Adult respiratory distress syndrome after limited thoracic radiotherapy

The authors report three patients who developed fatal respiratory failure after limited or unilateral thoracic radiation therapy for neoplasms. The respiratory failure was characteristic of the adult respiratory distress syndrome (ARDS) with refractory hypoxemia and diffuse bilateral infiltrates including areas of lung well outside of the radiation ports. No patient received drugs known to cause lung injury, and cardiogenic edema and infections were excluded. At autopsy the lungs exhibited interstitial fibrosis, Type II alveolar cell hyperplasia, inflammatory infiltrates, and squamous metaplasia. The etiology of the pulmonary injury is unclear.

Carcinoma of the lung with osseous stromal metaplasia

Calcification has long been a determinant in the radiologic distinction of a benign pulmonary mass. However, rare examples of calcification without ossification in pulmonary adenocarcinoma and ossification in the bronchial carcinoid have led some investigators to warn against this approach. A case of pulmonary adenocarcinoma with stromal ossification is reported herein. The literature is reviewed for neoplasms that exhibit pulmonary ossification either by primary or metastatic lesions. To our knowledge, this case represents the first report of benign osseous stromal metaplasia in the primary lesion of a pulmonary adenocarcinoma.

Cerebral polygyria in the Chiari Type II (Arnold-Chiari) malformation

Abnormalities of the cerebral cortical pattern have been observed in association with the Chiari Type II malformation and described as polymicrogyria, microgyria, stenogyria or polygyria. In order to characterize and quantify these abnormalities, the sulcal patterns of the brains of 15 patients with the Chiari Type II malformation were compared with those of 10 pediatric controls without cerebral malformations. In this analysis, sulci were grouped by anatomical characteristics into three categories. The first category, the fissures, were represented by the long, deep indentions in the cerebral cortex such as the Sylvian fissure. The second category, the principal sulci, were represented by the shorter, named, anatomically consistent sulci such as the superior frontal sulcus. The third category contained the minor sulci which were defined as those shallow grooves which depressed the cortical surface but were not recognizable as consistent anatomical landmarks. Subjectively all brains with Chiari Type II malformations demonstrated abnormal gyral patterns. These brains exhibited abnormalities in the number and distribution of principal and/or minor sulci. Sulcal density, defined as the length of sulcus per square millimeter of cortical area, was quantitated utilizing a computer assisted digitizer program. For the brains with the Chiari Type II malformations, the length of all sulci (principal and minor combined) per square mm was 0.238 +/- 0.045 mm-1 as compared with the control patients whose value was 0.182 +/ 0.021 mm-1 (t = .0015). Average length per square millimeter of principal sulci was 0.176 +/- 0.029 mm-1 as compared with 0.132 +/- 0.015 mm-1 (t = .0002) for the control brains.(ABSTRACT TRUNCATED AT 250 WORDS)

The glioblastoma multiforme in Georgia, 1977-1981

To characterize the incidence and mortality of the glioblastoma multiforme as it is seen at the primary care level, a retrospective study was done through the Georgia Tumor Registry on 299 patients with histologically confirmed supratentorial glioblastoma multiforme. Specifically, the age incidence distribution, sex ratio, and the postoperative survivals were studied. The Registry also provided the opportunity to define the relative racial frequencies of this neoplasm in a large biracial population. The mean age of the patients at the time of surgery was 58.6 years and the age group having the highest incidence was 60 to 74 years. The overall ratio of affected males to females was 1.04 to 1. The postoperative survival periods were considerably shorter than those reported from large cooperative clinical trials. The overall postoperative survivals at 12 and 24 months were only 22% and 4%, respectively. Advancing age had a strong negative relationship with the length of survival such that the 50% survival for patients less than 30 years of age was 17 months, for those age 30 to 44 years it was 10.2 months, for those age 45 to 59 it was 5.8 months, and for those older than 60 it was only 2.2 months. The study confirmed previous suggestions that the incidence of the neoplasm is considerably higher in whites. There were 2.3 glioblastomas in whites for every one in blacks. No difference was noted in the length of survival between whites and blacks.

Metabolic variation among rat lumbosacral alpha-motoneurons

Despite the wealth of literature concerned with muscle fiber biochemical, ultrastructural and physiological characteristics, little information is available regarding the metabolic enzyme activities of alpha-motoneurons. The present study examines the metabolism of alpha-motoneurons located in the lateral cell column of the rat lumbosacral enlargment with a quantitative histochemical technique. Variation in the activities of alpha-glucan phosphorylase, NADH-diaphorase, succinic dehydrogenase and acid phosphatase were detectable with the photographic densitometry and atomic absorption spectrophotometry technique. No difference in the glycolytic enzyme activity (mitochondrial alpha-glycerophosphate dehydrogenase) was observed. Analysis of lactate dehydrogenase isoenzymes demonstrated the existence of H type isoenzyme in alpha-motoneurons, consistent with other observations indicating predominance of aerobic metabolism within these neurons. The activities of the former enzymes in alpha-motoneurons formed a complete spectrum of activities, distributed unimodally. Smaller motoneurons exhibited the greatest NADH-D and acid phosphatase activities; phosphorylase activity was greatest in larger motoneurons. Significant variation in the enzyme activity of similar-sized motoneurons suggests that the metabolism of the motoneuron is regulated by factors other than cell size. Relationships between motoneuron metabolic enzyme activity and motor unit type are under current investigation.

Alternative method for quantitative enzyme histochemistry of muscle fibers. Application of photographic densitometry combined with atomic absorption spectrophotometry

The present study examines the use of photographic densitometry combined with atomic absorption spectrophotometry for the quantitation of enzyme activities (SDH and ATPase) in fresh frozen sections of rat tibialis anterior muscles. The technique eliminates some difficulties which are inherent in other methods. The reliability of the technique was found to be in the 98% range; the results were precise for all samples studied. The use of SDH to separate muscle fibers into "types" was found to be totally inaccurate since a full spectrum of activities was observed. ATPase activities could separate easily into two groups, but a continuum of ATPase activities was observed in the fast-twitch fibers. The simultaneous use of both enzymes was capable of separating the FG, FOG and SO fibers; however, variation within a single type was considerable and a great deal of information was lost when using any classification system. The continuum of SDH activities indicates the motor units are arranged as a spectrum of fatigue-resistant contractile units. The range of ATPase activities observed is comparable to ranges of motor unit contraction times emphasizing the importance of this enzyme in the regulation of contraction speed.