AMMONIACAL DERMATITIS—Clinical Observations on an Efficacious,Economical and Neglected Treatment

Several pediatricians in one community began instructing mothers of infants with ammoniacal diaper rash to use o-benzyl-p-chlorophenol (OBPC) in laundering diapers. This simple, previously reported item of management was prescribed in 87 cases of ammoniacal rash. In almost all uncomplicated cases the rash cleared in an average of four days; when complicated by Staphylococcus aureus or Monilia albicans infection, clearing took a few days longer. The few cases of less than satisfactory results were attributable to improper use of the chemical.Several of the mothers had mild irritation of the hands from use of OBPC.     

CARCINOMA OF THE PROSTATE—Diagnosis and Treatment

About 28 per cent of men between the ages of 71 and 75 have cancer of the prostate. Many of them do not die of the disease, but with the life span ever increasing, this problem is becoming more important.In the early stages the condition is asymptomatic; when the symptoms of urinary obstruction arise, the cancer is usually too advanced for cure. Cure depends on early diagnosis and, therefore, on routine rectal examination. The solitary hard nodule of early prostatic cancer becomes a stony hard fixed prostate as the condition progresses. X-ray and acid phosphatase studies are of help only after the cancer has metastasized. As many as 50 per cent of patients with rectally palpable early carcinoma of the prostate can be cured by radical perineal prostatectomy. Often, simple enucleation or transurethral resection is sufficient to effect cure in the case of occult carcinoma. However, some observers believe that when cancer is detected by microscopic examination of a prostate that has been removed, a radical operation should be done as soon after the initial operation as feasible. Early orchidectomy and estrogen therapy are of considerable help in slowing the process of advanced prostatic cancer and may postpone the need of transurethral resection to relieve obstruction. When these measures fail, bilateral adrenalectomy, cortisone therapy, pituitary irradiation, and pituitary extirpation have been employed, with moderate success, in an effort to diminish the androgen level.     

Intestinal Bacteria — The Role They Play in Normal Physiology,Pathologic Physiology,and Infection

Anaerobic bacteria predominate in the normal human fecal flora, out-numbering aerobes at least 100 to one. The two most prevalent organisms are Bacteroides fragilis and Bifidobacterium. Ileostomy flora is, on the other hand, chiefly aerobic and the total count is lower (10⁸ per ml of fluid, compared to 10¹⁰ per gram for feces). In normal people, small bowel bacterial counts are generally 10⁵ per ml or less. The upper small bowel consists primarily of Gram-positive aerobes in small numbers. In the terminal ileum, counts are higher and aerobes and anaerobes are present in equal numbers. In the presence of acute obstruction and certain bowel stasis or other syndromes, the small bowel flora may become relatively profuse and fecal in type. The stomach normally has less than 10³ organisms per ml but counts are higher in gastric samples with pH above 4.0.Intestinal bacteria are important in such processes as conversion of bilirubin to urobilinogen, supply of vitamin K to the host, defense against infection, bile acid deconjugation and conversion, infections related to the bowel, the malabsorption of blind loop and other bacterial overgrowth syndromes, and hepatic coma.     

HEMANGIOMAS—Histologic Structure,and Treatment

Hemangiomas are considered tumors originating in blood vessels and are classified as ectatic and hyperplastic. Controversy regarding active therapy occurs in the case of strawberry hemangiomas which are hyperplastic capillary hemangiomas. Although they may clear up spontaneously, on rare occasions they may predispose to grave sequelae. Port-wine stain hemangiomas should never be treated with x-ray or radium.     

Studies of the Chinese Woodsiaceae (2) — Comparative Morphology and Anatomy of Mature Sporophytes

the comparative studies of morphology and anatomy of 19 species of Chinese Woodsiaceae are reported in the present paper. It includes anatomy of root, rhizome, rachis and joint on stipe; comparative morphology of the fronds and its parts, trichomes and indusia and an observation of the spores under SEM. The information is applied to discussing phylogeny and systematics briefly. The anatomical studies do provide taxonomic studies with evidence so that they should not be abandoned. For example, the stipe joints of Woodsia have two types, the stipe joint below the attachment point of the base pair of pinnae and the stipe joint just at the attachment point of that; the abscission layer of the former does not have pinna trace in it and the basic chromosome number is 39. However, the abscission layer of the latter does and the basic chromosome number is 41. It is obvious that the anatomical cha-racters can be used for infrageneric subdivision of Woodsia.     

DIVERTICULITIS OF THE COLON—Surgical Treatment

Appropriate surgical treatment of diverticulitis of the colon can result in a highly satisfactory proportion of permanent cures, with an operative mortality of 2 to 5 per cent.Colostomy is a valuable emergency procedure for the control of severe infection or the relief of obstruction but is not a satisfactory definitive treatment for the cure of diverticulitis. Definitive surgical treatment requires resection of the involved segment of colon.Three indications for surgical intervention in “uncomplicated” diverticulitis are: (1) continued or repeated attacks, (2) persistent deformity as seen by x-ray examination, and (3) persistent blood in the stools.Although a three-stage operation is usually considered a safer procedure, one-stage resections may be safely and satisfactorily employed in many instances.     

Phenylketonuria—The Guthrie Screening Test—A Method of Quantitation,Observations on Reliability and Suggestions for Improvement

The Guthrie bacterial inhibition assay method of screening neonatal infants for phenylketonuria (pku) initiated mass screening for inborn errors of metabolism. It is a simple, cheap procedure admirably suited to private local use as against private or public central use. However, using parallel fluorometric determinations as a basis for comparison, and 4 mg per 100 ml serum phenylalanine as a presumptive positive threshhold, the Guthrie test yielded 53 per cent “false negatives.” Extrapolating from a combination of our data and reported phenylalanine levels at three days of age or less in proved pku patients, it is estimated the Guthrie test might fail to detect one of 25 pku patients screened at three days of age or less. Means to diminish this risk are considered.     

ONYCHOMYCOSIS OF THE FEET—Treatment with Griseofulvin

Griseofulvin, a new orally administered antifungal antibiotic which has proved to be effective for the treatment of a wide variety of superficial fungus infections of man, was used in the treatment of 51 patients with infections of the toenails due to T. rubrum. Thirty-four of the patients were treated with griseofulvin alone and seven were treated with griseofulvin combined with surgical avulsion of all involved toenails. The remaining ten had bilateral infections, and avulsion was done on one foot but not the other before griseofulvin therapy was begun.Of 34 patients who were treated with griseofulvin alone, few had complete cure even after prolonged treatment. Some nails showed improvement for a time, then no further gain; some showed no improvement; some showed resistant wedges of infection which penetrated proximally toward the posterior nail fold.In the instances of surgical avulsion, clinically normal nails regrew during griseofulvin therapy. This simple procedure, with thorough removal of all underlying keratinous debris, apparently did away with foci of possible reinfection.The results of the study indicated that surgical avulsion of the toenails in combination with griseofulvin therapy is an effective and practical method of treating onychomycosis of the toenails due to T. rubrum.     

DYSFUNCTIONAL UTERINE BLEEDING—The Relationship of Microscopic Observations to Treatment

Dysfunctional bleeding is not an entity, it is a symptom. With proper history, physical examination and laboratory aids a definitive diagnosis can be made. With this diagnosis rational and direct treatment may be instituted. Both diagnosis and treatment are outlined and discussed. When hormonal treatment is indicated, the type, amount and timing must be fitted to the patient''s needs.     

RECURRENT CARCINOMA OF THE RECTUM—Surgical Treatment

Following operations on the rectum for carcinoma, approximately half of the patients have recurrence in the perineum, pelvis, abdomen or at the suture line of anastomosis. The prognosis is almost uniformly poor and although the problems of management are complicated, dealing with them may give the patient worthwhile physical, emotional and economic benefits. Surgical procedures used in the treatment of the common types of recurrence are discussed.     

TREATMENT OF DIABETIC PATIENTS—Observations on the Use of Carbutamide and Tolbutamide

Of a group of 32 patients with diabetes, 26 had a favorable modification of the disease in response to administration of butyl-sulfonyl-urea. All but one of the patients who had good response were past the age of 38. All diabetic patients included in this group were those with little or no tendency to ketosis after cessation of insulin administration. No toxic manifestations were noted except for a slight decrease in leukocytes in one case.     

CARCINOMA OF THE THORACIC ESOPHAGUS—A Discussion of Early Diagnosis and Surgical Treatment

Dysphagia, substernal or epigastric distress, and regurgitation of food are important early symptoms in the diagnosis of carcinoma of the esophagus. Temporary remission in symptoms does not rule out esophageal cancer. The use of thick barium meal and routine thorough examination of the esophagus in upright and supine positions in all upper gastrointestinal roentgen studies, even though the clinical symptoms point to the upper abdomen, are of great importance.The spread of the cancer to both mediastinal and subdiaphragmatic lymph nodes makes transthoracic thoracolaparotomy the one approach which will permit the surgeon to perform a one-stage esophagogastrostomy, and to adequately evaluate and deal with cancerous tissue on both sides of the diaphragm. This one-stage procedure permits the patient to swallow normally after operation, and the costly and time-consuming uncertainties of the many-staged operations are avoided. The comfort which the operation gives to otherwise doomed patients, along with the improving postoperative mortality rate, offers new hope to those who have cancer of the esophagus.     

COXSACKIE VIRUSES—A Review of Pathologic,Epidemiologic, Diagnostic and Etiologic Observations

Coxsackie disease comprises three clinical entities—herpangina, so-called non-paralytic poliomyelitis, and epidemic pleurodynia. Several strains of antigenically-related viruses, Groups A and B, designated as Coxsackie virus have been isolated from stool specimens and from material from the throat of many patients with the diseases mentioned. Inasmuch as the virus has also been recovered from normal persons, there is as yet uncertainty as to causal relationship between the presence of the virus and the disease. Reports of the isolation of Coxsackie virus and poliomyelitis virus from the same patient make difficult the interpretation of the findings.The diagnosis of Coxsackie disease entails animal inoculation and serologic procedures. Emphasis is placed on the necessity of obtaining stool specimens, throat washings, and “paired” blood specimens from patients suspected of the disease.