ATOPIC DERMATITIS—ETIOLOGY AND CLINICAL MANAGEMENT

Atopic dermatitis is primarily an allergic problem, similar in most of its aspects to that of allergic bronchial asthma. It should be studied and treated like asthma, with especial emphasis on the significance of inhalant allergens. It is doubtful that psychic factors are of importance in primary genesis of the disease although they may be involved in exacerbation of it.     

XVITH SYMPOSIUM OF THE INTERNATIONAL BIOACOUSTICS COUNCIL—ABSTRACTS

ABSTRACT

Three vocalisation types of the másafuera rayadito Aphrastura masafuerae are described using sonograms: common call, alarm call, and song. They are analysed according to their structure, kHz-frequency, duration and time of day. The common call can be uttered singly or in a series with regular pauses. This intensive call is heard even through fog and wind and seems to be used for contacting the partner as well as signalling the home range to neighbours. The alarm call is a continuous series of similar syllables without pauses. The song is given exclusively in the morning before sunrise by only one individual of the pair. It has one type of phrase only, which is repeated. Phrases are interrupted by regular pauses. These vocalisation types are clearly different from each other, but also have features in common: the monotonous structure, repetition of units and temporal frequency of elements.     

MANAGEMENT OF ATOPIC DERMATITIS—A Preliminary Report

A treatment regimen for atopic dermatitis (disseminated neurodermatitis) which attempts to cope with the factors of dry skin and retention of sweat was successful in a series of 22 consecutive patients, all of whom remain under observation. Objectives of the treatment are: Preservation of the natural lipid surface film, avoidance of controllable stimuli to sweating, avoidance of greases and oils topically applied, control of bacterial infection in the skin, resolution of active dermatitis with topical corticosteroids in vehicles low in lipids or free of them, and correction of existing keratoderma. This program does not purport to alter atopic constitutional factors.Among the 22 patients were seven with severe dermatitis requiring prolonged, continuous or intermittent, systemic corticosteroid therapy who were treated and had no exacerbation for periods up to ten months at the time of last report. The total daily dose of topical corticosteroid is small. Systemic corticosteroid therapy was withdrawn at the initiation of this treatment and has not been reinstituted. No untoward reactions have been observed.Results to date warrant treatment and long term observation of additional patients to determine the ultimate value of this method.     

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.     

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.     

CARCINOMA OF THE NASOPHARYNX—Treatment with Radioactive Cobalt

A method of treatment of carcinoma of the nasopharynx is described, using a bead of radioactive cobalt in a Foley catheter placed through the nose and inside the nasopharynx. As an aid in proper placement of the cobalt bead a portion of the nasal septum is removed first. This method of treatment is to supplement rather than replace other methods of treatment such as external x-ray therapy and surgical excision of lymph nodes in the neck.Twenty-two patients were treated with radioactive cobalt beads and the results indicated that it is a useful method for treating carcinoma in the nasopharynx.     

BASAL CELL CARCINOMA OF THE NOSE—Treatment with Chemosurgery

Basal cell carcinomas of the nose probably originate from embryologic cell rests left between cartilages and bones in the fusion and migration of the nasal precursors. Some carcinomas have been found to invade to the mucosal surface between subcutaneous structures or around the alar margins. Recurrences are particularly likely to develop deep extensions due to overlying scar tissue.In many cases, chemosurgical removal has disclosed unsuspected deep and lateral extensions. It is the treatment method of choice for many such lesions.     

PRIMARY CARCINOMA OF THE GALLBLADDER—Review of 173 Cases

One hundred seventy-three cases of primary carcinoma of the gallbladder were analyzed. In the group studied they made 2.11 per cent of all malignant tumors found at autopsy and were found in 1.89 per cent of all cases in which operation was done on the biliary tract. There was no appreciable change in the incidence of this tumor at autopsy during the period studied (1918-1948) at the Los Angeles County Hospital. Sixty-eight per cent of the cases were in females. A particularly high incidence was noted in Mexican females.Upper abdominal pain, loss of weight, nausea and vomiting, jaundice, and palpable mass or enlarged liver were the most common clinical features. Approximately one-third of the patients in whom the lesion was found at operation and one-fifth of all the patients whose records were studied had a history of chronic gallbladder disease.All but two of the 38 patients operated on were dead or had clinical recurrence within two years. One was alive and well 12 years after cholecystectomy.The most common gross appearance, particularly at autopsy, was a large tumor mass replacing the gallbladder and radiating to nearby organs, particularly the liver. In about one-third of the cases the tumor was grossly limited to the gallbladder. Polypoid tumors occurred in only about 10 per cent of the cases and most of the tumors were diffusely growing adenocarcinoma. Perforation appeared in nine cases, usually with fistula to the gastrointestinal tract. All of the tumors were histologically adenocarcinoma, usually of simple glandular structure. No purely squamous cell growth occurred.Gallstones were found in 79.8 per cent of the cases.     

MANAGEMENT OF NEPHROSIS—The Use of Long Continued Hormone Therapy

The course of nephrosis in 36 children was evaluated. Twelve of 24 who received no treatment or short-term courses of steroids died. Eleven of the 24 had been well for six months to five years at the time of this report.Twelve patients received steroids by schedule over extended periods. One died and eleven had been free of signs and symptoms of nephrosis for four to eighteen months at the time of report. In only two cases was therapy discontinued. It seems evident that these patients are experiencing a better state of well-being. Whether or not the prognosis is being altered for any single patient cannot be determined.