[Verrucous carcinoma of the cervix]

An extremely rare case of verrucous carcinoma of the uterine cervix is reported. The most outstanding pathologic feature of this malignant tumor is the benign picture of the proliferative squamous epithelium, with remarkable hyperkeratosis and dyskeratosis. Therefore it is difficult for the pathologist to make an accurate diagnosis on the basis of the biopsy material. Surgery may be best treatment of this special tumor for its behavior of slow invasiveness and rare metastasis.

[Malignant fibrous histiocytoma (MFH) of the maxilla--an analysis of 7 cases]

Malignant fibrous histiocytoma is a rare tumor of the soft tissue or bone, especially if located in the head and neck. Up to the present, only 7 cases have been reported (6 in the mandible and only one in the maxilla). From Mar. 1958 to Mar. 1985, 7 patients with maxillary MFH, proved by pathology, were treated in our hospital. The X-ray manifestations were studied and analysed. The main X-ray characteristics are as follows: A large soft tissue mass in the maxilla, extending into the infratemporal fossa, pterygopalatina fossa, orbit, ethmoid sinuses, nasal cavity and cheek. Marked and extensive destruction of the maxilla with some amorphous reactive ossification. The bone appears like melting ice or ground glass. The value of computerized tomography in differential diagnosis and clinical staging of the maxillary malignant fibrous histiocytoma are discussed.

Ovarian steroid involvement in endogenous opioid modulation of LH secretion in seasonally anoestrous mature ewes

In June, 16 mature ewes were ovariectomized and allocated to four groups: 1, saline; 2, naloxone; 3, progesterone implant plus naloxone; 4, oestrogen implant plus naloxone. Steroids were implanted at the time of ovariectomy. At 5 days after ovariectomy, the animals were intravenously infused with saline for 8 h and naloxone (50 mg/h) in saline for 8 h the following day. Three intact ewes were given naloxone in a similar way. During infusions and for 8 h on the day after naloxone, jugular venous blood samples were taken every 15 min and assayed for LH. Naloxone resulted in significant increases in mean LH concentration (P less than 0.01), LH episode frequency and episode height (P less than 0.05) in Group 3 ewes, but was without effect in any other group. These results provide evidence that the progesterone status of the ewe affects its response to naloxone, that progesterone negative feedback on LH release may be mediated by an opioid system, and that increased oestradiol negative feedback during seasonal anoestrus is unlikely to work via increased opioid inhibition of LH.

T-cell lymphoma

Of a total of 3,366 cases of malignant lymphoma in China reviewed histopathologically, T-cell lymphomas accounted for an average of 26.1% among all non-Hodgkin's lymphomas. However, the proportion of lymphomas of T-cell lineage varied in different parts of China, with the highest proportion (30-40%) along the east coast. Immunologic typing of 41 non-Hodgkin's lymphomas by the avidin-biotin-peroxidase complex technique revealed similar patterns. When serum antibodies to human T-cell leukemia virus were assayed in 462 normal men and 103 monkeys, 2-5% of the men and 8.4-15% of the monkeys were positive for antibodies to this virus.

Phenotypic expression of Hodgkin's and Reed-Sternberg cells in Hodgkin's disease

The phenotypic expression of Hodgkin's and Reed-Sternberg (H-RS) cells was determined by analysis with a panel of monoclonal antibodies and peanut agglutinin (PNA) by an immunohistochemical technique. Seven antibodies, including T200, anti-HLA-DR, anti-Leu 10, A1G3, anti-Tac, OKT9, and anti-Leu M1, were found to react with a great majority of H-RS cells. In some cases, H-RS cells also bound PNA. Other antibodies, including those highly specific for T cells (eg, Lyt 3) and B cells (eg, B1, anti-Leu 14) were consistently negative. The results argue against the derivation of H-RS cells from T or B lymphocytes. The H-RS cells were also negatively stained with antibodies which react with monocytes (OKM1, Mo-2, 63D-3), follicular dendritic cells (DRC-1), and natural killer/killer cells (Leu 7, Leu 11a, B73.1). The presence of Leu M1 and Tac in H-RS cells is of interest. Anti-Leu M1 positivity was seen in all 20 of Hodgkin's disease (HD) cases tested and should provide a very useful reagent for differential diagnosis of HD from other reactive and neoplastic conditions. Tac normally is present only on activated T cells. The presence of Tac in H-RS cells may reflect expression of T-cell growth factor receptor or a closely related protein during a stage of neoplastic transformation. Although the nature of the neoplastic cell of HD cannot be determined by these studies, they are consistent with an origin from interdigitating reticulum cells. Both H-RS cells and interdigitating reticulum cells have a similar antigenic phenotype (Leu M1+, T200+, HLA-DR+, Leu 10+, A1G3+, and OKT9+) and a similar pattern of lysosomal enzyme activity.

Primary gastrin cell hyperplasia. Report of five cases and a review of the literature

Primary gastrin cell hyperfunction of the gastric antrum as a clinical syndrome consists of basal hypergastrinemia, an exaggerated gastrin response to feeding, the absence of any ectopic source of gastrin secretion, and peptic ulcer disease. The number of G-cells were quantitated in the gastric antrum of five patients with clinically diagnosed primary G-cell hyperfunction, and the results were compared to controls with a variety of gastric diseases. Patients with the clinical diagnosis of primary G-cell hyperfunction had a significantly increased number of antral G-cells (p less than 0.05). The clinical syndrome of primary G-cell hyperplasia appears to be associated with hyperplasia of G-cells rather than with the hypersecretion of gastrin by a normal number of G-cells.

Hairy cell leukemia: a B cell neoplasm with a unique antigenic phenotype

A panel of B, T, and monocyte antibodies was used to study the phenotype of hairy cell leukemia. It was found that the neoplastic cells had monoclonal surface immunoglobulins and, in addition, reacted with B1, HLA-DR, Leu 10, and Tac. Most of the above markers are features of B cell lymphocytes. However, Tac is a monoclonal antibody normally reactive with activated T lymphocytes. All other antibodies reactive with T cells were negative. An additional unexpected finding was intranuclear reactivity in 4/5 cases with an antibody to TdT. TdT enzymatic activity was not demonstrable by biochemical assay. All five cases were nonreactive with monocyte antibodies. The findings support the concept that hairy cell leukemia is of B cell lineage but demonstrates an unusual phenotype not seen in other normal or neoplastic B lymphocytes.

Pulmonary carcinoids. Immunohistochemical demonstration of brain-gut peptides

Antisera raised against serotonin, gastrin, somatostastin, motilin, bombesin, calcitonin, secretin, glucagon, ACTH, neurotensin, and pancreatic polypeptide carboxyterminal hexapeptide were employed to immunohistochemically stain seven pulmonary carcinoids. Argentaffin and argyrophil stains were also performed on all cases. Serotonin-like immunoreactivity was present in four tumors, pancreatic polypeptide-like immunoreactivity in four tumors, bombesin-like immunoreactivity in two tumors and ACTH-like immunoreactivity in one tumor. The cells shown to contain neuroendocrine products constituted a minority cell population in all tumors except the ACTH-immunoreactive tumor. This study suggests that pulmonary carcinoids, like their abdominal counterparts, contain a variety of neuroendocrine products, and may produce more than one neuroendocrine product. Serotonin and pancreatic polypeptide-like immunoreactivity were the most prevalent neuroendocrine products demonstrable in this study.

The neuroendocrine products of intestinal carcinoids. An immunoperoxidase study of 35 carcinoid tumors stained for serotonin and eight polypeptide hormones

The intestinal carcinoid tumors of 26 patients were stained for the presence of serotonin, gastrin, somatostatin, motilin, secretin, glucagon, pancreatic polypeptide, ACTH, and neurotensin. Argentaffin and argyrophil stains were also performed in all cases. Thirty-five separate tumors (counting metastases and multiple primaries) from the 26 patients were studied. Serotonin was present in 30 of the 35 tumors. Nineteen tumors contained serotonin only. Fourteen tumors contained multiple neuroendocrine products. One tumor contained gastrin only. One tumor did not stain immunohistochemically, but was argyrophilic. Metastatic deposits were studied in nine patients. Some metastases produced the identical neuroendocrine products as the primary tumor, whereas others produced either additional or fewer hormones than the primary tumor. Moreover, different metastases from the same primary tumor were observed to produce different hormones. Argyrophilic cells were present in all cases and were much more numerous than cells staining by immunohistochemistry. Argyrophilic cells probably contain monoamines and polypeptide hormones in addition to those studied in this series. The argyrophil stain was the best general stain in this study for the demonstration of neuroendocrine cells. Argentaffin staining was negative in ten cases that were serotonin positive and two argentaffin positive cases were serotonin negative. The carcinoid syndrome, as clinically defined by the presence of flushing and diarrhea, was noted in five patients, all of whom had serotonin-containing small bowel carcinoids. Endocrine-related symptoms were not clinically appreciated in the remaining patients.

A colonic adenocarcinoma with argentaffin cells. An immunoperoxidase study demonstrating the presence of numerous neuroendocrine products

A well-differentiated colonic adenocarcinoma containing large numbers of gastrointestinal neuroendocrine cells is presented. The presence of neurosecretory granules was confirmed by electron microscopy. Immunocytochemistry showed large numbers of serotonin-containing tumor cells and lesser numbers of somatostatin, gastrin, motilin, secretin and neurotensin-containing cells. Some of these hormones are not normally present in the colon in significant numbers of cells. The presence of several cell types within a single tumor supports the concept that the normal epithelial cells of the gastrointestinal mucosa are derived from a common endodermal stem cell. There exists a spectrum of tumors ranging from the classical adenocarcinoma to the classical carcinoid, and this report identifies the position of this case within that spectrum.

Anterior intervertebral disc excision and bone grafting in cervical spondylotic myelopathy

An analysis of 121 cases of cervical spondylotic myelopathy treated by anterior excision of the disc and fusion was undertaken. All patients were followed at least six months, and follow-up averaged 22 months. Results showed that 97.5% of patients had no aggravation of symptoms, 90.9% were improved, and 72.6% were able to resume normal activity. Surgical intervention can greatly improve the prospects of patients with severe cervical spondylotic myelopathy, and its use should not be lightly ruled out. Autografts yield higher fusion rates and better overall results than homografts. Selection of the number and level of discs to be excised depends upon clinical and roentgenographic indications, as well as the myelogram and the amount of fluid injected into the discs.

Acid phosphatase and alpha-naphthyl acetate esterase in neoplastic and non-neoplastic lymphocytes. A statistical analysis

Acid phosphatase and alpha-naphthyl acetate esterase reaction patterns were evaluated in lymphocytes from patients with a variety of neoplastic and non-neoplastic conditions: leukemia, 59; NHL, 53; and reactive follicular hyperplasia, 23. Fifteen individuals with normal peripheral blood were also studied. For both enzymes, statistical analysis showed a strong correlation between a globular reaction pattern and T lymphocytic origin in both non-neoplastic lymph nodes and normal peripheral blood specimens (P less than 0.0001). A similarly strong correlation was found between a granular acid phosphatase pattern and T lymphocytic origin in cell isolated from non-neoplastic lymph nodes (P less than 0.0001) but not in those obtained from normal peripheral blood where this pattern was observed with equal frequency in B, T, and "null" lymphocytes (P = 0.415). A granular alpha-naphthyl acetate esterase pattern was correlated with non-T lymphocytes from normal peripheral blood (P less than 0.0001), but was observed with equal frequency in B, T, and "null" lymphocytes fron non-neoplastic lymph nodes (P = 0.76). In the eight T cell neoplasias studied, a globular pattern was evident in the majority of cells for both enzymes. In the majority of the B cell neoplasias, however, a granular pattern was observed for both enzymes.

Physiochemical properties of aminophylline-dextrose injection admixtures

The compatibility and stability of aminophylline-dextrose injection admixtures were investigated. Aliquots of 5% dextrose injection, 0.9% sodium chloride injection, and 5% dextrose and 0.9% sodium chloride injection were studied for these physiochemical properties: pH, color, clarity, absorbance in a spectrophotometer at 400 nm, and hydroxymethylfurfural (HMF) content. Aminophylline injection was added to the solutions, and aliquots were withdrawn after 0, 6, 24, and 48 hours of storage at 5, 25, 35, and 55 degrees C for testing of the physiochemical properties and aminophylline content. An aminophylline admixture in 5% dextrose injection was passed through an in-line filter (IVEX-2), and eluents were collected for aminophylline assay and for testing the above physiochemical properties. HMF and theophylline were assayed to high-pressure liquid chromatography (HPLC). The aminophylline concentration remained constant in all admixtures studied. A yellow color developed in dextrose-containing aminophylline admixtures stored at 25, 35, and 55 degrees C for 48, 24, and 6 hours, respectively. HMF concentration, pH, and clarity remained within compendial limits. The in-line filter did not retain active ingredients or alter the physiochemical properties of the admixture. Solutions that were yellow showed additional peaks on HPLC. HMF seemed to be a precursor for this yellow color, inasmuch as HMF concentration increased with increasing color intensity. It is concluded that aminophylline-dextrose admixtures are visually and chemically stable for 48 hours when stored under refrigeration or at room temperature.

Intravenous solution compatibility and filter-retention characteristics of trace-element preparations

The compatibility of recently published AMA formulations of the four trace-element injections (zinc, copper, chromium, and manganese) with a representative total parenteral nutrition (TPN) formulation and commonly used intravenous solutions was evaluated in glass and plastic containers. The effect of in-line filtration on trace-element concentration was also studied. Individual metal-ion concentrations, pH, color, and clarity were measured at 0-, 12-, 24-, and 48-hour intervals following mixture in TPN, 5% dextrose injection, 0.9% sodium chloride injection, and 8.5% amino acid injection (Travasol, Travenol Laboratories). Multiple trace elements were studied in one-liter glass bottles of 5% dextrose and 0.9% sodium chloride injection. Trace-element contaminants were measured in the intravenous solutions and trace-element injections. The four trace-element preparations were added individually and in combination to the solutions in plastic or glass containers. The trace-element admixtures were passed through in-line i.v. filters (IVEX-2, Abbott Laboratories) during a three-hour period at controlled-flow rates. Concentrations of trace elements remained within 99% confidence limits in all i.v. solutions, with both individual trace elements and combinations of the four trace elements. Trace-element concentrations did not change when the admixtures were passed through the in-line filter unit. It is concluded that there are no obvious compatibility problems associated with admixture nor any detectable retention by the i.v. filter of trace elements.

Interferons, double-stranded RNA, and RNA degradation. Isolation and characterization of homogeneous human (2'-5')(a)n synthetase

(2'-5')(A)n synthetase is one of the mediators of interferon action. If activated by double-stranded RNA it converts ATP into pyrophosphate and (2'-5')(A)n. In turn, (2'-5')(A)n activates a latent endoribonuclease (RNase L) which cleaves single-stranded RNA. We report here the isolation and characterization of a homogeneous human (2'-5')(A)n synthetase. The enzyme was purified from interferon-treated HeLA S3 cells by chromatography of a ribosomal salt wash fraction on DEAE-cellulose, poly(I) . poly(C) agarose, and CM-cellulose. The purified (2'-5')(A)n synthetase can convert over 90% of ATP into (2'-5')(A)n. The enzyme is unstable but can be stabilized by certain nonionic detergents (e.g. Triton X-100). Its apparent Mr = 100,000, as determined by gel electrophoresis in sodium dodecyl sulfate, and about 80,000, as determined by centrifugation through a glycerol gradient. The human (2'-5')(A)n synthetase is similar to the corresponding enzyme from mouse Ehrlich ascites tumor cells, but differs from the latter in size (100,000 versus 105,000 daltons) and in ionic conditions required for maximal activity.

Childhood urinary tract infections in family practice

During one year in a private practice, 102 cases of childhood urinary-tract infection (UTI) were detected. Presenting symptoms and signs are given, and the sex and age of the children are related to bacterial and pus-cell counts in the urine. The urine was cultured in 68 cases, and eight patients were further investigated.Routine urinalysis and the physician's unceasing alertness are essential to diagnose and treat UTI in its early stages in children, and thus prevent renal disease in later life. The authors describe a simple practical routine by which the family doctor can detect the infection in children, and they outline preferred treatment schedules.