RHEUMATIC LESIONS IN LEFT ATRIAL APPENDAGES—Pathologic Studies of Material Removed During Mitral Commissurotomy

The left atrial appendage removed incidental to mitral valve commissurotomy was studied for rheumatic lesions in 128 cases. Endocardial Aschoff bodies, which are usually considered indicative of active rheumatic disease, were found in 35.9 per cent of the cases.Postoperative follow-up observations were available in only 53 patients. Of these, only eight had clinical evidence of postoperative rheumatic activity. In none of this group of eight cases had Aschoff bodies been observed in pathologic study of the surgically removed left atrial appendage.     

P~（53） PROTEIN OVEREXPRESSION IN PREMALIGNANT AND MALIGNANT LESIONS OF ORAL MUCOSA：IMMUNOHISTOCHEMICAL OBSERVATION

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INTERSTITIAL PNEUMONIA—A Pathologic Concept

Interstitial pneumonias present a pulmonary inflammatory reaction pattern that is common to a wide variety of noxious agents and disease processes. These include viruses, Rickettsiae, hypersensitivity reactions, the “collagen disease,” x-irradiation, uremia, certain chemicals, early histoplasmosis, toxoplasmosis and possibly unknown substances and diseases.Interstitial pneumonia is characterized histologically by interalveolar exudate, hyaline membranes, epithelialization of alveolar walls and lack of polymorphonuclear response. Histologic features that aid in differentiating among cases of varying etiology are few.It is postulated that the basic pathogenic mechanism of the interstitial inflammatory reaction is primary damage to pulmonary capillary endothelium that brings about increased capillary permeability.     

HYSTERECTOMY — TOTAL OR SUBTOTAL FOR BENIGN LESIONS

With careful use of a suggested technique for total hysterectomy which has been developed and used over a period of 20 years, the mortality rate associated with the operation need be no greater than that for subtotal hysterectomy. Moreover, the results obtained with it overcome many of the objections which advocates of subtotal hysterectomy raise against the routine use of the more extensive operation. At the same time none of the advantages of total hysterectomy are surrendered.     

Impetigo—Bacteriologic Features and Renal Involvement

One hundred children with impetigo were studied with particular emphasis upon the organism causing the infection and associated renal complications. In 50 per cent of cases, Group A beta-hemolytic streptococcus grew on cultures of material from the lesions, and evidence of recent infection with this organism as shown by an elevation of antistreptolysin O titer was present in an additional 17 per cent of cases.Acute glomerulonephritis developed in three of the 66 children with bacteriologic or serologic evidence of streptococcal infection. Four other children in this group and nine children with staphylococcal impetigo had unexplained microscopic hematuria.All children with nephritis already had evidence of the disease when first seen. In most of those with unexplained hematuria, this condition was detected at the first visit. Hematuria developed in others while they were receiving systemic antibiotics. The significance of isolated microscopic hematuria is uncertain, but is seen often in association with cutaneous infection with both staphylococcus and streptococcus. Microscopic hematuria as defined is apparently not prevented by antibiotic therapy.If acute glomerulonephritis that follows streptococcal cutaneous infection is to be prevented, streptococcal impetigo will have to be treated promptly after onset.     

PANCREATITIS AND CARCINOMA OF THE PANCREAS—Some Aspects of the Pathologic Physiology

The physiological phenomena accompanying pancreatic disease in adults are related to the local and generalized reaction of the body to the blockage and/or leakage of the three enzymes—amylase, lipase and trypsin. The measurements of amylase and lipase in the serum are the most reliable criteria in the diagnosis of acute disease. Related changes may include hypocalcemia, hypopotassemia, hyperlipemia, hyperglycemia and decreased renal function.In chronic pancreatitis, there is less fluctuation in the amounts of the enzymes in the blood. The presence of diabetes mellitus, demonstration of calculi by x-ray, and examination of the stools for excess fat and meat fibers are more important diagnostic guides.In cancer of the pancreas, function tests using secretin stimulation of the gland followed by an examination of the external secretion or determination of the serum amylase have been used with some success.     

CONSTRICTING ESOPHAGEAL LESIONS—Colon Interposition for Replacement,Combined With Radiotherapy for Carcinoma

The use of colon for esophageal replacement is a procedure that should be considered in the treatment of benign and malignant esophageal lesions. The five-year survival data following operations for carcinoma of the esophagus are not outstanding. The combination of colon transplantation and radiotherapy before and after operation is a procedure that should be utilized if an effort is to be made to increase the survival rate.     

PULMONARY HYALINE MEMBRANE DISEASE—A Panel Discussion: Internist's Point of View

Seventy-six digital and periungual warts in 40 patients were treated topically with cantharidin, a potent blistering agent. The material, dissolved in equal parts of acetone and collodion, was applied directly to the warts. Occlusion facilitated blistering. No pretreatment was required. The warts were re-treated at weekly intervals until clinically cured.Fifty-six per cent of digital warts and 33 per cent of periungual warts cleared after a single application of cantharidin. Few required more than three treatments. Observation was continued for more than six months in more than half of the cases. Cure was lasting in about 70 per cent of the cases in which the long term result was known.Cantharidin ranks with liquid nitrogen in effectiveness, but it is painless to apply and does not cause scarring. For these reasons it is especially useful in children.The main disadvantage is pain and tenderness at the treated site for two to four days in some patients. This can be avoided by careful application of the drug. Occasionally new warts appear at the edge of the cantharidin blister. They are best treated by curettage and desiccation.     

DIAGNOSIS OF ABDOMINAL LESIONS—The Use of Intravenous Aortography,Nephrotomography and Retrograde Aortography

New and safe methods of investigating the kidney by x-ray visualization of its circulation are now available. This can be done either by injecting large amounts of contrast material through a vein and then taking multiple x-ray exposures of the kidneys, or by injecting the contrast material backward into the aorta to the level of the renal arteries.Another method of x-ray examination now available is taking body section films of the kidneys when the contrast medium is in the kidney substance. This makes the kidney outline extremely sharp and allows more precise diagnosis.     

PULMONARY HYALINE MEMBRANE DISEASE—A Panel Discussion: Pediatrician's Point of View

Elevated serum amylase is a frequent concomitant of perforated gastroduodenal ulcer. To determine if there might be significant correlation between an increase in amylase and some of the other factors associated with ulcer perforation, a study was made of the clinical records of 1,000 patients with perforation of gastroduodenal ulcers. Sixteen per cent of the patients had amylase levels of 200 Somogyi units or more. This rise in serum amylase comes about in cases of perforated peptic ulcer as a result of peritoneal lymphatic absorption of fluid containing pancreatic enzyme which is spilled through the perforation. Among patients with perforated ulcers and elevated serum amylase levels, the higher the amylase level, the higher the mortality rate.The factors of amount of abdominal fluid spill, the duration of the perforation before surgical closure, the size of the perforation, shock and recent ingestion of food were also studied for possible relationship with elevated serum amylase. All appeared to be statistical if not etiological associates of abnormal serum amylase levels.Because high amylase values so often occur in perforated ulcer, there is no amylase level that can be considered diagnostic of acute pancreatitis.