Solid and papillary epithelial neoplasm of the pancreas. An ultrastructural and immunocytochemical study of six cases

Solid and papillary epithelial neoplasms of the pancreas from six female patients were studied using immunohistochemistry and electron microscopy to define better their histogenesis. The tumors ranged in diameter from 5 to 15 cm (average: 9 cm), and, on cross section, most had areas of hemorrhage and necrosis, sometimes extensive. Microscopically, there was a solid and pseudopapillary pattern, with tumor cells typically having ovoid nuclei with delicate folding and indistinct nucleoli. Of note were the following: a relatively low mitotic rate (range: 0-6/20 hpf), the presence of hyaline globules (four of six cases), and collections of foam cells (three of six cases). Staining for cytoplasmic argyrophil granules was negative in each case. Ultrastructurally, the solid and papillary epithelial neoplasms of the pancreas showed evidence of acinar or ductular differentiation. Two contained zymogen granules, one had intermediate filaments (probably keratin), and three had abundant rough endoplasmic reticulum and mitochondria. Immunostaining was positive for chymotrypsin (six of six cases), trypsin (four of six), and amylase (three of six). None was positive for alpha-1-antitrypsin, neuron-specific enolase, pancreatic polypeptide, gastrin, glucagon, somatostatin, or insulin. The findings support an origin from exocrine pancreas, and follow-up indicates a low rate of malignancy, with local recurrence in two of the six patients.

A review of the factors influencing the prognosis of medulloblastoma. The importance of cell differentiation

The clinical, therapeutic, and histological features of 54 patients with medulloblastoma were analyzed retrospectively by a multivariate approach with regard to prognosis. The overall 5-year survival rate was 60%, with 48% of patients free of recurrence at 5 years. Cell differentiation, when present, was associated with a significantly longer recurrence-free period. Seventy-two percent of patients with the histological finding of cell differentiation were recurrence-free at 5 years. A marginally significant increase in the 5-year survival rate was also seen in association with differentiation. Only 34% of the patients whose tumor exhibited necrosis were alive at 5 years. There was no statistically significant difference in 5-year survival for children under 3 years of age or for the group of children aged 5 years or under. However, a significantly larger fraction (72%) of the group aged 5 years or under had a recurrence-free period of 5 years or more. Other factors including sex, extent of surgical resection. Chang tumor stage, posterior fossa radiation dose, and adjuvant chemotherapy did not influence prognosis.

Adjuvant chemotherapy for osteosarcoma: a randomized prospective trial

To determine the role of chemotherapy in the multidisciplinary treatment of patients with osteosarcoma, a randomized prospective trial of postoperative adjuvant chemotherapy was begun in 1981. Fifty-nine patients with nonmetastatic classic intramedullary osteosarcoma were randomized; 32 received postoperative adjuvant chemotherapy consisting of high-dose methotrexate, Adriamycin (Adria Laboratories, Columbus, OH), and BCD (bleomycin, cytoxan, actinomycin D), and 27 patients received no adjuvant chemotherapy. At a median follow-up of 2 years, there was a statistically significant improvement in both disease-free and overall survival in those who received adjuvant chemotherapy. In addition, there was no difference in the less than 20% disease-free or overall survival of patients treated in the 1970s who did not receive chemotherapy, as compared with the concurrent nontreatment controls. Therefore, with identical staging procedures, uniform surgical management, and standard pathologic evaluation, postoperative adjuvant chemotherapy definitely improves disease-free and overall survival in patients with osteosarcoma.

Endovascular papillary angioendothelioma of childhood: a vascular lesion possibly characterized by "high" endothelial cell differentiation

Two cases of endovascular papillary angioendothelioma (EPA) of the skin were studied immunohistochemically to assess the expression of endothelial, leukocytic, and epithelial determinants by these lesions. The tumor cells in both cases were labeled by antibodies to Factor VIII-related antigen, vimentin, and blood group isoantigens; they also bound Ulex europaeus I agglutinin. On the other hand, immunoreactivity for epithelial membrane antigen, Leu-M1, HLA-DR (Ia-like antigen), and leukocyte common antigen (LCA) was not observed. Stromal and intravascular lymphocytes were labeled intensely with antibodies to LCA and HLA-DR and were intimately associated with papillary configurations of proliferating intravascular tumor cells. These results confirm the endothelial nature of EPA and suggest that the cells of this lesion may differentiate toward "high" endothelial cells, which have been shown to interact functionally with circulating lymphocytes.

Modulation of the chloride concentration of human sweat by prolactin

The purpose of this study was to determine whether the availability of PRL modulates the chloride concentration of human sweat. Full thickness human skin grafted into the back of immunoincompetent, nude, congenitally athymic mice heals in about 6 to 10 weeks and survives the life of the mice. Mice have no sweat glands in the back so this system provides a useful model for study of the physiology and pathology of human sweat glands. The graft can be induced to sweat and the sweat collected for analytical studies. Presumably normal skin obtained from 7 individuals undergoing reconstructive surgery was grafted successfully into 11 mice. On 49 occasions sweat was induced by pilocarpine iontophoresis and collected for 45 min. The chloride concentration was 12.9 +/- 6.7 meq/liter, values typical of normal human sweat. Nine mice bearing grafts were injected with rabbit anti-human PRL (hPRL). The chloride concentration of sweat obtained a day later was significantly elevated. The concentration generally increased after a second and sometimes a third injection of anti-PRL. The average maximum sweat chloride obtained was 61.9 +/- 8.25 meq/liter. Serum of rabbits that had not been exposed to hPRL was prepared and diluted in the same way as the anti-hPRL. The chloride concentration of sweat of 3 mice that received the preparation for several days remained unchanged at the low normal level. We conclude that depletion of PRL increases the concentration of chloride in human sweat.

Adjuvant chemo-immunotherapy in stage II carcinoma of the breast

From July of 1974 to June of 1978, 131 patients with Stage II carcinoma of the breast were randomly assigned to one of three treatment arms in order to assess the efficacy of adding immunotherapy to adjuvant chemotherapy. All patients had metastases in the axillary lymph nodes, but no clinical evidence of systemic disease. Prognostic factors were relatively equally distributed among the three treatment arms. All patients received adjuvant chemotherapy consisting of cytoxan, methotrexate, and 5-fluorouracil (CMF). In addition, patients received adjuvant immunotherapy consisting of Bacille Calmette Guerin (BCG) or BCG plus a tumor cell vaccine. This vaccine was a mixture of allogeneic breast cancer cell lines grown in tissue culture. Fourteen patients receiving tumor cell vaccine developed hepatitis B, leading to the abandonment of this arm of the study. Side effects of chemotherapy were tolerable. No statistically significant difference could be demonstrated in recurrence rate or survival. However, the two groups receiving adjuvant chemo-immunotherapy had a slightly shorter time to recurrence and lower overall survival. The use of chemo-immunotherapy as administered in this study did not improve the clinical course of patients with Stage II breast cancer and was associated with significant morbidity.

"Nasal gliomas" and related brain heterotopias: a pathologist's perspective

Brain heterotopias are rare congenital malformations embryologically related to encephaloceles. They present as a mass in or about the nose (nasal glioma) or in the nasopharynx. We present the clinical and pathological features of 5 cases of heterotopic brain tissue. Four nasal gliomas consisted of mature neuroglial tissue, including neurons in 2 cases, embedded in a fibrovascular stroma. A nasopharyngeal brain heterotopia showed histologic features of mature neuroglial tissue including neurons and ependymal-lined cystic structures. The finding of mature neuroglial tissue in a mass from the head and neck region raises three differential diagnostic possibilities: teratoma, encephalocele, or heterotopic tissue. A teratoma can be ruled out by examination of the entire specimen. Encephaloceles and brain heterotopias can be distinguished only after correlation with the patient's clinical and radiologic findings.

Treatment of word retrieval deficits in aphasia. A comparison of two therapy methods

The effects of two therapy methods in the treatment of picture naming problems are compared, using a within-patient design with 12 adult patients with chronic acquired aphasia. We contrast techniques that require the patient to process the meaning corresponding to the picture name (semantic treatment) with those that provide the patients with information about the phonological form of the name (phonological treatment). With each method, patients either had 4 sessions of treatment over one week, or 8 sessions over two weeks. Both methods caused day-by-day improvement that was specific to the actual items treated. Both methods resulted in significant improvement in naming when this was measured one week after the end of treatment, with a small, but significant advantage for the semantic treatment; this is mainly due to improvement that generalizes to untreated items. We conclude that specific and theoretically motivated treatment methods can cause significant improvement in the word retrieval ability of patients with chronic aphasia.

Causes of death from asthma in children

There were seven deaths from asthma at Children's Hospital National Medical Center from 1944 to 1984. There have been none since 1971 despite an increased frequency of admissions for the treatment of asthma. Review of records implicated undertreatment, infection, and sedation as factors that may have contributed to deaths.

Malignant endovascular papillary angioendothelioma. Cutaneous borderline tumor

Malignant endovascular papillary angioendothelioma, a rare but distinctive vascular tumor of childhood, was first described in 1969. It was termed malignant because of its mitotic activity, areas of necrosis, and demonstrated ability to metastasize to regional lymph nodes. Despite these features it had a uniformly good prognosis. We report an example of this lesion in a 6-year-old boy that does not show malignant histologic features. Based on its good long-term prognosis and variable histologic features, this lesion is better classified as a borderline vascular tumor.

Detection of herpes simplex infection in cytologic smears

We compare the results of direct immunofluorescence (IF) with cytology (Papanicolaou's stains) for diagnosis of herpes simplex infection. Thirty smears were examined. Yellow-green fluorescence was seen in 17 smears. Only eight of these smears had diagnostic cytology, and nine of the smears with positive fluorescence had none (four) to minimal (five) cytologic changes, suggesting that direct IF is a much more sensitive method for diagnosis of herpes simplex infection in cytologic smears.

Benign hepatocellular tumors in the young. A clinicopathologic spectrum

Hepatic tumors unassociated with cirrhosis were encountered in seven patients aged 10 to 19 years. Four patients had received androgens for aplastic anemia. Two patients had transfusional hemosiderosis. One patient had had a renal transplant 2 1/2 years ago. Two patients are alive at 2 3/4 and 2 1/2 years after surgical resections. Nodules were found at autopsy in the others. The tumors were well differentiated and, in the androgen-related cases, differed from the others in the following features: canalicular bile retention, mild nuclear atypia, and acinar formation. No mitoses, vascular invasion, or metastatic tumor were evident. The clinical setting was variable; different factors, including iron overload and androgen therapy, played a role in the development of tumor. Although the androgen-related cases showed mild cellular atypia, biologic evidence of malignancy was lacking as in most previous reports.

Effects of grinding and storage for one month on retention of vitamin A in premixes and mineral supplements

Tested standardized procedures for handling premixes and mineral supplements from time of sampling to time of analysis for vitamin A have not been developed, which could account for some unexplained inconsistent and low analytical results. Grinding premix samples and storing them in a freezer for one month had little effect on amount of vitamin A found, but there was a significant loss (about 10%) after storage for one month at room temperature. Results on replicated determinations of vitamin A in unground and ground mineral supplements and on effect of storage were somewhat more variable than for premixes, but only the loss (about 12%) during storage for one month at room temperature was significant.

Letter-by-letter reading: psychological descriptions of a neurological syndrome

Following a general description of the characteristics of letter-by-letter reading and a summary of previous explanations of this reading deficit in both neurological and psychological models, four single-case studies of patients with this syndrome are presented. One central topic, addressed by experimental investigation, concerns comprehension of written words. Despite the use of multiple techniques, no evidence was obtained for the hypothesis that comprehension of a word could occur prior to or in the absence of the letter-by-letter analysis required for oral reading. It appears that these patients must do sequential letter identification of a word in order both to understand it and to report it. A second central topic, addressed through analysis of reading errors, concerns procedures for word recognition. Two of the four patients showed a “pure” letter-by-letter syndrome, with no difficulty in word recognition once the component letters had been identified. For the other two patients, an additional lexical deficit often prevented a correctly identified sequence of letters from achieving recognition as the correct word. Alternative interpretations of these patterns are discussed in terms of a process model.

Terminal deoxynucleotidyl transferase expression in acute non-lymphoid leukaemia: an analysis by immunofluorescence

Indirect immunofluorescence for terminal transferase enzyme (TdT) was used to study the blasts of 64 patients with acute non-lymphoid leukaemia (ANLL). In 32 patients no TdT positive cells were seen. In 19 cases a small subpopulation of cells expressing TdT was detected; these constituted up to 5% of total nucleated cells, and it was not clear whether these TdT positive cells were part of the leukaemic process or represented residual normal bone marrow lymphoid cells. The remaining 13 patients had TdT positive cells accounting for 7-90% of the total. In two of these cases TdT was expressed on blasts with myeloid features, representing an aberrant expression of TdT by myeloid cells; in contrast, in three cases mixed populations of TdT positive lymphoid blasts and TdT negative myeloid blasts were observed. In the remaining cases it was not possible to determine whether the TdT positive cells had definite lymphoid or myeloid features. Cytogenetic analysis showed no evidence of the Philadelphia chromosome. Response to treatment was assessed in 11 of the 13 patients. Only one patient remitted with the initial choice of therapy (DAT); four failed to respond to initial regimes of vincristine and prednisone (V & P) while the other five patients did not respond to myelotoxic combinations (DAT). Only one patient subsequently entered complete remission on second line therapy (V & P). This group of patients with TdT+ ANLL had a particularly bad prognosis, and appeared to differ from cases of TdT positive acute undifferentiated leukaemia, which often respond to V & P therapy.

The histones of yeast. The isolation and partial structure of the core histones

The four core histones of yeast chromatin have been isolated. Amino acid composition, electrophoretic mobility and partial sequences identify one variant each of the histones H3 and H4, whereas the histones H2A and H2B are represented by two variants each. In the yeast histones H3 and H4 7% of the residues, positioned in the partial sequences vary if compared with the corresponding histones from higher plants and animals, for the histones H2A and H2B from yeast this figure is 20%.

Hemispheric differences in processing visual patterns

The dichotomies verbal/visuospatial, serial/parallel and analytic/holistic are reviewed with respect to differences in hemispheric processing. A number of experimental parameters may be varied in such tasks, and together with certain frequently-occurring weaknesses of experimental design may account for the often discrepant results hitherto reported. The above factors are systematically reviewed, and three further experiments are reported which attempt to fill in the missing designs. Further evidence is given in support of the hypothesis that right-hemisphere superiority is most apparent in processes leading to identity matching. It is quantitative rather than qualitative, and may depend upon operations on the entire gestalt, such as holistic matching, mental rotation, reflection, distortion, etc., rather than, e.g., simultaneous (parallel) processing of discretely analysed or isolated features or elements. On the other hand left-hemisphere involvement in visuospatial processing is thought to reflect analysis of the configuration into its separable components; such processing may be either serial or parallel, and may frequently lead to a judgement different.

The perception and identification of mirror-reversed patterns

Many species have difficulty in discriminating between mirror-image stimuli, especially those about a vertical axis, and when identificatory rather than purely perceptual processes are involved. Various theories are reviewed. In two experiments involving same-different judgments for pairs of stimuli, triangles or semicircles, these were simultaneously presented either unilaterally or bilaterally, and in mirror or aligned orientations with respect to each other. Mirror oriented stimuli presented to opposite cerebral hemispheres were no more readily matched than those possessing the same orientations (aligned), thus suggesting that at the perceptual level there is no interaction between mirror-corresponding points in the two visual cortices. Foreknowledge of stimulus orientations failed differentially to affect the findings. Two other studies were performed involving manual identification of single letters, correct or mirror oriented, in either visual field. Here, for most subjects, mirror reversal proved either less disruptive or even advantageous when in the visual field which is normally inferior with correctly oriented material. It was concluded that mirror-image confusion at the level of memory is almost certainly a consequence of reversed coding, in some form, in the opposite sides of the brain. A number of incidental findings were made with respect to visual field effects.