Hodgkin's disease in the Waldeyer's ring

Amongst 128 patients with Hodgkin's disease six were found to have involvement of Waldeyer's lymphoid ring, one in tonsil and five in nasopharynx. Of these, three were histologically verified by biopsies taken from Waldeyer's ring, whilst three had histology only from upper cervical lymph nodes. Disease was confined to head and neck area by five, one had a more widespread process. Discussing diagnostic difficulties of nasopharyngeal involvement the importance of roentgentomography is stressed. Principles of radiotherapy are expounded and a more diligent search for detecting nasopharyngeal disease is proposed.

Early myocardial disease and cramping myalgia in Becker-type muscular dystrophy: a kindred

We present a clinical and morphological study concerning a kindred with slowly progressive X-linked muscular dystrophy (Becker type). Five males were affected; one died of heart failure at age 16. Severe and early cardiac disorder is unusual in this type of muscular dystrophy, and death at such an early age had not been reported previously. In the other patients of the kindred, cardiac abnormalities, if present at all, were nonspecific. Another unusual feature in this kindred was severe muscle pain at an early stage of the disease, a feature that cannot yet be explained.

Analysis of rapid oscillations of glucose and free fatty acids in plasma

The authors analyzed rapid oscillations of blood sugar (GL) and free fatty acid levels (FFA) in serum of healthy subjects. They investigated a series of blood samples taken under conditions of absolute rest from the cubital vein at 15-s intervals for a period of 6 min. In addition to common statistical parameters, they calculated the course of autocorrelation and cross-correlation functions and periodograms. The magnitude of oscillations is significantly higher than the error of the biochemical methods. In some sequences periodicities were detected which were statistically significant in 23.8% of GL and in 38.1% of FFA. 24-point series of GL collected in parallel from both arms correlate in 36.3% positively, in 27.3% negatively, and in 36.4% they do not correlate. Series of FFA and GL collected simultaneously from one site correlate mutaually in almost all instances either positively or negatively, frequently with a time shift. The oscillations may be due to (a) feedback regulations of the levels of the two metabolites, (b) permanent mutual interaction between the FFA and glucose level and (c) an uneven concentration of the two metabolites in different parts of the circulation. The above factors may combine, and the list of possible factors may not be complete.

Postirradiation changes on the lymphatics studied by lymphography

Repeat lymphography was done in 33 patients following radiotherapy between 8--73 months. Absorbed dose delivered by 60Co-teletherapy ranged between 30--45 Gy-s in subdiaphragmatic and 30,6--56 Gy-s in mediastinal region. The main sequel of radiation was decrease in nodal size (66,6%), lumen narrowing of lymphatic vessels (51,5%); number of lymph nodes and lymph vessels diminished rarely (6%). Blocking of lymph circulation never developed. Dilatation of thoracic duct with accelerated contrast flow rate was thought to be arteficial due to decreased pooling capacity of decreased nodal size. Radiation induced changes develop within 12 months and do not progress further on. It is concluded that changes are mainly affected by the level of absorbed dose.

[South American blastomycosis (paracoccidioidomycosis) in Switzerland. Clinical course and morphological findings in a case following long-term therapy]

The clinical course and morphological findings are reported of visceral paracoccidioidomycosis or South American blastomycosis with lung involvement in a 47-year-old male after specific antimycotic treatment for 11 years. The patient had been infected during a stay in São Paulo, Brazil, from 1950 to 1954. The diagnosis was established in 1959 after his return to St. Gall, Switzerland, in tissue from buccal mucosa and cervical lymph node biopsy and in fungus cultures. The patient was treated with Fungizone (amphotericin B) and with the sulfonamide Fanasil. He died in 1970 from acute right heart failure. Autopsy revealed multiple encapsulated mycotic foci in both lungs, together with healed foci and pulmonary fibrosis. Histological examination showed a large amount of Paracoccidioides brasiliensis in the mycotic foci, but cultural proof was no longer possible. In the buccal mucosa and lymph nodes, only fungus-free scars were observed. There are only a few effective antimycotic agents. With a thorough knowledge of their side effects and dosage modalities, it is possible to achieve highly satisfactory results.

[Cellular immune response and concentrations of serum immunoglobulins in patients with Hodgkin's disease (author's transl)]

The cellular immune response was explored by us with the help of tuberculin and DNCB reactions in 73 cases of Hodgkin's disease. Serum immunoglobulins were simultaneously determined. Tuberculin and DNCB reactions had significantly been decreased before treatment. A significant augmentation of the IgA is remarkable in tuberculin and DNCB positive groups. The positivity of the cutaneous tests is only temporarily lowered by radiation therapy, the difference being not significant, while IgM values in patients who had undergone radiation therapy are remaining at a lower level. Patients in remission revealed a positivity in tests that was approximating the values before treatment. Lower values were observed in all the three groups of immunoglobulins; the decrease of the IgM-values was significant. In case of a relapse, a significant decrease of positivity developed, accompanied by significantly increased values of IgA in tuberculin and DNCB negative groups. Only insignificantly positive values of the cutaneous tests were seen in the course of cytostatic treatment, and the values of the IgM were significantly decreased.

The autosomal recessive (Becker) form of myotonia congenita

In the last two decades, two genetically distinct forms of myotonia congenita have been identified--an autosomal dominant and an autosomal recessive form. The purpose of this review is to describe the features that enable us to distinguish between these two forms in the absence of sufficient genetic data. Thus far, it can be concluded that the only probable difference between the two forms is in the fatty-acid pattern of muscle phospholipids. Clinical, histologic, ultrastructural, and electromyographic investigation may prove helpful, but they alone cannot provide a reliable means of identifying the genotype in an individual patient.

[Cardiomyopathies]

A) Definition and classification. Cardiomyopathy is defined as a dysfunction of cardiac muscle of unknown origin and classified according to genetic, morphological and functional criteria as follows: 1. cardiomyopathy of autosomal dominant inheritance with asymmetric septal hypertrophy (ASH) a) obstructive b) non obstructive 2. cardiomyopathy of autosomal dominant inheritance without ASH 3. cardiomyopathy of autosomal recessive inheritance 4. sporadic cardiomyopathy. It is assumed that at least the cardiomyopathies listed here are heterogeneous groups that have to be subdivided as soon as further discriminating findings--structural or enzymatic--are available. B) Diagnosis, prognosis, treatment. The diagnostic methods are evaluated, the prognosis and the treatment of the cardiomyopathies are reviewed.

[Increased insulin secretion in dystrophia myotonica]

Serum insulin levels were determined in patients with myotonic dystrophy after intravenous administration of glucose and were found to be higher than in control persons in about 60%. Although several interpretations of this observation are possible we favor the assumption, that an increased sensitivity of the insulin producing system of the pancreas is the reason. With regard to the most accepted hypothesis that myotonic dystrophy is a disorder due to impaired membrane function, it is tempting to explain our findings by an altered membranal function of the insulin producing cells, too.