Morphologic and morphometric studies on tumor necrosis produced by radiotherapy, and hyperthermia singly and in combination

The purpose of the present study was to evaluate the therapeutic effects of hyperthermia associated with radiotherapy on neoplasia. Two transplanted experimental tumors (undifferentiated carcinoma of mouse breast and sarcoma 37) were used. A protocol was followed that included, for both models, four groups of animals: 1) control group; 2) radiotherapy group; 3) hyperthermia group; 4) radiotherapy associated with hyperthermia group. The animals were sacrificed after therapy according to a different schedule for each type of tumor. The morphology of the neoplasia in every group of treated tumors was compared with that of the control group. For quantitative evaluation of the necrosis, we studied the ratio of the tumor necrotic areas (N) to a tumor standard area (T). From the results obtained, the following conclusions were made: 1) Necrosis produced by combined treatment was significantly greater than that obtained by using one only; 2) necrosis appeared early after treatment and remained relatively unchanged; 3) The damaging effect of the hyperthermia occurred earlier than that produced by radiotherapy when these methods were used separately, thus suggesting distinct mechanisms of tumor necrosis.

[Ceroid-lipofuscinosis: ultrastructural study of 8 cases]

The authors studied the clinical and ultrastructural features of 8 cases of Neuronal Ceroid-Lipofuscinosis (NCL). Five cases of the late-infantile type and 3 cases of the juvenile type. The clinical diagnosis of all cases was confirmed by the electron microscopy analysis of the peripheral blood lymphocytes and biopsy material from the skin, palpebral conjunctiva, skeletal muscle and rectal mucosa. Our observations agree with previous reports concerning the predominance of curvilinear bodies in the cells of the late infantile type, and fingerprint-like structures in those of the juvenile type. The finding of parallel tubular arrays and NCL inclusions associated in the same lymphocyte (frequently in the same vacuole) suggests that those structures could be related to the metabolic error of NCL. Ultrastructural examination of microbuffycoats of peripheric blood lymphocytes is a simple, time-saving and reliable method that allows specific confirmation of a clinical diagnosis of Neuronal Ceroid-Lipofuscinosis.

Diffuse sclerosing variant of papillary thyroid carcinoma. A clinicopathologic study of 10 cases

The clinico-pathologic features of ten cases of the diffuse sclerosing variant (DSV) of papillary carcinoma of the thyroid (PCT) are presented and compared with those of 259 common PCT diagnosed during the same period at the Instituto Português de Oncologia (Centro de Lisboa). The primary therapeutic approach was basically the same in every case and follow-up information was obtained in every patient. DSV comprises 3.4% of our series of PCT. Patients with DSV are suggestively younger (34.7 +/- 19.9), than those with common PCT (42.3 +/- 16.1) regional lymph node metastases and distant metastases are significantly greater in DSV (100.0% and 50.0%, respectively) than in common PCT (38.6% and 14.3%, respectively). No significant differences were found between the two groups with regard to sex-ratio, extrathyroid invasion and mortality rate. No differences were either found regarding the immunohistochemical results: neoplastic cells of both groups showed immunoreactivity with antisera for thyroglobulin, epidermal keratins, S-100 protein and NSE. Some foci of three DSV cases displayed histological and histochemical features resembling those of the so-called mucoepidermoid carcinoma. It is concluded that a) DSV is an exceptional example of PCT in which most of the usual morphologic features of this type of carcinoma are overexpressed; b) DSV is not exclusively found in young patients and, in older patients, merges with other variants of PCT; c) DSV is indeed a more aggressive tumor than common PCT and should therefore be treated accordingly regardless of the age of the patients.

A case of GM1 gangliosidosis type I

A six-month-old female gypsy child, the daughter of second degree cousins, born after a full-term pregnancy and normal delivery, is described. There was generalized neonatal edema. Abnormalities included psychomotor retardation from birth and progressive appearance of facial dysmorphism, organ enlargement, axial hypotonia, hypertonia in limbs, myoclonic jerks, optic atrophy and bilateral cherry-red spots. The diagnosis of GM1 type 1 gangliosidosis was confirmed by biochemical, enzymatic and ultrastructural findings.

Primary malignant melanoma of the nasal cavity: a clinicopathologic study of nine cases

Nine cases of primary malignant melanoma of the nasal cavity are presented. All the patients had epistaxis and nasal obstruction at admission. Gross aspect of the neoplasia showed a fungating mass located in the right nasal cavity in six cases and in the left nasal cavity in three. Eight tumors were formed by polygonal cells and one tumor by spindle cells. Melanosis of the adjacent mucosa was found in only 1 case. S-100 protein was demonstrated by indirect immunoperoxidase in all cases. The mean survival rate was 23.8 months. Prognosis was not related to the histologic pattern, cell atypia, necrosis, pigment secretion, or mitotic index. Radiotherapy seemed to have some beneficial influence on the survival but did not influence the local recurrence and metastatic spread of the disease.

Reaction of rectal mucosa of celiac patients to direct contact with gluten

It is assumed that the colonic mucosa of celiac patients is not sensitive to gluten. This assumption has been supported by the absence of clinical manifestations of colonic involvement in patients with active celiac disease which, by itself, does not confirm insensitivity to gluten. Eight children, aged from 11 to 25 months, with an initial diagnosis of celiac disease were studied: in five children a definite diagnosis has already been confirmed. Rectal gluten challenge was done by means of retention enemas. A volume of 100 ml of a 10% gluten suspension in water was introduced into the rectum three times per day for 8 days; each enema was retained at least 1 h. Rectosigmoidoscopies and rectal biopsies were done before and at the end of the challenge period. The endoscopic appearance of rectal mucosa was normal in all the children either before or after gluten challenge. The means of total mucosal thickness, intraepithelial lymphocyte counts, mitotic crypt cell activity, and cellular infiltration of lamina propria increased after challenge; the mean of goblet cell/epithelial cell ratio in the surface epithelium decreased. The differences between each pair of means (before and after challenge), however, were not significant except for total mucosal thickness (p less than 0.05), the meaning of which is unclear. This study did not definitely demonstrate that the rectal mucosa of celiacs is insensitive to gluten. For practical clinical purposes, however, it behaves as such. This makes the rectal mucosa a useless tool for the final diagnosis of celiac disease.

Gallium-67 imaging in human heart transplantation: correlation with endomyocardial biopsy

Endomyocardial biopsy seems to be the most accurate method to use for diagnosis and follow-up of acute rejection of the transplanted heart. This investigation compared a noninvasive procedure, gallium-67 imaging, with endomyocardial biopsy in the detection of acute rejection in heart transplantation. Seven male patients (aged 41 to 54 years) sequentially had 46 gallium-67 scintigrams and 46 endomyocardial biopsies between 1 week and 8 months after transplantation. Both studies were obtained in the same day, 48 hours after the administration of an intravenous injection of gallium-67 citrate. Cardiac uptake was graded as negative, mild, moderate, and marked according to an increasing count ratio with rib and sternal uptakes. Histologic findings were graded as negative, mild acute rejection, moderate acute rejection, severe acute rejection, resolving rejection, and nonspecific reaction. Negative biopsies were not found with moderate uptake, and neither moderate nor severe acute rejection were found with negative scintigrams. Imaging sensitivity was 83% with 17% false negatives and 9% false positives. Of seven studies with moderate uptake, five showed moderate acute rejection, and the patients had specific therapy with a decline in uptake, which correlated with resolving rejection. It is conceivable that in the future this technique may be used as a screening procedure for sequential endomyocardial biopsies in the follow-up of heart transplant patients.

Plasma cell granuloma of the tongue. Report of a case

A case of plasma cell granuloma of the tongue in an otherwise symptomless 48-year-old caucasian female is reported. The polyclonal nature of the plasmocytes was revealed by immunostaining of kappa and lambda light chains. Electron microscopic observations showed typical mature plasmocytes. A parasitic etiology of this type of lesion is suggested.

Confronting cisternae in human hepatocellular carcinoma

The Authors report the presence of confronting cisternae (CC) in two cases of poorly differentiated human hepatocellular carcinoma. They are interpreted as a peculiar phenotypical alteration of the tumor cells, probably related to a disturbance of the morphogenesis of nuclear and endoplasmic membranes.

Cow's milk protein-sensitive enteropathy: number and timing of biopsies for diagnosis

Intestinal biopsy is an essential procedure in the diagnosis of cow's milk protein-sensitive enteropathy. The number and timing of biopsies, however, is still controversial. Twenty-two infants who were clinically suspected of having cow's milk protein intolerance were put on a milk-free diet, during which they all improved. In the first 14 infants (Group I), milk withdrawal lasted 6-8 weeks; in the following 8 infants (Group II), milk withdrawal lasted 3.5-4 months. At the end of the withdrawal period, each patient was submitted to an oral lactose tolerance test and then to a first jejunal biopsy, followed by a cow's milk challenge, and a second biopsy (1-2 days later). None of the infants showed evidence of lactose intolerance, but they all reacted adversely to milk reintroduction. In Group I, the distribution of mucosae from grade 0 (normal) to III was almost the same before and after challenge (p greater than 0.5); this is considered to be due to the severe mucosal damage still present in prechallenge biopsies. In Group II, however, a significant difference was found in the distribution of mucosae before and after challenge (p less than 0.05), and a deterioration could be observed in each case after challenge. Intraepithelial lymphocyte counts and mitotic index determinations before and after milk reintroduction were of no diagnostic value in either group. It is suggested that the diagnosis of cow's milk protein-sensitive enteropathy may rely on two biopsies, the first after a period of 3.5-4 months on milk-free diet and the second following milk challenge.

Fractionation of glycoproteins according to lectin affinity and molecular size using a high-performance liquid chromatography system with sequentially coupled columns

The lectin phytohaemagglutinin was coupled to porous silica (10 micron) and used as adsorbent in a high-performance liquid affinity column sequentially coupled to a TSK-G 3000SW gel permeation column. This system was used for high-speed separation/analysis of human serum glycoproteins according to their lectin affinity and molecular size. Serum samples could be resolved in at least six different peaks representing glycoproteins exhibiting different molecular weights but with a carbohydrate content compatible with the specificity of phytohaemagglutinin.

Ventricular tachyarrhythmias following surgery for myocardial revascularization. A follow-up study

Of 1,599 patients who underwent surgery for direct myocardial revascularization in 1973 at Cleveland Clinic Hospital, 19 patients (1.2 percent) developed primary ventricular fibrillation or ventricular tachycardia during the immediate postoperative period. Occurrence of postoperative ventricular tachyarrhythmias could not be predicted by assessment of preoperative symptoms or by evaluation of the extent of coronary artery disease and left ventricular function. There was no increase in early or late mortality or morbidity (including postoperative myocardial infarction) among patients who developed postoperative primary ventricular tachyarrhythmias.