Cardiospasm

Cardiospasm and megaesophagus are well known clinical and pathological entities but the cause remains obscure. Megaesophagus is probably congenital or developmental in origin. The majority of cases of cardiospasm can be successfully treated by forceful dilatation of the narrow area. Some cases of megaesophagus are best treated by a plastic surgical procedure which enlarges the esophageal gastric opening. Additional experience with this method is necessary before it can be correctly evaluated.     

Idiopathic megaesophagus in a rat (Rattus norvegicus)

Necropsy and histopathologic examination of a rat (Rattus norvegicus) revealed megaesophagus and gangrenous bronchopneumonia. The esophageal dilitation, mural atrophy with persistence of neural structures, regurgitation and bronchopneumonia seen in this case were similar to findings in other animals with megaesophagus.     

Clinical forms of Trypanosoma cruzi infected individuals in the chronic phase of Chagas disease in Puebla, Mexico

In Mexico, despite the relatively high seroprevalence of Trypanosoma cruzi infection in humans in some areas, reported morbidity of Chagas disease is not clear. We determined clinical stage in 71 individuals seropositive to T. cruzi in the state of Puebla, Mexico, an area endemic for Chagas disease with a reported seroprevalence of 7.7%. Diagnosis of Chagas disease was made by two standardized serological tests (ELISA, IHA). Individuals were stratified according to clinical studies. All patients were submitted to EKG, barium swallow, and barium enema. Groups were identified as indeterminate form (IF) asymptomatic individuals without evidence of abnormalities (n = 34 cases); those with gastrointestinal alterations (12 patients) including symptoms of abnormal relaxation of the lower esophageal sphincter and absent peristalsis in the esophageal body, grade I megaesophagus, and/or megacolon; patients with clinical manifestations and documented changes of chronic Chagas heart disease who were subdivided as follows: mild (8 patients)--mild electrocardiographic changes of ventricular repolarization, sinus bradychardia); moderate (6 patients)--left bundle branch block, right bundle branch block associated with left anterior fascicular block); severe (8 patients)--signs of cardiomegaly, dilated cardiomyopathy); and the associated form (3 cases) that included presence of both cardiomyopathy and megaesophagus. These data highlight the importance of accurate evaluation of the prevalence and clinical course of Chagas disease in endemic and non-endemic areas of Mexico.     

Genome-wide association studies for multiple diseases of the German Shepherd Dog

The German Shepherd Dog (GSD) is a popular working and companion breed for which over 50 hereditary diseases have been documented. Herein, SNP profiles for 197 GSDs were generated using the Affymetrix v2 canine SNP array for a genome-wide association study to identify loci associated with four diseases: pituitary dwarfism, degenerative myelopathy (DM), congenital megaesophagus (ME), and pancreatic acinar atrophy (PAA). A locus on Chr 9 is strongly associated with pituitary dwarfism and is proximal to a plausible candidate gene, LHX3. Results for DM confirm a major locus encompassing SOD1, in which an associated point mutation was previously identified, but do not suggest modifier loci. Several SNPs on Chr 12 are associated with ME and a 4.7 Mb haplotype block is present in affected dogs. Analysis of additional ME cases for a SNP within the haplotype provides further support for this association. Results for PAA indicate more complex genetic underpinnings. Several regions on multiple chromosomes reach genome-wide significance. However, no major locus is apparent and only two associated haplotype blocks, on Chrs 7 and 12 are observed. These data suggest that PAA may be governed by multiple loci with small effects, or it may be a heterogeneous disorder.     

Cryodestruction of Haemorrhoids

Thirty-seven cases of second and third degree haemorrhoids have been treated by cryosurgery. Although the number of cases treated is small and the follow-up is short, we are greatly encouraged by the early excellent results. It is a simple and effective procedure with minimal complications, and it is especially recommended for those patients who are medically unfit for general anaesthesia. The rapidity of this procedure combined with the painless operative and postoperative course enables the patient to leave hospital the next day. More cases with long-term follow-up are needed before adequate evaluation of this form of treatment can be made.     

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.     

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.     

Advances in pediatric surgery

Recent advances in pediatric surgery have been made in several fields. Hydrocephalus is again being treated by draining the cerebrospinal fluid into either the ureter, the mastoid antrum or the peritoneal cavity. Funnel chest should be corrected surgically. Congenital atresia of the esophagus is best treated by a one-stage operative repair. Patent ductus should be closed. Operations are available for cyanotic children. Intussusception is again being treated by barium enema in selected cases. Megacolon can be benefited by surgical procedures, which now are directed at the distal spastic segment rather than the proximal dilated segment.     

ADVANCES IN PEDIATRIC SURGERY

Recent advances in pediatric surgery have been made in several fields. Hydrocephalus is again being treated by draining the cerebrospinal fluid into either the ureter, the mastoid antrum or the peritoneal cavity. Funnel chest should be corrected surgically. Congenital atresia of the esophagus is best treated by a one-stage operative repair. Patent ductus should be closed. Operations are available for cyanotic children. Intussusception is again being treated by barium enema in selected cases. Megacolon can be benefited by surgical procedures, which now are directed at the distal spastic segment rather than the proximal dilated segment.     

The determinants of Chagas disease: connecting parasite and host genetics

As a consequence of infection by Trypanosoma cruzi, 30% of victims may develop chronic Chagas disease, which presents a spectrum of pathology including cardiomyopathy, megacolon and megaesophagus. The outcome of infection in a particular individual is the result of a set of complex interactions among the host genetic background, environmental and social factors, and the genetic composition of the parasite, all of which can be complicated by mixed infections and re-infections. Initially we consider what is known about the genetic structure and biological properties of the protozoan. Currently, six distinct subgroups have been characterized by different combinations of four distinct genotypic classes. The recent demonstration of genetic exchange via non-meiotic cell fusion illustrates a mechanism by which maintained heterogeneous polyploidy may have been generated in these parasites. Subsequently, we consider factors in humans and in experimental mouse-infection and tissue culture models that have contributed to our understanding of the host's susceptibility or resistance to disease. Identification of the direct players in host-pathogen interactions at the establishment and chronic phases of the disease is perhaps the best hope of a clinical handle for treatment. At some point in the future, these disparate areas of study will have to come together. It is to be hoped that this scientific fusion will result in better prognosis and treatment of Chagas disease.     

Gonorrhea—The Office Management of Acute Infections

Gonorrhea has recently increased to epidemic proportions and is poorly controlled. The principal causes are probably increasing resistance of Neisseria gonorrheae to penicillin, the difficulty of establishing the diagnosis and proving the cure in female patients and the inadequacy of resources devoted to the eradication of the disease by public health agencies.While examination of smears is adequate for diagnosis of the disease in males, in females cultures of vaginal exudate are necessary. Gonorrhea can usually be successfully treated with large doses of short-acting penicillins. Intramuscular administration of aqueous procaine penicillin will bring about cure in most cases. Female patients should have cultures for several weeks to make sure they are cured.The physician should report all cases to the local health department so that contacts can be traced and treated.     

A paragonimiasis patient with allergic reaction to praziquantel and resistance to triclabendazole: successful treatment after desensitization to praziquantel

Paragonimiasis is an infectious disease caused by trematodes of the genus Paragonimus. This trematode can be treated successfully with praziquantel in more than 90% of the cases. Although praziquantel is generally well tolerated, anaphylactic reactions to this drug have been reported in a few cases. We report here a 46-year-old Korean female with paragonimiasis, presumed to be due to Paragonimus westermani, who displayed an allergic reaction to praziquantel and resistance to triclabendazole treatment. The patient was successfully treated with praziquantel following a rapid desensitization procedure. Desensitization to praziquantel could be considered when no alternative drugs are available.     

Fetal exsanguination associated with antepartum hemorrhage.

Fetal bleeding in utero is infrequent. It is usually life-threatening but can be treated successfully in most cases if recognized early. Four cases are described and it is suggested that screening for fetal blood be done in all instances of antepartum hemorrhage.     

Magic bullets need accurate guns--syphilis eradication, elimination, and control

When cases of early syphilis are treated promptly, the spread of the bacteria within a population is interrupted. However, if complacency is induced by successful control, then upsurges in syphilis incidence can occur. The methods and aims of syphilis control in industrialised countries are reviewed in the light of the potential for regional elimination and global eradication programmes. While the medical means to eliminate syphilis are at hand, acceptable means for finding and treating cases that transmit infection need to be developed, particularly in the marginalized communities with limited access to care.     

Recent Advances in the Treatment of Deafness

By the utilization of reconstructive procedures (tympanoplasty), middle ear and mastoid infections can be eliminated with the acquisition of a clean, dry ear in about nine out of 10 cases, and hearing can be improved in about half of the patients so treated. Incapacitating attacks of Ménière''s disease can be successfully treated in selected cases by labyrinthectomy, ultrasound destruction of the vestibular system, or streptomycin treatment. With the advent of the transistor, improved power packs and miniaturization, hearing aids have become more acceptable to patients with sensorineural hearing losses. The most successful procedure for the management of otosclerosis is the stapedectomy operation.     

A method for stereotactic laser microsurgery in the treatment of deep-seated CNS neoplasms

Intracranial tumors are reconstructed in stereotactic space by means of computerized axial tomographic data. The intracranial tumor is operated on with the patient in the stereotactic frame using a carbon dioxide laser to approach the lesion and vaporize it. Ultimately, a gas-filled cavity results which can be monitored on AP and lateral radiographs. Vaporization continues until the cavity produced is superimposable on the coronal and sagittal CT reconstruction. 2 cases treated by this method are presented.     

The Surgical Treatment of Pyorrhœa Alveolaris

(1) The technique of eradicating the pockets and occasionally trimming the alveolar margin is described. (2) Instruments designed for the operation are illustrated. (3) The whole mouth can be treated at one sitting. (4) The flap operation, in which the gum is reflected before scraping the alveolus and finally sutured, is not advisable. (5) Pyorrh?a can be eradicated by surgical measures in cases favourable for treatment. (6) Recurrence of the disease is due to: (a) Lack of suitable preliminary treatment. (b) Insufficient attention to detail when performing the operation. (c) Lack of suitable post-operative care by dental surgeon or patient. (d) Selection of cases not suitable for operation.     

Primary malignant melanoma of the nasal cavity: report of two cases and review of the literature

Primary malignant melanomas of the nasal cavity are rare, as only 400 cases have been reported to date. The present paper describes two cases recently seen in Caucasian women. The authors point out the difficult clinical diagnosis, as the symptoms are rather aspecific. From the histopathological point of view, diagnosis is easy in the melanotic cases while can show interpretating problems in the amelanotic ones, when melanoma is almost indistinguishable from other malignant neoplasms. A correlation between histological grading and prognosis was not detected, as both cases showed local recurrences within one year after surgery although they were, respectively, of epithelioid and undifferentiated type. While surgery appears to be the choice treatment of the primary lesion, the treatment of cervical metastasis is still disputable. On the whole, most authors think that the role played by radio- and mainly chemo-therapy is still limited and that cervical adenopathies should be treated by a simple lympho-adenectomy rather than by a neck dissection.     

Counting phylogenetic invariants in some simple cases.

An informal degrees of freedom argument is used to count the number of phylogenetic invariants in cases where we have three or four species and can assume a Jukes-Cantor model of base substitution with or without a molecular clock. A number of simple cases are treated and in each the number of invariants can be found. Two new classes of invariants are found: non-phylogenetic cubic invariants testing independence of evolutionary events in different lineages, and linear phylogenetic invariants which occur when there is a molecular clock. Most of the linear invariants found by Cavender (1989, Molec. Biol. Evol. 6, 301-316) turn out in the Jukes-Cantor case to be simple tests of symmetry of the substitution model, and not phylogenetic invariants.