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Adenocarcinoma/*RT; Case Report; Human; Male; Middle Age; Prostatic Neoplasms/*RT; Radiation Injuries/*; Reiter's Disease/*ET.

Reiter's syndrome after radiotherapy for prostatic carcinoma [letter]

LETTER.

Episodic arthritis is an uncommon manifestation of cystic fibrosis. We describe the case of a 21-year-old man with cystic fibrosis who suffered from episodic arthritis associated with vasculitic skin lesions. Aetiology is discussed with reference to the possible role of immune complex disease.

Stevens H; Hickling P; Tyrrell CJ; Hammonds JC.

Br J Rheumatol 8703; 25(4):417-8

Arthritis, Rheumatoid/*ET; Colitis, Ulcerative/CO; Crohn Disease/CO; Human; Intestinal Diseases/*CO; Lipodystrophy, Intestinal/CO.

Preliminary evidence of gut involvement in the pathogenesis of rheumatoid arthritis? [letter]

LETTER.

Episodic arthritis is an uncommon manifestation of cystic fibrosis. We describe the case of a 21-year-old man with cystic fibrosis who suffered from episodic arthritis associated with vasculitic skin lesions. Aetiology is discussed with reference to the possible role of immune complex disease.

Haslock I.

Br J Rheumatol 8703; 25(4):418

Arthritis, Rheumatoid/*MI; Clostridium Perfringens/*IP; Feces/*MI; Female; Human; Male; Support, Non-U.S. Gov't.

Clostridium perfringens and rheumatoid arthritis [letter]

LETTER.

Episodic arthritis is an uncommon manifestation of cystic fibrosis. We describe the case of a 21-year-old man with cystic fibrosis who suffered from episodic arthritis associated with vasculitic skin lesions. Aetiology is discussed with reference to the possible role of immune complex disease.

Struthers GR.

Br J Rheumatol 8703; 25(4):419-20

Adult; Aged; Citrates/UR; Female; Glycosaminoglycans/UR; Human; Hydrogen-Ion Concentration; Magnesium/UR; Male; Middle Age; Recurrence; Support, Non-U.S. Gov't; Urinary Calculi/*UR; Zinc/UR.

Inhibitors of urinary stone formation in 40 recurrent stone formers.

JOURNAL ARTICLE.

The excretion of four inhibitors of urinary stone formation (zinc, magnesium, citrates and glycosaminoglycans (GAG) was studied in 20 normal controls and 40 recurrent calcium stone formers who were placed on a fixed diet restricted in calcium, oxalates and purines. We were unable to show any abnormality in the excretion of Zn, Mg or GAG. In 11 patients, a low level of urinary citrate was a significant feature that was associated in most cases with a urinary pH value above 6. Citrate concentration (per litre) and output (per 24 h) were found to be lower than in the controls in 19 and 33% respectively of the determinations. The overall ratio of average urinary citrate concentration in patients and controls was 0.56, a figure in agreement with previous data.

Francois B; Cahen R; Pascal B.

Br J Urol 8703; 58(5):479-83

Adult; Case Report; Child, Preschool; Colon/PA; Colonic Diseases/*CO/PA; Female; Human; Intestinal Fistula/*CO/PA; Kidney/PA; Kidney Diseases/*CO/PA; Male; Middle Age; Pyelonephritis, Xanthogranulomatous/*CO/PA; Urinary Fistula/*CO/PA.

Fistula and sinus formation in xanthogranulomatous pyelonephritis. A clinicopathological review and report of four cases.

JOURNAL ARTICLE.

Fistula or deep sinus formation as a complication of xanthogranulomatous pyelonephritis (XPN) has not been described previously in the British literature. We present the clinicopathological features of one case of a nephrodiaphragmatic sinus complicating XPN, and three cases of nephrocolic fistula, including the first recorded case of fistula in childhood XPN. The detailed clinical, radiological and pathological features of XPN and its complications are reviewed. Total nephrectomy, together with primary excision of sinuses or fistulae, is the treatment of choice.

Parsons MA; Harris SC; Grainger RG; Ross B; Smith JA; Williams JL.

Br J Urol 8703; 58(5):488-93

Aged; Carcinoma, Squamous Cell/PA/SC; Case Report; Female; Human; Kidney Neoplasms/PA/RA/*SC; Lung Neoplasms/*PA; Male; Middle Age; Tomography, X-Ray Computed.

Renal metastases from carcinoma of the lung.

JOURNAL ARTICLE.

Five cases of clinically manifest solitary and bilateral renal lesions metastatic from the lung are presented. These cases are unusual in that renal metastases are usually silent lesions discovered at autopsy. Review of the autopsy data from this hospital identified renal metastases in 19% of patients who died from carcinoma of the lung. This incidence parallels that of other series. A solid renal lesion which is identified in a patient with a history of pulmonary carcinoma should raise the suspicion of renal metastases, especially if computed tomography of the mass demonstrates relative homogeneity and minimal enhancement. More frequent use of the abdominal CT scan in staging patients with lung cancer will render metastatic carcinoma from lung to kidney a more frequent ante mortem diagnosis.

Becker WE; Schellhammer PF.

Br J Urol 8703; 58(5):494-8

Adult; Aged; Endoscopy; Female; Human; Male; Middle Age; Ureter; Ureteral Calculi/RA/*TH.

Rigid ureteroscopy for the treatment of ureteric calculi: experience in 120 cases.

JOURNAL ARTICLE.

Over a 1-year period, rigid ureteroscopy has been used to retrieve ureteric calculi in 120 patients. The technical details, causes of failure and the complications are described. An initial success rate of 78% was obtained. It was concluded that ureteroscopy should replace blind procedures for the extraction of ureteric stones.

el-Kappany H; Gaballah MA; Ghoneim MA.

Br J Urol 8703; 58(5):499-503

Adolescence; Bladder, Neurogenic/*CO; Child; Child, Preschool; Endoscopy; Female; Human; Infant; Male; Polytetrafluoroethylene/AD; Vesico-Ureteral Reflux/ET/RA/*TH.

Endoscopic correction of vesicoureteric reflux secondary to neuropathic bladder.

JOURNAL ARTICLE.

Eleven patients with vesicoureteric reflux secondary to neuropathic bladder were treated by endoscopic injection of pyrolised polytetrafluoroethylene (Polytef) paste. Thirteen of the 15 ureters treated showed disappearance of reflux after one injection. The amount of Polytef paste injected varied from 0.2 to 0.9 ml (mean 0.45 ml). There were no complications, except in one ureter where distension of the collecting system was slightly increased compared with the pre-operative urogram.

Puri P; Guiney EJ.

Br J Urol 8703; 58(5):504-6

Animal; Bladder/*DE; Cyproheptadine/PD; Dose-Response Relationship, Drug; Female; Human; In Vitro; Ketanserin/PD; Methysergide/PD; Muscle Contraction/DE; Muscle, Smooth/*DE; Serotonin/*PD; Serotonin Antagonists/PD; Support, Non-U.S. Gov't; Swine; Urethra/*DE.

Influence of serotonin on lower urinary tract smooth muscle in vitro.

JOURNAL ARTICLE.

The influence of serotonin (5-hydroxytryptamine) on human detrusor and on pig detrusor, trigone, bladder neck and urethral smooth muscle was explored in a series of in vitro experiments. Serotonin evoked a dose-dependent and reversible contraction of the detrusor. The reverse response was triggered in trigone, bladder neck and urethral smooth muscle--a dose-dependent and reversible relaxation. The maximum amplitude of this relaxation was 85 +/- 15% of the relaxation produced by electrical nerve stimulation. The effect of serotonin was unaltered by blockade of ganglia, alpha- and beta-adrenergic receptors, cholinergic receptors and prostaglandin synthesis. The serotonin antagonists ketanserin, methysergide and cyproheptadine partly inhibited the effect of serotonin. The antagonism differed in potency on strips of different origin. The antagonists were ineffective or minimally effective in blocking responses to nerve stimulation. The effect of serotonin was probably mediated by specific serotonin receptors different from the serotonin-S2-receptors predominating in vascular smooth muscle. Serotonin is a potential neurotransmitter in lower urinary tract smooth muscle, but its importance in micturition physiology and pathophysiology is unknown.

Klarskov P; Horby-Petersen J.

Br J Urol 8703; 58(5):507-13

Adult; Bladder/PP; Female; Human; Middle Age; Pressure; Urethra/PP; Urinary Incontinence/DT/*PP/SU; Urination; Urodynamics/*.

The pressure-volume plot and prediction of treatment outcome in female incontinence.

JOURNAL ARTICLE.

A graphic representation of the micturition cycle by a pressure-volume plot has been obtained in 120 women, both incontinent patients and normal controls. The pattern of contraction during voiding allowed prediction of the outcome of treatment. Patients with urethral sphincter incompetence and a sustained detrusor contraction had a good result from colposuspension even if detrusor instability was found during filling. Where the urethral sphincter was competent, patients with urge incontinence with or without detrusor instability during filling cystometry had a good response to drugs, providing a sustained detrusor contraction was present during voiding. Urethral sphincter incompetence was characterised by a low detrusor voiding pressure.

Wheelahan JB.

Br J Urol 8703; 58(5):514-9

Adolescence; Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Hematuria/*ET; Human; Male; Middle Age; Time Factors.

A 5-year follow-up of undiagnosed haematuria.

JOURNAL ARTICLE.

Eighty-four patients with haematuria were seen during 1976 and 1977. This symptom was investigated but no definite cause could be found. Five or more years later they were followed up. Although some patients had experienced further urological symptoms, none was found to have developed a malignancy in the genito-urinary tract. Possible causes of their bleeding are discussed.

Appleton GV; Lutchman GD; Charlton CA.

Br J Urol 8703; 58(5):526-7

Cardiovascular Diseases/MO; Comparative Study; Estradiol/*AA/AE/TU; Estrogens, Synthetic/*TU; Ethinyl Estradiol/TU; Follow-Up Studies; Human; Male; Neoplasm Metastasis; Orchiectomy/*; Prognosis; Prostatic Neoplasms/*DT/MO/SU.

Comparison of primary orchiectomy with oestrogen therapy in advanced prostatic cancer. A 2-year follow-up report of a national, prospective prostatic cancer study.

JOURNAL ARTICLE.

Two hundred and seventy-seven patients with advanced prostatic cancer were treated by either orchiectomy or oestrogen. During the 2-year follow-up period, the response to treatment was considered more favourable in the oestrogen group, and this response was particularly emphasised in patients with poorly differentiated tumour and metastases at the time of diagnosis. Further evaluations included the cardiovascular side effects of oestrogen therapy.

Haapiainen R; Rannikko S; Alfthan O.

Br J Urol 8703; 58(5):528-33

Adolescence; Adult; Follow-Up Studies; Human; Male; Middle Age; Penile Erection; Penis/*IN/SU.

Fracture of the penis and long-term results of surgical treatment.

JOURNAL ARTICLE.

Twenty-five patients with fracture of the penis were treated surgically between 1968 and 1984. Long-term follow-up was obtained in 17. In no case were there any early post-operative complications. All patients stated that they were achieving normal, painless erections; two patients developed a slight penile curvature but this did not affect their sexual activities. We strongly recommend early surgical intervention because of these encouraging results. Urethral injury associated with the fracture did not occur in this series.

Ozen HA; Erkan I; Alkibay T; Kendi S; Remzi D.

Br J Urol 8703; 58(5):551-2

Aged; Case Report; Human; Male; Neoplasm Recurrence, Local/SU; Penile Neoplasms/*SU; Sarcoma, Kaposi's/*SU.

Kaposi's sarcoma of penis.

JOURNAL ARTICLE.

Twenty-five patients with fracture of the penis were treated surgically between 1968 and 1984. Long-term follow-up was obtained in 17. In no case were there any early post-operative complications. All patients stated that they were achieving normal, painless erections; two patients developed a slight penile curvature but this did not affect their sexual activities. We strongly recommend early surgical intervention because of these encouraging results. Urethral injury associated with the fracture did not occur in this series.

Maiche AG; Holsti P; Grohn P; Wasenius VM.

Br J Urol 8703; 58(5):557

Aged; Case Report; Fistula/*ET; Human; Male; Polycythemia Vera/*CO; Postoperative Complications/*; Prostatectomy/*; Prostatic Diseases/*ET; Skin Diseases/*ET; Thigh; Urinary Fistula/*ET.

Prostatocutaneous urinary fistula to the thigh after retropubic prostatectomy in a patient with polycythaemia rubra vera.

JOURNAL ARTICLE.

Twenty-five patients with fracture of the penis were treated surgically between 1968 and 1984. Long-term follow-up was obtained in 17. In no case were there any early post-operative complications. All patients stated that they were achieving normal, painless erections; two patients developed a slight penile curvature but this did not affect their sexual activities. We strongly recommend early surgical intervention because of these encouraging results. Urethral injury associated with the fracture did not occur in this series.

Snooks SJ; Dharmasena F; Mitchell TJ; Crisp JC.

Br J Urol 8703; 58(5):558

Adult; Case Report; Human; Hydronephrosis/*CO/RA; Kidney/*AB; Male.

Giant hydronephrosis in a pelvic kidney.

JOURNAL ARTICLE.

Twenty-five patients with fracture of the penis were treated surgically between 1968 and 1984. Long-term follow-up was obtained in 17. In no case were there any early post-operative complications. All patients stated that they were achieving normal, painless erections; two patients developed a slight penile curvature but this did not affect their sexual activities. We strongly recommend early surgical intervention because of these encouraging results. Urethral injury associated with the fracture did not occur in this series.

McGlinchey J; Walsh A.

Br J Urol 8703; 58(5):558-9

Adenocarcinoma/*DI; Case Report; Endometriosis/*DI; Human; Male; Middle Age; Prostatic Neoplasms/*DI.

Endometrioid carcinoma of the prostatic utricle.

JOURNAL ARTICLE.

Twenty-five patients with fracture of the penis were treated surgically between 1968 and 1984. Long-term follow-up was obtained in 17. In no case were there any early post-operative complications. All patients stated that they were achieving normal, painless erections; two patients developed a slight penile curvature but this did not affect their sexual activities. We strongly recommend early surgical intervention because of these encouraging results. Urethral injury associated with the fracture did not occur in this series.

Gillatt DA; O'Reilly PH; Reeve NL.

Br J Urol 8703; 58(5):559-60

Adolescence; Case Report; Cysts/SU; Epididymis/*SU; Human; Male; Spermatic Cord Torsion/*SU.

Torsion of a large epididymal mass.

JOURNAL ARTICLE.

Twenty-five patients with fracture of the penis were treated surgically between 1968 and 1984. Long-term follow-up was obtained in 17. In no case were there any early post-operative complications. All patients stated that they were achieving normal, painless erections; two patients developed a slight penile curvature but this did not affect their sexual activities. We strongly recommend early surgical intervention because of these encouraging results. Urethral injury associated with the fracture did not occur in this series.

Hedelin H; Eddeland A; Johansson S; Mark J.

Br J Urol 8703; 58(5):560-1

Adrenal Gland Neoplasms/BS/RA/*SC; Case Report; Female; Human; Kidney Neoplasms/*SU; Middle Age; Nephrectomy; Postoperative Complications/RA; Renal Artery/RA.

Bilateral adrenal metastases from renal carcinoma treated surgically with prolonged survival.

JOURNAL ARTICLE.

Twenty-five patients with fracture of the penis were treated surgically between 1968 and 1984. Long-term follow-up was obtained in 17. In no case were there any early post-operative complications. All patients stated that they were achieving normal, painless erections; two patients developed a slight penile curvature but this did not affect their sexual activities. We strongly recommend early surgical intervention because of these encouraging results. Urethral injury associated with the fracture did not occur in this series.

Fox M; Grant JB; Grainger RG.

Br J Urol 8703; 58(5):561-3

Aged; Bladder/*SU; Case Report; Female; Human; Reoperation; Time Factors; Urinary Diversion/*.

Rehabilitation of bladder after 32 years of suprapubic cystostomy.

JOURNAL ARTICLE.

Twenty-five patients with fracture of the penis were treated surgically between 1968 and 1984. Long-term follow-up was obtained in 17. In no case were there any early post-operative complications. All patients stated that they were achieving normal, painless erections; two patients developed a slight penile curvature but this did not affect their sexual activities. We strongly recommend early surgical intervention because of these encouraging results. Urethral injury associated with the fracture did not occur in this series.

Pawar HN; Davenport TJ.

Br J Urol 8703; 58(5):563

Adult; Case Report; Human; Male; Ureter/*AB/RA.

Inverted Y ureter in the male.

JOURNAL ARTICLE.

Twenty-five patients with fracture of the penis were treated surgically between 1968 and 1984. Long-term follow-up was obtained in 17. In no case were there any early post-operative complications. All patients stated that they were achieving normal, painless erections; two patients developed a slight penile curvature but this did not affect their sexual activities. We strongly recommend early surgical intervention because of these encouraging results. Urethral injury associated with the fracture did not occur in this series.

Harrison GS; Williams RE.

Br J Urol 8703; 58(5):564-5

Case Report; Genital Neoplasms, Male/*PA; Human; Lymphoma/*PA; Male; Middle Age; Spermatic Cord/*PA.

Primary lymphoma of the spermatic cord.

JOURNAL ARTICLE.

Twenty-five patients with fracture of the penis were treated surgically between 1968 and 1984. Long-term follow-up was obtained in 17. In no case were there any early post-operative complications. All patients stated that they were achieving normal, painless erections; two patients developed a slight penile curvature but this did not affect their sexual activities. We strongly recommend early surgical intervention because of these encouraging results. Urethral injury associated with the fracture did not occur in this series.

Hautzer NW; Nikolai V.

Br J Urol 8703; 58(5):565-6

Actinomycosis/*CO; Adult; Case Report; Human; Kidney/*AB; Kidney Diseases/*CO; Male.

Primary renal actinomycosis in the presence of horseshoe kidney.

JOURNAL ARTICLE.

Twenty-five patients with fracture of the penis were treated surgically between 1968 and 1984. Long-term follow-up was obtained in 17. In no case were there any early post-operative complications. All patients stated that they were achieving normal, painless erections; two patients developed a slight penile curvature but this did not affect their sexual activities. We strongly recommend early surgical intervention because of these encouraging results. Urethral injury associated with the fracture did not occur in this series.

McGibney D; Clarke PB.

Br J Urol 8703; 58(5):566

Case Report; Female; Human; Intervertebral Disk Displacement/SU; Intraoperative Complications; Laminectomy/*AE; Middle Age; Ureter/*IN.

An unusual ureteric injury.

JOURNAL ARTICLE.

Twenty-five patients with fracture of the penis were treated surgically between 1968 and 1984. Long-term follow-up was obtained in 17. In no case were there any early post-operative complications. All patients stated that they were achieving normal, painless erections; two patients developed a slight penile curvature but this did not affect their sexual activities. We strongly recommend early surgical intervention because of these encouraging results. Urethral injury associated with the fracture did not occur in this series.

Defay P; L'Hermite J; Wiederkehr P; Raul P; Guillemin P.

Br J Urol 8703; 58(5):567

Human; Urinary Catheterization/*MT.

A new method for changing suprapubic catheters.

JOURNAL ARTICLE.

Twenty-five patients with fracture of the penis were treated surgically between 1968 and 1984. Long-term follow-up was obtained in 17. In no case were there any early post-operative complications. All patients stated that they were achieving normal, painless erections; two patients developed a slight penile curvature but this did not affect their sexual activities. We strongly recommend early surgical intervention because of these encouraging results. Urethral injury associated with the fracture did not occur in this series.

Hamilton JB.

Br J Urol 8703; 58(5):568-9

Acquired Immunodeficiency Syndrome/EP; Communicable Diseases/*EP; Great Britain; Human; Lyme Disease/EP; Meningitis, Meningococcal/EP/PC; Rabies/EP/PC; Salmonella Infections/EP/PC.

Report from the PHLS Communicable Disease Surveillance Centre. Public Health Laboratory Service [published erratum appears in Br Med J (Clin Res Ed) 1986 Nov 22;293(6558):1356]

JOURNAL ARTICLE.

Twenty-five patients with fracture of the penis were treated surgically between 1968 and 1984. Long-term follow-up was obtained in 17. In no case were there any early post-operative complications. All patients stated that they were achieving normal, painless erections; two patients developed a slight penile curvature but this did not affect their sexual activities. We strongly recommend early surgical intervention because of these encouraging results. Urethral injury associated with the fracture did not occur in this series.

Hamilton JB.

Br Med J (Clin Res Ed) 8703; 293(6557):1293-5

Adult; Child; Electromyography; Female; Human; Male; Middle Age; Movement/*; Muscle Spasticity/*PP; Muscles/PP; Reflex, Abnormal/PP; Reflex, Stretch/*; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..

Movement deficits caused by hyperexcitable stretch reflexes in spastic humans.

JOURNAL ARTICLE.

Spastic patients were instructed to make accurate, rapid ankle dorsiflexion and plantarflexion movements over different distances to a target. Ankle position and surface electromyograms (EMGs) from tibialis anterior (TA) and soleus (SOL) muscles were recorded. In 3 of 8 spastic patients tested, dorsiflexion evoked velocity-dependent activation of the antagonist (SOL) muscle which impeded the movement to the extent that the limb unintentionally reversed movement direction. We propose that this activation is reflex in origin since it is tightly synchronized, has a large peak amplitude, occurs about 50 ms after the initiation of the movement, and is velocity dependent. One of the 3 patients who had reflex-induced antagonist activation in dorsiflexion also demonstrated sustained clonus during plantarflexion. This usually occurred only if the target had been overshot so that the return of the limb stretched the soleus muscle and triggered clonus. We conclude that in some patients, hyperactive stretch reflexes cause movement deficits.

Corcos DM; Gottlieb GL; Penn RD; Myklebust B; Agarwal GC.

Brain 8703; 109 ( Pt 5):1043-58

Animal; Corpus Striatum/*PH; Dopamine/PH; Female; Forelimb/*PH; Methamphetamine/PD; Motor Cortex/*PH; Psychomotor Performance/*PH; Rats; Rats, Inbred Strains; Stereotyped Behavior/DE; Substantia Nigra/*PH; Support, Non-U.S. Gov't.

The contributions of motor cortex, nigrostriatal dopamine and caudate-putamen to skilled forelimb use in the rat.

JOURNAL ARTICLE.

Skilled forelimb use was studied in rats with unilateral lesions of the sensorimotor cortex, the caudate-putamen, or the dopaminergic nigrostriatal bundle, in a task involving reaching for food. Limb preference and efficiency were evaluated, as well as the relationship between limb use, spontaneous, and methamphetamine-induced rotation bias, both preoperatively and postoperatively. To induce use of the nonpreferred limb, a bracelet, which prevented reaching but not other movements, was attached to the forearm of the preferred forelimb. Whereas small cortical lesions of the forepaw area of the sensorimotor cortex mildly influenced limb preference and use, larger lesions changed preference. Furthermore, medium-sized sensorimotor cortex lesions impaired contralateral limb use, although surprising recovery occurred on the forced tests with the bracelet. Large cortical lesions abolished effective reaching even on the forced tests. Impairments similar to those following sensorimotor cortex lesions were also obtained following small and large caudate-putamen lesions. By contrast, unilateral dopamine depletions not only blocked use of the limb contralateral to the depletion but also impaired use of the ipsilateral limb. There was recovery in use of the ipsilateral forelimb but not the contralateral forelimb. Correlational analysis showed a weak relation between methamphetamine-induced rotation and limb preference preoperatively but no significant relation between these two variables postoperatively. The similarity in the deficits following sensorimotor cortex lesions and basal ganglia lesions suggests that skilled forelimb use depends upon a shared neural organization within the two systems.

Whishaw IQ; O'Connor WT; Dunnett SB.

Brain 8703; 109 ( Pt 5):805-43

Adult; Aged; Aged, 80 and over; Cognition/PH; Corpus Striatum/PH; Female; Frontal Lobe/*PP; Human; Laterality/PH; Male; Memory/PH; Mental Processes/*PH; Middle Age; Neuropsychological Tests; Parkinson Disease/*PP; Psychomotor Performance; Support, Non-U.S. Gov't.

Frontal lobe dysfunction in Parkinson's disease. The cortical focus of neostriatal outflow.

JOURNAL ARTICLE.

This study investigates the hypothesis that, as a consequence of Parkinson's disease, disturbed caudate outflow will lead to deficits in cognitive functions dependent upon the integrity of the prefrontal cortex, the cortical focus of caudatofugal signals. Since Parkinson's disease also involves lesions in extra-striatal midbrain cells which reduce the extrinsic supply of dopamine to this cortical region, such functions are at double risk. Forty nondemented parkinsonian patients were drawn from a pool of 100 consecutive patients and matched with 40 normal control subjects according to age, education, IQ, and sex. All patients were quantitatively rated on neurological indices of disease. Neuropsychological assessment of the patient and normal groups included tests of general intelligence, psychomotor skills, memory, visuospatial and executive functions. No global cognitive decline was observed in the parkinsonian group. Moreover, memory and visuospatial abilities were generally intact. A small cluster of deficits emerged, interpreted as reflecting impairment in the ability to spontaneously generate efficient strategies when relying on self-directed task-specific planning. In addition, several tests thought to be sensitive to frontal lobe function distinguished patients with symptoms strongly lateralized to the right versus left side of the body. Deficits in strategic planning were later investigated in relation to severity of disease and to patient attributes including IQ and age, both of which were relevant to performance on specific tasks. Results were compared with previous investigations in parkinsonian patients and discussed from the perspective of both animal and human studies involving damage to the cerebral cortex and basal ganglia. As the prefrontal cortex is thought to play a crucial role in self-directed behavioural planning, the validity of an outflow model in predicting the consequences of caudate nucleus dysfunction was supported.

Taylor AE; Saint-Cyr JA; Lang AE.

Brain 8703; 109 ( Pt 5):845-83

Animal; Axoplasmic Flow/*DE; Doxorubicin/*PD; Fucose/ME; Male; Methionine/ME; Neurons, Afferent/DE; Peripheral Nerves/*DE; Rats; Rats, Inbred Strains; Sciatic Nerve/DE; Support, Non-U.S. Gov't.

The effect of doxorubicin on slow and fast components of the axonal transport system in rats.

JOURNAL ARTICLE.

The study was designed to investigate the changes in axonal transport that result from disturbances in protein synthesis. Doxorubicin, an antineoplastic drug which interferes with the function of DNA, has a selective effect on peripheral sensory nerves because of the high vascular permeability in the dorsal root ganglia. After the intravenous administration of a moderate dose (4 mg/kg) to male Wistar rats, the transport of slow component a (SCa) was found to be retarded, transport velocity being decreased by 17% (0.85 +/- 0.06 mm/day vs 1.03 +/- 0.06 mm/day in controls). The transport kinetics of the fast anterograde and retrograde components (aFC and rFC) were unchanged after the administration of a dose of 6 mg/kg, although the relative amount of aFC was decreased by 27% (3.2 +/- 0.9% vs 4.4 +/- 1.1% in controls). It is suggested that the neuronopathy induced by doxorubicin is mediated by changes in axonal transport.

Sidenius P.

Brain 8703; 109 ( Pt 5):885-96

Adolescence; Adult; Aged; Case Report; Central Nervous System Diseases/ET; Creatine Kinase/BL; Eye Diseases/ET; Female; Human; Lactates/BL; Male; Middle Age; Mitochondria, Muscle/*ME; Muscular Diseases/*CL/CO/GE; Neurologic Examination; Succinate Dehydrogenase/ME; Support, Non-U.S. Gov't; Tomography, X-Ray Computed.

The clinical features of mitochondrial myopathy.

JOURNAL ARTICLE.

The clinical features of 66 patients with histologically defined mitochondrial myopathy are described. The age of onset of symptoms ranged from birth to 68 years, but was before 20 years in 61%. Nineteen patients had similarly affected relatives. Three groups of cases could be identified clinically: a combination of progressive external ophthalmoplegia and weakness of the limbs induced or increased by exertion (55%); such limb weakness alone (18%); and those with clinical features, such as ataxia, dementia, deafness, involuntary movements and seizures, predominantly or exclusively arising from the CNS (27%). There was considerable overlap between these groups, and pigmentary retinopathy, present in 36% of patients, occurred in all three. At a mean disease duration of twenty years, 9 patients (all from Group 3) were severely disabled but 42 were still able to work. In vitro studies of mitochondrial metabolism, performed in 33 cases, most commonly showed deficiencies of the mitochondrial respiratory chain localized to complex I (18 patients) or complex III (9). No typical clinical picture emerged for any of the identifiable biochemical defects.

Petty RK; Harding AE; Morgan-Hughes JA.

Brain 8703; 109 ( Pt 5):915-38

Aged; Aged, 80 and over; Amyotrophic Lateral Sclerosis/*PA; Anterior Horn Cells/*PA; Cell Count; Female; Human; Image Processing, Computer-Assisted/MT; Male; Middle Age; Motor Neurons/*PA; Spinal Cord/PA; Support, Non-U.S. Gov't.

Focal loss of anterior horn cells in the cervical cord in motor neuron disease.

JOURNAL ARTICLE.

In a three-dimensional study of the distribution of anterior horn cells in the C8 segment of the human spinal cord we have recognized lateral and medial zones of motor neuron groupings, but have not been able to recognize subgroups of neurons within these groupings resembling the anatomical columns described by earlier investigators. This observation does not invalidate the concept of functional groupings within these anterior horn cell pools. In studies of the same segment in cords obtained at autopsy from patients with motor neuron disease, zones of focal loss of motor neurons were identified, without consistent severity or distribution at different sectional levels. These findings imply varying resistance to the disease in different pools of motor neurons.

Swash M; Leader M; Brown A; Swettenham KW.

Brain 8703; 109 ( Pt 5):939-52

Adolescence; Brain/PP; Case Report; Child; Corpus Callosum/PP/*SU; Female; Human; Male; Motor Skills/*PH; Neural Pathways/PP; Neurologic Examination; Neuropsychological Tests; Seizures/SU; Stereognosis/PH; Support, Non-U.S. Gov't; Touch/*PH.

Effects of early and late transection of the corpus callosum in children. A study of tactile and tactuomotor transfer and integration.

JOURNAL ARTICLE.

Five children, aged 6 to 16 years, were tested for unilateral discrimination and interhemispheric transfer of tactile information as well as tactuomotor learning at various intervals before and after therapeutic callosotomy. Comparison of preoperative and postoperative capacities revealed that younger children are considerably less affected by the interruption of callosal transmission than older children. Bilateral organization of speech and participation of the anterior commissure can largely be excluded as possible compensatory mechanisms. The most plausible explanation for the excellent preservation of interhemispheric integration of tactile functions in the younger patients appears to be continued reliance on ipsilateral pathways. The relatively greater deficits observed in the older children, on the other hand, suggest that sensorimotor functions come to depend more extensively on contralateral pathways as the corpus callosum reaches functional maturity.

Lassonde M; Sauerwein H; Geoffroy G; Decarie M.

Brain 8703; 109 ( Pt 5):953-67

Adult; Antibodies, Viral/AN; Environment; Female; Human; Leukocyte Count; Longitudinal Studies; Male; Middle Age; Multiple Sclerosis/*GE/IM; Suppressor Cells/*.

Suppressor T cells in family members of patients with multiple sclerosis.

JOURNAL ARTICLE.

Previous serial measurements of lymphocyte subpopulations in individuals with multiple sclerosis (MS) have demonstrated periodic reductions in the number of OKT8 positive (T8+) cells. In this longitudinal study, involving twice monthly samples from each participant and carried out in two phases lasting at least six and three months respectively, we have confirmed that fluctuations in T8+ cells occur in patients with MS and also found a significant reduction in this lymphocyte subpopulation in patients' spouses but not their siblings, compared with unrelated controls. The changes observed in spouses were related in time to those occurring in patients on 10/13 occasions from 5/9 families; no temporal relationship occurred in the remainder. Taking two or more low T8+ values as significant, 12/13 patients, 7/9 spouses, 6/13 siblings and 4/13 controls (chi 2 = 12.5; P less than 0.01) were abnormal at some stage. Our results provide indirect evidence for the role of environmental factors in determining certain immunological abnormalities present in patients with MS and illustrate the role of family studies in determining the specificity of these changes to the disease.

Hughes PJ; Kirk PF; Compston DA.

Brain 8703; 109 ( Pt 5):969-85

Female; Human; Male; Middle Age; Parkinson Disease/*PP; Psychomotor Performance; Reaction Time; Space Perception/*PH; Support, Non-U.S. Gov't.

Visuospatial function in Parkinson's disease.

JOURNAL ARTICLE.

Previous research on visuospatial function in Parkinson's disease is reviewed. The present experiment was designed to test two fundamental aspects of spatial ability, namely right-left discrimination and the manipulation of those concepts in different spatial perspectives. Measures of accuracy and reaction time were taken. The performance of patients with Parkinson's disease did not differ from that of normal subjects in the spatial components of the task. Neither a review of the literature, nor the results of the present study, give support to the idea of a generalized visuospatial deficit in Parkinson's disease.

Brown RG; Marsden CD.

Brain 8703; 109 ( Pt 5):987-1002

Animal; Burns, Inhalation/*ME; Dextrans/DU; DTPA/DU; Extracellular Space/*ME; Lung/*ME; Rabbits; Technetium/DU.

Early detection of extravascular lung water in an inhalation injury animal model [published erratum appears in Burns Incl Therm Inj 1987 Feb;13(1):82]

JOURNAL ARTICLE.

A rabbit inhalation injury model using a dual tracer radioactive isotope technique (Rowland et al., 1986), has been utilized with small- and medium-sized molecular weight tracers. There is oedema formation at 2 h after smoke inhalation or fluid resuscitation and especially with the combination of inhalation injury and fluid resuscitation [corrected]. This oedema appears to have decreased by 24 h post-injury. There does not appear to be any difference between the small- and medium-sized tracers in the transit times of tracer in the lung vascular compartment. The increases in extravascular water volume have been confirmed by gravimetric analyses of the lungs. Thus the pulmonary oedema in the rabbit animal model is detectable within 2 h post-injury, with a return towards normal values some time within 24 h if fluid challenged for short periods. Fluid resuscitation exacerbates the amount of oedema that developed. The onset of pulmonary oedema may therefore be earlier than previously seen clinically, and fluid resuscitation modifications may be of benefit in smoke inhalation injury.

Stewart RJ; Yamaguchi KT; Rowland RR; Santibanez AS; Rahimian J.

Burns Incl Therm Inj 8703; 12(7):457-60

Animal; Burns/*PP; Cytochromes/ME; Male; Mitochondria, Liver/EN/*PH; Oxidative Phosphorylation; Rats; Rats, Inbred Strains; Succinate Dehydrogenase/ME.

Functional changes in rat-liver mitochondria during the early phase of burn injury.

JOURNAL ARTICLE.

Using succinate as a substrate, the respiratory control ratios of liver mitochondria from burned male Sprague-Dawley rats with full skin thickness burns covering 20 per cent of the body surface area were increased at 15, 30, 45 and 60 min after burn, the peak being at 30 min post-burn. A sham group acted as control. In comparison with the sham group, the specific activity of succinic dehydrogenase was slightly decreased and the activities of cytochromes b and c + c were decreased significantly 30 min after burning. All the results suggest a lack of increased metabolic activity during the early phase of burn injury.

Wang XM; Chen KM; Wang Y; Shi SP.

Burns Incl Therm Inj 8703; 12(7):461-4

Axilla/*; Burns/*CO; Contracture/CL/ET/*SU; Human; Neck/*; Surgical Flaps.

Burn contracture of the neck-axillary region.

JOURNAL ARTICLE.

Using succinate as a substrate, the respiratory control ratios of liver mitochondria from burned male Sprague-Dawley rats with full skin thickness burns covering 20 per cent of the body surface area were increased at 15, 30, 45 and 60 min after burn, the peak being at 30 min post-burn. A sham group acted as control. In comparison with the sham group, the specific activity of succinic dehydrogenase was slightly decreased and the activities of cytochromes b and c + c were decreased significantly 30 min after burning. All the results suggest a lack of increased metabolic activity during the early phase of burn injury.

Leung PC; Cheng JC; Ma GF.

Burns Incl Therm Inj 8703; 12(7):465-9

Adult; Burns/*SU; Case Report; Cicatrix/*; Female; Human; Male; Surgical Flaps/*.

Use of scarred flaps and secondary flaps for reconstructive surgery of extensive burns.

JOURNAL ARTICLE.

We report the usefulness of scar flaps and secondary flaps in the surgical repair of extensively burned patients. Burn scar contractures repaired with scarred axial pattern flaps, scarred musculocutaneous flaps and scarred fasciocutaneous flaps are described. However, it is our contention that their application should be strictly limited. An example of the use of scarred secondary axial pattern and musculocutaneous flaps for reconstruction of a burned ear is shown.

Hyakusoku H; Okubo M; Suenobu J; Fumiiri M.

Burns Incl Therm Inj 8703; 12(7):470-4

Bacterial Infections/IM; Burns/*IM; Female; Human; Male; Rosette Formation/*.

Evaluation of E and EAC rosette-forming cells in patients with thermal injuries.

JOURNAL ARTICLE.

Thermal injuries lead to changes in both the cell-mediated and humoral responses of the patient. This study was undertaken to assess these responses in the post-burn period and also to see if bacterial infection altered these responses. It has been concluded that alterations in the cell-mediated and humoral immune responses following thermal injuries are altered by infection and consequently are also important in the healing process.

Priya D; Keswani RK; Singh V; Saini AS.

Burns Incl Therm Inj 8703; 12(7):475-8

Adult; Burns/*PX; Child; Counseling/*MT; Female; Human; Male; Parents/*PX.

A multidisciplinary group approach to counselling the parents of burned children.

JOURNAL ARTICLE.

This study has shown that a multidisciplinary group approach to counselling parents of burned children will decrease parental anxiety, and that medical, psychological and social problems will feature primarily in group discussions.

Rivlin E; Forshaw A; Polowyj G; Woodruff B.

Burns Incl Therm Inj 8703; 12(7):479-83

Accidents, Occupational/*; Adult; Australia; Burns/*EP; Burns, Chemical/EP; Eye Burns/EP; Female; Human; Male.

Epidemiology of industrial burns in Brisbane.

JOURNAL ARTICLE.

A retrospective epidemiological study of industrial burns admitted to the Royal Brisbane Hospital was conducted over a period of 7 years. A total of 182 patients were included in this survey--173 males (95 per cent) and 9 females (5 per cent). The proportion of industrial burns has decreased from 31.5 per cent to 18.5 per cent of total admissions to the burns unit over the past 10 years. Fifty per cent of the burns occurred in males less than 30 years old. The average age was 31 years. Two-thirds of the burns covered less than 10 per cent of the body and 84 per cent covered less than 20 per cent. While scalds were the commonest cause of industrial burns in our study (19.4 per cent), flame burns with clothing ignited caused the most extensive burns. Face and hands were the most common sites involved. Burns to these regions were mainly caused by flame and electrical burns. Eye burns comprised 5.5 per cent of the sample and were due to chemicals, gas explosions and electric flash. Twenty-six patients (14 per cent) suffered respiratory injury. Only one patient out of our series of 182 died. Progress has been made in industrial safety in the past few years but carelessness and human error still take their toll.

Pegg SP; Miller PM; Sticklen EJ; Storie WJ.

Burns Incl Therm Inj 8703; 12(7):484-90

Accidents, Home; Burns/*EP; Denmark; Female; Fires; Human; Male.

Epidemiology of severe burn injuries.

JOURNAL ARTICLE.

The epidemiology of severe burns is analysed. From 1 September 1982 to 31 August 1983 75 patients, 27 females and 48 males were admitted to the Burns Unit in Copenhagen. The majority of burns were domestic and fire was the predominant cause. The most vulnerable areas were the arms and the legs, and small children still have the highest incidence of thermal injury. As predisposing factors were of significance in several accidents, the importance of further prevention is stressed.

Lyngdorf P.

Burns Incl Therm Inj 8703; 12(7):491-5

Animal; Electric Injuries/*ET/MO; Human; Lightning/*; Mice; Rats; Rats, Inbred Strains; Support, Non-U.S. Gov't.

Lightning injury caused by discharges accompanying flashovers--a clinical and experimental study of death and survival.

JOURNAL ARTICLE.

During the 17 years preceding March 1985, 140 patients sustained lightning injuries caused by 44 thunderbolts. Fifty patients showed evidence of current flow through their bodies. These 50 victims were classified into two groups, the first consisting of 9 victims who showed rupture of their clothes or linear superficial dermal burns along their whole bodies from head to feet, indicating the occurrence of surface flashovers. The remaining 41 patients showed no evidence of this flash effect. It is noteworthy that in the first group 5 of the 9 survived, whereas in the second group only 6 among 41 survived. The result indicates that when a flashover occurs along the whole body, the probability of survival is higher than 50 per cent. The conditions which determine death or survival were investigated experimentally, imposing artificial lightning voltage impulses on rats and developing flashovers on them. The rats survived when the voltage drop caused by flashover occurred immediately after the peak point, and the current waveform exhibited a sharp peak. In contrast, the rats were killed when the voltage drop caused by flashover was delayed by more than 20 microseconds, and the current waveform showed a blunt cone shape. It has been concluded that a fast flashover appreciably diminishes the energy dissipation within the body and consequently results in survival.

Ohashi M; Kitagawa N; Ishikawa T.

Burns Incl Therm Inj 8703; 12(7):496-501

Adult; Burns/*CO; Calcinosis/*ET; Case Report; Human; Male; Skin Diseases/*ET; Time Factors.

Calcinosis cutis--a rare late complication of burns.

JOURNAL ARTICLE.

Pillars of calcification are rarely found in the skin. An interesting case is described where rows of new bone developed in the skin which had been grafted 31 years previously to cover partial skin thickness burns of the shin. The problems of heterotropic ossification are discussed.

Heim M; Blankstein A; Friedman B; Horoszowski H.

Burns Incl Therm Inj 8703; 12(7):502-4

Adult; Bladder Fistula/*ET; Case Report; Electric Injuries/*CO; Human; Intestinal Fistula/*ET; Intestine, Small/*; Male.

Abdominal visceral perforation secondary to electrical injury: case report and review of the literature.

JOURNAL ARTICLE.

A patient with a vesico-enteric fistula was successfully treated with resection of the small intestine and dome of the bladder and drainage of the intervening abscess. A search of the literature reveals this to be a very unusual complication of high-voltage electrical injury.

Miller FE; Peterson D; Miller J.

Burns Incl Therm Inj 8703; 12(7):505-7

Burns/*RH; Hand Injuries/*RH; Human; Occupational Therapy/*; Play and Playthings/*.

The use of games in occupational therapy of hand burns.

JOURNAL ARTICLE.

The need for active range of motion in hand burns is obvious and through adapted games the patient's interest is aroused and provides an incentive for active participation in his/her therapeutic programme. All the games are for individual players, on different intellectual levels, and provide different active ranges of motion: for fingers, wrist, elbow and shoulder. Most of the games were made by a former patient, now retired, copied from games in the collection of the occupational therapist, and some of the games are of Israeli idea and manufacture. All the games can be gas autoclaved and therefore be used from patient to patient. The games also provide a much needed outlet for intellectual stimuli and distraction from the burns unit and all it signifies.

van Straten O.

Burns Incl Therm Inj 8703; 12(7):521-5

Anterior Eye Segment/RE; Choroid/RE; Eye/*RE; Human; Light/*AE; Pigment Epithelium of Eye/RE; Retina/RE; Vitreous Body/RE.

The potential damaging effects of light on the eye (Part I).

JOURNAL ARTICLE.

The electromagnetic spectrum consists of radiant energy that is classified according to specific wavelengths. Man is constantly exposed to a portion of the electromagnetic spectrum, particularly to radiation in the ultraviolet, visible and infrared regions. The tissues of the eye and skin are particularly sensitive to the non-ionizing wavelengths of radiant energy. Although both tissues possess endogenous protective mechanisms to minimize the effects of such exposure, problems still occur due to the absorption of radiation. The cornea, lens and retina have been shown to be susceptible to damage from light in the ultraviolet, visible and infrared range. Part I of this two-part article examines the structures of the eye that are most susceptible to light damage; part II, which will be published in the next issue of the Journal, focuses on eye protection.

Jordan DR.

Can J Ophthalmol 8703; 21(6):216-24

Equipment Design; Human; Irrigation/IS; Suction/*IS; Support, Non-U.S. Gov't; Vitrectomy/*IS.

A new variable suction system with finger-tip control.

JOURNAL ARTICLE.

We have developed a variable suction system for irrigation, aspiration and vitrectomy. The system is regulated by the operator's finger-tip.

Peyman GA; Diamond J.

Can J Ophthalmol 8703; 21(6):225-6

Abducens Nerve/*; Adolescence; Adult; Aged; Case Report; Child; Cranial Nerve Diseases/SU; Evaluation Studies; Human; Middle Age; Oculomotor Muscles/*SU; Oculomotor Nerve/*; Paralysis/*SU.

Supramaximal horizontal rectus surgery in the management of third and sixth nerve palsy.

JOURNAL ARTICLE.

Supramaximal medial and lateral rectus surgery was performed to correct horizontal deviations in seven cases of sixth nerve palsy and three cases of third nerve palsy, with satisfactory results in most cases. The advantages and disadvantages of such procedures are discussed.

Kattleman B; Flanders M; Wise J.

Can J Ophthalmol 8703; 21(6):227-30

Adult; Brain Neoplasms/*CO/PP/RA; Case Report; Female; Human; Male; Middle Age; Nerve Fibers/PP; Tomography, X-Ray Computed; Vision Disorders/*ET; Visual Acuity; Visual Fields/*.

Nerve fibre bundle visual field defects and intracranial mass lesions.

JOURNAL ARTICLE.

Nerve fibre bundle visual field defects are the hallmark of pathology at the optic nerve head or retina. In the present series, six eyes of four patients with large intracranial mass lesions demonstrated such field defects with visual acuity spared in three of the involved eyes. In no cases did visual function in the opposite eye offer a clue to the localization of the lesion.

Hupp SL; Savino PJ; Schatz NJ; Sergott RC; Bosley TM.

Can J Ophthalmol 8703; 21(6):231-5

Carbamazepine/TU; Case Report; Fasciculation/DT/PP/*SU; Female; Follow-Up Studies; Human; Middle Age; Oculomotor Muscles/*.

Superior oblique myokymia: when treatment is necessary.

JOURNAL ARTICLE.

A 56-year-old woman presented with a 10-year history of torsional diplopia and right monocular oscillopsia. These symptoms, which had been intermittent at first, continued practically uninterrupted during the last 2 years. She was diagnosed as having superior oblique myokymia of the right eye. Adequate trials of oral carbamazepine, baclofen and phenytoin were unsuccessful in suppressing her symptoms. One year after her initial presentation, she underwent a right superior oblique tenectomy and a right inferior oblique recession. She eventually required a second operation on her other eye to cure her of an annoying diplopia on down-gaze.

Staudenmaier C.

Can J Ophthalmol 8703; 21(6):236-41

Case Report; Cellular Inclusions/UL; Cytoplasm/UL; Female; Human; Lymphoma/*PA/RA/UL; Microscopy, Electron; Middle Age; Orbital Neoplasms/*PA/RA/UL.

Signet-ring cell lymphoma in the orbit: a case report and review.

JOURNAL ARTICLE.

The authors report on the first case of signet-ring cell lymphoma involving the orbit. This variant of non-Hodgkin's lymphoma contains either vacuolated or eosinophilic cytoplasmic inclusions that squeeze the nucleus to one side of the cell. In this case, the inclusions were eosinophilic and stained positively for PAS, immunoglobulin M (IgM) heavy chain and kappa light chain. Electron microscopy showed granular electron-dense material trapped within distended loops of rough endoplasmic reticulum. Twenty-two cases of signet-ring cell lymphoma previously reported elsewhere in the body are reviewed, and their clinical significance is discussed.

Dolman PJ; Rootman J; Quenville NF.

Can J Ophthalmol 8703; 21(6):242-5

Accidents, Traffic/*PC; Automobile Driving/*; Canada; Human; Lighting/*.

Daytime vehicle lights [letter]

LETTER.

The authors report on the first case of signet-ring cell lymphoma involving the orbit. This variant of non-Hodgkin's lymphoma contains either vacuolated or eosinophilic cytoplasmic inclusions that squeeze the nucleus to one side of the cell. In this case, the inclusions were eosinophilic and stained positively for PAS, immunoglobulin M (IgM) heavy chain and kappa light chain. Electron microscopy showed granular electron-dense material trapped within distended loops of rough endoplasmic reticulum. Twenty-two cases of signet-ring cell lymphoma previously reported elsewhere in the body are reviewed, and their clinical significance is discussed.

Frizzell JB.

Can Med Assoc J 8703; 135(11):1248

Human; Nicotinic Acids/*; Nomenclature.

"Vitamin B3" [letter]

LETTER.

The authors report on the first case of signet-ring cell lymphoma involving the orbit. This variant of non-Hodgkin's lymphoma contains either vacuolated or eosinophilic cytoplasmic inclusions that squeeze the nucleus to one side of the cell. In this case, the inclusions were eosinophilic and stained positively for PAS, immunoglobulin M (IgM) heavy chain and kappa light chain. Electron microscopy showed granular electron-dense material trapped within distended loops of rough endoplasmic reticulum. Twenty-two cases of signet-ring cell lymphoma previously reported elsewhere in the body are reviewed, and their clinical significance is discussed.

Hoffer A.

Can Med Assoc J 8703; 135(11):1250

Adult; Aged; Burns/*ET; Child; Child, Preschool; Heat/*; Human; Legionnaires' Disease/*PC; Risk; Water Supply/*.

Balancing the risks: Legionella pneumophila pneumonia and tap water scalds in the home [editorial]

EDITORIAL.

The authors report on the first case of signet-ring cell lymphoma involving the orbit. This variant of non-Hodgkin's lymphoma contains either vacuolated or eosinophilic cytoplasmic inclusions that squeeze the nucleus to one side of the cell. In this case, the inclusions were eosinophilic and stained positively for PAS, immunoglobulin M (IgM) heavy chain and kappa light chain. Electron microscopy showed granular electron-dense material trapped within distended loops of rough endoplasmic reticulum. Twenty-two cases of signet-ring cell lymphoma previously reported elsewhere in the body are reviewed, and their clinical significance is discussed.

Stanwick RS.

Can Med Assoc J 8703; 135(11):1251-2

Aerospace Medicine/*; Canada; Human; Legislation, Medical/*; Physician-Patient Relations/*.

Aeronautics Act and the doctor-patient relationship.

JOURNAL ARTICLE.

The authors report on the first case of signet-ring cell lymphoma involving the orbit. This variant of non-Hodgkin's lymphoma contains either vacuolated or eosinophilic cytoplasmic inclusions that squeeze the nucleus to one side of the cell. In this case, the inclusions were eosinophilic and stained positively for PAS, immunoglobulin M (IgM) heavy chain and kappa light chain. Electron microscopy showed granular electron-dense material trapped within distended loops of rough endoplasmic reticulum. Twenty-two cases of signet-ring cell lymphoma previously reported elsewhere in the body are reviewed, and their clinical significance is discussed.

Johnson DG.

Can Med Assoc J 8703; 135(11):1254-6

Canada; Female; Genetic Screening/*; Human; Human Rights/*; Infant, Newborn; Legislation, Medical/*; Pregnancy; Quebec; Truth Disclosure/*.

Genetic information and the law: constraints, liability and rights.

JOURNAL ARTICLE.

The authors report on the first case of signet-ring cell lymphoma involving the orbit. This variant of non-Hodgkin's lymphoma contains either vacuolated or eosinophilic cytoplasmic inclusions that squeeze the nucleus to one side of the cell. In this case, the inclusions were eosinophilic and stained positively for PAS, immunoglobulin M (IgM) heavy chain and kappa light chain. Electron microscopy showed granular electron-dense material trapped within distended loops of rough endoplasmic reticulum. Twenty-two cases of signet-ring cell lymphoma previously reported elsewhere in the body are reviewed, and their clinical significance is discussed.

Knoppers BM.

Can Med Assoc J 8703; 135(11):1257-9

Acute Disease; Adult; Aged; Aged, 80 and over; Allopurinol/*AE; Anti-Inflammatory Agents, Non-Steroidal/*AE; Antibiotics/*AE; Cephaloridine/AE; Cimetidine/*AE; Female; Fenoprofen/AE; Human; Indomethacin/AE; Kidney/PA; Male; Middle Age; Nephritis, Interstitial/*CI/DI/PA; Penicillins/AE.

Drug-induced acute interstitial nephritis: report of 10 cases.

JOURNAL ARTICLE.

Between January 1979 and June 1985, 10 patients with acute allergic interstitial nephritis were seen in a clinical nephrology service at a large regional hospital. The onset of renal failure was temporally related to the use of a drug: a nonsteroidal anti-inflammatory agent (NSAID) (in four patients), cimetidine (in three), antibiotics (in two) or allopurinol (in one). The onset of renal failure was acute in three patients and insidious in seven. Two patients also exhibited marked proteinuria. Clinical features such as fever, rash, hematuria, pyuria with or without eosinophiluria, and mild to marked proteinuria had led to suspicion of the disease. The diagnosis was confirmed by renal biopsy findings of inflammatory cells, predominantly lymphocytes, plasma cells and eosinophils. Three patients required hemodialysis; two of them received steroids as well. Steroid therapy was also used in two patients with NSAID-induced proteinuria. Renal function improved in nine patients by 35 days, but one patient continued to have slow but progressive deterioration of renal function. Acute interstitial nephritis can be distinguished from other forms of acute renal failure by heavy renal uptake of gallium 67, maximal 48 hours or more after injection. The improvement in renal function after discontinuation of the implicated drug, the characteristic histopathological findings of allergic interstitial nephritis, and the presence of eosinophils and sometimes IgE in the blood suggest a hypersensitivity reaction.

Handa SP.

Can Med Assoc J 8703; 135(11):1278-81

British Columbia; Cacao/*PO; Child, Preschool; Disease Outbreaks/*EP; Female; Human; Plants, Edible; Salmonella/*IP; Salmonella Food Poisoning/*EP/ET.

Salmonella nima in British Columbia.

JOURNAL ARTICLE.

Between January 1979 and June 1985, 10 patients with acute allergic interstitial nephritis were seen in a clinical nephrology service at a large regional hospital. The onset of renal failure was temporally related to the use of a drug: a nonsteroidal anti-inflammatory agent (NSAID) (in four patients), cimetidine (in three), antibiotics (in two) or allopurinol (in one). The onset of renal failure was acute in three patients and insidious in seven. Two patients also exhibited marked proteinuria. Clinical features such as fever, rash, hematuria, pyuria with or without eosinophiluria, and mild to marked proteinuria had led to suspicion of the disease. The diagnosis was confirmed by renal biopsy findings of inflammatory cells, predominantly lymphocytes, plasma cells and eosinophils. Three patients required hemodialysis; two of them received steroids as well. Steroid therapy was also used in two patients with NSAID-induced proteinuria. Renal function improved in nine patients by 35 days, but one patient continued to have slow but progressive deterioration of renal function. Acute interstitial nephritis can be distinguished from other forms of acute renal failure by heavy renal uptake of gallium 67, maximal 48 hours or more after injection. The improvement in renal function after discontinuation of the implicated drug, the characteristic histopathological findings of allergic interstitial nephritis, and the presence of eosinophils and sometimes IgE in the blood suggest a hypersensitivity reaction.

Handa SP.

Can Med Assoc J 8703; 135(11):1286

Adult; Canada; Child; Human; Influenza/PC; Influenza Vaccine/*AD; Orthomyxovirus Type A, Human/IM; Vaccination/*.

Supplementary statement on influenza vaccination in 1986-87.

JOURNAL ARTICLE.

Between January 1979 and June 1985, 10 patients with acute allergic interstitial nephritis were seen in a clinical nephrology service at a large regional hospital. The onset of renal failure was temporally related to the use of a drug: a nonsteroidal anti-inflammatory agent (NSAID) (in four patients), cimetidine (in three), antibiotics (in two) or allopurinol (in one). The onset of renal failure was acute in three patients and insidious in seven. Two patients also exhibited marked proteinuria. Clinical features such as fever, rash, hematuria, pyuria with or without eosinophiluria, and mild to marked proteinuria had led to suspicion of the disease. The diagnosis was confirmed by renal biopsy findings of inflammatory cells, predominantly lymphocytes, plasma cells and eosinophils. Three patients required hemodialysis; two of them received steroids as well. Steroid therapy was also used in two patients with NSAID-induced proteinuria. Renal function improved in nine patients by 35 days, but one patient continued to have slow but progressive deterioration of renal function. Acute interstitial nephritis can be distinguished from other forms of acute renal failure by heavy renal uptake of gallium 67, maximal 48 hours or more after injection. The improvement in renal function after discontinuation of the implicated drug, the characteristic histopathological findings of allergic interstitial nephritis, and the presence of eosinophils and sometimes IgE in the blood suggest a hypersensitivity reaction.

Handa SP.

Can Med Assoc J 8703; 135(11):1287

Canada; Human; Physicians/*SD; Schools, Medical/*.

Medical school cutbacks would be unfair to young Canadians, conference told.

JOURNAL ARTICLE.

Between January 1979 and June 1985, 10 patients with acute allergic interstitial nephritis were seen in a clinical nephrology service at a large regional hospital. The onset of renal failure was temporally related to the use of a drug: a nonsteroidal anti-inflammatory agent (NSAID) (in four patients), cimetidine (in three), antibiotics (in two) or allopurinol (in one). The onset of renal failure was acute in three patients and insidious in seven. Two patients also exhibited marked proteinuria. Clinical features such as fever, rash, hematuria, pyuria with or without eosinophiluria, and mild to marked proteinuria had led to suspicion of the disease. The diagnosis was confirmed by renal biopsy findings of inflammatory cells, predominantly lymphocytes, plasma cells and eosinophils. Three patients required hemodialysis; two of them received steroids as well. Steroid therapy was also used in two patients with NSAID-induced proteinuria. Renal function improved in nine patients by 35 days, but one patient continued to have slow but progressive deterioration of renal function. Acute interstitial nephritis can be distinguished from other forms of acute renal failure by heavy renal uptake of gallium 67, maximal 48 hours or more after injection. The improvement in renal function after discontinuation of the implicated drug, the characteristic histopathological findings of allergic interstitial nephritis, and the presence of eosinophils and sometimes IgE in the blood suggest a hypersensitivity reaction.

Sullivan P.

Can Med Assoc J 8703; 135(11):1299, 1301

Human; Physicians/*; Prisoners/*; Torture/*.

Doctors and torture: a tortuous issue.

JOURNAL ARTICLE.

Between January 1979 and June 1985, 10 patients with acute allergic interstitial nephritis were seen in a clinical nephrology service at a large regional hospital. The onset of renal failure was temporally related to the use of a drug: a nonsteroidal anti-inflammatory agent (NSAID) (in four patients), cimetidine (in three), antibiotics (in two) or allopurinol (in one). The onset of renal failure was acute in three patients and insidious in seven. Two patients also exhibited marked proteinuria. Clinical features such as fever, rash, hematuria, pyuria with or without eosinophiluria, and mild to marked proteinuria had led to suspicion of the disease. The diagnosis was confirmed by renal biopsy findings of inflammatory cells, predominantly lymphocytes, plasma cells and eosinophils. Three patients required hemodialysis; two of them received steroids as well. Steroid therapy was also used in two patients with NSAID-induced proteinuria. Renal function improved in nine patients by 35 days, but one patient continued to have slow but progressive deterioration of renal function. Acute interstitial nephritis can be distinguished from other forms of acute renal failure by heavy renal uptake of gallium 67, maximal 48 hours or more after injection. The improvement in renal function after discontinuation of the implicated drug, the characteristic histopathological findings of allergic interstitial nephritis, and the presence of eosinophils and sometimes IgE in the blood suggest a hypersensitivity reaction.

Gilmore A.

Can Med Assoc J 8703; 135(11):1305-8

Philosophy, Medical/*.

Philosophy of medicine [letter]

LETTER.

Between January 1979 and June 1985, 10 patients with acute allergic interstitial nephritis were seen in a clinical nephrology service at a large regional hospital. The onset of renal failure was temporally related to the use of a drug: a nonsteroidal anti-inflammatory agent (NSAID) (in four patients), cimetidine (in three), antibiotics (in two) or allopurinol (in one). The onset of renal failure was acute in three patients and insidious in seven. Two patients also exhibited marked proteinuria. Clinical features such as fever, rash, hematuria, pyuria with or without eosinophiluria, and mild to marked proteinuria had led to suspicion of the disease. The diagnosis was confirmed by renal biopsy findings of inflammatory cells, predominantly lymphocytes, plasma cells and eosinophils. Three patients required hemodialysis; two of them received steroids as well. Steroid therapy was also used in two patients with NSAID-induced proteinuria. Renal function improved in nine patients by 35 days, but one patient continued to have slow but progressive deterioration of renal function. Acute interstitial nephritis can be distinguished from other forms of acute renal failure by heavy renal uptake of gallium 67, maximal 48 hours or more after injection. The improvement in renal function after discontinuation of the implicated drug, the characteristic histopathological findings of allergic interstitial nephritis, and the presence of eosinophils and sometimes IgE in the blood suggest a hypersensitivity reaction.

Gilmore A.

Can Med Assoc J 8703; 135(12):1336

Amniocentesis; Chorionic Villi/AN; Ethics, Medical/*; Female; Human; Pregnancy; Pregnancy Trimester, First; Prenatal Diagnosis/*.

First-trimester fetal diagnosis: prudential ethics [letter]

LETTER.

Between January 1979 and June 1985, 10 patients with acute allergic interstitial nephritis were seen in a clinical nephrology service at a large regional hospital. The onset of renal failure was temporally related to the use of a drug: a nonsteroidal anti-inflammatory agent (NSAID) (in four patients), cimetidine (in three), antibiotics (in two) or allopurinol (in one). The onset of renal failure was acute in three patients and insidious in seven. Two patients also exhibited marked proteinuria. Clinical features such as fever, rash, hematuria, pyuria with or without eosinophiluria, and mild to marked proteinuria had led to suspicion of the disease. The diagnosis was confirmed by renal biopsy findings of inflammatory cells, predominantly lymphocytes, plasma cells and eosinophils. Three patients required hemodialysis; two of them received steroids as well. Steroid therapy was also used in two patients with NSAID-induced proteinuria. Renal function improved in nine patients by 35 days, but one patient continued to have slow but progressive deterioration of renal function. Acute interstitial nephritis can be distinguished from other forms of acute renal failure by heavy renal uptake of gallium 67, maximal 48 hours or more after injection. The improvement in renal function after discontinuation of the implicated drug, the characteristic histopathological findings of allergic interstitial nephritis, and the presence of eosinophils and sometimes IgE in the blood suggest a hypersensitivity reaction.

Bennett MJ.

Can Med Assoc J 8703; 135(12):1336-7

Aged/*; Aged, 80 and over; Angina Pectoris/*DI; Electrocardiography; Exercise Test; Human.

"Silent angina" in the elderly [letter]

LETTER.

Between January 1979 and June 1985, 10 patients with acute allergic interstitial nephritis were seen in a clinical nephrology service at a large regional hospital. The onset of renal failure was temporally related to the use of a drug: a nonsteroidal anti-inflammatory agent (NSAID) (in four patients), cimetidine (in three), antibiotics (in two) or allopurinol (in one). The onset of renal failure was acute in three patients and insidious in seven. Two patients also exhibited marked proteinuria. Clinical features such as fever, rash, hematuria, pyuria with or without eosinophiluria, and mild to marked proteinuria had led to suspicion of the disease. The diagnosis was confirmed by renal biopsy findings of inflammatory cells, predominantly lymphocytes, plasma cells and eosinophils. Three patients required hemodialysis; two of them received steroids as well. Steroid therapy was also used in two patients with NSAID-induced proteinuria. Renal function improved in nine patients by 35 days, but one patient continued to have slow but progressive deterioration of renal function. Acute interstitial nephritis can be distinguished from other forms of acute renal failure by heavy renal uptake of gallium 67, maximal 48 hours or more after injection. The improvement in renal function after discontinuation of the implicated drug, the characteristic histopathological findings of allergic interstitial nephritis, and the presence of eosinophils and sometimes IgE in the blood suggest a hypersensitivity reaction.

Cohen G.

Can Med Assoc J 8703; 135(12):1337, 1340

Canada; Female; Human; Jurisprudence/*; Premenstrual Syndrome/*PX; Violence.

Legal implications of premenstrual syndrome: a Canadian perspective [letter]

LETTER.

Between January 1979 and June 1985, 10 patients with acute allergic interstitial nephritis were seen in a clinical nephrology service at a large regional hospital. The onset of renal failure was temporally related to the use of a drug: a nonsteroidal anti-inflammatory agent (NSAID) (in four patients), cimetidine (in three), antibiotics (in two) or allopurinol (in one). The onset of renal failure was acute in three patients and insidious in seven. Two patients also exhibited marked proteinuria. Clinical features such as fever, rash, hematuria, pyuria with or without eosinophiluria, and mild to marked proteinuria had led to suspicion of the disease. The diagnosis was confirmed by renal biopsy findings of inflammatory cells, predominantly lymphocytes, plasma cells and eosinophils. Three patients required hemodialysis; two of them received steroids as well. Steroid therapy was also used in two patients with NSAID-induced proteinuria. Renal function improved in nine patients by 35 days, but one patient continued to have slow but progressive deterioration of renal function. Acute interstitial nephritis can be distinguished from other forms of acute renal failure by heavy renal uptake of gallium 67, maximal 48 hours or more after injection. The improvement in renal function after discontinuation of the implicated drug, the characteristic histopathological findings of allergic interstitial nephritis, and the presence of eosinophils and sometimes IgE in the blood suggest a hypersensitivity reaction.

Robinson GE.

Can Med Assoc J 8703; 135(12):1340-1

Acute Disease; Anesthesia, Inhalation/*AE; Hepatitis, Toxic/*ET; Human; Isoflurane/*AE.

Acute hepatitis after isoflurane anesthesia [letter]

LETTER.

Between January 1979 and June 1985, 10 patients with acute allergic interstitial nephritis were seen in a clinical nephrology service at a large regional hospital. The onset of renal failure was temporally related to the use of a drug: a nonsteroidal anti-inflammatory agent (NSAID) (in four patients), cimetidine (in three), antibiotics (in two) or allopurinol (in one). The onset of renal failure was acute in three patients and insidious in seven. Two patients also exhibited marked proteinuria. Clinical features such as fever, rash, hematuria, pyuria with or without eosinophiluria, and mild to marked proteinuria had led to suspicion of the disease. The diagnosis was confirmed by renal biopsy findings of inflammatory cells, predominantly lymphocytes, plasma cells and eosinophils. Three patients required hemodialysis; two of them received steroids as well. Steroid therapy was also used in two patients with NSAID-induced proteinuria. Renal function improved in nine patients by 35 days, but one patient continued to have slow but progressive deterioration of renal function. Acute interstitial nephritis can be distinguished from other forms of acute renal failure by heavy renal uptake of gallium 67, maximal 48 hours or more after injection. The improvement in renal function after discontinuation of the implicated drug, the characteristic histopathological findings of allergic interstitial nephritis, and the presence of eosinophils and sometimes IgE in the blood suggest a hypersensitivity reaction.

Webster JA.

Can Med Assoc J 8703; 135(12):1343-4

Accidents, Traffic/*; Adolescence; Adult; Athletic Injuries/ET; Canada; Child; Human; Transportation/*.

The dangers of off-road vehicles to young drivers [editorial]

EDITORIAL.

Between January 1979 and June 1985, 10 patients with acute allergic interstitial nephritis were seen in a clinical nephrology service at a large regional hospital. The onset of renal failure was temporally related to the use of a drug: a nonsteroidal anti-inflammatory agent (NSAID) (in four patients), cimetidine (in three), antibiotics (in two) or allopurinol (in one). The onset of renal failure was acute in three patients and insidious in seven. Two patients also exhibited marked proteinuria. Clinical features such as fever, rash, hematuria, pyuria with or without eosinophiluria, and mild to marked proteinuria had led to suspicion of the disease. The diagnosis was confirmed by renal biopsy findings of inflammatory cells, predominantly lymphocytes, plasma cells and eosinophils. Three patients required hemodialysis; two of them received steroids as well. Steroid therapy was also used in two patients with NSAID-induced proteinuria. Renal function improved in nine patients by 35 days, but one patient continued to have slow but progressive deterioration of renal function. Acute interstitial nephritis can be distinguished from other forms of acute renal failure by heavy renal uptake of gallium 67, maximal 48 hours or more after injection. The improvement in renal function after discontinuation of the implicated drug, the characteristic histopathological findings of allergic interstitial nephritis, and the presence of eosinophils and sometimes IgE in the blood suggest a hypersensitivity reaction.

Wiley JJ.

Can Med Assoc J 8703; 135(12):1345-6

Academic Medical Centers/*EC; Canada; Fund Raising; National Health Programs; Research Support.

It's time to put universities first.

JOURNAL ARTICLE.

Between January 1979 and June 1985, 10 patients with acute allergic interstitial nephritis were seen in a clinical nephrology service at a large regional hospital. The onset of renal failure was temporally related to the use of a drug: a nonsteroidal anti-inflammatory agent (NSAID) (in four patients), cimetidine (in three), antibiotics (in two) or allopurinol (in one). The onset of renal failure was acute in three patients and insidious in seven. Two patients also exhibited marked proteinuria. Clinical features such as fever, rash, hematuria, pyuria with or without eosinophiluria, and mild to marked proteinuria had led to suspicion of the disease. The diagnosis was confirmed by renal biopsy findings of inflammatory cells, predominantly lymphocytes, plasma cells and eosinophils. Three patients required hemodialysis; two of them received steroids as well. Steroid therapy was also used in two patients with NSAID-induced proteinuria. Renal function improved in nine patients by 35 days, but one patient continued to have slow but progressive deterioration of renal function. Acute interstitial nephritis can be distinguished from other forms of acute renal failure by heavy renal uptake of gallium 67, maximal 48 hours or more after injection. The improvement in renal function after discontinuation of the implicated drug, the characteristic histopathological findings of allergic interstitial nephritis, and the presence of eosinophils and sometimes IgE in the blood suggest a hypersensitivity reaction.

Osmond DH.

Can Med Assoc J 8703; 135(12):1347-9

Aerosols; Child; Human; Infant; Paramyxovirus Infections/*DT; Respiratory Syncytial Viruses; Respiratory Tract Infections/*DT; Ribavirin/AD/AE/*TU; Ribonucleosides/*TU.

Ribavirin: indications for use in pediatrics. Infectious Diseases and Immunization Committee, Canadian Paediatric Society.

JOURNAL ARTICLE.

Between January 1979 and June 1985, 10 patients with acute allergic interstitial nephritis were seen in a clinical nephrology service at a large regional hospital. The onset of renal failure was temporally related to the use of a drug: a nonsteroidal anti-inflammatory agent (NSAID) (in four patients), cimetidine (in three), antibiotics (in two) or allopurinol (in one). The onset of renal failure was acute in three patients and insidious in seven. Two patients also exhibited marked proteinuria. Clinical features such as fever, rash, hematuria, pyuria with or without eosinophiluria, and mild to marked proteinuria had led to suspicion of the disease. The diagnosis was confirmed by renal biopsy findings of inflammatory cells, predominantly lymphocytes, plasma cells and eosinophils. Three patients required hemodialysis; two of them received steroids as well. Steroid therapy was also used in two patients with NSAID-induced proteinuria. Renal function improved in nine patients by 35 days, but one patient continued to have slow but progressive deterioration of renal function. Acute interstitial nephritis can be distinguished from other forms of acute renal failure by heavy renal uptake of gallium 67, maximal 48 hours or more after injection. The improvement in renal function after discontinuation of the implicated drug, the characteristic histopathological findings of allergic interstitial nephritis, and the presence of eosinophils and sometimes IgE in the blood suggest a hypersensitivity reaction.

Osmond DH.

Can Med Assoc J 8703; 135(12):1351-2

Adolescence; Adult; Aged; Female; Follow-Up Studies; Human; Interview, Psychological; Male; Middle Age; Motivation/*; Ontario; Paraquat/PO; Suicide/EP; Suicide, Attempted/*PX; Time Factors.

Changing motivation in severely suicidal patients.

JOURNAL ARTICLE.

While the ambiguity of suicidal patients' stated motivations has been studied in some detail, less attention has been given to the changeability of their motivations. Twenty-six patients who had taken an overdose of paraquat, a highly lethal herbicide, were questioned about their motivation at the time of admission and 24 hours and 3, 7 and 10 days later. Although 25 patients claimed that they wished to die at the time of admission, all of the 14 surviving patients wished to live at the time of discharge from hospital. Of the 12 patients who died, 6 stated that they no longer wished to die in the last interview before their death. During the following year 3 of the 14 surviving patients killed themselves. The findings emphasize the importance of thoroughly assessing all aspects of the suicidal patient's situation in determining risks. The patient's stated intentions should be but one factor considered.

Wright N; Adam KS.

Can Med Assoc J 8703; 135(12):1361-3

Accidents, Traffic/*; Adolescence; Athletic Injuries/*ET; Child; Child, Preschool; Fractures/ET; Human; Male; Seasons; Transportation/*.

Injuries associated with off-road vehicles among children.

JOURNAL ARTICLE.

Off-road vehicles have attained growing popularity, expanding markets and increasing rates of associated injury, especially among young people. In 1984-85, 148 patients were treated at the Children's Hospital of Eastern Ontario, Ottawa, for injuries suffered in off-road vehicle accidents. The average age of the patients was 14 years. Soft-tissue injuries occurred in 33 patients, 21 of whom had severe injuries. There were 179 fractures in 133 patients. One patient died as a result of his injuries. The most common mechanism of injury was losing control of and tumbling from the machine. Seventeen patients were struck by their own vehicles, and 39 collided with objects such as cars, trees or people. The health care costs of these accidents are no less serious than the concerns for the appropriate legislation to protect consumers, particularly the young.

Wiley JJ; McIntyre WM; Mercier P.

Can Med Assoc J 8703; 135(12):1365-6

Acute Disease; Adult; Animal; Bites and Stings/*CO; Case Report; Cats; Emergencies; Female; Fetal Death/ET; Human; Pasteurella Infections/*TM; Pregnancy; Pregnancy Complications, Infectious/*ET; Septicemia/*ET; Zoonoses/TM.

Pasteurella multocida septicemia during pregnancy.

JOURNAL ARTICLE.

Off-road vehicles have attained growing popularity, expanding markets and increasing rates of associated injury, especially among young people. In 1984-85, 148 patients were treated at the Children's Hospital of Eastern Ontario, Ottawa, for injuries suffered in off-road vehicle accidents. The average age of the patients was 14 years. Soft-tissue injuries occurred in 33 patients, 21 of whom had severe injuries. There were 179 fractures in 133 patients. One patient died as a result of his injuries. The most common mechanism of injury was losing control of and tumbling from the machine. Seventeen patients were struck by their own vehicles, and 39 collided with objects such as cars, trees or people. The health care costs of these accidents are no less serious than the concerns for the appropriate legislation to protect consumers, particularly the young.

Rasaiah B; Otero JG; Russell IJ; Butler-Jones DA; Prescott JF; West MM; Maxwell BE; Beaver J.

Can Med Assoc J 8703; 135(12):1369-72

Adult; Blood Coagulation Tests/*; Case Report; Drug Interactions; Female; Human; Partial Thromboplastin Time/*; Prothrombin Time/*; Trazodone/*AE; Warfarin/ME.

Reduction of prothrombin and partial thromboplastin times with trazodone.

JOURNAL ARTICLE.

Off-road vehicles have attained growing popularity, expanding markets and increasing rates of associated injury, especially among young people. In 1984-85, 148 patients were treated at the Children's Hospital of Eastern Ontario, Ottawa, for injuries suffered in off-road vehicle accidents. The average age of the patients was 14 years. Soft-tissue injuries occurred in 33 patients, 21 of whom had severe injuries. There were 179 fractures in 133 patients. One patient died as a result of his injuries. The most common mechanism of injury was losing control of and tumbling from the machine. Seventeen patients were struck by their own vehicles, and 39 collided with objects such as cars, trees or people. The health care costs of these accidents are no less serious than the concerns for the appropriate legislation to protect consumers, particularly the young.

Hardy JL; Sirois A.

Can Med Assoc J 8703; 135(12):1372

Case Report; Female; Human; Infant; Ovarian Diseases/*MO; Sudden Infant Death/*ET; Torsion.

Ovarian torsion related to sudden infant death.

JOURNAL ARTICLE.

Off-road vehicles have attained growing popularity, expanding markets and increasing rates of associated injury, especially among young people. In 1984-85, 148 patients were treated at the Children's Hospital of Eastern Ontario, Ottawa, for injuries suffered in off-road vehicle accidents. The average age of the patients was 14 years. Soft-tissue injuries occurred in 33 patients, 21 of whom had severe injuries. There were 179 fractures in 133 patients. One patient died as a result of his injuries. The most common mechanism of injury was losing control of and tumbling from the machine. Seventeen patients were struck by their own vehicles, and 39 collided with objects such as cars, trees or people. The health care costs of these accidents are no less serious than the concerns for the appropriate legislation to protect consumers, particularly the young.

Kasian GF; Taylor BW; Sugarman RG; Nyssen JN.

Can Med Assoc J 8703; 135(12):1373

Acquired Immunodeficiency Syndrome/EP; Adult; Age Factors; Canada; Female; Herpesviridae/IP; Herpesvirus Infections/*EP; Human; Infant; Male; Middle Age; Sex Factors.

Laboratory reports of herpesvirus infections in Canada in 1985.

JOURNAL ARTICLE.

Off-road vehicles have attained growing popularity, expanding markets and increasing rates of associated injury, especially among young people. In 1984-85, 148 patients were treated at the Children's Hospital of Eastern Ontario, Ottawa, for injuries suffered in off-road vehicle accidents. The average age of the patients was 14 years. Soft-tissue injuries occurred in 33 patients, 21 of whom had severe injuries. There were 179 fractures in 133 patients. One patient died as a result of his injuries. The most common mechanism of injury was losing control of and tumbling from the machine. Seventeen patients were struck by their own vehicles, and 39 collided with objects such as cars, trees or people. The health care costs of these accidents are no less serious than the concerns for the appropriate legislation to protect consumers, particularly the young.

Kasian GF; Taylor BW; Sugarman RG; Nyssen JN.

Can Med Assoc J 8703; 135(12):1377-9

Abnormalities, Multiple/*; Child Advocacy; Ethics, Medical/*; Human; Infant, Newborn; Infanticide/*; Parents/PX; Quality of Life.

Ethical issues in infanticide of severely defective infants.

JOURNAL ARTICLE.

Off-road vehicles have attained growing popularity, expanding markets and increasing rates of associated injury, especially among young people. In 1984-85, 148 patients were treated at the Children's Hospital of Eastern Ontario, Ottawa, for injuries suffered in off-road vehicle accidents. The average age of the patients was 14 years. Soft-tissue injuries occurred in 33 patients, 21 of whom had severe injuries. There were 179 fractures in 133 patients. One patient died as a result of his injuries. The most common mechanism of injury was losing control of and tumbling from the machine. Seventeen patients were struck by their own vehicles, and 39 collided with objects such as cars, trees or people. The health care costs of these accidents are no less serious than the concerns for the appropriate legislation to protect consumers, particularly the young.

Lister D.

Can Med Assoc J 8703; 135(12):1401-4

Aged; Bone Marrow/UL; Chromosome Aberrations/*; Female; Human; Male; Middle Age; Myeloproliferative Disorders/GE; Preleukemia/*GE; Prognosis; Support, U.S. Gov't, P.H.S..

Chromosome studies in preleukemic states. V. Prognostic significance of single versus multiple abnormalities.

JOURNAL ARTICLE.

The prognostic value of marrow chromosome findings was examined in 242 patients with preleukemic myelodysplastic syndromes (MDS) or myeloproliferative disorders (MPD), with emphasis on the significance of single versus multiple karyotypic changes. In both groups, the results showed that patients with multiple chromosome abnormalities in a marrow clone had a very high probability of early death, from progression to leukemia or from other complications of hematopoietic dysfunction. Conversely, in patients with a hemic clone having only one karyotypic alteration (involving a single chromosome or single translocation), survival over 2 years was only slightly reduced as compared to those without chromosome abnormality. The only single karyotypic alteration perhaps associated with a markedly shortened survival was monosomy 7. These findings suggest that the conclusions of previous studies concerning the grave consequences of chromosome alterations in preleukemia largely reflect the clinical significance of clones with multiple cytogenetic changes. Prior knowledge of the karyotypic status of preleukemic patients should be helpful in evaluating current attempts to find effective treatment for these difficult disorders.

Nowell PC; Besa EC; Stelmach T; Finan JB.

Cancer 8703; 58(12):2571-5

Adult; Case Report; Drug Evaluation; Female; Human; Interferon Type I/*TU; Male; Melanoma/*TH; Middle Age; Neoplasm Metastasis; Recombinant Proteins/*TU; Skin Neoplasms/*TH.

Recombinant leukocyte A interferon (rIFN-alpha A) in the treatment of disseminated malignant melanoma. Analysis of complete and long-term responding patients.

JOURNAL ARTICLE.

Ninety-six patients with disseminated malignant melanoma received thrice weekly intramuscular injections of leukocyte A recombinant interferon (rIFN-alpha A, Roferon-A, Hoffmann La Roche) at doses of 12 X 10(6) U/m2 or 50 X 10(6) U/m2 with or without cimetidine as an immunorestorative agent. Four patients, two with prior chemotherapy, demonstrated either a complete response (3 months, soft tissue metastasis) or exceptionally durable response durations (months) of 29+ (soft tissue; lung lesion), 31+ (soft tissue), and 35+ (soft tissue; liver lesions). None of these patients had particularly characteristic clinical parameters. As noted previously, using chemotherapy, a small proportion of patients with advanced malignant melanoma, despite prior therapy, may achieve prolonged objective regression with rIFN-alpha A.

Creagan ET; Ahmann DL; Frytak S; Long HJ; Itri LM.

Cancer 8703; 58(12):2576-8

Adolescence; Child; Child, Preschool; Female; Human; Infant; Infant, Newborn; Male; Mesonephroma/MO/PA; Neoplasms, Embryonal and Mixed/MO/*PA; Ovarian Neoplasms/MO/PA; Support, U.S. Gov't, P.H.S.; Teratoma/MO/PA; Testicular Neoplasms/MO/PA.

Nongerminomatous malignant germ cell tumors in children. A review of 89 cases from the Pediatric Oncology Group, 1971-1984.

JOURNAL ARTICLE.

Clinical and morphologic features of 89 cases of childhood yolk sac tumor (YS) and embryonal carcinoma (EC) (29 associated with teratomas) submitted to the Rare Tumor Registry of the Southwest Oncology Group (1971-1979) or the Pediatric Oncology Group (1980-1984) between 1971 and 1984 were reviewed and submitted to statistical analysis. This review showed an improved survival for each 5-year period regardless of tumor site, no statistically significant difference between "pure" tumors and those mixed with other teratomatous components, no statistically significant difference between YS and EC in children, a better than reported prognosis for sacrococcygeal tumors occurring after the neonatal period, a particularly poor prognosis for neonatal "benign" sacrococcygeal teratomas resected without coccygectomy when they recur as YS, excellent survival for all testicular tumors regardless of age or the presence of EC, and the occurrence of mediastinal tumors in females.

Hawkins EP; Finegold MJ; Hawkins HK; Krischer JP; Starling KA; Weinberg A.

Cancer 8703; 58(12):2579-84

Aged; Animal; Cats; Diarrhea/CI; Drug Evaluation; Female; Head and Neck Neoplasms/*DT; Human; Male; Middle Age; Mitoguazone/TO/*TU; Nausea/CI; Support, U.S. Gov't, P.H.S.; Vomiting/CI.

Phase II trial of methylglyoxal bis (guanylhydrazone) (MGBG) in advanced head and neck cancer.

JOURNAL ARTICLE.

Methylglyoxal bis (guanylhydrazone) (MGBG) is an inhibitor of polyamine synthesis. In vitro studies demonstrate the accumulation of some tumor cells in S and G2 phases of the cell cycle. Nineteen patients with advanced head and neck cancer were entered in a Phase II trial of MGBG. MGBG, 500 mg/M2, was administered as a brief intravenous infusion weekly for 4 weeks, then every 2 weeks. Dose modifications were based on cumulative toxicity after 2 weekly treatments. All but three patients had prior exposure to chemotherapy for disease recurrence. Of 17 patients evaluable for response and toxicity, one brief partial response was observed. The most common toxicities were mild to moderate nausea, vomiting, diarrhea, and stomatitis. Myelosuppression occurred in three patients. Dose modifications were required in four patients; a maximum dose of 700 mg/M2 was tolerated. The results of four other Phase II single and combination chemotherapy trials of MGBG in head and neck cancer are reviewed. The single agent response rate in 59 patients was 22% (range, 6%-41%). The poor response rate observed in this trial was similar to that in other trials in which a heavily pretreated group of patients was evaluated. It is concluded that single agent MGBG is not a useful drug in heavily pretreated recurrent disease patients. However, because of its biochemical effects, further testing in combination with cycle specific agents and in larger numbers of patients with minimal prior treatment may be warranted.

Forastiere AA; Natale RB; Wheeler RR.

Cancer 8703; 58(12):2585-8

Adult; Aged; Antineoplastic Agents, Combined/*TU; Bone Neoplasms/*SC; Breast Neoplasms/*DT; Female; Fractures/ET; Human; Middle Age; Spine; Time Factors.

Clinical course of breast cancer patients with osseous metastasis treated with combination chemotherapy.

JOURNAL ARTICLE.

Between July 1973 and December 1979, 1171 patients with metastatic breast cancer were treated with doxorubicin-containing chemotherapy. Of those patients, 195 had osseous metastases only. Upon initial diagnosis, 48% had osteolytic metastases; 13% had osteoblastic metastases; 38% had mixed metastases; and 1% had diffuse osteoporosis without any obvious bone destruction. The most common sites of involvement were the dorsal spine (62%), lumbosacral spine (72%), and pelvis (79%). Objective response to chemotherapy was observed in 59% of patients; complete responses were noted in 7%, and partial responses in 52%. The median survival was 28 months (range, 1-118 months). The median time lapse between the start of chemotherapy and disease progression was 14 months (range, 1-109 months). In 32 patients who responded to the treatment, chemotherapy was discontinued after 2 years, and their median duration of continued remission at 39 and 75 months after the completion of therapy. The incidence of pathological fractures was 57%; the most common sites were the spine, which sustained compression fractures, and the ribs. The incidences of hypercalcemia and spinal cord compression due to metastases were 19% and 10%, respectively.

Scheid V; Buzdar AU; Smith TL; Hortobagyi GN.

Cancer 8703; 58(12):2589-93

Adolescence; Adult; Antineoplastic Agents, Combined/*TU; Bleomycins/AD; Case Report; Cisplatin/AD; Dysgerminoma/*DT; Etoposide/AD; Female; Human; Lymphatic Metastasis; Neoplasm Recurrence, Local/DT/SU; Ovarian Neoplasms/*DT.

Chemotherapeutic complete remission in patients with metastatic ovarian dysgerminoma. Potential for cure and preservation of reproductive capacity.

JOURNAL ARTICLE.

Two patients with metastatic dysgerminoma of the ovary were treated with a combination of etoposide, bleomycin, and cisplatin at The University of Texas M.D. Anderson Hospital and Tumor Institute at Houston. Both patients achieved a complete remission. Patient 1 developed a massive recurrence in the para-aortic lymph nodes 21 months after diagnosis and treatment with right salpingo-oophorectomy alone. She received four cycles of chemotherapy and is free of disease 21 months from the start of chemotherapy. Patient 2 had Stage III dysgerminoma and a lymphangiogram positive for tumor in the para-aortic lymph nodes. After surgery she received three cycles of chemotherapy and is free of disease 20 months from the start of chemotherapy. Both complete remissions were documented with second-look laparotomy. Chemotherapy may be an alternative to radiotherapy for the treatment of metastatic dysgerminoma and should also be considered for selected patients with Stage I disease. A literature review further supports the conclusion that additional clinical trials might expand the indications for chemotherapy in patients with this disease.

Gershenson DM; Wharton JT; Kline RC; Larson DM; Kavanagh JJ; Rutledge FN.

Cancer 8703; 58(12):2594-9

Antineoplastic Agents, Combined/AE/*TU; Case Report; Cisplatin/*AD; Follow-Up Studies; Gastrointestinal Diseases/CI; Human; Male; Neoplasms, Embryonal and Mixed/*DT/MO; Raynaud's Disease/ET; Support, Non-U.S. Gov't; Testicular Neoplasms/*DT/MO.

Long-term survival and morbidity in patients with metastatic malignant germ cell tumors treated with cisplatin-based combination chemotherapy.

JOURNAL ARTICLE.

Forty-three of 79 patients treated for clinically metastatic germ cell cancer survived for a median of 66 months (range, 52-83). In patients without previous chemotherapy the 5-year survival rate was 69%, whereas only 32% of patients with prior chemotherapy survived for 5 years. Limited disease, complete clinical response, histopathologically proven postchemotherapy tumor necrosis or complete resectability of a posttreatment mature teratoma indicated a favorable prognosis in patients without prior chemotherapy. Only 20% to 30% of the patients with less than a clinical complete response or with posttreatment residual malignant tumor can be salvaged by second line therapy. Posttreatment mature teratoma should be resected completely whenever possible, as this condition may lead to reactivation of the malignancy even after several years. Raynaud-like phenomena and/or gastrointestinal problems are the main long-term sequel (10%-15%) after modern multimodality treatment of advanced germ cell cancer (fertility-related problems are not considered here). In the majority of surviving patients, the lifestyle seems unaffected by the previous intensive treatment, evaluated about 5 years after discontinuation of all therapy.

Fossa SD; Aass N; Kaalhus O; Klepp O; Tveter K.

Cancer 8703; 58(12):2600-5

Antineoplastic Agents/AD/AE; Combined Modality Therapy; Female; Human; Infant; Infant, Newborn; Male; Rhabdomyosarcoma/CN/*EP/PA; Support, U.S. Gov't, P.H.S..

Infants younger than 1 year of age with rhabdomyosarcoma.

JOURNAL ARTICLE.

Of a total of 1561 patients registered in the Intergroup Rhabdomyosarcoma Study (IRS) as of May 1983, 78 patients (5%) were younger than 1 year of age. These infants did not differ from the older children (1-20 years of age) in male/female ratio, clinical grouping, or survival rates. Infants younger than 1 year of age had a significantly greater frequency of undifferentiated sarcoma, 18% versus 7% in older children (P less than 0.005). Infants also had a significantly greater proportion of cancers with botryoid pathology, 10% versus 4% in older children (P less than 0.005). When reviewed by the newly proposed IRS cytopathologic classification, there was no difference in pathologic types between the two age groups. Infants younger than 1 year of age had a higher rate of bladder-prostate-vagina primary tumor sites than older children, 24% versus 10% (P less than 0.05). In addition, infants tended to receive less of the prescribed doses of chemotherapy and radiation therapy than older children, and to develop more toxicity to treatment than older children. Despite these differences, the overall survival curve for the two age groups appears to be similar. In contrast to Wilms' tumor and neuroblastoma, in which age (less than 1 year) is a favorable prognostic factor, age does not appear to be an important prognostic factor in rhabdomyosarcoma.

Ragab AH; Heyn R; Tefft M; Hays DN; Newton WA Jr; Beltangady M.

Cancer 8703; 58(12):2606-10

Adult; Aged; Antineoplastic Agents, Combined/AE/*TU; Bleomycins/AD; Doxorubicin/AD; Female; Human; Liver Diseases/CI; Lymphatic Metastasis; Male; Mechlorethamine/AD; Methotrexate/AD; Middle Age; Mycosis Fungoides/*DT/SU; Neutropenia/CI; Skin Diseases/CI; Skin Neoplasms/*DT; Splenectomy.

Treatment of advanced stage mycosis fungoides with bleomycin, doxorubicin, and methotrexate with topical nitrogen mustard (BAM-M).

JOURNAL ARTICLE.

Ten patients with advanced stage (TNM IIB-IVB) mycosis fungoides were treated with a combination chemotherapy program consisting of bleomycin and methotrexate weekly, doxorubicin every 3 weeks, and topical nitrogen mustard daily (BAM-M). Seven patients obtained histologically documented complete remissions ranging from 4 to 105+ months in duration. Median survival is 16.5+ months. Three patients in whom splenomegaly was detected during their staging evaluation underwent splenectomy. These three patients have had unmaintained disease-free survivals of 36+, 100+, and 105+ months. This study indicates that BAM-M is effective therapy for advanced stage mycosis fungoides and suggests that the therapeutic role of splenectomy should be evaluated further.

Zakem MH; Davis BR; Adelstein DJ; Hines JD.

Cancer 8703; 58(12):2611-6

Evaluation Studies; Gallium Radioisotopes/*DU; Human; Lymphography; Lymphoma, Non-Hodgkin's/*RA/*RI; Retrospective Studies; Support, Non-U.S. Gov't; Tonsillar Neoplasms/*RA/*RI.

Value of gallium scans and lymphangiography in non-Hodgkin's lymphoma of the Waldeyer's ring.

JOURNAL ARTICLE.

In 37 patients with seemingly localized non-Hodgkin's lymphoma of the Waldeyer's ring (WR-NHL), lymphangiography (LAG) and/or gallium-67 scans (Ga-67 scans) were done. Before these procedures, 20 patients were diagnosed as Stage I, and 17 as Stage II. LAG was done for 30, and Ga-67 scans for 32, 25 of whom had both. Five patients (16%) were upstaged to Stage III or IV by Ga-67 scans. Only one (3%) had abnormal LAG findings, in whom Ga-67 scans also showed abnormal accumulation in the para-aortic region. Because of this low positive rate, LAG is not recommended for staging of WR-NHL.

Shigematsu N; Kondo M; Kubo A; Hashimoto S.

Cancer 8703; 58(12):2622-4

Adult; Antibody Formation/*; Antibody-Producing Cells/IM; Comparative Study; Female; Human; Immunity, Cellular/*; Immunoglobulins/AN; Leukoplakia/IM; Male; Middle Age; Mouth Diseases/*IM; Mouth Neoplasms/IM; Oral Submucous Fibrosis/*IM; Rosette Formation; Support, Non-U.S. Gov't.

Cell mediated and humoral immune responses in oral submucous fibrosis.

JOURNAL ARTICLE.

Cell-mediated and humoral immune responses were assessed in 50 patients with oral submucous fibrosis (OSMF) and the results were compared with those of 50 patients with oral-leukoplakia, 50 oral cancer patients, and 50 normal healthy adult controls. The number of high-affinity rosette-forming cells (HARFC) was found to be significantly decreased in OSMF and oral cancer, whereas the number of total rosette-forming cells (TRFC) remained unaltered. Levels of serum IgA, IgD, and IgE were found to be elevated both in OSMF and oral cancer. Immunologic derangements were found to be more pronounced in oral cancer than in OSMF. The enumeration of HARFC along with the estimation of serum levels of IgA, IgD, and IgE indicates that OSMF can be an intermediary stage in the malignant transformation of a normal cell, and that these parameters may serve as markers for the early detection of oral cancer.

Rajendran R; Sugathan CK; Remani P; Ankathil R; Vijayakumar T.

Cancer 8703; 58(12):2628-31

Aged; Bone Marrow/PA; Case Report; Endometrium/PA; Female; Histiocytosis, Malignant/*CO/PA; Human; Lymph Nodes/PA; Male; Middle Age; Phagocytosis; Tuberculosis/*CO.

Tuberculosis-associated hemophagocytic syndrome. A systemic process.

JOURNAL ARTICLE.

Virus-associated hemophagocytic syndrome has been recently identified as a benign, reactive histiocytic proliferation distinct from Rappaport's malignant hystiocytosis. Other etiologic agents, including different bacteria, have also been identified. Three autopsy cases of hemophagocytic syndrome associated to acute tuberculous sepsis are presented. Benign histiocytic proliferation with striking hemophagocytosis was present in a disseminated, multisystemic pattern in all three cases. A relationship between systemic histiocytic proliferation and an anergic status in these patients is suggested.

Campo E; Condom E; Miro MJ; Cid MC; Romagosa V.

Cancer 8703; 58(12):2640-5

Adolescence; Adult; Aged; Bone Neoplasms/*CL/IM/PA; Child; Child, Preschool; Female; Human; Infant; Lymphoma/*CL/IM/PA; Male; Middle Age; Neoplasm Recurrence, Local; Prognosis; Time Factors.

Malignant lymphoma of bone.

JOURNAL ARTICLE.

A total of 422 patients with malignant lymphoma of bone who were seen at the Mayo Clinic from 1907 through 1982 were placed into four major groups based on stage of disease. There was one group with primary lymphoma of bone, one group with multifocal osseous lymphoma, and two groups with lymphoma of bone and nodal or soft tissue (or both) disease. The last-mentioned two groups were separated on the basis of time of onset of osseous lymphoma in relation to the nonosseous disease. The stage of disease was the single most important prognostic indicator of overall survival in malignant lymphoma of bone. The 5- and 10-year survival rates were, respectively, 58% and 53% for patients with primary bone lymphoma, 22% and 12.5% for patients with bone and nodal or soft tissue (or both) disease, and 42% and 35% for patients with multifocal osseous disease. Features having no significant prognostic value were sex of the patient, histologic grade of the lymphoma (according to the Working Formulation and the Kiel system), and presence of T-cell features or cleaved cells (or both). This study is not able to adequately address efficacy of treatment. In fact, treatment may be very important in outcome.

Ostrowski ML; Unni KK; Banks PM; Shives TC; Evans RG; O'Connell MJ; Taylor WF.

Cancer 8703; 58(12):2646-55

Adult; Aged; Carcinoma/CF/*SC; Case Report; Female; Head and Neck Neoplasms/CF/*PA; Human; Male; Meningeal Neoplasms/CF/RA/*SC; Tomography, X-Ray Computed.

Meningeal carcinomatosis in head and neck cancer. Report of six cases and review of the literature.

JOURNAL ARTICLE.

Head and neck cancer has rarely been reported to be a cause of meningeal carcinomatosis. These tumors are known more for their local invasiveness rather than distant metastasis. This would appear to preclude meningeal involvement, but close proximity to multiple cranial nerves may provide an access to the meninges. Six cases of head and neck cancer with meningeal invasion are presented. All six cases had malignant cells in their cerebrospinal fluid. Three cases had malignant cells recovered from a ventricular specimen after lumbar punctures were negative. The most common clinical finding on presentation was cranial nerve involvement. The optic nerve was involved most often with nerves VI and V the next most frequent. Headache was present in four patients and seizures occurred in two. No patient had meningismus. Our current treatment plan involves insertion of an Ommaya Reservoir and intraventricular methotrexate. Only patients whose primary head and neck tumor shows a response to systemic therapy undergo Ommaya placement. Meningeal carcinomatosis in head and neck cancer may be more prevalent than previously thought and the likely mechanism is via direct extension rather than hematogenous spread.

Redman BG; Tapazoglou E; Al-Sarraf M.

Cancer 8703; 58(12):2656-61

Carcinoma/*BL/SU; Female; Follow-Up Studies; Gastrectomy; Human; Male; Stomach Neoplasms/*BL/SU; Testosterone/*BL.

Serum testosterone level of patients with gastric carcinoma before and after gastrectomy.

JOURNAL ARTICLE.

The serum testosterone level (STL) was determined in 84 male and 32 female patients with gastric carcinoma and in 58 male and 20 female patients with benign diseases as a control group. The STL of the male patients with carcinoma was lower (446 +/- 149 ng/dl) than that of the male control group (532 +/- 132 ng/dl) (P less than 0.001). Even 17 male patients of the early carcinoma showed lower STL (440 +/- 117 ng/dl) than the normal group (P less than 0.001). In the female patients, it was also lower (31.6 +/- 16.0 ng/dl) than in the control group (46.3 +/- 15.3 ng/dl) (P less than 0.005). The postoperative STL of the cases surviving the gastrectomy was higher than the preoperative data in 32 male patients (P less than 0.005) as well as in 12 female patients (0.025 greater than P greater than 0.01), whereas it obviously decreased in the patients who died of recurrence. Therefore, it appears that gastric carcinoma decreases the STL by some mechanism.

Inutsuka S; Kodama Y; Natsuda Y; Kumashiro R; Maekawa T.

Cancer 8703; 58(12):2675-9

Adolescence; Adult; Aged; Blood Proteins; Female; Human; Lipids/*BL; Liver Neoplasms/SC; Lymphatic Metastasis; Male; Middle Age; Neoplasm Metastasis; Neoplasms/*BL; Sialic Acids/*BL; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..

Total and lipid-associated serum sialic acid levels in cancer patients with different primary sites and differing degrees of metastatic involvement.

JOURNAL ARTICLE.

Serum total sialic acid (TSA) and lipid-associated sialic acid (LASA) levels have drawn considerable interest because of carbohydrate aberrations in malignant cells. The current investigation determined the TSA, LASA, total protein (TP), and TSA/TP values for 171 cancer patients with various primary sites and differing degrees of metastatic disease, 102 patients with nonmalignant diseases (pathologic controls), and 42 normal individuals. Data analysis indicated significant (p less than 0.01) increases in the mean (+/- SD) TSA and TSA/TP values in the cancer patients (78.1 +/- 19.2 mg/dl and 12.4 +/- 3.8 mg/g, respectively) and in the pathologic controls (76.0 +/- 7.5 mg/dl and 11.6 +/- 2.5 mg/g) when compared to the normal controls (67.3 +/- 7.1 mg/dl and 9.0 +/- 1.1 mg/g), and a significant decrease in the mean TP values in the cancer patients (6.4 +/- 1.1 g/dl) and pathologic controls (6.6 +/- 1.1 g/dl) when compared to normal controls (7.5 +/- 0.5 g/dl). No significant difference was observed between groups in LASA values. Further analysis of the data in patient subgroups based on the tissue involved, specific disease, or severity of the malignancy indicated that the lack of specificity of the markers was due primarily to restricted subgroups and that the sensitivity of TSA and TSA/TP increased as the malignancy became more severe. The results show that TSA/TP was the most useful of the markers tested for detecting malignancies. This marker should prove useful for monitoring malignant disease recurrence and/or progression and for evaluating the effectiveness of various therapeutic approaches.

Plucinsky MC; Riley WM; Prorok JJ; Alhadeff JA.

Cancer 8703; 58(12):2680-5

Adolescence; Adult; Aged; Case Report; Chondrosarcoma/*DI/PA/RT; Female; Human; Male; Middle Age; Protons/TU; Skull Neoplasms/*DI/PA/RT; Temporal Bone/*; Tomography, X-Ray Computed.

Chondrosarcoma of the temporal bone. Diagnosis and treatment of 13 cases and review of the literature.

JOURNAL ARTICLE.

Chondrosarcoma of the temporal bone is a rare lesion. Clinically it has been confused with multiple sclerosis, glomus jugulare tumors, meningioma, and chordomas. The cranial nerve palsies frequently observed with the tumors are related to the anatomic locations of the tumors. Thirteen patients with this entity are presented and the eleven other cases in the literature are reviewed. Histologically the tumors are low grade and exhibit myxoid features. The myxoid features must be differentiated from chordoma and chondroid chordoma. The tumor locations preclude surgical excision and conventional radiation therapy can cause unacceptable neurologic sequelae. Proton beam therapy has been effective in short-term results and appears capable of avoiding serious neurologic side effects.

Coltrera MD; Googe PB; Harrist TJ; Hyams VJ; Schiller AL; Goodman ML.

Cancer 8703; 58(12):2689-96

Carcinoma/*PA/RA; Carcinoma, Oat Cell/PA/RA; Case Report; Cerebral Ventricle Neoplasms/RA/*SC; Female; Human; Lung Neoplasms/PA; Male; Middle Age; Tomography, X-Ray Computed.

Diffuse subependymal periventricular metastases. Report of three cases.

JOURNAL ARTICLE.

Three clinicopathologic cases with a remarkable pattern of extensive diffuse subependymal periventricular spread of cerebral metastases from solid systemic cancer are reported. Two patients had a small cell carcinoma of the lung. In the third case, the histologic features of the brain metastases were consistent with a neuron-specific enolase-positive, small cell anaplastic carcinoma. Involvement of the choroid plexus and leptomeninges was moderate or absent. Intraparenchymatous nodular metastases were not found except in one case in which rare nodular superficial cortical metastases were present. The clinical data were nonspecific except for orthostatic hypotension, in one patient, which was probably due to the infiltration of the floor of the third and fourth ventricles. Results of the cerebrospinal fluid examination, available in two cases, were normal. The only diagnostic investigation was contrast-enhanced computed tomography scanning.

Vannier A; Gray F; Gherardi R; Marsault C; Degos JD; Poirier J.

Cancer 8703; 58(12):2720-5

Age Factors; Child; Child, Preschool; Denmark; Female; Human; Male; Neuroblastoma/*MO/TH; Prognosis; Regression Analysis; Sex Factors.

Prognostic factors in neuroblastomas treated in Denmark from 1943 to 1980. A statistical estimate of prognosis based on 253 cases.

JOURNAL ARTICLE.

Multivariate analysis on an unselected patient population consisting of all 253 children treated for neuroblastoma in Denmark during 1943 to 1980 shows that stage, age, and treatment given are independent prognostic variables. Calendar year of diagnosis, sex of the patient, and site of primary tumor were not significant prognostic factors. Further analysis shows that multimodal treatment with surgery, irradiation, and chemotherapy, especially in patients older than 1 year of age with Stage II disease, has influenced the survival significantly. The fact that age at diagnosis and the administration of chemotherapy have independent prognostic significance can be explained by the theory that all neuroblastomas are virtually congenital; therefore, the difference in age at diagnosis largely reflects the difference in growth rates of the tumor. Thus, according to this theory, age may be a measure of the probability of micrometastases in addition to the clinical extent or stage of the disease, as it represents the duration of the disease. Additional chemotherapy may thus have eradicated these micrometastases in the older children, since the age influence on Stage II disease disappeared when multimodal treatment was given in this study. The implications for treatment policy are discussed in view of this theory.

Carlsen NL; Christensen IJ; Schroeder H; Bro PV; Erichsen G; Hamborg-Pedersen B; Jensen KB; Nielsen OH.

Cancer 8703; 58(12):2726-35

Adult; Breast Neoplasms/*GE; Case Report; Human; Male; Pedigree; Support, Non-U.S. Gov't.

Familial breast cancer in males. A case report and review of the literature.

JOURNAL ARTICLE.

The occurrence of breast cancer in two related males, an uncle and nephew is reported. A review of previously reported cases of male breast cancer occurring in families and the association with other cancers in other family members is included. In previous reports on breast cancer in males, familial or hereditary factors have not generally been recognized as a major contributing factor. Of ten families reported (including our own) where there is sufficient information given, six families (60%) had females with breast cancer. It appears there are some families in which males as well as females have an increased risk of developing breast cancer.

Kozak FK; Hall JG; Baird PA.

Cancer 8703; 58(12):2736-9

Catheterization; Human; Male; Neoplasms/*CO; Peritoneum; Pleural Effusion/*SU.

Pleuroperitoneal shunting for malignant pleural effusions.

JOURNAL ARTICLE.

Traditional therapy for malignant pleural effusions includes thoracentesis or tube drainage with instillation of irritants to achieve pleurodesis. This can require a lengthy hospitalization, causes pain and discomfort, and has an appreciable failure rate. Because of these drawbacks, the authors used a shunting device to transfer fluid to the peritoneal cavity in 17 patients with malignant pleural effusions. Eleven patients had undergone previous therapeutic thoracenteses and three had chest tube placement with failed sclerosis. The shunt was a subcutaneous valved pump chamber with attached pleural and peritoneal catheters, which used manual compression to transfer fluid against the normal abdominal/pleural pressure gradient. Operative placement under local or general anesthesia was performed without complication. Five patients achieved minimal benefit, either because of moribund status or their inability to compress the pump effectively. In the other 12 patients, there was radiographic evidence of diminished or stabilized pleural effusion; respiratory symptoms were effectively palliated, and no further treatment for their effusion was required. Peritoneal dissemination of malignant cells has not been clinically detected. We feel that pleuroperitoneal shunting is a valid new method for treatment of malignant pleural effusions which can effectively palliate respiratory symptoms with low morbidity. Advantages include the absence of external tubing and the possibility for only a short hospitalization or even outpatient placement. Shunting is applicable for patients who are able to perform the requisite pumping and is particularly suitable for those with trapped lungs or who have failed attempted pleural sclerosis.

Little AG; Ferguson MK; Golomb HM; Hoffman PC; Vogelzang NJ; Skinner DB.

Cancer 8703; 58(12):2740-3

Adult; Aged; Autopsy; Echocardiography; Electrocardiography; Female; Heart/*PP; Heart Neoplasms/SC; Human; Male; Mesothelioma/*PP; Middle Age; Pleural Neoplasms/*PP; Support, U.S. Gov't, P.H.S..

Cardiac abnormalities in patients with diffuse malignant pleural mesothelioma.

JOURNAL ARTICLE.

Many patients with diffuse malignant pleural mesothelioma have dyspnea or chest pain. Cardiac symptomatology is frequently difficult to differentiate from symptoms of pleuropulmonary disease. To better define the clinical characteristics of cardiac involvement in patients with mesothelioma, the electrocardiographic (EKG) and echocardiographic findings in 64 patients with biopsy-proven malignant pleural mesothelioma were reviewed. A total of 19/64 (30%) patients had autopsy studies available for review. The EKG was abnormal in 55 patients (89%). Over half (60%) had an arrhythmia, including sinus tachycardia (42%), premature atrial and ventricular contractions (13%), atrial fibrillation (3%), and atrial flutter (1%). Over one third (37%) had a conduction abnormality, including bundle branch block (13%), hemiblock (8.5%), and incomplete right bundle branch block (13%). Echocardiography revealed a total of 13 patients with pericardial effusions, two with pericardial thickening, and one with an anterior sonolucent space. Of 19 autopsies, cardiac invasion was found in 14 (74%), with more than half to the pericardium and more than one quarter to the myocardium. It is concluded that: clinical cardiac abnormalities occur in the great majority of patients with malignant pleural mesothelioma, pathologic cardiac invasion occurs in the great majority of patients with pleural mesothelioma, and the EKG and echocardiogram are helpful in differentiating cardiac involvement from progressive pulmonary disease in patients with pleural mesothelioma.

Wadler S; Chahinian P; Slater W; Goldman M; Mendelson D; Holland JF.

Cancer 8703; 58(12):2744-50