Determination of nuclear DNA content and hormone receptors in breast cancer by the CAS 100 cell analysis system as related to morphologic grade and biochemical results.

Quantitative DNA analysis by the CAS 100 Cell Analysis System was performed on 120 cases of primary breast carcinoma using touch preparations from fresh biopsy specimens in 110 cases and archival, restrained fine needle preparations in 10 cases. Fifteen cases of metastatic breast carcinoma and 15 cases of benign breast lesions were also analyzed. Overall, 76.7% of the carcinomas examined were aneuploid, with most DNA indices between 1.6 and 2.0. DNA anomalies were strongly related to nuclear atypia but not to structural differentiation. The hormone receptor content, when compared with DNA data and morphologic features, emerged as a biologically independent factor. Agreement between quantitative immunocytochemical assay (QICA) using the CAS system and traditional dextran-coated charcoal assay (DCCA) in discriminating positive and negative status for estrogen receptors and progesterone receptors was 86% and 82%, respectively. Marked variations, however, occurred in the numerical values. Considering the advantages of QICA and the importance of tumor heterogeneity in particular, the use of traditional DCCA as the reference technique and only guide for therapy no longer seems justified.

[Malformations (duplications) of the terminal ileum in adults. Report of 3 unusual cases]. / Missbildungen (Duplikaturen) des terminalen Ileums bei Erwachsenen. Bericht über 3 aussergewöhnliche Fälle.

Three cases of rare malformations of the ileo-cecal region (duplications) are discussed and compared to 20 others of the same kind already published. The main characteristics are an inflammatory symptomatology, especially in the right hypogastrium, with periodic recurrences. Since the clinical, radiological, endoscopic and biopsy findings often simulate Crohn's disease, patients must frequently undergo years of unsuccessful medical treatment and innumerable follow-up examinations. Nevertheless, when certain findings are taken into consideration they can lead to correct diagnosis of this rare disease, which is established through pathological anatomy. The special features of the disease are described in detail. It can be definitively cured through resection of the ileo-cecal segment.

[Massive lung necrosis in klebsiella pneumonia (so-called massive lung gangrene)]. / Ausgedehnte Lungennekrose bei Klebsiellen-Pneumonie (sogenannte massive Gangrän der Lunge).

In the literature only 13 cases of voluminous necrosis of lung tissue, generally referred to as massive pulmonary gangrene, could be found. This disease constitutes an unusual, very severe complication of lobar pneumonia, mostly due to Klebsiella. This type of pneumonia generally affects old or otherwise debilitated persons, quite often chronic alcoholics. It has a high lethality of 20%. Our own observation in a 48-year-old man is presented. He suffered from recurrent massive hemoptysis in relation with a huge cavity of the right lung, filled with necrotic lung tissue. Following right pneumonectomy empyema developed, also due to Klebsiella; it was successfully treated with thoracic fenestration according to Clagett. Knowledge of this severe infrequent complication of pneumonia is necessary since it requires early operative treatment: Out of the 14 patients four were treated medically only and died, while the remaining ten underwent surgery and were all cured.

[Portal hypertension without liver cirrhosis in chronic vitamin A intoxication]. / Portale Hypertonie ohne Leberzirrhose bei chronischer Vitamin-A-Intoxikation.

The ysmptoms and findings in a patient after prolonged intake of excessive amounts of vitamin A for treatment of psoriasis are presentd. All the characteristic signs of chronic intoxication were reversible after withdrawal of the medication. Initially portal hypertension could be demonstrated, although histologically there was no cirrhosis of the liver. During the period of observation the disturbed liver function returned to normal and the signs of portal hypertension disappeared completely. Reversibility of portal hypertension is a unusual observation and is discussed in relation to similar situations in toxic liver disease.

[Endoscopic diagnosis of oesophagitis: problems of differentiation from normal (author's transl)]. / Endoskopische Diagnose der Osophagitis Wo liegt die Grenze zum Normalen

The diagnostic significance of endoscopically early signs of oesophagitis in the absence of macroscopic evidence of epithelial abnormalities has been studied prospectively. Changes from the usually observed shininess, pale-pink colour, smooth texture, regular capillaries, sharp Z-line and a decreased mechanical resistance of the mucosa to mechanical damage do not indicate oesophagitis. Nor should one infer gastro-oesophageal reflux from these endoscopic findings. They are presumably ageing changes in the oesophagus.

Giant-cell arteritis of the uterus. Report of two cases.

Two cases of giant-cell arteritis of uterus were found incidentally in association with uterine prolapse. One similar case has been reported in the literature. Microscopic examination disclosed fragmentation of the elastic laminae of the myometrial arteries with a giant-cell and mononuclear infiltrate. The relationship between giant-cell arteritis of the uterus, temporal arteritis, and polymyalgia rheumatica is discussed in view of similar cases reported in the literature.

Esophageal function in progressive systemic sclerosis.

A prospective study was performed in 13 consecutive patients with systemic progressive sclerosis (PSS). For the diagnosis of impaired esophageal peristalsis cineradiography and manometry are equally useful. Esophageal suction biopsy allows the diagnosis of esophagitis but not of scleroderma. Mild to severe esophageal involvement was observed in 12 patients. In only one patient the esophagus was virtually normal. Dysfunction of the esophageal body may occur early in the course of the disease while incompetence of the lower esophageal sphincter is observed on an average after 7 to 8 years. Both impairment of peristalsis and pressure of the lower esophageal sphincter may lead to delayed esophageal clearance. Relaxation of LES is normal even in the absence of primary peristalsis. Extensive esophageal damage including severe gastroesophageal reflux may be present in the absence of esophageal symptoms.

Abdominal splenosis.

Abdominal splenosis was an incidental finding at laparotomy for acute appendicitis in a 39-year-old man who had had splenectomy for traumatic rupture of the spleen nine years previously. Similar cases of abdominal and intrathoracic splenosis are reviewed.