THERAPEUTIC STUDIES IN HYPERTHYROIDISM—Use of Radioactive Iodine

Of 112 patients with hyperthyroidism who were treated with radioactive iodine, 110 were relieved of the disease. Nine had transient hypothyroidism. Twelve had permanent hypothyroidism. No other adverse effects that could be attributed to radioactive iodine were noted.     

TUMORS OF THE URACHUS—Report of Five Cases

Reports of three patients with malignant and one with benign urachal tumor are presented.Survival of one patient in good health 11 years after removal of adenocarcinoma of a urachal cyst with vesical invasion is reported.Methods of diagnosis and treatment are discussed.     

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.     

DETERMINING DRUG SENSITIVITY—Use of the Gel Diffusion Method

A study was carried out to determine whether the double diffusion gel test when applied to the serum of patients with clear-cut penicillin reactions of various types, might be useful for demonstrating the presence of precipitating antibody. Results did not demonstrate the antibody.The difference in results with this test obtained by various workers was not explained by the observations in this study.Other approaches to determination of the mechanism of the penicillin reaction are discussed, and it is noted that the hemagglutination test, newly applied to the penicillin reaction problem, may be useful after further investigation.     

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.     

THE ELECTROENCEPHALOGRAM IN PEDIATRICS—The Indications for Use and the Limitations

Electroencephalograms normally undergo pronounced serial changes during maturation of the brain.Many physiological and nonphysiological influences may alter the EEG tracing.As regards EEG''s, appraisal of cerebral function is based on comparison with normal standards of frequency, rhythm, wave configuration and amplitude, bilateral synchrony, and response to various physiological stimuli.Various abnormal EEG patterns are fairly constantly related to concomitant clinical disease.A laboratory tool which may be used to supplement clinical data but not to make a clinical diagnosis, the EEG may also sometimes be of value in helping to suggest prognosis and in helping with evaluation of a therapeutic program.     

SEROLOGIC DIAGNOSIS OF SYPHILIS—The Use of Treponema Pallidum Immobilization and Immune Adherence Tests

TPI tests were carried out on 4,060 sera. Among 3,934 patients with reactive STS and no history of syphilis, 2,148 or 54.6 per cent had negative reaction to TPI tests, 1,695 or 43.1 per cent had positive reaction and 91 or 2.3 per cent had doubtful reaction.Two hundred and ninety-two or 73.0 per cent of 400 pregnant women with reaction to STS in the absence of a history of syphilis showed negative results by TPI test, 103 or 25.8 per cent had positive results and five or 1.2 per cent had doubtful reaction.Ninety-five or 75.4 per cent of 126 patients with a history of treated syphilis had positive reaction to TPI tests, 20 or 20.2 per cent had negative reaction and nine or 9.1 per cent had doubtful reaction.TPI and TPIA tests were done on 143 sera carefully selected for the study. Among 102 sera subjected to the TPI test, 46 or 100 per cent of these positive were also positive by TPIA tests, while 52 or 94.5 per cent of 55 TPI-negative sera were also nonreactive by TPIA test. One serum gave doubtful TPI test reaction and positive TPIA test reaction.     

DETERMINING BLOOD PRESSURE IN INFANTS—Use of the Flush Technique

The flush technique that recently has come into use is probably the most satisfactory method available for measuring blood pressures in infants and is of great aid in diagnosis of diseases associated with hypertension or hypotension. The method is practical and highly accurate. Readings obtained by this technique are not influenced by the width of the cuff, are usually higher at the wrist than at the ankle, and approximate the mean rather than the systolic blood pressure.     

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.     

CARCINOMA OF THE UTERINE CERVIX—Interstitial Radioactive Colloidal Gold Therapy of the Lateral Pelvic Nodes

Since January 1955 radioactive colloidal gold has been used interstitially as an adjunct to radium therapy in the treatment of 48 patients with squamous cell cancer of the uterine cervix. In 40 cases the lesions were Stage I and in eight cases Stage II. Five in the series have died, all of them of advanced metastatic disease.Although our data are not extensive enough to warrant conclusions, from results to date we feel the method used is proving to be an effective weapon for control of most Stage I and II and some latent Stage III cancers of the cervix.     

SURGICAL MANAGEMENT OF DISSECTING ANEURYSM—The Use of a Simplified Bypass

The alarming mortality in cases of dissecting aneurysm of the aorta has stimulated the development of a surgical technique which results in re-entry of the dissecting channel. During the operative procedure prolonged cross-clamping of the aorta is necessary. While hypothermia will provide protection to the spinal cord and kidneys during reasonable periods of aortic occlusion it will not relieve back pressure on the left ventricle.By the use of a simple bypass blood is drained from the left atrium into a reservoir and then pumped into the lower aorta via the femoral artery. Thus an adequate supply of oxygenated blood is delivered to the spinal cord and kidneys distal to the occlusion while the left ventricular pressure is decompressed to normal levels. The volume of the shunted blood is simply controlled by monitoring the brachial artery pressure with a cuff sphygmomanometer. This simplified bypass has permitted successful repair of a dissecting aneurysm with complete occlusion of the thoracic aorta for a period of two hours.     

CANCER OF THE LARYNX—The Advantages of More Conservative Treatment

Properly administered irradiation therapy for cancer of the larynx in properly selected cases can be successful. Reported herein is the case of a woman 49 years of age with a Grade 3 squamous cell carcinoma of the larynx, who at first was scheduled for radical operation but was treated by irradiation therapy with an estimated total dose of 5292 r given in 29 treatments. The tumor and all subjective and objective symptoms disappeared. The patient was still well when last observed a year later.     

THE MANAGEMENT OF ALLERGIC PATIENTS—The Role of the Internist

There has been an increasing trend in the United States toward intensive specialization in allergic diseases. Whereas the tendency toward specialization has led to greater knowledge of the scientific aspects of allergic phenomena, it has somewhat diverted the specialists'' attention from the many clinical problems that await solution.Effective treatment of the allergic patient depends in no small measure on the broad viewpoint and clinical experience of the internist. This fact has been reemphasized by the growing awareness of the significance of the secondary or precipitating causes, such as climatic, nutritional, hormonal and psychogenic factors which influence allergic manifestations. Overemphasis on specialization in allergic diseases with their wide ramifications may defeat the main objective—a successful therapeutic result.To meet this challenge, the internist should be trained in allergy and yet retain a broad approach to the more basic problems of internal medicine. This objective may be attained by certain modifications in undergraduate medical instruction in allergy. Postgraduate training sponsored by our national allergy societies affords internists an excellent opportunity to advance their knowledge of clinical allergy.     

RUPTURE OF DISSECTING ANEURYSM OF THE AORTA—The Relationship of Effort to Onset

Physicians are constantly being asked to testify in cases in which a complication of a degenerative disease occurred during the course of employment. In one of two such cases reported herein, compensation was granted, in the other, not.A physician can say for certain that the effort did not cause the disease, but he cannot say for certain that it had nothing to do with the rupture.     

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.     

Pain Syndromes—The Use of Nerve Block in Diagnosis and Treatment

There are four distinct pain entities which may be treated by injection of local anesthetic or neurolytic agents. These entities are somatic, visceral, sympathetic mediated and myofascial pain. Each entity should be recognized as separate from other types of pain and the appropriate therapeutic approach prescribed.