Relation of HVH-II to carcinoma of the cervix.

An animal model is described that demonstrates the development of varying degrees of basal cell hyperplasia, metaplasia, and dysplasia following cervicovaginal herpesvirus hominis type II (HVH-II) infection. Although the study spanned a period of 30 months, the equivalent of 60 human years, there was no evidence of anaplasia. These results are considered in relation to the role of HVH-II as an initiator in the multistep process leading to cervical carcinoma.

Lipoma and liposarcoma of the parotid gland: high-resolution preoperative imaging diagnosis.

Over the past 7 years, nine fatty tumors within the parotid gland have been managed (eight lipomas, one liposarcoma). High-resolution computed tomography examination was carried out in all cases; with correct preoperative diagnosis recorded each time. The computed tomography imaging characteristics of lipoma, liposarcoma, and the differential diagnosis from other fat density lesions, such as a fatty infiltration, appear quite specific. The liposarcoma and six of the lipomas were resected at formal parotidectomy with facial nerve preservation. Two patients with small intraglandular lipomas have elected to undergo long-term clinical and imaging observation. Our experience indicates that high-resolution, soft-tissue imaging with computed tomography and magnetic resonance imaging permits consistent preoperative fatty tumor diagnosis. This imaging input facilitates rational treatment decision-making.

Results of long-term prospective study of the hepatitis B surface antigen (HBsAg) carrier state.

In a prospective study of 180 HBsAg carriers, excluding patients from renal units or active drug users, excluding were followed by up to 8 years (mean 4 years). Four became HGsAg negative. SGPT was normal throughout in 70.6%. The rest had either intermittent, persistent or occasional elevations. The commonest pattern of SGPT abnormally was the intermittent one lasting weeks or months. Serial liver biopsies in carriers with normal SGPT showed mainly lobular infiltrates which reverted to normal. In carriers with elevated SGPT, portal infiltrates were found which persisted, compatible with a clinico-pathologic diagnosis of chronic persisting hepatitis (CPH). One patient progressed to liver cirrhosis and one developed CAH and cirrhosis. No patient developed hepatocellular carcinoma. HBsAg carriers can be divided into 2 groups: a) healthy, b) with asymptomatic chronic hepatitis B. Liver biopsy is recommended in group b, but not in group a.

Comparison of four stains and a urease test for rapid detection of Helicobacter pylori in gastric biopsies.

Gastric biopsies were obtained from 125 subjects to compare detection of Helicobacter pylori by culture, a rapid urease test and histopathologic examination using haematoxylin-eosin, Gram, Giemsa, Warthin-Starry silver and acridine orange stains. Helicobacter pylori was isolated from 39 specimens. Acridine orange and Giemsa were the most sensitive stains, detecting 85% and 79% of positive specimens respectively. All stains showed high specificity (97-100%). The sensitivity and specificity of the rapid urease test was 62% and 100% respectively. These stains or the rapid urease test may be useful for rapid detection of Helicobacter pylori in gastric biopsies.

Histological changes in the genital tract in transsexual women following androgen therapy.

Thirty-two young women who desired sexual reassignment were treated with large doses of androgen for a period of 1 year or more, followed by total hysterectomy. Histological examination revealed marked atrophy of cervical epithelium which could mimic dysplasia, and variable degrees of endometrial atrophy. The ovaries showed occasional corpora lutea indicating that even in the face of long term androgen therapy, ovulation may occur.

Schwannoma of the intrasternomastoid portion of the spinal accessory nerve: sophisticated preoperative CT diagnosis and appropriate surgical management.

Neurogenic tumors of the cervical portion of the cranial nerves are rare, and hence frequently misdiagnosed and mismanaged. A unique case of an isolated schwannoma of the spinal accessory nerve was correctly diagnosed by the constellation of signs demonstrated on a CT examination. This led to appropriate surgical removal with full motor nerve preservation. The primary purpose of this manuscript is to demonstrate the qualitative and quantitative radiologic signs indicative of the diagnosis and the surgical management resulting therefrom. The second more subtle purpose is to demonstrate the sophisticated clinical implications which can result from effective high-technology imaging.

Clinical and epidemiological significance of the HBSAg (Australia antigen): carrier state.

One hundred fifteen asymptomatic Australia antigen (HBSAg) carriers, discovered by routine testing of volunteer blood donors in Toronto, were investigated and followed for up to 30 months. The carrier state seems to be largely host-dependent, and its prevalence is modified by ethnic origin, sex, and age. A high prevalence of carriers was found in persons coming from Mediterranean countries and the Orient. The carrier state was 3 times more common in males than in females, and the majority of the carriers were under 30 years of age. Family clustering of HBSAg-positive individuals was observed. All carriers were asymptomatic and only one gave a history of jaundice in the past. Seven gave a history of intravenous drug use. Four had moderate hepatomegaly. Fifty-four had some abnormality in their liver function tests. The SGPT was the most frequently abnormal test and correlated best with the histological findings. Twenty of 29 liver biopsies showed features of chronic benign persisting hepatitis. All patients remained well during the follow-up period. In no patient was there evidence of deterioration or progression in either their clinical state, liver function, or pathological findings. Only 1 of the 115 carriers became HBSAg-negative over the period of observation.

Endometriosis: an unusual cause of ureteral obstruction.

Endometriosis is a common disorder, affecting women in the child-bearing years. While urologic involvement is rare, the bladder is more often affected than the ureter. The authors describe the case of a 30-year-old woman who had unilateral ureteral obstruction secondary to an isolated periureteral retroperitoneal area of endometriosis. The theories of histogenesis are discussed. Current treatment consists of surgery or hormonal manipulation or a combination of the two.

Fatal bronchiolitis obliterans associated with chrysotherapy.

We describe a patient who developed fatal bronchiolitis obliterans following gold therapy and review the relationship between rheumatoid arthritis and bronchiolitis.

Parathyroid crisis of unusual features in a child.

BACKGROUND: A case of familial parathyroid crisis resulting from presumptive cancer in a 14-year-old boy impressed the authors with its rarity and need for recognition. METHODS: The authors performed a retrospective review of the relevant literature and described the case. RESULTS: The case report cited is the eighth example of parathyroid cancer occurring in a child younger than 16 years of age. It represents the first example of malignant parathyroid crisis because of familial hyperparathyroidism and illustrates the demand for appropriate diagnosis and methods of management in parathyroid cancer. CONCLUSIONS: Familial hyperparathyroidism may become manifest in young patients, which justifies screening among affected families to avoid serious sequelae of disease. Parathyroid cancer is an example of a malignant neoplasm in the young and is managed best by en bloc resection of primary disease, appropriate neck dissection for nodal involvement, and aggressive resection for recurrence, if possible, to control the lethal effects of hypercalcemia; this permits prolonged survival even in discouraging situations.

The prevalence of Campylobacter pylori gastritis among asymptomatic adults.

To determine the prevalence of Campylobacter pylori colonization in the healthy population we studied 54 asymptomatic volunteers and 65 patients referred because of gastrointestinal symptoms. All subjects underwent gastroscopy and gastric biopsy. C. pylori was isolated from 6 volunteers (11%) and 36 patients (55%). Histologic evidence of inflammation was present in 98% of the culture-positive subjects. Linear regression analysis revealed that the prevalence of C. pylori colonization increased with age. There was no difference in the isolation rate between the two groups when adjusted for age. Four of the six culture-positive volunteers underwent repeat endoscopy and gastric biopsy 1 year later; despite remaining asymptomatic, all still had positive culture results and histologic evidence of gastritis. We conclude that the prevalence of C. pylori-associated gastritis among symptomatic patients increases with age and that the organism may be present in the gastrointestinal tract for prolonged periods without symptoms or evidence of disease progression.