bluuebunny/crossref_metadata_2025 huggingface dataset:
Numerous Sebaceous Neoplasms in a Patient without Visceral Carcinomas
Authors: Ang G. , Campanelli C. , Ringpfeil F. , Webster G. , Lee J.
Published: August 2010

We present a 58‐year‐old Caucasian man who spawns sebaceous neoplasms with a widely varying histopathologic pattern, the true nature of which were difficult to determine in some of the cases. In a 10‐year period, the patient developed over 20 lesions that varied in size, shape, and location. The patient denied a family history of either similar cutaneous lesions or internal malignancies that would fulfill the criteria of Hereditary Nonpolyposis Colorectal Cancer (HNPCC). Vigilant screening failed to reveal visceral carcinomas. The histopathologic findings of the neoplasms as well as the results of tests for microsatellite instability(MSI) in various tumors and the immunohistochemical staining for the mismatch repair genes (MMR) MSH2 and MLH1 will be discussed. Our patient has been maintained on low‐dose isotretinoin since 1995.
Epidermotropic Mucinous Adenocarcinoma Arising at Mucocutaneous Stomal Anastomosis Site
Authors: Fullen D. , Lowe L.
Published: August 2010

Polypoid lesions arising at ileostomy sites are uncommon and include inflammatory polyps related to prolapse and neoplastic polyps. Primary mucinous adenocarcinoma arising at an ileostomy site is rare and usually occurs in longstanding ulcerative colitis. An 82‐year‐old woman presented with an erythematous 1.5 cm polyp at the mucocutaneous junction of her ileostomy. Her history is significant for a cystectomy with ileal loop 23 years earlier for transitional cell carcinoma of the bladder. She had no prior history of ulcerative colitis. Histologically, a polypoid lesion was produced by variable‐sized cystic spaces filled with mucin and lined by columnar epithelium with goblet cells. The epithelial cells demonstrated cytological atypia and occasional mitotic figures were observed. Smaller neoplastic glands infiltrated the dermis and scattered, multiple epidermotropic foci were noted. We present an unusual case of a primary mucinous adenocarcinoma with multiple epidermotropic foci arising at an ileostomy site in a patient without a known history of ulcerative colitis. Primary mucinous adenocarcinoma arising at an ileostomy site is a rare occurrence described primarily in the gastrointestinal literature but could easily be unrecognized by a dermatopathologist. Knowledge of this phenomenon may prove helpful in arriving at the correct diagnosis.
Histopathologic Differential Diagnosis of Subepidermal Cutaneous Blisters and Erosions at Autopsy
Authors: Kovarik C. , Stewart D. , Cockerell C. , Barnard J.
Published: August 2010

The histopathologic differential diagnosis of subepidermal blisters is broad and most commonly includes primary dermatologic diseases (i.e. bullous pemphigoid), secondary blistering conditions (i.e. bullous lichen planus), and drug reactions (i.e. toxic epidermal necrolysis); however, when examining blister specimens taken during autopsy, several other entities need to be added to the differential diagnosis. For one year, we biopsied cutaneous blisters and erosions found during autopsies performed at the Dallas County Medical Examiner’s Office and examined them histologically. The objective of this study was to determine the primary cause of blisters and erosions seen at autopsy, characterize them histologically in order to allow differentiation from other blistering conditions, and emphasize causes of subepidermal blisters that are often not considered in the differential diagnosis. We present eight representative cases in order to illustrate the following points. The majority of blisters and erosions examined were subepidermal and secondary to physical causes, such as burns, defibrillation, submersion, fetal maceration, and decomposition. Although primary skin conditions need to be considered when examining blisters and erosions at autopsy, the most common entities are secondary to physical causes, and these need to be included in the differential diagnosis in order to obtain an accurate diagnosis.
P‐ANCA Positive Cocaine Associated Vasculitis: A Case Report
Authors: Pham T. , Heinly C. , Herman C. , Selim M. A.
Published: August 2010

Antineutrophilic cytoplasmic antibodies (ANCA) are classically associated with primary vasculitic syndromes, including Churg‐Strauss syndrome, microscopic polyangiitis, and Wegeners granulomatosis. Recently, drug induced ANCA positive vasculitis has been reported, most frequently in association with propylthiouracil in Grave’s disease. Cocaine use is known to be associated with pulmonary and systemic eosinophilia as well as various vascular pathology, including vasospasm, atherosclerosis, and vasculitis. We report a case of cocaine associated perinuclear antineutrophilic cytoplasmic antibody (p‐ANCA) positive vasculitis. A 46‐year‐old man with a history of crack cocaine abuse presented with arthralgia, lower extremity edema, and multiple purpuric, tender papules and plaques over the hands and lower extremities. Peripheral blood studies revealed hypereosinophilia, and serologic tests demonstrated a p‐ANCA titer of 1:2560. A skin biopsy demonstrated injured small dermal vessels with a perivascular infiltrate of neutrophils, karyorrhectic debris, erythrocytes, and abundant eosinophils. His symptoms and eosinophilia resolved with cessation of cocaine use and intravenous dexamethasone. Following a 2 year period of reported abstinence, the patient relapsed on cocaine and presented with similar clinical, serologic, and histologic findings. Although p‐ANCA has been reported in patients with cocaine associated midline destructive lesions, to our knowledge, this is the first report of cocaine associated p‐ANCA positive systemic vasculitis.
Disseminated Acanthamoebiasis
Authors: Readinger A. , Blumberg M , Wang Z. , Colome‐Grimmer M , Aronson J. , Kelly E.
Published: August 2010

A 60‐year‐old male with a history of pulmonary fibrosis and lung transplant presented to clinic with a three week history of cutaneous eruption on the extremities associated with nausea and fatigue. His medications included prednisone and azathioprine. Exam revealed the patient was afebrile with multiple perforating nodules and subcutaneous nodules in a sporotrichoid pattern over the extremities. Tissue was sent for histopathological evaluation, and culture for bacteria, acid‐fast bacteria, and deep fungal organisms was performed. Histopathology revealed necrotizing panniculitis, but no organisms were found, and tissue cultures were negative. Due to choreoathetoid movements of the right extremities and persistence of cutaneous nodules, the patient was hospitalized and an extensive search for infectious etiology of his condition undertaken. Empiric antibacterial and antifungal therapy was given, but he progressed to multiorgan failure and expired. Autopsy revealed rare amoebic trophozoite forms in the skin in addition to cysts in the lung and brain. Cause of death was determined to be disseminated Acanthamoebiasis. Review of initial skin biopsy showed rare trophozoites. Differing from Entamoeba, Acanthamoeba is a rare but important emerging pathogen. Histopathological diagnosis of Acanthamoeba rests on high index of suspicion in cases of suspected infectious etiology.
Tinctorial Properties of Zygomycosis in Cutaneous Biopsy Specimens
Authors: Rubin A. , Silvers D.
Published: August 2010

It is a little known fact that the organisms causing Zygomycosis are often better visualized with routine Hematoxylin and Eosin (H and E) staining than Periodic Acid Schiff (PAS) staining. Experienced dermatopathologists, when evaluating histologic samples suspected of harboring deep fungal infection often rely more heavily on PAS staining to detect fungi. The diagnosis of Zygomycosis may be delayed or missed entirely if sufficient attention is not devoted to the H and E stained specimen. A review of multiple dermatopathology textbooks shows there is no universal agreement on the usefulness of routine H and E staining versus use of special stains for the detection of Zygomycosis. Grocott’s Methanamine Silver (GMS) staining can give false negative results if background staining of reticulum fibers is enhanced. This can occur because of overexposure in silver solution, excessive heat during processing, or use of incorrectly titrated solutions. Three consecutive culture proven cases of cutaneous Zygomycosis infection were evaluated. In each case, organisms were clearly visualized on routine H and E sections while PAS staining was variable. Examples of false negative GMS staining are also shown. Recognition of these staining properties can help dermatopathologists better detect the agents of Zygomycosis.
Congenital Annular Erythema in Two Newborns: Similar Morphology, Divergent Etiologies
Authors: Satter E. , Andea A. , Caplan M. , Soder B. , Dodson J. , Metcalf J.
Published: August 2010

The inconsistent use of the term “erythema annulare centrifugum” has created confusion, in that it has been applied to a group of distinct diseases as if they were a single condition. The literature becomes more ambiguous when different names are given to annular eruptions that have a similar pathogenesis. We present two neonates who presented at birth with similar diffuse erythematous annular eruptions, but differed in their serologic and histopathologic findings. The first child was otherwise healthy and had normal laboratories findings that excluded both infectious and autoimmune diseases. His biopsy showed a perivascular and interstitial infiltrate throughout the entire dermis that was composed of lymphocytes, histiocytes and numerous eosinophils. The second neonate had elevated anti‐Ro and anti‐La antibodies, thrombocytopenia and a non‐anion gap metabolic acidosis. His biopsy showed focal vacuolar degeneration of the basal layer. There was a perivascular and interstitial infiltrate that extended throughout the dermis which consisted primarily of nuclear debris. Within the cytoplasm of the few intact histiocytes and neutrophils, were hematoxylin bodies, giving these cells the appearance of LE cells. We discuss the clinical and histopathological findings in these two neonates and attempt to clarify the nomenclature pertaining to the annular erythemas.
Perivascular Myoma of Myofibromatosis and Myopericytoma‐Type Arising in a Chronic Scar: A Case Report
Authors: Scott Rolf Sjuve , Blank Kristie L. , Proffer Liana H. , Kraus Eric W
Published: August 2010

We describe a case of a cutaneous perivascular myoma with features overlapping between the myofibromatosis and the myopericytoma type. The patient is a 58‐year‐old female with a painless plaque‐like and multinodular lesion in the pretibial dermis. She reported repeated trauma to this site, first in her early youth that left an area of hyperpigmentation, and then again at age 40. She had noticed the appearance of nodules in this area 5 years prior to presentation, which had increased in size and number over the last six months. The biopsy showed a biphasic pattern with a myofibromatosis type component composed of spindle cell myoid nodules and more cellular round cell areas. The myopericytoma‐like areas appeared to be infiltrating along vessels. These areas contained aggregates of immature cells arranged concentrically around vascular lumina reminiscent of pericytes. Immunohistochemical stains showed focal positivity for smooth muscle actin. Immunohistochemical and ultrastructural studies have shown these pericyte‐like cells to be of a myoid origin. The reason for the neoplastic proliferation of perivascular myoid cells is presently unknown. The association of trauma and neoplastic transformation of the skin is rare. We report the first case of a cutaneous perivascular myoma arising in a chronic scar.
Atypical Fibroxanthoma with Granular Cell Change
Authors: Zeikus P. , Pajvani U. , Kuperman M. , Telang G. , Robinson‐Bostom L.
Published: August 2010

Atypical fibroxanthoma is a fairly common dermal neoplasm that is characterized histologically by infiltrating pleomorphic spindle cells and atypical giant cells with numerous mitoses. Clinically, the lesion most commonly presents as a solitary ulcerated papule on the head or neck of elderly males. We report a patient with a rare granular cell variant of atypical fibroxanthoma. The patient was a seventy‐five‐year‐old male with a history of squamous cell carcinoma on the left scalp treated by Mohs surgery two years prior. In the vicinity of the previous squamous cell carcinoma site, the patient presented with a slow growing, approximately 1.0 by 1.0 cm red, violaceous, firm nodule on the left scalp. The clinical impression was recurrent squamous cell carcinoma. Biopsy of the lesion revealed a dermal tumor composed of pleomorphic cells with eosinophilic granular cytoplasm with numerous typical and atypical mitoses. The tumor stained focally with Factor VIII, CD 68, and SMA and 30% of the neoplastic cells stained with Ki 67. Staining for Keratin cocktail, High Molecular Weight Keratin, Melan A and S100 were negative. PAS strongly stained the granules. These features are consistent with a granular cell variant of atypical fibroxanthoma.
HTERT Expression in Melanocytic Lesions: An Immunohistochemical Study on Paraffin‐Embedded Tissues
Authors: Zhu W. , Su L. , Thomas D. , Fullen D.
Published: August 2010

Telomerase plays a role in the immortalization of cells and carcinogenesis. Previous studies have yielded conflicting results on whether human telomerase RNA (hTER) expression differs in nevi, atypical nevi and melanomas using PCR‐based telomeric repeat amplification protocol (TRAP) or in situ hybridization assays. The aim of this study was to evaluate human telomerase reverse transcriptase (hTERT) staining in melanocytic lesions on paraffin‐embedded tissues. Paraffin‐embedded sections from 6 acquired nevi, 4 dysplastic nevi, 5 Spitz nevi, 6 primary invasive melanomas, and 3 metastatic melanomas, were studied for staining intensity (0–3+) and % of labeled cells with anti‐hTERT. HTERT staining was observed in most cells (>75%) in all lesions, and was of greater intensity in the nucleus, especially the nucleolus, compared to the cytoplasm. Spitz nevi tended to have weaker hTERT staining (mean = 1.2) compared to acquired nevi (mean = 2.0), dysplastic nevi (mean = 2.5), primary melanoma (mean = 2.17), or metastatic melanoma (mean = 3). Although telomerase activity was weaker in Spitz nevi, there was overlap with other nevi and primary invasive melanomas in our small series. Thus, hTERT expression does not appear to be a reliable adjunct to the histological diagnosis of primary melanocytic lesions.
Cutaneous squamous cell carcinoma: a comprehensive clinicopathologic classification
Authors: Cassarino David S. , DeRienzo Damian P. , Barr Ronald J.
Published: August 2010

Abstract: Cutaneous squamous cell carcinoma (SCC) includes many subtypes with widely varying clinical behaviors, ranging from indolent to aggressive tumors with significant metastatic potential. However, the tendency for pathologists and clinicians alike is to refer to all squamoid neoplasms as generic SCC. No definitive, comprehensive clinicopathological system dividing cutaneous SCCs into categories based upon their aggressiveness has yet been promulgated. Therefore, we have proposed the following based upon the malignant potential of SCC variants, separating them into categories of low (≤2% metastatic rate), intermediate (3–10%), high (greater than 10%), and indeterminate behavior. Low‐risk SCCs include SCC arising in actinic keratosis, HPV‐associated SCC, tricholemmal carcinoma, and spindle cell SCC (unassociated with radiation). Intermediate‐risk SCCs include adenoid (acantholytic) SCC, intraepidermal epithelioma with invasion, and lymphoepithelioma‐like carcinoma of the skin. High‐risk subtypes includede novoSCC, SCC arising in association with predisposing factors (radiation, burn scars, and immunosuppression), invasive Bowen's disease, adenosquamous carcinoma, and malignant proliferating pilar tumors. The indeterminate category includes signet ring cell SCC, follicular SCC, papillary SCC, SCC arising in adnexal cysts, squamoid eccrine ductal carcinoma, and clear‐cell SCC. Subclassification of SCC into these risk‐based categories, along with enumeration of other factors including tumor size, differentiation, depth of invasion, and perineural invasion will provide prognostically relevant information and facilitate the most optimal treatment for patients.
De la pathogénie de certaines formes d'insuffisance surrénale chronique et secondaire.
Authors: BARKMAN ÅKE
Published: August 2010

Chez une patienle atteinte de maladie d'Addison on rencontrait des signes cliniques de néphrite s'accompagnant cl'une pression sanguine élevée, laquelle s'abaissa plus lard en même temps gu'apparaissaient les divers symptômes caractéristiques de la maladie d'Addison.

 Dans quatre autres cas de la même maladie on découvrit dans les reins des altérations d'une nature telle qu'on était en droit de supposer qu'une pression sanguine élevée existait antérieurement à la date où ces patients furent soumis à l'observation clinique. Dans l'un de ces cas (Obs. IV) pareille supposition est des plus vraisemblables.

 Il ressort des recherches de Wiesel que certaines néphrites accompagnées d'hypertrophie cardiaque et de pression sanguine élevée évoluent avec une hyperplasie du système chromaffine (y compris la substance médullaire des capsules surrénales).

 L'hypothèse suivante concernant la, pathogénie de la maladie (d'Addison peut étre considerée comme fondée: L'hyperplasie du systàme chromaffine accompagnant certaines lésions chronigues des reins (pa des vaisseaux) peut réaliser un locus minor is resistantice du côté des capsules surrénales par rapport aux bacilles tuberculeux circulant dans le sang.
Zur atypischen Amyloidose mit besonderer Berücksichtigung des Herzens.
Authors: SOISALO P. , RITAMA V.
Published: August 2010

Es wurde das klinische und pathologisch‐anatomische Bild eines Falles von atypischer Amyloidose mitgeteilt. Die hauptsächliche Lokalisation des Amyloids fand ausser in den parenchymatösen Organen in den Wänden der kleinen Blutgefässe statt. Die Amyloidentartung der Gefässe des Herzens hatte eine Koronarinsuffizienz und dadurch einen schweren Herzfehler zur Folge, der ein Elektrokardiogramm mit sehr kleinen Ausschlägen in allen Ableitungen und Senkung des Zwischenstückes in Abl I und I I verursachte. Ausserdem fanden Amyloidablagerungen im Peri‐ und Endocard sowie im Bindegewebe des Myocards statt. Die Muscularis mucosae des Dünndarmes war gänzlich amyloiddegeneriert.— Weder durch die klinische noch durch die pathologisch‐anatomische Untersuchung war eine ätiologische Krankheit der Amyloidose festzustellen.
THE LATE CARDIAC PROGNOSIS AFTER COXSACKIE‐B INFECTION
Authors: Orinius E.
Published: August 2010

Abstract Patients with positive Coxsackie‐B cultures but without diagnosed myocarditis were subjected to a cardiologic follow‐up examination after 2–11 years. At the time of follow‐up, the men were at the most 35 years of age and the women were 45 years or less. The possibility of cardiomyopathy was established in two of the 53 cases studied.
PHYSICAL WORK CAPACITY AND STATIC LUNG VOLUMES IN ELDERLY PEOPLE
Authors: Ericsson Per , Irnell Lars
Published: August 2010

Abstract.Results of determinations of lung volumes and physical work capacity in apparently healthy individuals of ages 57–71 years are reported. Function parameters for physical work capacity are correlated to certain lung volumes and parameters constituting measures of ventilatory capacity. The series would appear to fulfil, to a reasonable degree, the requirement of being representative of the population within the age range concerned, which does not seem to have been taken into account to the same extent in previous investigations. In this study, as in previous investigations, it is found that the maximal achievement capacity for circulation‐limited work (Wmax) decreased with increasing age, but in addition, our study, in contrast to previous investigations, indicates a decrease in submaximal indirect measures of physical work capacity (W170, W150, W130) with increasing age. This should mean that the reduction in physical work capacity with increasing age is not only due to a decrease in the maximal heart rate (HRmax), but that other factors are also of importance. It is probable that a reduced degree of physical training plays an important role in this respect.

No strong correlations are found either between lung volumes and physical work capacity or between ventilation capacity and physical work capacity. In this respect our results differ from the results of previously published studies on younger persons. The hypothesis is considered that the regression of physiological function with increasing age may have different time courses for the respiratory and the circulatory systems.
ST CHANGES AT EXERCISE IN PATIENTS WITH SHORT P‐R INTERVAL
Authors: Åstrand Irma , Blomqvist Gunnar , Orinius Erik
Published: August 2010

Abstract. Twelve patients with a P‐R interval of 0.12 sec or less and no delta wave or ST‐T changes in the resting ECG performed a multiple‐stage graded exercise test. For each of these patients a control subject of the same age and sex was selected. The controls fulfilled the same requirements as the patients except for short P‐R interval. ST segment amplitudes were not significantly different at rest in the two groups. ST‐J and ST segment amplitudes in lead CR5, were, however, significantly lower in the group with short P‐R interval both during and 3 min after exercise. This observation is important to keep in mind when evaluating exercise electrocardiograms.
V. THE CHEMICAL COMPOSITION OF THE FAT EMBOLI IN DOGS WITH EXTIRPATED LIVER AND INTESTINES
Authors: KERSTELL J.
Published: August 2010

Abstract. The formation and composition of fat emboli were studied in traumatized dogs in which the synthesis of lipoproteins was eliminated by extirpation of the liver and intestines. Neither the amount of the emboli nor the composition of the emboli differed from those found in earlier experiments in dogs with these organs intact. The results indicate, therefore, that the fat emboli are not formed from FFA released by the trauma and then reesterified in the liver and intestines.
PLASMA GROWTH HORMONE AND HYPERTROPHIC OSTEOARTHROPATHY IN CARCINOMA OF THE BRONCHUS
Authors: Dupont B. , Høyer I. , Borgeskov S. , Nerup J.
Published: August 2010

Abstract. Three cases of hypertrophic osteoarthropathy (Pierre Marie‐Bamberger syndrome) with co‐existing carcinoma of the bronchus are reported. Estimations of plasma growth hormone including the variations during hypo‐ and hyperglycemia were undertaken pre‐ and postoperatively. In one case the fasting plasma growth hormone concentration was elevated, presenting characteristics suggestive of autonomous secretion. The clinical picture of hypertrophic osteoarthropathy to some extent mimics that of acromegaly, but the evidence that hypertrophic osteoarthropathy is the result of increased production of growth hormone is not found to be convincing. It is concluded that cells from malignant lung tumors might be able to synthesize and secrete growth hormone or growth‐hormone‐like substances.
PLASMA 11‐HYDROXYCORTICOSTEROIDS IN ACUTE MYOCARDIAL INFARCTION
Authors: Nitter‐Hauge Sigurd , Kirkeby Knut , Alvsaker Jens‐Olai , Aakvaag Asbjörn
Published: August 2010

Abstract Serial determinations of plasma 11‐hydroxy‐corticosteroid (11‐OH‐CS), serum transaminase and venous blood lactate have been carried out over a 3‐day period after admission in 26 patients with acute myocardial infarction (AMI). On admission, values for 11‐OH‐CS above the upper normal range were found in slightly more than one half of the patients. Initial plasma 11‐OH‐CS levels higher than 40 μg/100 ml heralded a grave prognosis. Normal or moderately elevated levels were found in good risk patients. The study supports the assumption that determination of plasma 11‐OH‐CS may be of prognostic aid in the early phase of AMI. The rise in plasma 11‐OH‐CS preceded the rise in serum transaminase, but seemed to parallel the rise in venous blood lactate. Peak values for both the latter parameters showed close correlation with the steroid response.
THE NATURAL HISTORY OF INTERMEDIATE CORONARY SYNDROME
Authors: Skjæggestad öyvind
Published: August 2010

Abstract The prognosis in 132 patients with intermediate coronary syndrome (ICS) admitted to a coronary care unit has been investigated. All patients were monitored for at least 24 hours and they stayed in the hospital for at least 5 days. The observation period was 2 months. Sudden death occurred in 5 patients, fatal acute myocardial infarction (AMI) in 2 and non‐fatal AMI in 15. Altogether 22 events (16.7%) occurred, 9 during the first 2 days, all except 3 during the first 3 weeks. The incidence of events has been examined with regard to previous coronary heart disease, sex, age, ECG changes and enzyme levels, but no significant differences were found. The status as regards angina of effort after 2 months in the 110 patients without events was unchanged in 79 patients and worse in 31 patients. Four patients had intractable angina. The results indicate that patients with ICS are liable to suffer from AMI within a short time. The risk declines gradually and reaches a fairly steady state during the second month. These patients should be kept under surveillance in hospital during the first days and in close contact with a hospital during the following month. The risk and benefit of coronary surgery in these patients should be weighed against the fatality, incidence of infarction and of intractable angina mentioned above.
PLASMA CORTICOSTEROID RESPONSE TO METYRAPONE
Authors: Jørgensen Hans , Aakvaag Asbjørn
Published: August 2010

Abstract An oral metyrapone test has been carried out in 25 patients without endocrine disease. Metyrapone was administered in divided doses over 24 hours. For the assessment of the response a method for the determination of plasma corticosteroids, including Cortisol and 11‐deoxycortisol, has been established. The method is based upon the competitive protein binding principle. The results have been compared with those obtained by measurement of urinary excretion of 17‐hydroxycorticosteroids (17‐OHCS). The average increase in plasma corticosteroids was about 100% from the morning before the start of metyrapone administration till the next morning. With normal pituitary and adrenal function an increase in plasma corticosteroids of at least 5 μg/100 ml can be expected, and the plasma level on the morning after metyrapone should be at least 19 μg/100 ml. The response in urinary 17‐OHCS excretion was greater, an average increase of 200% was observed. It may therefore be expected that determination of 17‐OHCS in 24‐hour urine gives a better discrimination between the normals and those with reduced pituitary reserve than evaluation of the corticosteroid response from a plasma sample. The latter method is, however, easier to carry out, since it does not require urine collections, and can therefore be used in out‐patients.
MYDRIASIS OF UNUSUAL CAUSE IN A THROMBOCYTOPENIC, ANEMIC WOMAN WITH TEMPORARY AMAUROSIS
Authors: Åberg Hans , Levander Hans , Westerberg Karl Einar
Published: August 2010

Abstract. A 30‐year‐old female developed after curettage for menometrorrhagias a high intracranial pressure, choked optic discs with ocular bleedings, amaurosis and mydriasis. The cause is obscure and the explanation of the mydriasis is unusual and to our knowledge not previously described.
CLINICAL DIAGNOSTICS; EXPERIENCE FROM 383 AUTOPSIED CASES
Authors: Britton Mona
Published: August 2010

Abstract. The aim of the present study was to investigate whether the experience of clinical diagnostics could still further be enriched through routine autopsies. The question was studied by comparing diagnoses made by the same clinicians before and after autopsy in 383 subjects. Clinical misinterpretations thereby revealed were further analysed and described. Acute myocardial infarction (AMI) was the most common main cause of death. The diagnosis was seldom disproved when clinically considered fairly certain, but the disorder had often been missed ante mortem, especially among patients with known chronic ischaemic heart disease (IHD). Hidden behind this latter label were also cases with valvular lesions or with lung disorders and right heart failure. Apart from chronic IHD, cerebrovascular diseases were clinically overdiagnosed as main cause of death; sometimes recent myocardial infarcts or malignant neoplasms were instead disclosed at autopsy. Clinical diagnoses of neoplastic disorders were seldom found to be erroneous, but malignancy should be more often considered clinically. In several cases where it had been impossible to establish a definite diagnosis on clinical grounds acute abdominal disorders were revealed post mortem. An increased suspicion as regards these diseases seems warranted in obscure cases. The misinterpretations were frequently a consequence of our tendency to stick to earlier diagnoses and to overlook the development of new signs and symptoms. The same mechanism might partly explain why disorders contributing to death had often been unrecognized clinically —most frequently pulmonary embolism, AMI, cirrhosis of liver, and ulcer of stomach or duodenum. It is concluded that the Latin epigram regarding autopsies is still valid: “Mortui vivos docent”, let the dead teach the living.
DOSE REGIMEN OF KANAMYCIN AND GENTAMICIN
Authors: Lumholtz B. , Kampmann J. , Siersbæk‐Nielsen K. , Hansen J. Mølholm
Published: August 2010

Abstract. The half‐lives of kanamycin and gentamicin have been determined in 74 and 49 patients, respectively. In patients with normal serum creatinine values the kanamycin T½ varied from 90 to 538 min and the gentamicin T½ from 40 to 370 min, and in both cases an inversely proportional relationship with creatinine clearance was found. The half‐lives of both drugs increased with advancing age, reflecting the age‐dependent decrease in endogenous creatinine clearance which takes place with unaltered serum creatinine values. This finding invalidates many calculations of drug half‐lives based solely upon serum creatinine values. Using a previously described nomogram it is possible to evaluate a patient's creatinine clearance if the age, sex, weight and serum creatinine are known. Calculations of kanamycin and gentamicin half‐lives based upon evaluation of creatinine clearance from the nomogram are compared with the measured half‐lives. Dose regimens for kanamycin and gentamicin are suggested.
THE PROBLEM OF TISSUE OXYGENATION IN DIABETES MELLITUS
Authors: Ditzel Jørn , Standl Eberhard
Published: August 2010

Abstract.The underlying cause leading to the reversible functional changes in the microcirculation of insulin‐dependent diabetic subjects early during the disease prior to any clinical signs of retinopathy and nephropathy(functional microangiopathy)is discussed. It is suggested that the initial microvascular dilatation observed in diabetics is due to an autoregulatory response to relative tissue hypoxia providing an increased tissue perfusion in order to improve tissue oxygen delivery. Supporting evidence for this suggestion is derived from the findings that diabetics simultaneously may show increased tissue oxygen consumption and decreased ability of the circulating blood to release oxygen to the tissues. The latter defect is likely to be caused by two interrelated factors: 1. an increased proportion of haemoglobin A 1c with high oxygen affinity, and 2. difficulties of maintaining a sufficiently high concentration of plasma inorganic phosphate in order to provide an optimal 2,3‐diphosphoglycerate (2,3‐DPG) content in the erythrocytes. The basal oxygen demand of diabetics may fluctuate even within a few hours dependent upon the state of metabolic control and is increased at times of poor regulation. Hence, diabetics may suffer from innumerable cellular hypoxic injuries, which during the first years of the disease are counteracted in the microcirculation by an autoregulatory response. These microvascular reactions associated with increased plasma permeation may over the years be of major importance for the development of the degenerative microangiopathy in diabetes.
On the Use of Renal Angiography and Intravenous Urography in the Investigation of Renovascular Hypertension
Authors: Erikson Uno , Hemmingsson Anders , Ljungström Anders , Åberg Hans
Published: August 2010

Abstract. The value of renal angiography for revealing renovascular changes has been investigated in 126 patients with hypertension, and in 102 of them a comparison was made with i.v. urography. It was concluded that i.v. urography does not reveal renovascular changes and thus the primary investigation should be renal angiography, in some cases followed by urography in the same session.
The Role of Lymphography in the Investigation of Patients with Fever of Unknown Origin
Authors: Jonsson K.
Published: August 2010

Abstract. Lymphography has been performed in 21 patients with fever of unknown origin. In 8 of the patients, lymphography was positive, demonstrating retroperitoneal lymphoma. The value of lymphography before planning a laparotomy is stressed.
Quantitation of the Gain in Mortality and Life‐Time after Pacemaker Treatment
Authors: Forsberg Sven Åke
Published: August 2010

ABSTRACT. A total of 140 patients given permanent pacemaker 1963‐73 were followed during three years with regard to survival. Indication for pacemaker implantation was AV block in 82% and disturbed consciousness in 84%. The first half of the series had a survival equal to that of the second half. The survival was 86, 73 and 64% and the excess mortality, which is above normal, was 9, 16 and 20% after one, two and three years, respectively. Concepts of fractional life‐time and death‐time were developed. These express the proportion of the total observation time that is life and death, respectively. The fractional life‐time was 0.80 and the fractional death‐time 0.20. The excess death‐time was 0.12 (12%) of the total observation time. Mortality, survival, life‐time and death‐time were compared in three studies, the present one and two from Denmark. The great similarities were obvious. An estimation of the un‐paced survival during three years, based on studies of AV block before the pacemaker era, indicated the great benefit of pacemaker treatment.
Comparative Natriuretic and Diuretic Efficacy of Theophylline Ethylenediamine and of Bendroflumethiazide during Long‐Term Treatment with the Potent Diuretic Bumetanide
Authors: Sigurd Bjarne , Olesen Knud H.
Published: August 2010

ABSTRACT.The additive natriuretic and diuretic effects of theophylline ethylenediamine and of bendroflumethiazide have been compared in permutation trial tests in patients with advanced congestive heart failure receiving long‐term treatment with the highly potent diuretic, bumetanide. Statistical analysis of renal water and electrolyte excretion revealed that theophylline ethylenediamine, 400 mg orally, and bendroflumethiazide, 5 mg orally, had very similar effects, both quantitatively and qualitatively. The mechanism of action of the supplementary diuretics is discussed. It is concluded that theophylline ethylenediamine represents a useful alternative to thiazide diuretics when supplementary natriuretic treatment is considered in patients with congestive heart failure during long‐term treatment with potent diuretics. The significance of maintaining the potassium balance during such a combined regimen is stressed.
Distribution of Immunoglobulin‐Containing Cells in Bone Marrow and Lymphoid Tissues in Patients with Monoclonal Gammapathy
Authors: Turesson Ingemar
Published: August 2010

ABSTRACT. Cell suspensions of bone marrow and lymphoid tissue from 85 patients with monoclonal gammapathy were investigated by a direct immunofluorescence procedure for the detection of intracellular immunoglobulin alpha, mu, gamma, kappa and lambda chains. Serum Ig levels were determined and daily synthetic rates estimated. In all cases the majority of Ig‐containing bone marrow cells contained the same Ig class as that of the M‐component in serum or urine indicating a diffuse distribution of these clones in the bone marrow. This was observed not only in myeloma but also in benign monoclonal gammapathy (BMG) and lymphoma with an M‐component. The M‐component producing clone could be traced to extramedullary lymphoid tissue in myeloma but usually not in BMG. A positive correlation was found between the calculated synthetic rate of the M‐component and the number of Ig‐containing cells in the bone marrow and some indication was found that the synthetic rate per cell might be lower in IgM and IgG than in IgA monoclonal gammapathy. The depressed level of polyclonal Ig in myeloma and to some extent in BMG was parallelled by a diminished number of Ig‐containing cells in the bone marrow.
The Epidemiology of Febrile Reactions in Haemodialysis
Authors: Kolmos Hans Jørn , Møller Susanne
Published: August 2010

ABSTRACT. Febrile reactions were studied in 2000 consecutive haemodialyses performed in 85 patients. A number of 219 febrile reactions were registered in 49 patients (11%). The overall month‐to‐month incidence showed little variation. Febrile reactions were not distributed randomly among the patients; those with respiratory tract infection experienced more febrile reactions during periods with infection than during periods without. Similarly, the incidence was higher in patients with than without chronic urinary tract infection. A low incidence was registered both in patients under 40 years of age and in patients having had more than 100 dialyses at the beginning of the observation period. The frequency was the same whether single‐pass or recirculating single‐pass monitors had been used, and it was not influenced by blood transfusions during dialysis. Thus, our analysis leads to the conclusion that the majority of the febrile reactions registered among the present patients were determined by endogenous factors such as infection, while exogenous factors such as dialysate bacteria and pyrogens seem to have played only a minor role.
Renal Cadmium Concentration in Relation to Smoking Habits and Blood Pressure
Authors: østergaard Karen
Published: August 2010

ABSTRACT. The cadmium concentration of renal tissue from 120 patients, who had died at the age of 45–65 years, has been determined by atomic absorption spectrophotometry. The concentration did not differ significantly either between urban and rural dwellers or between male and female subjects. The concentration of cadmium in kidneys from cigarette smokers was about twice as high as in kidneys from non‐smokers. Renal cadmium concentration was higher in normotensives than in hypertensives. When smoking habits were taken into account, renal cadmium concentration was found to be 82% higher in normotensives than in hypertensives. The possible roles of water hardness and selenium intake are discussed.
Organization and Efficacy of an Out‐Patient Hypertension Clinic
Authors: Andersson Ove , Berglund Göran , Hansson Lennart , Sannerstedt Rune , Sivertsson Ramon , Wikstrand John , Wilhelmsen Lars
Published: August 2010

ABSTRACT. A description is given of the diagnostic and therapeutic routines at an out‐patient hypertension clinic. The efficiency of treatment in terms of BP control, patient adherence and frequency of side‐effects is presented. The patients were derived from a screening examination of a random third of an urban male population aged 47–54 years. Cut‐off points for hypertension were BP above 175 (systolic) or 115 (diastolic) mmHg on two separate occasions or current antihypertensive therapy. With these criteria, 11.2% of the population was considered hypertensive. Out of 686 hypertensive men, cared for at the clinic, only 4.2% defaulted during a two‐year follow‐up. At the second annual examination 83% had casual diastolic BP below 105 mmHg, with an average reduction of 10 mmHg. The antihypertensive therapy consisted of single drugs, a diuretic or a β‐adrenergic blocking agent, in 32% of the patients. Fifty per cent of the patients had a combination of two drugs; diuretics and β‐adrenergic blockers or β‐adrenergic blockers and hydralazine, while 14% had the triple combination of diuretics, β‐adrenergic blockers and hydralazine. Side‐effects so serious as to cause withdrawal of a drug occurred in 15% of the patients during the first year and in 3% during the second year of antihypertensive therapy.
The Prognosis of Insulin Dependent Diabetes Mellitus and the Importance of Supervision
Authors: Deckert Torsten , Poulsen Jacob K. , Larsen Mogens
Published: August 2010

ABSTRACT 1451 patients with IDDM, onset before 1953 and before the age of 30 were followed until death or until 1976. Survival with diabetes, relative survival and the influence of supervision on survival were examined. It is shown that only 50% of the patients survived more than 30 diabetes years. The patients had an overmortality of more than 600% in relation to age and sex matched non‐diabeties. Frequent supervisions in the out‐patient clinic reduced as well the overmortality as the prevalence of severe complications significantly.
Kinetics of Propylthiouracil in the Elderly
Authors: Kampmann Jens P. , Mortensen Henrik B. , Bach Bodil , Waldorff Stig , Kristensen Mogens B. , Hansen Jens Mølholm
Published: August 2010

ABSTRACT The pharmakokinetics of propylthiouracil was evaluated in 9 elderly patients and compared to previous results from 6 younger subjects. By giving the drug both by the intravenous and oral route of administration it was possible to estimate the rate and extent of bioavailability. The various kinetic parameters were calculated according to a two‐compartment model by use of two different methods: a graphical hand drawn one and by a special developed computer program based on a least squares minimalisation.

While no significant differences could be demonstrated between the two age groups concerning volumes of distribution, clearance and extent of absorption, a large difference was found with regard to the absorption rate constant ka, which was about 3 times higher in the younger than in the elderly subjects, presumably due a reduced gastric emptying time. Considering the comparison between the two methods of calculations all the kinetics parameters were similar except ka, and the slow disposition rate constant β which were underestimated by the graphical method.

It is concluded that no age‐dependent changes exist concerning the kinetics of propylthiouracil except for a decreased rate of absorption. Graphical methods in pharmacokinetics are useful in obtaining distribution and elimination data but seem often biased for the evaluation of absorption rate constants.
EFFECT OF INCREASES IN AFTERLOAD ON THE SYSTOLIC THICKENING OF ACUTELY ISCHEMIC MYOCARDIUM. AN EXPERIMENTAL ECHOCARDIOGRAPHIC STUDY
Authors: KERBER R.E. , MARCUS M.E. , EHRHARDT J. , ABBOUD F.M.
Published: August 2010

Changes in arterial blood pressure have been shown to alter epicardial ST segment elevations, and have been advocated to minimize infarct size and “salvage” ischemic myocardium. The effect of such changes on the regional function of ischemic myocardium has not been established. To investigate this, we studied the effect of increased afterload on the systolic wall thickening and myocardial perfusion of ischemic ventricular myocardium. In 20 open‐chest dogs, an echocardiographic transducer was fixed to the exposed right ventricle and directed to record the motion of the left ventricular posterior wall. Posterior ischemia was created by occlusion of the circumflex coronary, so that the ultrasound beam registered the motion of acutely ischemic myocardium. The ratio of end‐systolic to end‐diastolic posterior wall thickness (PTs/PTd) was greater than 1 (i.e. systolic thickening) before, and less than 1 (systolic thinning) after, posterior ischemia. Mean arterial pressure was then increased by infusion of methoxamine (Mx) or norepinephrine (NE) or by aortic constriction (CN). PTs/PTd improved from 0.89± 0.03 to 1.10± 0.06 (p<0.05) with CN. Perfusion of the ischemic areas, assessed with 8μ radioactive labled microspheres, showed a corresponding improvement; with MX ischemic myocardial perfusion improved from 32.4±6.2 to 59.6±13.8 ml/100g/min (p<05) and with CN perfusion rose from 30.2±9.3 to 43.8±10.3 ml/100g/min (p<0.5). Thus, increase in afterload improved both the perfusion and regional function of acutely ischemic myocardium.
Poisoning with Brown Fly Agaric, Amanita Regalis
Authors: Elonen Erkki , Tarssanen Leo , Härkönen Marja
Published: August 2010

ABSTRACT. Three patients ate different amounts of a common northern mushroom, brown fly agaric, Amanita regalis. All of them believed they had eaten delicious parasol mushrooms, Macrolepiota procera. The symptoms of poisoning began 1–2 hours after ingestion of the mushrooms. All the patients had marked gastrointestinal symptoms: nausea and heavy vomiting. Two had central nervous system manifestations and cholinergic symptoms: hallucinations, confusion, or loss of consciousness as well as copious salivation, or sweating. All patients recovered within 4–24 hours without any damage to liver, kidneys or central nervous system. It seems that cooking the mushrooms does not completely neutralize the toxic agents of Amanita regalis. The analysis of fried mushrooms shows that it may be possible to identify mushrooms reliably from the remains of a meal.
PITUITARY FUNCTION DURING X—RAY TREATMENT OF THE HYPOTHALAMIC—PITUITARY REGION AS EVALUATED BY THE TRH TEST RESPONSE
Authors: Halse J. , Larsen I. Frøyshov , Rootwelt K.
Published: August 2010

The effect of conventional radiotherapy on the TRH response was studied in fourteen patients, all but one previously surgically treated for pituitary tumors.

No change in the TSH response to TRH could be observed either during or after a four week treatment period, thus demonstrating a relative resistance of the pituitary gland against irradiation in these patients. We also conclude that the diagnostic value of the TRH test remains unhampered during and in the immediate period after irradiation.
Importance of Potassium in Patients With Acute Myocardial Infarction
Authors: Solomon Richard J. , Cole Alan G.
Published: August 2010

The records of 151 patients entering a coronary care unit and subsequently diagnosed as having an acute myocardial infarction were reviewed. The prevalence of hypokalemia, its relationship to diuretic treatment and the development of either ventricular tachycardia or ventricular fibrillation were studied.

At admission, 14 % of patients were hypokalemic. The presence of hypokalemia was related to previous diuretic therapy. Twenty‐three percent of patients receiving diuretics as compared to 7 % of patients not taking diuretics had a serum potassium of 3.5 mEq/L or less.

Thirty‐seven patients experienced either ventricular tachycardia or ventricular fibrillation. The presence of hypokalemia was associated with an increased frequency of both of these arrhythmias. Sixty‐seven percent of patients with a serum potassium of less than 3.1 mEq/L had these serious ventricular arrhythmias compared to 40% of patients with a serum potassium between 3.1 and 3.5 mEq/L and 20 % of normokalemic patients. The prevalence of premature ventricular beats was not correlated with the presence of hypokalemia.

We conclude that hypokalemia is not only a common problem in patients with acute myocardial infarction but a clinically significant factor in the development of life threatening arrhythmias. Primary prevention of hypokalemia and its prompt treatment are indicated in these patients.