Diagnosis of breast lesions by fine needle aspiration biopsy

The authors performed 480 fine needle aspiration biopsies (FNAB) of breast masses for cytologic diagnosis in 464 patients. Parallel surgical biopsy with histologic examination was carried out in 163 patients; the results were identical in 161. Two hundred eight of 297 benign lesions and 83 of 96 malignant tumors were diagnosed positively by FNAB. In 87 instances FNAB was not diagnostic but excluded malignancy, while in 87 others, the cytologic specimen was inadequate for diagnosis. There was one false-positive and one false-negative result. There were virtually no complications. FNAB of breast masses is a simple and reliable method, easy to carry out in ambulatory patients.

Individualized diets for diabetic patients

A flexible system for diet education and meal planning for diabetic patients is presented. Although this program may be accomplished by interested, knowledgeable physicians, it is best done by a diet counselor (registered dietitian or nurse educator). Nevertheless, physicians should be intimately involved by discussing the patient's progress with the diet counselor and by providing reinforcement of the efforts of the counselor.

Regulation of the androgen receptor in human genital skin fibroblasts, with a review of sex steroid receptor regulation by homologous and heterologous steroids

When normal human genital skin fibroblasts are cultured for 3 days with 2-3 nM methyltrienolone (R1881, a synthetic nonmetabolizable androgen), they augment their specific androgen-receptor activity (two- to four-fold) with a time pattern that is always most rapid in the first 24 h, usually peaks by 48 h, and often declines, sometimes substantially, in the third 24-h interval. The time pattern is highly reproducible within experiments on confluent monolayers and is not influenced by the presence or absence of 10% fetal calf serum in the medium, the temperature (37 vs. 40 degrees C) at which the incubation is conducted, or the basal activity (up to 40 fmol/mg protein) that is saturated by incubation for 30-45 min at 37 degrees C. It does appear to be influenced by an unusually rapid increase in the first 24 h and by nonconfluent density of the monolayers, but these factors do not explain the considerable interexperimental variation, within and among cell lines, under nominally identical conditions. The time pattern is interpreted to represent an initial phase of "up-regulation" that is followed by one of compensatory adjustment, despite a constant level of unmetabolized ligand. A review of sex steroid receptor regulation by homologous and heterologous sex steroids reveals numerous examples of apparently homologous regulatory behavior.

Possible implications of the comparative dissociative behavior of testosterone- and 5 alpha-dihydrotestosterone-receptor complexes formed by human skin fibroblasts

We have studied the dissociative behavior of 5 alpha-dihydrotestosterone (DHT)- or testosterone (T)-receptor complexes extracted from normal and 5 alpha-reductase-deficient human genital skin fibroblasts, respectively. The rate at which each hormone dissociates from the androgen receptor is temperature-dependent (29-40 degrees C), but DHT does so in a first-order (monophasic) manner, while T yields complex (biphasic) dissociation kinetics. Prior exposure to 0.1 M sodium thiocyanate induces DHT-receptor complexes to dissociate with complex kinetics. The temperature dependence of these complex dissociation profiles can be simulated identically by a kinetic model involving three conformational states of the androgen-receptor complex. Neither the rate constants of the rapidly- or slowly-dissociating components of T-receptor dissociation, nor the magnitude of the latter are affected by sodium molybdate (5 mM). Similarly, neither sodium molybdate nor potassium chloride (0.1-0.3 M) alters the complex dissociative behavior of DHT-receptor complexes that is induced by 0.1 M sodium thiocyanate.

Regulation of the androgen receptor by androgen in normal and androgen-resistant genital skin fibroblasts

Normal genital skin fibroblast (GSF) monolayers incubated with serum-free medium containing 3 nM [3H]-5 alpha-dihydrotestosterone (DHT) at 37 degrees C for 20 h have about 35% more specific DHT-binding than replicates incubated in serum-free medium with [3H]-DHT for only 1 h to saturate basal specific androgen-receptor activity. If, after 19 h, spent medium is replaced by fresh medium with 3 nM [3H]-DHT for 1 h, specific DHT binding is 85% more than basal. The acquisition of increased binding is temperature dependent (37 greater than 27 degrees C) and cycloheximide (2 microM) suppressible. The increased binding activity is considered to represent an augmentation of androgen receptor concentration because it has the same equilibrium dissociation constant (KD approximately 0.5 nM), rate constant of dissociation (k-1 approximately 6 x 10(-3) min-1) and ligand specificity as basal androgen-receptor activity, and because basal DHT-binding activity is stable in cells preincubated in androgen-free or serum-free medium alone for up to 72 h before assay. Prolonged incubation with methyltrienolone (R1881), a nonmetabolizable synthetic androgen, causes a greater, more persistent increment of androgen receptor activity than does equimolar DHT. The fibroblasts from two subjects with receptor-positive, partial androgen resistance lose their basal receptor activity during prolonged incubation with DHT, but augment it normally with R1881. This suggests that defective DHT metabolism is somehow involved in the pathogenesis of their androgen resistance.

The dissociation of testosterone- and 5 alpha-dihydrotestosterone-receptor complexes formed within cultured human genital skin fibroblasts

We have studied the rate and character with which testosterone (T) and 5 alpha-dihydrotestosterone (DHT) dissociate from the androgen receptor both within intact cultured genital skin fibroblasts of a subject with 5 alpha-reductase deficiency and after the androgen-receptor complexes have been extracted from the cells. Within the cells, the kinetics of the dissociative process for each hormone was first-order, but T dissociated four times faster than DHT. An Arrhenius plot of the variation of the dissociation rate constants with temperature for T was linear and yielded an activation energy of 28 kcal/mol. This value is identical with the one previously determined for activated DHT-receptor complexes. T-receptor complexes extracted from the cells dissociated with complex kinetics: at 37 degrees C the rate constants of the "fast" and "slow" components were 40 and 14 X 10(-3) min-1, respectively. In contrast, DHT-receptor complexes extracted from the cells dissociated with first-order kinetics and at a rate identical to that observed within cells, except after exposure to pyridoxal 5'-phosphate (5 mM) or concentration by Amicon (B-15) filtration, when their dissociation kinetics became complex. We interpret these data to mean that, within the cells, both T- and DHT-receptor complexes exist predominantly in the activated state whereas, when extracted from the cells, DHT-receptor complexes remain activated, unless perturbed, while T-receptor complexes become unstable spontaneously, probably by reverting to a preactivated state.

Sodium thiocyanate: a probe for the conformations of the androgen-receptor complex

In the presence of sodium thiocyanate (NaCNS), partially purified 5 alpha-dihydrotestosterone-receptor (DHT-R) complexes extracted from normal genital skin fibroblasts (GSF) dissociate with complex (biphasic) kinetics. The rate constant of the 'fast' component and the magnitude of the 'slow' component vary with temperature (29-37 degrees C) and NaCNS concentration (0.1-0.4 M). Equimolar sodium bromide is much less effective; potassium chloride up to 1 M has no effect. DHT-R complexes from the GSF of a subject with partial androgen insensitivity (PAI) yield biphasic dissociation profiles that differ from normal and are influenced by NaCNS. Together with the temperature-dependent, first-order (monophasic) dissociative behavior of normal DHT-R complexes in the absence of NaCNS (Kaufman et al., 1982), the foregoing data have been used to construct a kinetic model involving the dissociation of DHT from 3 conformationally related forms of the androgen-receptor complex: (1) dysactivated; (2) preactivated; (3) activated.

Effects of dexamethasone on antigen expression and virus production in avian sarcoma virus-transformed cells

We studied the effects of dexamethasone on virus production and antigen expression in avian retrovirus-infected chick embryo fibroblast (CEF) cells. The presence of specific receptors for this hormone in both normal and infected CEF cells could only be demonstrated using cultures that were at or near confluence. Dexamethasone, while not toxic to the cells, exerted a growth-retarding influence when employed at concentrations of 10(−8) or 10(−9) M. These same concentrations of hormone were inhibitory to virus production, elaboration of plasminogen activator activity, and antigen expression as determined in a sensitized lymphocyte stimulation assay. In contrast, infected cells that had been treated with hormone displayed enhanced reactivity in a specific immunofluorescence test.

Comparison of the composition of faecal fluid in Crohn's disease and ulcerative colitis

We determined the ionic composition of faecal fluid from 13 patients with Crohn's disease limited to the colon, 10 with diffuse ulcerative colitis, and eight with ulcerative proctitis. The Crohn's and colitis groups had similar proportions of colon surface involved radiographically and similar 24 hour faecal weights. However, Crohn's patients' faecal fluid had arithmetically lower mean sodium and statistically lower mean chloride (34.8 mmol/l +/- 16.2 SD vs. 53.1 mmol/l +/- 23.1 SD) and higher potassium (49.2 mmol/l +/- 20.2 SD vs. 33.0 mmol/l +/- 13.8 SD) concentrations (p less than 0.05 for each) and much higher osmolality (487.1 mOsmol/kg +/- 87.1 SD vs. 341.1 mOsmol/kg +/- 88.9 SD, p less than 0.001). Separation of these patients using the faecal osmotic gap agreed with the clinical classification in 86% of cases. The diarrhoea of proctitis patients had a nearly normal ionic composition which was clearly distinguishable from that of diffuse colitis. These results suggest differences in the composition and perhaps the pathogenesis of the diarrhoea of Crohn's and ulcerative colitis. The composition of fluid may prove a useful, non-invasive method for classifying patients with inflammatory bowel disease and, in ulcerative colitis, determining the extent of the inflammatory process.

Defective activation of androgen-receptor complexes: a marker of androgen insensitivity

Partially-purified 5 alpha-dihydrotestosterone-receptor (DHT-R) complexes, extracted from normal genital skin fibrolasts (GSF) previously labelled with [3H]DHT, dissociate with monophasic kinetics and dissociation rate constants (k-2) of 10, 6, 3 and 2 x 10(-3) min-1 at 40, 37, 32 and 29 degrees C, respectively. An Arrhenius plot yields an activation energy of 28 kcal/mole. We studied 2 subjects who have constitutional androgen insensitivity (AI) despite a normal level of specific DHT-R activity in their GSF. Subject 1 has complete AI and unambiguous female external genitalia; subject 2 has partial AI and had ambiguous external genitalia at birth. In contrast to normal, the DHT-R complexes extracted from the GSF of these 2 subjects dissociate with biphasic kinetics. At 37 degrees C the k-1 of their early ('fast') component is 21 +/- 0.4(+/-SEM) x 10(-3) min-1(n = 7), while that of their late ('slow') component (k-2) is 7.8 +/- 0.3 x 10(-3) min-1 (n = 7). The latter value is very similar to the single k-2 (6.1 +/- 0.1 x 10(-3) min-1, n = 9) of the DHT-R complexes extracted from normal fibroblasts. When dissociation of DHT-R complexes is studied with intact fibroblasts, monophasic kinetics are observed for both the normal and mutant subjects. A k-1 of 18 x 10(-3) min-1 was previously observed for both mutant subjects at 37 degrees C (normal: K-2, 5.9 +/- 0.3 x 10(-3) min-1, n = 15). At 40 degrees C subject 1 has a rate constant of 25 while that of subject 2 is 50 x 10(-3) min-1(normal: 10 x 10(-3) min-1). An Arrhenius plot of the results from subject 1 yields an activation energy of 18 kcal/mole. The 2 sets of data suggest that inability of DHT-R complexes to transform from a rapidly dissociating to a slowly-dissociating form within intact target cells is a marker of genetic mutations that alter the androgen receptor and thereby cause certain types of partial of complete AI.

Evaluation of internal carotid stenosis with the Chronopulse, an automated ocular pulse arrival time recorder

The diagnostic value of ocular pulse time measurement with the Chronopulse was evaluated in 67 patients who had carotid arteriography. The diagnostic accuracy of 85.5 percent was comparable to that obtained by two other groups using a different timing device. Identification of bilateral stenosis was the major problem encountered and resulted from measuring the external carotid circulation at the ear. Ocular pneumoplethysmography performed in the same patients yielded a higher diagnostic accuracy than the pulse timing, and combining the two did not enhance the results. Therefore, we recommend that the Chronopulse not be used as part of the routine ocular pneumoplethysmographic examination but that it be reserved for selective application.

Quality assurance in ambulatory nutritional care. II. Field testing of criteria

Quality assurance criteria developed for six target populations of pregnant women and obese infants, children, and adolescents were field tested in 102 ambulatory care settings to determine whether they were relevant, understandable, measurable, behavioral, and achievable. Field testing identified specific problems in ambulatory nutritional care settings related to documentation and feasibility of using patient care records to provide data to assess quality of care and to determine how statements were formulated. Field test results were used to rewrite the criteria. Findings are consistent with those of other authors.

Quality assurance in ambulatory nutritional care. I. Past, present, and future

Public health nutritionists have begun to coordinate efforts toward development of national standards for ambulatory nutritional care by writing and field testing criteria for selected target populations of pregnant women, infants, and children. These efforts have identified problems related to the "state of the art" in both quality assurance and nutrition science. This article reviews the literature on quality assurance in nutritional care and summarizes the current efforts culminating in publication of a preliminary guide on quality assurance in ambulatory nutrition care by the U.S. Department of Health and Human Services.

Marlex mesh in giant ventral hernia repair

Marlex mesh (polypropylene) is an excellent prosthetic material for closure of major defects in the abdominal wall. It helps to overcome many technical difficulties, making possible the repair of virtually every hernia. We describe two methods of ventral hernia repair, using Marlex mesh. In 20 operations in which one of the two methods was used, the results were uniformly satisfactory with acceptably low morbidity and no deaths.

Pleuroscopy in patients with pleural effusion and pleural masses

We performed diagnostic pleuroscopy in 66 patients with pleural effusion and in 14 with pleural masses. The findings were diagnostic in 76 patients (95%). Pleural metastases were found in 63 patients, primary pleural or lung tumor in 5, and less common findings in the remainder. Only 1 minor complication occurred, and there were no deaths. Malignant pleural effusion causing dyspnea was managed successfully by talc insufflation under direct vision in 31 of 35 patients. Talc also was used with equal success and without complications in management of recurrent pneumothorax. We conclude that pleuroscopy is a useful diagnostic and therapeutic procedure. It is simple and well tolerated, has a diagnostic yield of 95%, and is virtually free from complications. It provides the best way of insufflating talc for pleurodesis.

Cephalic neurulation and optic vesicle formation in the early mouse embryo

The overall pattern of cephalic neurulation and the concomitant early development of the optic vesicles in mouse embryos were examined by scanning electron microscopy. Paraffin-sectioned specimens were also examined. The overall pattern of closure of the cephalic neural folds accords well with earlier observations of this process. The earliest indication of optic placode formation was seen in histological sections of embryos at the 4-somite stage, while optic pit formation was first observed at the 5- to 6-somite stage. The upper halves of the optic vesicles were formed in 10- to 15-somite embryos by the fusion of the neural folds at the junction between the mesencephalon and prosencephalon, while closure of the lower halves was associated with the closure of the rostral neuropore, and was usually completed by about the 20-somite stage. By the 25- to 30-somite stage, a rapid increase in the volume of the forebrain was observed, so that the optic vesicles were displaced laterally. An overall increase in the volume of the optic vesicles and decrease in the diameter of the optic stalks were also observed at this time. This account of cephalic neurulation and optic organogenesis provides useful baseline data relevant to the study of the normal early development of the mouse. A comparison is made between similar events in the rat, the hamster, and the human embryo.

Vietnam, 1978: crisis in food, nutrition, and health

Evidence of shortages of food, medical equipment, and supplies and indications of malnutrition were observed by an American Study Mission to Vietnam in the summer of 1978. Recommendations of humanitarian aid were made by the study team and presented as promoting peace and stability in Southeast Asia.

Characteristics of the primary lesion of malignant melanoma as a guide to prognosis and therapy

The histologic materal from the original lesion of 113 patients suffering from Clinical Stage I and Clinical Stage II malignant melanomas were reviewed in an attempt to correlate depth of invasion with prognosis and to test whether or not current methods of microstaging were a valid guide to therapy. Both the microstaging methods of Clark and Breslow were eminently successful in indicating the prognosis of the patient, but were of no greater utility than other histologic parameters such as mitotic activity, perineural, vascular, or lymphatic invasion, or the presence of superficial ulceration. The value of elective node dissection for the treatment of primary malignant melanoma is uncertain. Deterents against empiric dissection are its low yield of occult metastases, its inability to prevent recurrence in a substantial portion of patients independent of the status of the nodes, and the difficulty in demonstrating an improved survival rate when this method of therapy is employed. Neither Clark's nor Breslow's methods or microstaging appeared to yield adequate criteria by which to choose node dissection. A simplified method of microstaging is proposed utilizing well defined anatomic levels, and yields statistically valid criteria for the performance of elective node dissection. Using this method, elective node dissection is advocated solely for those tumors that clearly invade the reticular dermis. Patients with tumors restricted to the papillary dermis do not appear to be benefited by empiric node dissection.

Complete androgen insensitivity with a normal amount of 5 alpha-dihydrotestosterone-binding activity in labium majus skin fibroblasts

We have studied labium majus skin fibroblast strains from six unrelated, previously unreported, patients with complete androgen insensitivity (CAI). Four have markedly reduced specific 5 alpha-dihydrotestosterone-binding (DHT-binding) activity (receptor-negative). The other two (receptor-positive) have normal activities in whole-cell homogenates, the 100,000g supernatant of cell sonicates prepared in 0.4 MKCl, purified whole nuclei, and the nuclear fraction that resists extraction with 0.4 MKCl. In one of the two, the DHT-binding macromolecules in the cytosol and 0.4 M KCl-extractable nuclear fraction have normal molecular sieving profiles and binding activities. One of the receptor-positive patients has maternally related affected relatives in three successive genetations. Appreciable unexplained interexperimental variation of the DHT-binding activities in genital skin fibroblast strains demands that multiple assays be performed on a strain before its receptor status is classified quantitatively. In our experience to date with genital skin fibroblasts, four of 13 propositi with CAI have been receptor-positive.

Some properties of the specific androgen-binding activities in cultured human genital skin fibroblasts

Specific 5 alpha-dihydrotestosterone (DHT)-binding activity in the cytosol (C) and 0.4 M KCl-extractable nuclear fraction (N) of cultured human fibroblast cell strains developed from preputial (n = 12) and labium majus (n = 12) skin were analyzed by gel exclusion chromatography, sucrose gradient sedimentation, and thermostability. Both fractions had activities that were excluded from Sephacryl S-200 columns; another component (mol wt, 20,000) was present in the N fraction. The C was more thermostable than a homologous N activity, and addition to the former of KCl to 0.4 M had no effect. There was large, overlapping variation in thermostability of the C and N activities among strains from either site, sister strains developed from a single skin biopsy, and even among serial subcultures within a strain; likewise, the variable sedimentability of the C (4-7S) and N (3.2-5.9S) activities prevented their consistent discrimination. Each type of variation occurred despite excellent intraexperimental replication. The thermostability of a given N activity varied directly with its sedimentation coefficient. By cluster analysis, the data relating thermostability of a given N activity with the percentage of 0.4 M KCl-resistant nuclear activity segregated into two populations; within each population these two measurements were related inversely. We suggest that these coordinate behaviors of the N activity reflect intrinsic properties of the androgen-receptor system in normal genital skin fibroblasts which may be useful for defining qualitative aberrations of the system in receptor-positive forms of congenital androgen insensitivity.

5alpha-reductase activity of genital and nongenital skin fibroblasts from patients with 5alpha-reductase deficiency, androgen insensitivity, or unknown forms of male pseudohermaphroditism

Serially subcultured fibroblast strains from genital (foreskin, labium majus) skin, as a group, have considerably more steroid (testosterone) 5alpha-reductase activity than those form nongenital skin. Foreskin strains varied 40-fold and labial strains even more. Labial strains overlapped nongenital strains of either sex more frequently than did prepuce strains. The activity of foreskin strains from two siblings with proven 5alpha-reductase deficiency was clearly lower than that of any of 18 control stains. The comparative behavior of the various strain types indicates that labial and nongenital strains should not be used to support a clinical suspicion of male pseudohermaphroditism due to 5alpha-reductase deficiency. The activities of labial strains from patients with complete androgen insensitivity (testicular feminization) - five with the receptor-negative variety and two with the receptor-positive type - were as variable as those of control labial strains. The decreased 5alpha-reductase activity observed in fresh skin slices of some patients is probably and expression of their functional estrogen/androgen imbalance in vivo.

Male pseudohermaphroditism: diagnosis in cell culture

Testicular feminization is a classic form of complete male pseudohermaphroditism. The individuals have a normal XY karyotype but unambiguously female external genitalia. They have congenital complete insensitivity to androgen due to an X-linked mutation. In four patients (from tow families with several affected members) with the typical phenotype of testicular feminization, a severe deficit of specific androgen-binding activity was detected in cultured fibroblasts from labium majus skin. Measurement of this activity in genital skin fibroblasts improves the differential diagnosis in patients with complete or imcomplete male pseudohermaphroditism before puberty.

Stilbestrol administration in the puerperium and its effect on the prolactin excretion of non-lactacting patients

The relationship between stilbestrol treatment and placebo treatment was studied in 2 groups of non-nursing patients. Plasma prolactin levels were evaluated in these 2 groups on day 1, 3 and 7 of the treatment, by a radioimmunoassay technique with the double antibody method using Serono hPRL kit. Our results show that prolactin values increased significantly in the stilbestrol-group and decreased in the placebo group. It seems that the main reason for "the drying up of milk" is the lack of stimulation of the nipples, which after a releatively constant time of 5--10 days will lead to decreased prolactin levels. Stilbestrol treatment is not effective in "drying up" the milk more rapidly in patients who do not want to nurse. When patients have symptoms a combination of analgesia and breast support usually brings relief within 24 to 48 hours.

Expression of androgen-responsive properties in human skin fibroblast strains of genital and nongenital origin

Specific 5alpha-dihydrotestosterone (DHT) binding capacity (Bmax) has been determined for human skin fibroblast strains from non-genital areas of males and females (N = 8), as well as prepuce and labium majus (N = 9). Genital strains had a mean three times that of non-genital ones (32 vs. 11 fmol/mg cell protein). There were no sex differences. Variation among strains was not simply correlated with donor age; that within strains was unrelated to in vitro age. The lowest values for genital strains overlapped the nongenital ones; those of the nongenital strains approached the limit of detectability. These results parallel those for delta4-3-ketosteroid 5alpha-reductase activity. Thus, serially cultured genital and nongenital skin fibroblasts express their relative differentiative ancestry as androgen target cells. This expression may affect the diagnosis of androgen insensitivity and certain inborn errors of metabolism; its variability is discussed in terms of clonal heterogeneity.

Male pseudohermaphroditism presumably due to target organ unresponsiveness to androgens. Deficient 5alpha-dihydrotestosterone binding in cultured skin fibroblasts

Maximum specific 5alpha-dihydrotestosterone (DHT) binding activity (Bmax) had been measured in intact confluent monolayers representing fibroblast strains derived form nongenital and genital (labium majus) skin of normal individuals and of 11 patients fulfilling the clinicogenetic criteria of complete testicular feminization (TF). Nine labium majus strains from adult females had a mean Bmax value three times greater than that of seven nongenital strains from adult females (33 vs. 11 fmol/mg cell protein). The Bmax results for 13 adult nongenital strains varied from 5.6 to 23.3 fmol/mg protein; the values for males and females had very similar means and ranges. The variation could not be correlated with the chronologic age of adult skin explant donors or with the in vitro age (mean population doubling level) of the cultures assayed. The Bmax activities of three nongenital strains from normal infants (two male, one female) did not exceed 5 fmol/mg protein. Seven of eight nongenital TF strains had Bmax values below 2 fmol/mg protein; the value for the eighth coincided with the lower limit of normal adults. The lower limit of DHT binding in normal labium majus strains was 15 fmol/mg protein. Three of five labial strains from patients with TF had Bmax values close to zero; the other two fell between 10 and 15 fmol/mg protein. It is apparant that labial skin fibroblast strains from clinically homogeneous patients with TF had highly variable degrees of DHT binding deficiency, and that they permit a more reliable diagnosis of severe and intermediate degrees of DHT binding deficiency than do strains of nongenital skin fibroblasts.

Specific 5alpha-dihydrotestosterone binding in labial skin fibroblasts cultured from patients.with male pseudohermaphroditism

The cytoplasm of skin fibroblasts serially subcultured from the labium majus of normal human females binds 5alpha-dihydrotestosterone (5alpha-DHT) with high affinity and low capacity. Such binding was absent from the strains of two male pseudohermaphrodites with unambiguous female external genitalia: one of these was from a patient with the clinical features and a family history typical of complete testicular feminization; the other merited the same diagnosis on anatomic and endocrine grounds, but had an XYY karyotype in multiple tissues, including the testes. Normal cytoplasmic binding was found in strains from two prepubertal male pseudohermaphrodites with bilateral inguinal testes: one had unambiguous female external genitalia, the other had clitoromegaly; the former had normal specific nuclear binding of 5alpha-DHT, and thereby the target cell capacity for pubertal masculinization. Measurement of specific 5alpha-DHT binding by cultured labial skin fibroblasts should be an early step in the investigation of male pseudohermaphroditism with female external genitalia.

Primary carcinoid tumor of the urethra

The first reported case of a carcinoid tumor of the urinary tract is presented. Because of rapid local recurrence and distant spread early radical surgery is recommended. Several methods of palliation of the carcinoid syndrome-surgical, pharmacologic and chemotherapeutic-are discussed.

Peritonitis fibroplastica incapsulata with superadded post-operative starch powder peritonitis

Peritonitis fibroplastica incapsulata is not generally accepted as a distinct syndrome. However, characteristic pathological alterations can be identified at laparotomy and by histological examinations. The aetiology of the disease is unknown. In the case reported a second disease arose, i.e. the peritoneal reaction to corn starch powder in the course of the surgical treatment of the peritonitis fibroplastica.