Treatment of testicular tumors

A total of 145 consecutive primary testicular tumors were treated with radiation therapy at the University of Michigan Hospital from 1955 through 1974. In patients with seminoma, the 5-year survival rate was 98% for Stage I and 88% for Stage II regardless of whether retroperitoneal lymph node dissection was done. The 5-year survival rate for embryonal carcinoma was 63% for Stage I and 66% for Stage II. For teratocarcinoma it was 100% for Stage I and 54% for Stage II. Adjuvant chemotherapy appeared to be beneficial for patients with Stage II teratocarcinoma but made no difference in patients with embryonal carcinoma.

Accessory blood supply to the liver from the dorsal pancreatic artery: an unusual anatomic variant

A case of an accessory hepatic artery from the dorsal pancreatic artery is illustrated. A discussion of anatomic variations and embryology of the arterial blood supply to the liver from the celiac axis and aberrant blood supply from other vessels is presented with a consideration of the surgical and diagnostic significance of anatomic variance.

Anteroposterior dysplasia indicator: an adjunct to cephalometric differential diagnosis

1. Cephalograms of 102 children with normal occlusion (Group 1) and 874 children with various malocclusions were analyzed to determine which measurements would produce the highest correlation against the displacement of the molar relationships. 2. Molar displacement was measured directly on the study casts, and an average of the measurements of the right and the left sides was obtained. 3. The malocclusion sample was divided into groups according to molar displacement: 214 neutroclusion cases (Group 2), 624 distoclusion cases (Group 3), and 36 mesioclusion cases (Group 4). 4. The mean value of the anteroposterior dysplasia indicator (APDI) in the normal group was 81.4 degrees, with a standard deviation of 3.79. 5. The APDI reading was obtained by tabulating the facial angle plus or minus the A-B plane angle and plus or minus the palatal plane angle. 6. Among the measurements tested, the APDI was found to show the highest correlation against the molar displacement, with a correlation value of 0.643. 7. The four variable that produced the highest correlation coefficient value--that is, the ANB angle (-0.495), the A-B pland angle (0.566), the "Wits" appraisal (-0.639), and the APDI (0.643)--were subjected to a study of their frequency distribution patterns. High percentage of overlapping of the two extreme groups (distoclusion and mesioclusion groups) were found in the above variables, with the exception of the APDI. 8. A discussion of the differential diagnostic value of the APDI was presented, together with illustrations and various clinical examples.

Enzymatic oxidation of disulfides and thiolsulfinates by both rabbit liver microsomes and a reconstituted system with purified cytochrome P-450

Both rabbit liver microsomes and reconstituted system with purified cytochrome P-450 and cofactors enzymatically oxidized o-dithiane (1, 2-dithiane), 3-methyl-o-dithiane, thiane and 2-methylthiane to the corresponding mono-oxygenated products; sulfides or disulfides were oxidized to the corresponding sulfoxides or thiosulfinates, while thiosulfinate was oxidized to thiolsulfonate. The reconstituted systems required oxygen and NADPH and were not affected by the catalase which decomposes H2O2, or by 1,4-diazabicyclo-[2,2,2]octane (DABCO), which is a good quencher of singlet oxygen. The differences in the binding of substrates such as sulfides and disulfides with the enzyme system are discussed in connection with differences in the spectra of the substrates in the reconstituted system with pure cytochrome P-450. A correlation was found between the rates of oxidation of the substrates and the rates of oxidation of NADPH.

Brunnian adenoma (inverted papilloma) of the urinary bladder: report of a case

An additional case of a benign polypoid tumor of the urinary bladder is reported, the first one observed at autopsy and the first in which photographic documentation of the gross appearance is presented. The lesion was first described as an adenomatoid polyp in 1927. We consider the subsequent (1963) designation of inverted papilloma misleading. Because its histologic morphology bears a striking resemblance to Brunn's nests and because the term papilloma of the urinary bladder connotes potential malignant change, we propose the designation brunnian adenoma. All cases previously reported have been benign.

Intracranial ependymomas

Clinically significant spinal implants develop in intracranial ependymomas. Spinal subarachnoid implants developed in 11 of 32 patients who received local irradiation at the University of Michigan between 1955 and 1972 for intracranial ependymoma. Seven of these patients received spinal axis irradiation for neurological disturbances resulting from the implants, and implants were found in the other 4 patients postmortem. Ten patients had infratentorial tumors, and one had a supratentorial tumor; nine tumors were poorly differentiated, two were well differentiated. The authors conclude that spinal irradiation is required if the tumor is poorly differentiated, or located in the infratentorial fossa.

Radiation necrosis of the scalp: a complication of cranial irradiation and methotrexate

A case of childhood leukemia with a severe skin reaction following a course of medium-dose cranial irradiation and intrathecal methotrexate is presented. Necrosis of the scalp of partial to full thickness resulted. The authors believe potentiation of the radiation reaction by methotrexate was the probable cause.

A clinical histologic, and immunologic study of a case of metastatic malignant melanoma undergoing spontaneous remission

A patient with biopsy-proven dermal recurrent malignant melanoma who refused therapy, and who was observed to undergo clinical regression during the period of November 1972 through June 1974 was studied to define the histologic features of spontaneous remission, and to evaluate the immune response as measured by in vitro assays of lymphocyte cytotoxicity and serum effects during the course of regression. Biopsy of regressed areas showed the following histologic features: 1) absence of malignant melanoma cells in basal layers of epidermis with relative increase in basal layer clear cells; 2) dermal inflammatory reaction with lymphocytic infiltrate, melanophages, and degenerate malignant melanocytes; and 3) dermal reactive vascular proliferation and interstitial edema progressing to reparative dermal fibrosis. Using a microcytotoxicity assay with two established allogeneic melanoma cell cultures as target cells, a statistically significant (p less than 0.01) increase in lymphocyte cytotoxicity values was observed over the clinical time course of regression. No significant serum cytotoxic or serum blocking effects were detectable. These findings are consistent with an immunologic basis for the spontaneous remission of the dermal melanoma metastases present in this patient.

Synthesis and biological activity of 10-thia-10-deaza analogs of folic acid, pteroic acid, and related compounds

The 10-thia analogs of pteroic acid, folic acid, their esters, and their 4-amino analogs were synthesized through a reaction sequence involving, as a key step, the condensation of 2-amino-3-cyano-5-chloromethylpyrazine with appropriately substituted thiols. The abilities of the products to inhibit the growth of methotrexate (MTX)-sensitive and MTX-resistant microorganisms were investigated as were their abilities to inhibit dihydrofolic acid reductase and thymidylic acid synthetase. Several compounds had high activity.

Tetrodotoxin: Occurrence in atelopid frogs of Costa Rica

The potent neurotoxin tetrodotoxin, which has previously been found in puffer fish of the order Tetraordontiformes, a goby (Gobius criniger), and the California newt (Taricha torosa), has now been identified in the skins of frogs of the genus Atelopus from Costa Rica.

Triage abilities of nurse practitioner vs pediatrician

The ability of ediatric nurse practitioners (PNPs) to perform triage functions for ill children in a busy pediatric outpatient service was compared to that of a group of pediatricians. One hundred thirteen children were seen separately on arrival by a PNP and by a pediatrician. The PNPs' evaluations agreed with the pediatricians' 84% of the time. Only two significant differences were shown: PNPs were more diligent in recording patient problems, while pediatricians were better able to anticipate the need for roentgenograms and laboratory studies. The results indicate that valuable physician time may be conserved by using the PNP to perform triage in large pediatric outpatient services.

Angiographic evidence of spontaneous closure of nontraumatic arteriovenous fistula of the vertebral artery. Case report

✓ A case is reported in which a congenital arteriovenous fistula of the left vertebral artery closed spontaneously 4 years after becoming symptomatic. The course was followed and confirmed by retrograde left brachial angiography.