Entrapment of the median nerve after posterior dislocation of the elbow

The authors present two cases of complete median nerve paralysis due to entrapment after posterior dislocation of the elbow. Previous literature on the subject matter is reviewed, and management and therapeutic indication of these lesions are discussed.

Subcortical correlates of the auditory brainstem potentials in the monkey: referential responses

Referential responses correlated with the vertex auditory brain-stem potentials (ABSP) were recorded from different brainstem and diencephalic structures of large monkeys under barbiturate anesthesia. Polarity, latency, and amplitude of various response components were determined from structures located 2 mm apart along five different vertical trajectories aiming at the trapezoid body (TB), superior olivary complex (SOC), mesencephalic reticular formation (MRF), medial geniculate nucleus thalami (MG), and inferior colliculus (IC). Latency correlations, amplitude differences, voltage profiles, current-source-density-distribution, and current flows of the various response components were subsequently calculated. Subcortical referential responses were formed by seven initial fast positive components (I, II, A, B, C, D and E) and one late slow negative component (F) correlated to waves I to VII and SP3 of the vertex ABSP respectively. Positive components C and D' also correlated to SP1 and SN1 of ABSP respectively. Amplitude of component B at contralateral SOC and C, D' and F at contralateral MRF was significantly larger than those of other subcortical responses and vertex ABSP. A single component of the subcortical referential responses accompanied changes in voltage, CSD, and current flows of various brainstem structures. However, considering only major changes in these parameters, component B accompanied a voltage positive and a CSD positive-negative peak and an ascending current flow at the SOC; component C accompanied similar changes at MRF, and components D' and F accompanied voltage negative and CSD negative-positive-negative peaks and ascending and descending current flows at MRF. In contrast, no systematic changes in voltage, CSD and current flows accompanied components I, II, A, D and E.

Simultaneous presentation of carcinoma involving the ovary and the uterine corpus

Twenty-nine patients had simultaneous malignant epithelial neoplasms of the uterine corpus and ovary. Three groups were defined on the basis of tumor histology: Group A: those with endometrioid carcinoma in both the uterus and ovary; Group B: those with special variants of corpus carcinoma (papillary, clear cell, mucinous) and identical neoplasms in the ovary; and Group C: those whose uterine and ovarian carcinomas were of dissimilar histologic types. Sixteen women had endometrioid carcinoma in both sites. The median age at diagnosis, 41 years, was younger than is usual for corpus or ovarian cancer. For all 16 patients, the grade of the ovarian endometrioid carcinoma was similar to that of the endometrioid carcinoma of the uterine corpus. Seven patients had bilateral ovarian neoplasms. Only one patient had myometrial invasion by the corpus carcinoma. No patient with simultaneous ovarian and uterine endometrioid carcinoma, regardless of grade, has died of cancer although one vaginal relapse was treated successfully. This excellent survival of patients with simultaneous endometrioid carcinomas is better than would be expected for either Stage III adenocarcinoma of the endometrium or Stage II ovarian carcinoma. These simultaneously occurring endometrioid neoplasms of ovary and endometrium are considered to be separate primary tumors. The morphologic reasons for this view and therapeutic implications are discussed. In contrast to the patients with endometrioid carcinoma, the eleven patients with other histologic types of carcinoma in the ovary and corpus were older (median age, 61 years) and more often postmenopausal (90%). These neoplasms were more aggressive, with frequent deep myometrial involvement (63%), tubal involvement (27%), and extension to other pelvic tissues (36%) at the time of initial diagnosis. Six of these 11 patients succumbed to their cancer despite surgical therapy and radiation. The distribution of tumor in some of these patients with nonendometrioid types of carcinoma is suggestive of a single primary with metastases. The therapeutic implications of these findings are discussed.

Breast edema following staging axillary node dissection in patients with breast carcinoma treated by radical radiotherapy

Seventy-four patients with carcinoma of the breast were treated by irradiation without a mastectomy at Stanford between May 1973 and March 1980. Seventy-six breasts were treated because two patients had bilateral simultaneous cancers. Breast edema was noted in 41% of these cases. Analysis of potential predisposing factors revealed that this complication occurred primarily in patients who received a staging axillary lymph node dissection. Lymphedema occurred in 26 of 33 breasts (79%) in patients who had staging axillary dissections; this complication developed in only three of 12 (25%) with axillary samplings and two of 31 (6%) with no axillary surgery. Two groups of patients were identified: (1) 28 patients whose breast edema occurred early (prior to or during radiation therapy), and (2) three patients with late onset edema that developed several months postirradiation. The early edema, which is clearly related to axillary lymph node dissection, gradually improved during the follow-up period with complete or near complete resolution expected by three years. Late onset edema was rare, appears to be related to an axillary radiation dose greater than 5500 rad, and may be irreversible. There was no correlation of breast edema with tumor stage, radiation time/dose factors, the use of bolus, patient weight, or breast size.

Uterine papillary serous carcinoma: a highly malignant form of endometrial adenocarcinoma

A review of 256 cases of pathologic Stage I uterine adenocarcinoma treated at Stanford University Hospital revealed 26 cases of uterine papillary serous carcinoma (UPSC), a clinically aggressive and morphologically distinct variant of adenocarcinoma which closely resembles ovarian papillary serous carcinoma. These lesions are easily recognized by microscopic examination and typically feature a high degree of cytologic anaplasia and a papillary growth pattern. Invasion of the lymphatics has been a frequent finding. The relapse rate among patients with pathologic Stage I UPSC was 50% (13/26), five times the rate which would have been predicted by the incidence of UPSC. Patients with Stage I UPSC fared significantly worse than the group of nonpapillary grade II or grade III adenocarcinomas (p less than 0.0001). Forty percent of Stage I UPSC patients had deep myometrial invasion, as compared with 12% of those with all other histologic types of adenocarcinoma (p = 0.001). Women with UPSC deeply invading the myometrium tended to do worse than those with deeply invasive lesions of the more usual endometrioid type as reflected by relapse rates (after surgery alone) of 63% and 30%, respectively. Of seven Stage I corpus carcinoma patients whose initial site of failure was in the upper abdomen, six had UPSC. Thus, UPSC shares the tendency of its ovarian counterpart to spread over peritoneal surfaces. In addition to the original study group of 26 Stage I patients, 34 patients with more advanced stages of UPSC were also reviewed. Of these, 26 have been followed and four survive. Eleven of these women presented or relapsed with abdominal carcinomatosis. UPSC is a clinically aggressive neoplasm which should be distinguished from other types of primary endometrial adenocarcinoma. In cases of invasive UPSC the mode of spread, similar to that of ovarian surface epithelial carcinomas, suggests the need for adjuvant upper abdominal and pelvic irradiation or effective chemotherapy.

A children's fair

As outdoor, free, public Children's Fair for Multicultural Health Activities provided appropriate participatory exhibits, experiences, materials, and conversations for predominantly non-Anglo children and families. The purpose was to reduce fears, create greater understanding of the role of parents, and increase awareness of the family's emotional needs when the child is in health care.

Chronic lateral instability of the ankle

The authors present 14 cases of chronic lateral instability of the ankle in 13 patients, in whom we performed ligamentoplasty using peroneus lateral brevis. The importance of careful preoperative evaluation of clinical findings as well as stress-roentgenograms and arthrographies is emphasized and a simple surgical technique is presented. We also realize an assessment of the results obtained which are very encouraging at the present.

Primary mediastinal seminoma

Primary mediastinal seminoma is a rare germ cell neoplasm histologically identical to testicular seminoma. Thirteen patients have been treated with definitive megavoltage radiotherapy at the Stanford University Medical Center, Division of Radiation Therapy, between 1961 and 1976. Doses ranged from 2500 rads over five weeks to 6000 rads over seven weeks. Actuarial survival at ten years is 69% with relapse-free survival of 54%. No patient receiving greater than 4700 rads to the primary lesion had local or systemic relapse. Patterns of relapse and recommendations for diagnostic evaluation are discussed. Primary megavoltage irradiation to the mediastinum and neck with a dose of 4500 to 5000 rads over five to six weeks is appropriate treatment.

Molecular dynamics of hemoglobin subunits as seen by fluorescence spectroscopy

Fluorescent conjugates of beta A subunits and their respective heme-free derivatives have been prepared in which a 1,5-N-iodoacetylaminoethyl-5-naphthylamine-1-sulfonate probe has been specifically placed at the beta-93 or beta-112 cysteine. The fluorescence anisotropy decay and static fluorescence polarization of these conjugates have been examined. Fluorescence measurements have also been made using 1-anilino-8-naphthalenesulfonate complexes, as well as the intrinsic fluorescence of the tryptophan groups. For the cases of the beta-93 and beta-112 conjugates there is substantial evidence for internal rotational freedom of the subunits. The internal mobility of the polypeptide is especially pronounced for the beta-112 conjugate. In contrast, the 1-anilino-8-naphthalenesulfonate probe placed within the heme pocket shows no indication of any rotation, other than that associated with the entire beta-subunit. Tryptophan fluorescence has been measured for the apo-beta subunits and for the peptides beta (1-55) from hemoglobins A and S. Perrin-Weber plots show the presence of multiple rotational modes suggesting mobility of the tryptophan groups.

Defect measurements in digital optical disks

A method of characterizing defects on an unrecorded optical disk is described. Information on the density of defects is obtained by analyzing the statistical distribution of the widths of the pulses obtained when playing back an unrecorded disk. It was shown that disk quality, as measured by bit error rates on actual recording, can be correlated with defect densities measured in this manner. The same method can also be used to characterize defects on uncoated substrates. It was demonstrated that defects on tellurium coated disks are largely the result of defects on the uncoated substrates.

Irradiation with external beam and interstitial radioactive implant as primary treatment for early carcinoma of the breast

The locoregional control of 60 to 61 patients supports the results published by other centers and compares favorably with results of any surgical series. The cosmetic results are excellent with only three of 61 patients having severe fibrosis of the breast develop. No rib fractures, skin ulcerations, symptomatic radiation pneumonitis, edema of the arm or limitation of arm movement have been observed as complications. Ten of the 28 patients who have had axillary dissection had transient edema of the breast develop. Results of numerous studies suggest that primary radiotherapy without mastectomy is appropriate treatment for early carcinoma of the breast. The accessibility of the breast makes it relatively easy to deliver curative doses of radiation with minimal damage to surrounding normal tissues. The cumulative radiotherapy experience has demonstrated the gratifying results of not only maintaining a rather normal breast but also avoiding the negative physical and psychologic repercussions of the mastectomy. Radiation therapy is an alternative to Halsted's radical mastectomy.

125Iodine prostate implants for recurrent carcinomas after external beam irradiation: preliminary results

Fourteen patients with locally recurrent prostate carcinomas after external beam irradiation received 135I seed implants at Stanford between 1975 and 1979. Clinical local control has been obtained in 11 of the 14 patients for follow-up periods of 6 to 36 months. Eight remain without evidence of disease, but 2 of the 3 patients whose pelvic lymph nodes were involved by carcinoma have developed distant metastases. Complications, consisting of either cystoproctitis, urinary incontinence, or the development of a vesicorectal fistula occurred in 4 of the 14 patients. These complications were noted only in those patients who had implantation of high intensity 125I seeds (greater than 0.50 mCi) into large prostatic volumes (greater than or equal to 50 cc). No complications occurred in patients who received lower intensity 125I seed implants in smaller prostatic volumes. We conclude that 125I seed implants may be used in a second attempt to obtain local control after a local relapse following external beam irradiation, if the use of high intensity 125I sources and/or the implantation of large prostate volumes are avoided.

[Retroperitoneal perforation of a duodenal ulcer (author's transl)]

A case or retroperitoneal perforation of a duodenal ulcer is presented. Firstly was erroneously diagnosed as an acute appendicitis, and operated upon. The result were good but four successives surgical gests became necessary : first, to treat a very severe parietal infection ; after that, to resolve one very impressive gastro-intestinal hemorrhage and lastly, to treat the duodeno-cutaenous fistula and the duodenal ulcer. The published cases in the recent literature are very scanty but similar to ourselves. The difficulties of promp diagnosis, the erroneously planned first operation in seriously ill patients would be the main causes of the very high mortality.

Tobramycin nephrotoxicity. A prospective clinical study

The nephrotoxicity of tobramycin given at a dose of 4·5 mg/kg/day for a period of 12 days to a group of 90 patients with a mean age of 62·9 years was studied. Toxicity was determined on the basis of 3 main criteria (oliguria <400 ml/24 hr, serum creatinine 0·4 mg increase over a minimum basal level of 1·2 mg/100 ml, BUN 5 mg increase over a minimum of 25 mg/100 ml); and 3 minor criteria (proteinuria, microhaematuria and cylindruria). These parameters were determined before treatment at 7, 10, 14, 17, 21, and 30 days afterwards. The age and coexistence of factors such as hypertension, diabetes, anaemia, cardiac insufficiency, shock and dehydration were considered. Nephrotoxicity level ranges from 3·3 to 38·8% depending on the criterion used, and is related to hypertension (P<0·001), age (P<0·005) and association with ampicillin (P<0·005). Nephrotoxicity was reversible spontaneously in 96·7% of the cases and no differences have been observed between patients with moderate renal insufficiency and those with normal renal function on the initiation of treatment.

Radioactive suture in the treatment of head an neck cancer

I-125 seeds in Vicryl suture have been used as a radioactive suture in 24 cases of advanced malignancy of the head and neck. Twelve cases had metastatic carcinoma attached to the internal or common carotid artery. The goal was to excise surgically as much tumor as possible, then implant any residual tumor with this radioactive suture which remains as a permanent implant (half-life of 60 days). This preliminary study shows that use of I-125 impregnated Vicryl suture in this manner appears to produce improved long-term palliation and may increase local cure rates.

Quantitative inheritance and barriers to crossability in Cicer arietinum L

Three different diallel crosses were studied in Cicer arietinum; two of size 6×6, one within each of the two botanical groups 'macrosperma' and 'microsperma' of the cultivated subspecies, and one of 9×9 involving lines covering most of the morphological variation of chickpea. Barriers to crossability present neither a botanical nor a geographical pattern, being probably a direct consequence of interactions between genotypes. The genetic systems of twelve quantitative characters were analysed. Full dominance in a negative sense (small values dominant) is shown by leaflet length, width and shape index, rachis length, leaflet density on the rachis and pod length. Full dominance in a positive sense is shown by seeds per pod. Overdominance (in a positive sense) is evident for pods, seeds and yield per plant. Weak reciprocal differences were manifested by pod length, and pods, seeds and yield per plant. The system controlling number of leaflets per leaf is not clear. Dominance of 'primitive' over 'selected' characters seems to be the rule. As far as the environmental effects have permitted the analysis, no differences in genetic systems were observed between botanical groups.

Intestinal mucosal changes following induced hypothyroidism in the developing rat

In this study, morphological changes which occur in the small intestine of hypothyroid rats are described. Hypothyroidism was induced during the first 24 h postnataly. - Samples from duodenojejunal and ileocecal junctions were taken, and histologic, histomorphometric, and ultrastructural studies were performed. The most prominent feature was the decrease of the villous height and total mucosal thickness. At electron microscopic level, microvillous height was also markedly decreased. These changes probably represent a direct effect of hormonal deprivation upon the intestinal mucosa, combined with the effect that hypothyroidism may have on the villi.

Early changes in the Schwann cells in experimental allergic neuritis

Experimental allergic neuritis (EAN) was induced in guinea-pigs by intradermal injection of rabbit peripheral nerve emulsified in Freund's adjuvant. Both sciatic nerves were obtained between 12--24 hr after clinical symptoms were evident. Several fascicles from each nerve were isolated for histochemical studies with NADH-diaphorase (NADH) and acid phosphatase (AP) applied to teased nerve fibres. Small pieces were processed for electron microscopy, and a fascicle was teased after staining with osmium tetroxide. In isolated nerve fibres stained with histochemical techniques myelin lesions of segmental character were found closely related to inflammatory cells; Schwann cell cytoplasm in contact with mononuclear cells showing a heavy enzymatic activity (NADH and AP). Under polarized light, the underliying myelin showed focal loss of birefringence. Some electron-microscopic pictures suggested active myelin breakdown by mononuclear cells. The possibility of primary Schwann cell damage by mononuclear cells with subsequent demyelination is discussed.

Vesicoureteral reflux associated with intact orthotopic ureterocele

Two cases of vesicoureteral reflux into intact, orthotopic ureteroceles are described. A review of the literature failed to reveal any similar reports. Insufficient submucosal ureteral length was thought to be the cause in each of the cases. Both patients were satisfactorily managed with standard ureteroneocystostomy after resection of the ureterocele.

Sites of sulfatation in the chondrocytes of the articular cartilage of the rabbit. A study by quantitative radioautography of high resolution

35S sulfate uptake by the articular cartilage chondrocytes, from biopsies of rabbit, have been studied by high resolution autoradiography. The Golgi apparatus, rough endoplasmic reticulum, cytosol, cytoplasmic membrane and extracellular space were considered as cell compartments in the quantitative analysis of the autoradiograms. The results obtained show: 1) a high activity of radiosotope incorporation in the Golgi apparatus; 2) a fast rhythm of transfer of the substances labelled in the Golgi apparatus to the cell membrane; 3) significant labelling of the rough endoplasmic reticulum, throughout the experiment. It is concluded: 1) The grains observed in the rough endoplasmic reticulum show a significant radioisotope uptake on this level, and this evidence some sulfotransferase activity. 2) The high 35S sulfate uptake level which is observed in the Golgi apparatus demonstrates that the highest sulfotransferase enzyme activity is located in this cell area, thus showing that the "early" sulfation that began in the rough endoplasmic reticulum was completed by a "late" sulfation in the Golgi apparatus. It is here that complete chondromucoprotein building takes place before being excreted. 3) The high transfer level of the labelled substances from the Golgi apparatus shows that the sulfated product secretion for building the cartilage matrix takes place rapidly since a great label increase can be already observed at the beginning of the chase period in the outer surrounding area of the chondrocyte membrane.

Involved field radiation therapy for early stage Hodgkin's disease in children: preliminary results

Twenty Stage I and II children with Hodgkin's disease were treated with involved field radiation therapy. Twelve patients were Stage I. The histologic types were:nodular sclerosis(seven cases), mixed cellularity (two) and lymphocyte predominant (three). There were eight Stage II patients (six nodular sclerosis and two of mixed cellularity). One Stage I and 4 Stage II patients had class B disease. Involved field irradiation was used in these children after staging laparotomy showed no disease below the diaphragm. Eight of the 20 patients relapsed, five in lymph nodes adjacent to the primary site, two in areas across the diaphragm; the other had both local and distant extension. The median time to relapse after completion of radiation therapy for Stage I and II were 15 and 5 months, respectively. Two of the eight children with recurrent disease are dead. The other six were retreated and are alive and free of disease for periods ranging from 24 to 68 months after original treatment (median, 36 months). Two of the six survivors in this group received irradiation to the site of the recurrent disease only, one was given total nodal irradiation, and three had chemotherapy. The other 12 patients are in continuous first remission. They have been followed for a median time of 26 months. The actuarial relapse-free survival and survival rates at 3 years are 57 and 89%, respectively.

Combination chemotherapy and radiation therapy in the treatment of metastatic osteogenic sarcoma

Fourteen patients with 16 metastatic ostogenic sarcoma lesions were treated with high-dose methotrexate (HDMTX) with citrovorum factor rescue (CFR), adriamycin, and pulse high-dose cyclophosphamide combined with radiation therapy. Thirteen of 16 lesions responded. Responses consisted of relief of pain (6/6 patients) in bone lesions, roentgenographic and clinical evidence of decrease in the size of the bone lesions (6/7 patients), and a decrease in the size of pulmonary metastases (2/4 patients). The 2 patients whose pulmonary metastases responded to combined therapy developed pulmonary fibrosis and pneumonitis in the treated areas 3 months after radiation therapy (RT) (1400 and 1600 rads respectively). Of two bulky primary tumors that appeared to respond, both were ultimately found to contain viable tumor; a third less bulky primary tumor appeared to respond more completely. Three smaller metastatic bone lesions that were ultimately biopsied showed no evidence of active tumor. It is concluded that: 1) combination therapy (particularly HDMTX and RT) has an additive effect in controlling osteogenic sarcoma bone lesions, but bulky primary tumors cannot be completely eradicated; 2) although synergistic in treating osteogenic sarcoma, combination therapy can produce enhanced toxicity in surrounding normal lung tissue; and 3) combination therapy is of value in the palliative treatment of metastatic lesions other than that of lung, and in the treatment of small primary bone lesions. However, experience to date does not justify the delay in surgical ablation of a primary lesion in a child who presents without metastatic disease.

Pressure in the hydrocephalic fetal head during the first stage of labor

Intraamniotic pressure was studied in the 30th week of amenorrhea in relationship with fetal intracranial pressure with open-tip catheters. The fetus had a severe hydrocephalus (echoscopy 16 cm) due to a teratologic malformation of the cerebrum. Clinically nonoperative treatment was indicated. Intracranial pressure (X) was invariably higher than intraamniotic pressure (Y) between contractions: Y = 2.04 + 0.54 X, and during contractions: Y = 5.30 + 0.55 X. There was no definite relationship between intrauterine and intracranial pressure, and the fetal tachogram. A definite relationship was established with the supine position of the patient and decelerations in the fetal tachogram. It is suggested that when fetal cardiac decelerations are seen during the first stage of labor it seems advisable to look for factors such as umbilical cord compression and decrease of materno-placental perfusion rather than fetal head compression.