Occlusion amblyopia secondary to a mixed capillary-cavernous hemangioma

We report a case of amblyopia that developed in an infant and was secondary to occlusion of the visual axis by a capillary-cavernous hemangioma. In addition to occlusion amblyopia, hemangiomas can cause astigmatic and myopic refractive errors, which usually persist throughout life. Indications for treatment and therapeutic modalities are discussed. Patients with cavernous and/or capillary hemangiomas of the periorbital region need ophthalmologic consultation and close follow-up during the first year of life. Therapy should be started promptly if growth of the hemangioma threatens to occlude vision or induce refractive error.

Steroid sulfatase activity in human lung tissue and in endothelial pulmonary cells in culture

The conversion of tritium-labeled estrone sulfate to [3H]estrone was evaluated in human lung tissue in vitro. Under standardized conditions, the rate of hydrolysis of [3H] estrone sulfate to [3H]estrone was linear with time of incubation up to 4 h and with wet tissue weight up to 400 mg/ml. The apparent Km of sulfatase for estrone sulfate was 9 microM, and the maximum velocity was 1.4 nmol substrate hydrolyzed/100 mg lung . h. The lung tissue also metabolized the primary metabolite of [3H]estrone sulfate, [3H]estrone, to 17 beta-[3H]estradiol. The hydrolysis of [3H]dehydroisoandrosterone sulfate to [3H]dehydroisoandrosterone by human lung tissue was also measured. Sulfatase activity with this substrate was linear as a function of wet tissue weight up to 800 mg/ml. The apparent Km of sulfatase for dehydroisoandrosterone sulfate was 7 microM, and the maximum velocity was 1.0 nmol substrate hydrolyzed/100 mg lung . h. The highest specific activity of lung sulfatase for [3H]dehydroisoandrosterone sulfate was found in a microsomal fraction of lung homogenate. The primary metabolite, [3H]dehydroisoandrosterone, was metabolized further by lung tissue to [3H]androstenedione and [3H]5-androstene-3 beta, 17 beta-diol. Although isolated segments of human pulmonary arteries also metabolized both [3H] estrone sulfate and [3H]dehydroisoandrosterone sulfate, cultures of pulmonary arterial endothelial cells lacked sulfatase activity. The cell(s) source of sulfatase activity in human lung tissue and isolated arteries has not yet been identified. Our findings suggest that the metabolism of sulfated steroids by the lung should be considered in evaluating homeostasis.

The pathologic effect of ureteral ligation, with clinical implications

Inadvertent, ureteral ligation is a frequent occurrence with pelvic surgery. We determined the effect of the ureteral ligation of varying lengths of time in an animal model in order to provide a rational basis for the clinical management of such injuries in humans. In the rat, simple deligation of a ureter that has been ligated for as long as 24 hours results in complete resolution of the injury with no gross or microscopic evidence of the trauma. After 48 and 72 hours of ligation, hydroureter was apparent.

Peliosis of the spleen with rupture

A case of peliosis of the spleen without apparent involvement of the liver or other organs is presented. The peliosis was discovered following rupture of the spleen after minimal trauma and was successfully treated by surgery. None of the common associations of peliosis was present (i.e., tuberculosis or intake of steroid compounds). Drugs addiction and chronic alcoholism were the only coexisting debilitating conditions exhibited by this patient.

Papillated squamous cell carcinoma in situ arising in a seborrheic keratosis

A 73-year-old man had developed a 27 x 60-mm seborrheic keratosis on his trunk. Some months previously, an 18 x 19-mm cauliflower-like area had developed within this seborrheic keratosis. Histologic examination showed a papillated squamous cell carcinoma in situ arising in a seborrheic keratosis. Seborrheic keratoses are the most common cutaneous neoplasms in man. Malignant changes are most unusual but should be suspected in lesions of unusual clinical appearance.

Interstitial irradiation of carcinoma of the prostate with 125iodine and simultaneous extraperitoneal pelvic lymphadenectomy in 32 patients: trials, tribulations and possible triumphs

A series of 32 patients with carcinoma of the prostate who underwent 125iodine interstitial irradiation to the prostate and simultaneous extraperitoneal pelvic lymphadenectomy was reviewed. The patients were segregated into 3 groups: group 1-patients with early localized low grade disease, group 2-patients with advanced localized high grade disease and group 3-patients with early localized high grade disease and those with advanced localized low grade disease. Owing to the high degree of predictability of the absence or presence of pelvic lymph node metastasis in patients in groups 1 and 2 and the morbidity associated with superficial pelvic lymphadenectomy we do not advocate this procedure in these patients. However, we advocate pelvic lymphadenectomy in patients in group 3 because of the unpredictability of lymph node metastasis. Furthermore, our data indicate that 1) the morbidity of the combined procedures is relatively low, with no patients becoming incontinent and only 12.5 per cent becoming impotent, 2) 125iodine interstitial irradiation of the prostate after transurethral prostatectomy is safer in terms of postoperative complications than is radical prostatectomy and 3) while superficial pelvic lymphadenectomy is not an innocuous procedure it generally is safe and, at times, an important diagnostic staging procedure.

Simultaneous occurrence of gastric carcinoma in identical twins

Gastric carcinoma is a rare entity in twins at any age. A 31-year old black male presented with a nine-month history of epigastric pain and was found to have cancer of the stomach. His asymptomatic twin was therefore evaluated and also found to have gastric carcinoma. Both patients underwent gastric resection. Pathologically the cancers were similar, although the associated changes of the gastric mucosa showed some remarkable differences. The uniqueness of carcinoma in twins has resulted in extensive utilization of twin studies in an attempt to clarify genetic, environmental and immunological factors in the development of cancer. The results of these studies reported in the literature, however, are inconclusive. Gastric cancer is quite uncommon in the younger population but must be promptly excluded when symptoms doe not quickly respond to usual therapy.

Benign lipoblastomatosis: ultrastructure and histogenesis

Ultrastructural study of a case of benign lipoblastomatosis revealed a cellular spectrum which included undifferentiated mesenchymal cells, stellate myxoid cells, fibroblasts, lipoblasts, lipocytes and many intermediate forms. The uni- and multivacuolated fat cells contained membrane and non-membrane bound cytoplasmic vacuoles, predominatly of saturated lipid. Their cytoplasm also contained simple-structured mitochondria devoid of intramatrical or crystalloid bodies. The fine structure of the cellular components of lipoblastomatosis supports the concept that this is a neoplasm related to fetal white fat rather than to brown fat.

Oligosymptomatic Melkersson-Rosenthal syndrome

A patient with cheilitis granulomatosa and sialopenia is presented herein as a variant of the oligosymptomatic type of Melkersson-Rosenthal syndrome. Evidence is presented to support its possible neurotrophic origin.

Halo congenital nevus

A case of halo congenital nevus is reported in a fifteen year old Mexican-American girl with pre-existing vitiligo.

Topical tretinoin, hydroquinone, and betamethasone valerate in the therapy of melasma

Twenty adult female patients with melasma were followed over a ten week clinical trial in which a combination of depigmenting agents was used daily. Past clinical experience and objective assessment point to enhanced efficacy of this simple depigmenting combination. Certainly, most of depigmenting agents at our command to date have been relatively ineffective. Even this new combination is not the final answer. The purpose of this study is to provide the clinician with a simple yet effective and readily accessible combination of commercially-formulated and available depigmentary agents. A stable combination in a single vehicle with greater efficacy remains to be perfected.

Factitious pseudoainhum of the nipple

A patient with a cosmetically disfiguring swelling of his nipple for many years was found to have factitious mechanical pseudoainhum. The possibility of occult mechanical constriction as the cause of acute or chronic deformities of appendages is emphasized.

Endobronchial metastasis from cancer of the breast

Endobronchial metastasis is reported to occur in less than 5% of the autopsies of patients dying with extrathoracic malignant neoplasms. Frequently associated primary tumors include those of the kidney, pancreas, colon, ovary, and thyroid. To our knowledge, this is the first report of a case of cancer of the breast which metastasized to the mucosa of a major bronchus. The possible factors involved in the widespread, early unusual spread in this 25-year-old woman are discussed.