Role of irradiation in the management of superior vena cava syndrome.

The records of 125 patients treated for superior vena cava syndrome secondary to malignant disease were reviewed retrospectively. The mean age of patients was 55 years. Bronchogenic carcinoma was the cause of the syndrome in 79% of cases, malignant lymphoma 18%, and other tumors 6%. Approximately 80% of the patients obtained good to excellent symptomatic relief. High initial dose radiation therapy (300-400 cGy daily for three fractions) yielded good symptomatic relief in less than 2 weeks in 70% of patients; conventional dose radiation therapy (200 cGy daily, five weekly fractions) yielded the same response in 56% of patients (p = 0.09). Lymphoma patients displayed a 1 year survival of 41%, small cell carcinoma 24%, and other types of bronchogenic carcinoma 17%. Combination of radiation and chemotherapy did not improve response rate, degree of symptomatic relief or long-term survival. Patients exhibiting symptomatic relief within 30 days had a significantly better survival rate than those who did not (p = 0.002). Thirteen percent of patients showed a recurrence of superior vena cava syndrome. There was no correlation between tumor regression and symptomatic relief. Side effects of therapy were minimal; dysphagia was the most common complaint (26% of patients).

Acute pediatric rhabdomyolysis.

Rhabdomyolysis is a relatively common condition that may occur intermittently in chronic and inflammatory myopathy, muscular dystrophy, and metabolic myopathy. Rhabdomyolysis can also present acutely in otherwise healthy individuals. The list of etiologies for acute muscle cell lysis is enormous, with new causes described yearly. Series on acute pediatric rhabdomyolysis have not yet been published. This article describes a retrospective review of children admitted to the authors' institution during an 8-year period in whom rhabdomyolysis was recognized as a complication during their hospital stay. Patients with intermittent or relapsing rhabdomyolysis were excluded. Nineteen children were identified. Trauma (five cases), nonketotic hyperosmolar coma (two cases), viral myositis (two cases), dystonia (two cases), and malignant hyperthermia-related conditions (two cases) were the most common causes of rhabdomyolysis. Acute renal failure was the most frequent complication, occurring in 42% of cases. The mean age of renal failure patients was 13.9 years, compared to 8 years for non-renal failure children. Careful assessment of the initial urinalysis would have suggested a diagnosis of rhabdomyolysis in 9 of 16 patients tested.

Protocol: isolated systolic hypertension in the elderly.

Isolated systolic hypertension is common in the elderly population and has only recently been recognized as a pathophysiologic process. In the past it was considered to be part of the normal aging process. Assessment of isolated systolic hypertension is covered, including the differentiation between isolated systolic hypertension, essential hypertension and secondary hypertension. Non-pharmacologic therapy, the treatment of first choice, and pharmacologic therapy are discussed, including treatment considerations related to the aging process. Also included are patient education guidelines and indications for physician referral. Isolated systolic hypertension is an important clinical entity in the growing elderly population and can be appropriately diagnosed and managed by the nurse practitioner in primary care.

Electron microscopy of Listeria monocytogenes-infected mouse spleen.

Armstrong, B. A. (The University of Kansas, Lawrence), and C. P. Sword. Electron microscopy of Listeria monocytogenes-infected mouse spleen. J. Bacteriol. 91:1346-1355. 1966.-Mouse spleen infected with Listeria monocytogenes was observed during the acute phase of infection; 72 hr after infection, organisms were usually found within phagocytic vacuoles in the cytoplasm of macrophages. These vacuoles, which resembled phagosomes, often contained several organisms as well as varying amounts of amorphous electron-dense material, ferritin-like particles, membrane fragments, and vesicles of varying density. Breakdown of vacuolar membranes appeared to be accompanied by damage to the host cell cytoplasm. Nuclear membrane damage was occasionally observed when phagocytic vacuoles were close to the nucleus.

Anomalous origin of the left coronary artery in tetralogy of Fallot associated with abnormal mitral valve pathology.

The association of anomalous left coronary artery with congenital heart disease is a rare occurrence. Seven cases of anomalous left coronary artery associated with tetralogy of Fallot have been reported in the literature. We report a unique case with severe mitral valve abnormality that precluded standard surgical repair.

Alterations in the Ha-ras-1 and the p53 pathway genes in the progression of N-methyl-N-nitrosourea-induced rat mammary tumors.

Well-differentiated mammary carcinomas carrying mutated Ha-ras-1 oncogenes arise frequently in pubescent rats exposed to the direct-acting methylating agent N-methyl-N-nitrosourea (MNU). When these tumors are serially transplanted, they acquire more aggressive phenotypes. To determine the genetic alterations underlying local invasion, hormone independence, and metastasis, we studied alterations in the Ha-ras-1, p53, and mdm2 genes in successive generations of tumors passaged in intact or ovariectomized rats. Although previous studies have shown that selective amplification of the mutant Ha-ras-1 allele correlates strongly with the acquisition of hormone independence, we found that the acquisition of an invasive phenotype did not depend on mutational activation or amplification of Ha-ras-1. Mutations in the p53 gene were rare. Of a total of 120 primary, locally invasive, hormone-independent, and metastatic tumors tested for mutations in exons 4-9 of the p53 gene, only one mutation was detected in the later passages of an invasive tumor line. No gross gene alteration or amplification was seen in mdm2, a negative regulator of p53 transcription. Thus, the p53 gene is an infrequent mutational target, and amplification of the mdm2 gene does not appear to play a role in initiation or progression of rat mammary tumorigenesis.