DERMATITIS OF THE HANDS IN INDUSTRY

Three hundred and twenty-eight patients were referred for opinion as to whether a dermatologic condition was due to occupational causes. The answer was affirmative in two-thirds of the cases.Of 2,260 patients seen in ordinary private dermatological practice, about 9 per cent had lesions on the hands. Of 128 patients with contact dermatitis considered to be of industrial origin, 121, or 94.5 per cent, had lesions on the hands.Establishing industrial responsibility in cases of suspected occupational dermatitis of the hands is difficult, but in most cases a just conclusion can be reached by following certain guides.     

Recent data on monoclonal gammopathies

Monoclonal gammopathies (M.G.) are a group of disorders characterized by the proliferation of a single clone of plasma-cells that produce a Monoclonal Immunoglobulin (M-Ig). The presence of M-Ig can be demonstrated by electrophoresis in the patient' serum and identified by immunoelectrophoresis as a molecule containing two heavy chains of a single class and two light chains of a single type. In M.G. of malignant origin, free light chains (Bence Jones Proteins) can be evidenced in the concentrated urines. The fact that M.G. may be more frequent in certain families show the existence of a familial predisposition of this disease whereas its origin is still unknown. M.G. are often associated with malignant proliferation of B lymphocytes such as multiple myeloma, Waldenstr?m's macroglobulinemia, heavy chain disease as well as some other lymphoproliferative disorders. However, in a certain number of cases, the malignant origin of the M.G. was not proved, because M-Ig can occur in the serum of people apparently in good health and without clinical or hematological features (asymptomatic "benign" M.G.). Asymptomatic benign M.G. have been detected in increasing numbers during the last decade due to use of cellulose acetate electrophoresis for the routine examination of patients or in the course of systemic screening in normal populations such as blood donors. At the present time, a malignant origin of M.G. cannot be proved in more than thirty per cent of case and these "asymptomatic M.G." must be follow-up by a yearly clinical, hematological and electrophoretical check-up in order to detect a possible malignant evolution. In other cases, M.G. can be associated with neoplasms of cells types not known to produce M-Ig, in cold chronic agglutinin disease, and during the course of some auto-immune disorders.     

Clinical evaluation of a bleomycin-group antitumor antibiotic bleomycetin

The efficacy of bleomycetin or bleomycin A5 was studied in 128 patients with different malignant neoplasms. The antibiotic was used as a systemic or intracavitary chemotherapeutic agent. Bleomycetin was effective in 75-80, 81.8, 58.3, 70 and 50 per cent of the cases with disseminated derminogenic tumor of the testicle, squamous cell carcinoma of the head and neck, cancer of the penis, carcinoma of the skin and lymphogranulomatosis, respectively. When used intracavitarily the drug was effective in 41.2 per cent of the patients with cancer of the ovaries and lungs, teratoblastoma of the ovaries, cancer of the mammary gland and sarcoma of the soft tissues. Hyperthermia and focal hyperkeratosis as the adverse reactions were observed in 40.6 and 5.4 per cent of the patients, respectively. No toxicity with respect to the lungs was registered.     

Prostatectomy in private practice; a review of 589 cases in a five-year period

Prostatectomy was done in 589 cases in a five-year period. The operation was done transurethrally in 530 cases of benign disease and in 50 cases of malignant lesions. In six cases of malignant disease and three of benign, open procedures were used. Results of transurethral prostatectomy were considered good or excellent in 94.4 per cent of the cases of benign hypertrophy and in 92 per cent of the cases of carcinoma. It was felt that radical perineal prostatectomy was advisable for early operable cases of carcinoma, but that the transurethral procedure was more suitable in almost all cases of benign hypertrophy.     

Histopathology of tumorous ribs: a review of 130 cases

There were studied histopathologically 130 tumorous ribs out of 167 tumoral processes of the thoracal wall (77 per cent) and representing about 2 per cent of all the neoplasms studied between 1949 and 1984. There were distinguished 50 malignant primary tumors (Ewing's sarcomas, Parker-Jackson's reticulosarcomas, endotheliosarcomas, low differentiated myelosarcomas and myelomas, osteogenic sarcomas, chondro- and osteochondrosarcomas, and fibrosarcomas), 45 secondary (metastatic) malignant tumors of ribs out of which 32 (75 per cent) originated from lung cancers, and 35 benign lesions (osteoclastomas, chondromas and osteochondromas, fibromas and osteofibromas, eosinocytic histiocytomas, and various osteodystrophies). Morphological differentiating criteria were discussed for each group. There were analysed, when possible, the ways of rib involvement by neighbouring processes, especially the periosteum relationships with the soft tissues of the thoracal wall and with vessels and pleura. Some histogenetic problems were also emphasized.     

Effectiveness of smear technique in detection of pulmonary and gastric cancer

In the initial use of cytologic examination of smears to detect pulmonary and gastric cancer at the Los Angeles County Hospital during the period April 1949 to June 1950, 350 patients with suspicion of pulmonary disease and 128 with gastric problems were studied. In the pulmonary group, 80 per cent of 51 malignant lesions were diagnosed by the smear technique. Sixty per cent of 15 neoplasms in the stomach were diagnosed by the method. The results are analyzed in terms of sensitivity, accuracy, reliability and "yield" for the method. Cytological criteria of the presence of malignant disease are given and illustrated by photomicrographs. The method is one of potentially great value as an aid to diagnosis. Use of it in examination of selected categories of patients seems warranted.     

Effect of dietary fat on lymphocyte proliferation and metabolism

The effect of diets enriched with fat containing different fatty acids on glucose and glutamine metabolism of mesenteric lymph nodes lymphocytes, spleen, and thymus and lymphocyte proliferation was examined. The following fat-rich diets were tested: (1) standard chow (CC); (2) medium chain saturated fatty acids (MS)—coconut fat oil; (3) long chain saturated fatty acids (LS)—cocoa butter; (4) monounsaturated fatty acids (MU)—canola oil (n-9); (5) polyunsaturated fatty acids (PU)—soybean oil (n-6). Of the fat-rich diets tested, MS was the one to present the least pronounced effect. Lymphocyte proliferation was reduced by LS (64 per cent), MU (55 per cent), and PU (60 per cent). Hexokinase activity was enhanced in lymph node lymphocytes by PU (67 per cent), in the spleen by MS (42 per cent), and in the thymus by PU (30 per cent). This enzyme activity was reduced in the spleen (33 per cent) by LS and MU (35 per cent). In the thymus, this enzyme activity was reduced by LS (26 per cent) and MU (13 per cent). Maximal phosphate-dependent glutaminase activity was raised in lymphocytes by MS (70 per cent) and MU (20 per cent). This enzyme activity, however, was decreased in lymphocytes by PU (26 per cent), in the spleen by LS (15 per cent), and in the thymus by MU (44 per cent). Citrate synthase activity was increased in lymphocytes by MU (35 per cent), in the spleen by LS (56 per cent) and MU (68 per cent), and in the thymus by LS (42 per cent). This enzyme activity was decreased in lymphocytes by PU (24 per cent) only. [U-¹⁴C]-Glucose decarboxylation was raised by all fat-rich diets; MS (88 per cent), LS (39 per cent), MU (33 per cent), and PU (50 per cent), whereas [U-¹⁴C]-glutamine decarboxylation was increased by LS (53 per cent) and MU (55 per cent) and decreased by MS (17 per cent). The results presented indicate that the reduction in lymphocyte proliferation due to LS, LU and PU could well be a consequence of changes in glucose and glutamine metabolism. Copyright © 1998 John Wiley & Sons, Ltd.     

TRANSURETHRAL PROSTATECTOMIES—A Review of 560 Cases

Of 560 prostatectomies in an 11-year period on patients with benign or malignant disease of the prostate gland, almost 98 per cent were done transurethrally.Although many of the patients were considered to be in poor condition preoperatively, results achieved by the transurethral operation were excellent or good in 91 per cent of those who had benign disease of the prostate and in 84 per cent of those with malignant invasion. The rate of deaths attributable to the operation was 3.1 per cent in the group of patients with benign disease, 5.3 per cent in patients who had cancer.Complications, such as urinary incontinence, persistent pyuria, epididymitis, strictures of the urethra and of the meatus, and contracture of the neck of the bladder, arose in a surprising number of cases.     

CEA, ZGM and EMA localization in cells of pleural and peritoneal effusion: a preliminary study

Carcinoembryonic antigen (CEA), the zinc glycinate marker (ZGM) and epithelial membrane antigen (EMA) have been described as epithelial or tumour markers of varying specificity. These antigens were studied by immunoperoxidase localization in selected cell blocks of 62 pleural or peritoneal effusions and compared to cytological findings and review of the clinical records. By cytological criteria, 25 of the cell blocks were positive for malignancy, 30 negative, and 7 inconclusive. CEA, ZGM, and EMA by immunoperoxidase staining were localized on the cell surface and often in the cytoplasm of malignant cells, in 11/25 (44 per cent), 17/25 (68 per cent) and 22/25 (88 per cent) of the positive cell blocks respectively. Ten (40 per cent) of these cases were positive for all three antigens, 7 (28 per cent) for two, and 6 (24 per cent) for one. Of the 7 cases which were inconclusive on routine cytological reporting, 5 were positive for at least one marker. In 3 of the 5 a diagnosis of malignancy was confirmed, and in the other two was strongly suspected as malignant on clinical grounds. Macrophages were sometimes positive for one or more markers (but showed cytoplasmic staining only) and mesothelial cells in some cases stained positively for EMA but were always negative for CEA and ZGM. Localization of the 3 antigens in cells of malignant effusions was compared with their localization in the primary tumours in 9 cases. Localization corresponded for CEA in 7 of 9 cases, for EMA in 8 of 8 an for ZGM in only 2 of 9. Effusion fluid levels for CEA were compared with the cytological and immunocytochemical findings in 30 cases. Mucin stains performed on the cell blocks were also compared with the immunoperoxidase findings.     

L-GLUTAMIC ACID DECARBOXYLASE IN NON-NEURAL TISSUES OF THE MOUSE

Abstract— Low levels of γ-aminobutyric acid (GABA) and of glutamic acid decarboxylase (GAD) activity have been detected in mouse kidney, liver, spleen and pancreas. Quantitation of both ¹⁴CO₂ and [¹⁴C]GABA produced in radiometric assays from [U-¹⁴CJglutamic acid has shown that measurement of ¹⁴CO₂ evolution alone is not, in all cases, a valid estimate of true GAD activity. As evidenced by increased ^,14CO₂ production upon addition of NAD and CoA to assay mixtures, radiometric assay of GAD activity in crude homogenates may yield ¹⁴CO₂ via the coupled reactions of glutamic acid dehydrogenase and a-ketoglutarate dehydrogenase. The addition of 1 mM aminooxyacetic acid (AOAA) to assays of kidney homogenates inhibited [^,14C]GABA production 92 per cent while ¹⁴CO₂ production was inhibited only 53 per cent. No evidence was found to confirm the reported existence of a second form of the enzyme, GAD II. previously described by Haber el al. (H aber B., K uriyama K. & R oberts E. (1970) Biochem. Pharmac. 19, 1119-1136). Based on sensitivity-to AOAA and chloride inhibition, the GAD activity in mouse kidney is. apparently, indistinguishable from that of neural origin.     

ORIGIN AND TREATMENT OF MALIGNANT MELANOMA

Studies in man and other animals indicate that tendency to development of malignant melanoma may be congenital. Dark-skinned races have a lower incidence than light-skinned races.Sixty-five per cent of all malignant melanomas arise from possibly congenital moles; in over half of the 57 cases included in this study the patient observed gross change in the precurrent lesion. Trauma, even a single blow, is often the cause of malignant change. Excision of all pigmented moles subject to trauma is urged as a means of reducing the incidence of this highly malignant lesion.Biopsy of suspected lesions, followed by excision of a wide area and adjoining lymph nodes if indicated, is the only adequate treatment. The removal of hirsute moles for cosmetic reasons is discussed.     

Incidence of monoclonal gammopathies in blood donors]

A routine screening of monoclonal gammopathies (M.G.) was performed in the serum from 36, 015 blood donors by cellulose acetate electrophoresis. The incidence of M.G. was estimated to 0.14 per cent. About 86 per cent of cases can be classified as asymptomatic M.G. and 14 per cent as malignant M.G. (myeloma or Waldenstr?m macroglobulinemia). In asymptomatic forms, heavy chain classes are only IgG or IgM with a large predominance of IgG (86,4%). It is suggested that donors in whom M.G. have been detected should not be allowed to give blood. A yearly clinical, hematological and an immunoglobulin check-up is recommended to these patients in order to defect the first sign of a malignant process.     

MANAGEMENT OF EARLY PROSTATIC CARCINOMA

It is important to make a diagnosis of prostatic carcinoma as early as possible, because early treatment gives the best results whether radical prostatectomy is done or endocrine therapy used. Open perineal biopsy is the most accurate method of making a diagnosis. Perineal needle biopsy or the newer approach of transrectal needle biopsy is probably about 75 per cent accurate in making a diagnosis.Ten-year survival with conservative therapy, as determined in a review of a series of cases, was 50 per cent—about the same as that following radical prostatectomy; but the patients with prostatectomy are clinically free of malignant disease whereas the former are not. Radical prostatectomy is indicated in a few selected cases.The results from endocrine therapy begun immediately after diagnosis are significantly better than those from delayed treatment. Orchiectomy and estrogens promise a little longer survival than estrogens alone.     

Poikilocytosis in Cancer Patients

The incidence of poikilocytosis in 100 patients with cancer of various organ systems was found to be 12 per cent. Poikilocytosis was more frequently seen in patients with adenocarcinoma of the gastrointestinal tract and with inoperable metastatic carcinoma than in patients with other malignant lesions. Anemia was associated in three cases, but in nine instances the patient was not significantly anemic at admission. Two of these patients may have been dehydrated. Uremia was not a factor in any of the cases.Fifty per cent of the patients exhibiting poikilocytosis died or were in a terminal condition within one month after the observation was made, as compared with 21 per cent of the patients who did not have evidence of poikilocytosis. These findings show that poikilocytosis may occur in cancer patients without anemia or uremia; and they indicate that its presence is an unfavorable prognosis sign.     

Dermatopathic Lymphadenopathy—A Clinicopathologic Analysis of Lymph Node Biopsy Over a 15-Year Period

Forty cases of dermatopathic lymphadenopathy were found in a series of 906 consecutive lymph node biopsies (4.8 per cent).The histologic development and progression of the disease was correlated with the clinical state of the patient.In 35 of 40 cases the patients had active skin disease at the time of the biopsy; one of the remaining five patients had Hodgkin''s disease, one had multiple myeloma and one had secondary syphilis. In the other two, no organic cause was found.In nine cases (22.5 per cent), the histological pattern typical of dermatopathic lymphadenopathy was associated with malignant lymphoma. Except for two biopsies, which showed coexisting malignant lymphoma and dermatopathic lymphadenopathy, no histologic features were found which distinguished patients with malignant lymphoma from the remainder.While the pathogenesis of the lymph node changes remains obscure, the histologic features suggest that it is at least in part an immune response, although the nature of the responsible antigen is unknown.     

SALIVARY GLAND TUMORS

In a review of a series of 248 salivary gland tumors, seen over a 28-year period, all pathologic material was brought up to date by reclassification according to more recent criteria and nomenclature. In parotid tumors, a probable lowered recurrence rate and a definite decrease in incidence of permanent facial nerve paralysis was found in the more recent cases in which the "Y" incision was used, with identification of the seventh nerve as it leaves the stylomastoid foramen. The five-year recurrence rate for primary mixed tumor was 8.3 per cent, and in recurrent cases it was found to be 18.1 per cent. Of 44 patients with malignant salivary gland tumors in all sites who were observed for five years or more, 32 or 72.7 per cent survived five years.     

Fine needle aspiration of metastatic and hematologic malignancies clinically mimicking pancreatic carcinoma.

The fine needle aspiration (FNA) cytology findings in 19 cases of hematopoietic and metastatic neoplasms that radiographically mimicked primary pancreatic carcinoma are reported. These cases represented 11% of 176 malignant diagnoses in a series of 304 pancreatic FNAs. The cytologic diagnoses included 7 non-Hodgkin's lymphomas, 2 Hodgkin's lymphomas, 6 small cell carcinomas (4 lung, 1 gallbladder, 1 skin), 3 squamous cell carcinomas (2 cervix, 1 esophagus) and 1 hepatocellular carcinoma. In six cases the pancreatic lesion was the initial presentation of malignant disease. These included five lymphomas, which probably involved peripancreatic lymph nodes, and a metastatic small cell carcinoma of pulmonary origin. Recognition of unusual morphologic features of pancreatic carcinoma raised the possibility of extrapancreatic malignancies. Electron microscopy and immunocytochemistry performed on FNA specimens were helpful in selected cases. The FNA diagnosis of hematopoietic and metastatic neoplasms that clinically mimic pancreatic carcinoma prompts appropriate clinical studies and treatment and eliminates the need for open pancreatic biopsy and/or resection.     

Retroperitoneal tumors in children; roentgen diagnosis

A study was undertaken to determine whether there are any features of retroperitoneal tumors in children that might be demonstrated on roentgenograms to aid in identifying them preoperatively. Study was limited to Wilms' tumor of the kidney and neuroblastoma. Calcification was found in 57 per cent of the neuroblastomas and in only 12 per cent of Wilms' tumors. Calcifications in neuroblastomas differed from those in Wilms' tumors. Calcification in neuroblastoma was more frequent in older children than in the younger ones. The kidney was frequently displaced by both types of tumor. However, the neuroblastoma always displaced the kidney downward, or downward and slightly outward. In most instances, the Wilms' tumor also displaced the kidney downward and outward, but in some instances upward and medially. This, of course, depended upon the site of origin of the tumor. There was a distortion of the intrarenal structures in 75 per cent of the cases of neuroblastoma and in 71 per cent of the cases of Wilms' tumor.     

268例难治性下呼吸道感染的细菌学分析

通过本组２６８ 例难治性呼吸道感染病人标本培养结果分析,阳性２４６ 例占９１．８ ％ ,有１５４ 例检出厌氧菌,占５７ ％ ,１０４ 例检出需氧菌,占３９ ％ ,混合感染１３３ 例,占５０ ％ 。试验结果证实,厌氧菌感染在难治性下呼吸道感染病例中占了很大比例,这一结果为难治性下呼吸道感染的治疗提供了有价值的参考数据。     

RESULTS OF IRRADIATION IN CANCER OF THE LIP,TONGUE AND EAR

Cancer of the lip: The primary lesion can be controlled by irradiation in approximately 80 per cent of cases. For lesions with metastases there is only about a 25 per cent chance of five-year arrest (irradiation of the primary lesion followed by excision of involved nodes).Cancer of the tongue: Lesions in the anterior two-thirds are controllable by irradiation in about 50 per cent of cases if the nodes are not involved; the salvage is only about 15 per cent if the nodes are involved (nodes treated surgically). Lesions in the posterior third of the tongue are seldom controlled in the author''s experience.Cancer of the ear (auricle): Five-year arrest of basal-cell lesions should be attained by irradiation in about 80 per cent of cases; of squamous-cell lesions in about 60 per cent. If the lesion is extensive, radiation does not offer a superior cosmetic result to operation and entails danger of late chondronecrosis. Therefore extensive lesions are probably best treated surgically. In either event, it appears probable that results of irradiation can be improved by the use of more adequate fields and greater fractionation.