyroiditis, and in one girl with a lingual thyroid. Moderately raised TSH was found in 3 girls with thyroiditis, 2 brothers with goitres due to enzyme defect, and a girl with an ectopic thyroid. In one girl with a defect of iodine organification and in 3 boys with thyroxine binding globulin deficiency the TSH levels were normal despite very low serum thyroxine values. Serum TSH was also estimated in 20 children during treatment for primary hypothyroidism. 3 of these children showed slightly raised TSH levels despite apparently adequate replacement therapy with L-thyroxine. One girl showed a very high TSH level 3 weeks after treatment had been temporarily withdrawn.

Sleep physiology at high altitude

All night sleep EEG, EKG, and respiration were recorded from six young men during 2 nights at sea level and 4 nonconsecutive nights at high altitude (14.110 ft., 4301 m). Sleep at high altitude was chraacterized initially by a significant decrease in Stages 3 and 4, a significant increase in the number of arousals, and a trend towards more time spent awake. In terms of actual time spent sleep, however, a relatively good night's sleep was obtained, which suggests that the objective sleep disturbance was not commensurate with the marked subjective complaints of sleeplessness. Periodic respiration during sleep was frequent at high altitude, was quickly terminated by oxygen administration, was not clearly related to the increased number of arousals, and usually was not seen during REM periods. Heart rate was increased during sleep at high altitude. All measures tended to return towards sea level means during 12 days at altitude. We suggest that the marked increase in the number of arousals may account for the disparity between the subjective reports and objective measures of sleep disturbance at high altitude. Although the objective sleep disruption is probably related in some fashion to hypoxemia, it is unclear whether hypoxemia itself or the alkalosis commonly present shortly after arrival at altitude is the major factor.

Primary malignant melanoma of the oral cavity

The natural history of malignant melanoma of the oral cavity is discussed with reference to the findings of previous writers, and six additional cases are reported. These demonstrate the considerable variations in detail of the course of the disease while confiriming the difficulty of treatment and the inexorable nature of the condition.

Effects of large doses of intravenous atropine on heart rate and arterial pressure of anesthetized patients

A bolus of 3 mg. of atropine was given intravenously (I.V.) TO 123 ANESTHETIZED PATIENTS. Increases in heart rate were seen in 109 patients (88 percent), while 7 patients (5.7 percent) had no change. A mean increase in systolic arterial blood pressure of 14 mm. Hg was noted. A certain pattern in increases in heart rate and systolic blood pressure was observed. Ninety-six percent of the patients under cyclopropane, fluroxene, ether, ketamine, or regional (spinal or epidural) anesthesia had heart-rate increases, compared with only 77 to 89 percent of the patients anesthetized with halothane, enflurane, or neuroleptanalgesics. Rise in systolic blood pressure was seen in 40 to 50 percent of the former, but only in 31 to 40 percent of the latter group. The arrhythmias observed were transient A-V junctional tachycardias in three instances and bigeminal rhythm in one patient under cyclopropane anesthesia, The administration of a vagolytic dose of atropine to anesthetized patients appears not to be as arrhythmogenic as previously considered.

Vibrating umbilicus

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Measurement of serum parathyroid hormone, with particular reference to some infants with hypocalcaemia

Parathyroid hormone (PTH) in serum has been determined by a double antibody radioimmunoassay which is suitable for use in infants. The concentration in normal infants rose after birth from a mean level of 97 pg/ml in cord blood to 217 pg/ml at 6 days of age. It remained at this level in the older infants and children. In a group of infants with hypocalcaemia and many complicating factors, the PTH concentration was significantly lower than normal. All but one of the affected infants maintained a normal serum calcium without treatment 1 year after the episode of hypocalcaemia. It is suggested that prolonged immaturity of parathyroid function may contribute significantly to the aetiology of hypocalcaemia and may be related to immaturity of the mechanisms responsible for converting glandular PTH to secreted PTH.

Renal transplantation: an analysis of 33 cases

Thirty-three patients with end-stage renal failure have had transplants over a three-year period, four patients receiving kidneys from siblings and the remainder cadaver organs. Twenty-seven kidneys survived with stable function for periods of six months to three years. Graft survival at one year was 85% and at two years 82%. One patient died and five were returned to dialysis. Complications included rejection episodes, technical problems, respiratory and wound infections, gastrointestinal disorders, and side effects of steroids.