Incidentally discovered mass of the adrenal gland

Increasing numbers of asymptomatic masses of the adrenal gland are being discovered by high resolution computed tomography (CT) scanning. The significance of these masses and the question of further evaluation or treatment, or both, have posed a dilemma. From 1976 to 1983, an incidental finding of adrenal gland mass was identified in 88 patients undergoing abdominal CT scanning for unrelated problems. Adrenelectomy was performed upon 23 patients (26 per cent), including three adenomas (2.5, 3.0 and 6.5 centimeters), five carcinomas of the adrenal gland (6 to 20 centimeters), two hyperplasias and three adenocarcinomas of unknown origin. Thirty-eight (43 per cent) of the nonfunctioning masses were observed with repeat scans for an average of 25.1 months (three to 60 months), revealing no change in size. Twenty-seven patients (31 per cent) were lost to follow-up study. Silent primary (nonmetastatic) masses 3.5 centimeters or less manifested benign behavior without exception. Based upon these data, we conclude that all solid metabolically inactive lesions in the adrenal glands greater than 3.5 centimeters on CT abdominal scan deserve exploration. Lesions less than 3.5 centimeters may be safely followed with serial CT scans.

CT diagnosis of adrenal abnormalities in patients with primary non-adrenal malignancies

Fifty-seven patients with primary non-adrenal malignancy were found to have unsuspected adrenal abnormality on CT. In 33, comparison of histopathologic findings and/or the patients' hospital course or follow-up lead to the diagnosis of adrenal metastases (23), benign non-functioning adenomas (7), metastasis with hyperplasia (1), benign hyperplasia (1), and fatty infiltration (1). The analysis of CT findings indicated that: I) A heterogeneous adrenal mass showing contrast enhancement was always metastatic, II) Nonfunctioning adenomas were always 3 cm or smaller in diameter, III) Bilateral adrenal masses and growth of adrenal mass on follow-up CT or regression on treatment indicated metastases, and IV) metastatic disease could not be excluded purely on the basis of the size of the adrenal mass.

Ultrasonography of pancreatic schistosomiasis: a case report

A 10 year old girl presented with fever, pain, anaemia, hepatosplenomegaly and eosinophilia. No schistosomal ova were found on stool examination. Abdominal ultrasound revealed a mass in front of the portal vein conforming to the shape of an enlarged pancreas. Laparotomy revealed a firm, granular, whitish mass involving the pancreas. Examination of biopsy samples showed granulomata of Schistosoma mansoni in the pancreas, liver and lymph nodes. The patient responded to therapy with oxamniquine.

The effect of tumor size and axillary lymph node metastasis on estrogen and progesterone receptors in primary breast cancer

We evaluated the estrogen receptors (Er) and the progesterone receptors (Pr) in 209 female patients with primary breast cancer. There is statistically a very highly significant negative correlation between the size of the tumor and the Pr (p = 0.007); large tumor contains low Pr. The same correlation was found with Er, but it was not statistically significant (p = 0.40). There is also a negative correlation between the number of axillary metastatic lymph nodes and Er and Pr, but this was not statistically significant.

The effect of age on estrogen and progesterone receptor in primary breast cancer

We evaluated the estrogen receptors (Er) and progesterone receptors (Pr) in 228 female patients with primary breast cancer by Dextran-Charcol method. Their ages vary from 30 to 91 years. Mean age 60.7 years. (SD: 13.6 years). Er mean was 70.31. (SD:103); there exists a statistically significant correlation between age and Er at p less than .001; older patients have higher Er. Pr mean was 60.73, (SD:128). There is statistically significant correlation between age and Pr at .01 less than p less than .025; older patients have higher Pr. There is also very statistical significant correlation between Er and Pr at p less than 0.1; when Er is high Pr is high.

Long-term ureterostomy with suprapubic intravesical drainage used to bypass severe schistosomal obstructive uropathy--preliminary report

Severe obstructive uropathy due to infection with S. hematobium often requires reconstructive surgery. Recent reports, have emphasized that many lesions will disappear after specific chemotherapy given the necessary time. Time for effective chemotherapy may be impossible to allow in severe obstruction. The necessary surgical procedures range from ureteric dilatation to ureteric resection with ileal loop replacement. We suggest that temporary long-term bypass of the diseased ureter using silastic tubes may offer an alternative to resection in many cases while the effect of specific chemotherapy is awaited. One case is described in which ureterostomy with suprapubic intravesical drainage adequately bypassed the diseased and obstructed lower two thirds of the left ureter. In the following six months specific chemotherapy had encouraging effects on the bypassed area.

Synovial swellings over wrist in leprosy

Soft cystic swellings are noticed in leprosy patients during the course of disease and are seen all through the spectrum. The commonest site for these is the dorsum of wrist. At times these are seen over the dorsum and the lateral aspects of ankle as well. These contain straw colored sticky but clear fluid. On exploration these appear to arise from the synovial covering of the extensor tendons of wrist and fingers and have no communication with the wrist joint. Histology of the synovium suggests these swellings to be of inflammatory nature.

Incidence of C5 isozyme of serum cholinesterase (E2 locus) in populations of Andhra Pradesh, South India

The distribution of the C5 isozyme of the serum cholinesterase (E2 locus) was studied in several endogamous Hindu caste groups and Muslim sub-sects of Andhra Pradesh in South India. Both intra and inter population variation was marked with a comparatively low incidence of C5 in the populations studied.

Differentiation of malignant from benign adrenal masses: predictive indices on computed tomography

CT findings in 43 adrenal masses were analyzed to see which features correlated most significantly with malignancy. Size, contrast enhancement, and consistency emerged as important discriminators of malignant from benign adrenal masses. These three factors were further analyzed by logistic regression technique to examine the joint influence of computed tomographic (CT) features in prediction of malignancy. As a result of logistic regression analysis, a table of estimated probability of malignancy as a function of tumor size alone and another table of estimated probability as a joint function of size and contrast enhancement were developed. Given a similar patient sample and by using the data given, it would be possible to predict chances of malignancy in an adrenal mass if its CT features are known; for example, a 5-cm adrenal mass without enhancement has a 0.31 probability of malignancy; with enhancement, a 0.68 probability.

Ultrasonographic diagnosis of schistosomal periportal fibrosis

Hepatosplenic schistosomiasis results from infestation by Schistosoma mansoni, a blood fluke. Presinusoidal periportal fibrosis is invariably the result of this infestation. The ultrasonic pattern of schistosomal periportal fibrosis in 22 patients in whom schistosomal hepatic involvement was proven histologically is described. Echogenic areas of pipestem fibrosis seen as tubular shadows, some containing central lucencies, were present in every case. These tubular shadows conformed to the structure of the portal veins, producing a characteristic appearance. In endemic areas this appearance may be the only clue to the diagnosis of hepatosplenic schistosomiasis, because patients may remain asymptomatic for years after the onset of the disease.

Urography and cystoscopy in bladder mucosal abnormality

A prospective study was carried out on 60 patients. The diagnostic usefulness of intravenous urography (IVU) compared with that of cystoscopy in assessing the state of the bladder mucosa was evaluated. Collectively, radiology was as good as cystoscopy in suggesting the final diagnosis of the location and severity of a mucosal lesion. The after-micturition film (AMF) from IVU was the single most informative film which produced correct results in 59 of 60 patients. The full bladder film was the least useful examination and in 45 cases suggested an incorrect or misleading diagnosis.

Chemical reactivity and mutagenicity of some dihalomethanes

Four dihalomethanes; dichloromethane, bromochloromethane, dibromomethane and diiodomethane, have been studied with respect to their reactivities towards nucleophilic compounds of different strengths in water solution and with respect to their toxicities and mutagenic effectiveness in bacterial test systems. The correlation between biological activity (toxicity and mutagenic effectiveness in Salmonella TA100) and reactivity towards strong nucleophiles indicates that reactions with nucleophilic groups of high reactivity in the biological material, possibly SH or amino groups in proteins, are involved in their mechanism of action.

The production of high affinity monoclonal antibodies to human growth hormone

The primary aim of this work was to produce specific monoclonal antibodies to human growth hormone (hGH) for use in a diagnostic RIA of hGH levels in serum. Three different schedules were used for immunization of BALB/c mice and the splenocytes from each mouse were fused with myeloma cells Sp 2/0 Ag 14. Each fusion resulted in the production of hundreds of hybridomas secreting hGH-directed antibodies. Six antibodies have been fully characterized and have been grouped into pairs which recognize 3 different epitopes on the hGH molecule. One pair exhibits no cross reaction with the structurally related placental hormone, human placental lactogen (hPL), a second pair has low cross reaction with hPL (1.6-3%) and a third pair reacts equally well with hGH and hPL indicating binding to a common epitope in the 2 molecules. The highest affinity antibody, 74/6, which has an affinity constant of 4.4 X 10(10) l/mol and 3% cross-reactivity with hPL, has been used to establish a RIA for serum hGH measurements. Evidence is provided that hGH levels measured in this assay correlate well with those obtained in a conventional rabbit antiserum assay.

Estimation of genetic risks of alkylating agents. VI. Exposure of mice and bacteria to methyl bromide

Methyl bromide was studied in a forward mutation system of E. coli to evaluate the relationship between dose and mutagenic response. The compound had a high toxicity and a low mutagenic efficiency, as expected from the high s value. The mutagenic effectiveness was estimated to be 1 mutation per 10(8) surviving bacteria per mM . h, in reasonable agreement with expectation from reaction kinetic data. To study the possibilities of using hemoglobin alkylation for an estimation of DNA alkylation in vivo, mice were treated with 14C-labeled methyl bromide. The degree of alkylation of DNA, determined in liver and spleen, was considerably lower than expected (200 and 20 times, respectively) from the degree of alkylation of hemoglobin and from the relative reactivities of DNA and hemoglobin towards methyl bromide in vitro. when hemoglobin alkylation is used for quantitative risk estimations, a correction factor has to be applied by taking into account the difference between the dose in red blood cells and the dose in the compartments of DNA.

Preoperative arteriographic spasm and outcome from aneurysm operation

The timing of intracranial operation for the treatment of ruptured cerebral aneurysm remains controversial. To find objective parameters to guide us, we performed angiography 24 to 72 hours before contemplated operation in 35 Grade I patients in whom subarachnoid hemorrhage had occurred at least 1 week earlier. Operation in the presence of angiographic vasospasm in Grade I patients over 1 week after SAH was associated with increased morbidity and mortality rates. Only 1 of 28 patients in whom spasm was absent or mild at the time of operation had an unsatisfactory outcome from operation (P less than 0.003). There was no correlation between clinical grade and significant spasm; 17 patients who were clinically Grade I over 1 week after SAH had moderate or severe angiographic spasm. These data suggest that all patients should undergo angiography just before contemplated operation and that operation should be postponed if vasospasm is present.