ANDREWES'S CHRISTMAS FAIRY TALE: ATYPICAL THINKING ABOUT CANCER AETIOLOGY IN 1935.

This paper uses a short 'Christmas fairy-story for oncologists' sent by Christopher Andrewes with a 1935 letter to Peyton Rous as the centrepiece of a reflection on the state of knowledge and speculation about the viral aetiology of cancer in the 1930s. Although explicitly not intended for public circulation at the time, the fairy-story merits publication for its significance in the history of ideas about viruses, which are taken for granted today. Andrewes and Rous were prominent members of the international medical research community and yet faced strong resistance to their theory that viruses could cause such tumours as chicken sarcomas and rabbit papillomas. By looking at exchanges between these men among themselves and other proponents of their theories and with their oncologist detractors, we highlight an episode in the behind-the-scenes workings of medical science and show how informal correspondence helped keep alive a vital but then heterodox idea about the role of viruses in causing cancer.

Papilomatosis reticulada y confluente: reporte de un caso y revisión de la literatura / Confluent and reticulated papillomatosis: report of one case and review of the literature

La papilomatosis reticulada y confluente (PRC) es una rara dermatosis de etiología desconocida, que se caracteriza por placas hiperpigmentadas que confluyen en el centro y presentan patrón reticulado en la periferia. Es subdiagnosticada y no tiene tratamiento específico. Se reporta el caso de una paciente mujer de 36 años con papilomatosis reticulada y confluente en zona intermamaria. Se realiza revisión de la literatura.

Confluent and reticulated papillomatosis is a rare dermatosis of unknown etiology, characterized by hyperpigmented plaques that meet in the center and reticulated pattern present in the periphery. Is underdiagnosed and no specific treatment. We report the case of a woman aged 36 with confluent and reticulated papillomaiosis intermammary area. Literature review was performed.

Morell Mackenzie and Crown Prince Frederick: an unpublished manuscript from the Royal Society of Medicine Library.

The story of Morell Mackenzie and his involvement in the case of Crown Prince Frederick III (the future Emperor of Germany) is as well known as it is controversial. The consequences of the case were profound, both medically and politically. Most documents concerning the case are affected by varying degrees of bias, and as a result our understanding of the true events is incomplete. We present a brief summary of the case, and review an unpublished manuscript which adds to our understanding of the events. This manuscript is supportive of Mackenzie's early management of the Crown Prince's illness and acknowledges the importance of the case in medical history.

Legacy of Edwin Beer: fulguration of papillary bladder tumors.

PURPOSE: Edwin Beer introduced the first endoscopic treatment of papillary bladder tumors in 1910. This historical review describes how his landmark discovery paved the way for office cystodiathermy to treat recurrent papillary tumors. MATERIALS AND METHODS: The medical writings of Edwin Beer and all studies pertaining to the treatment of papillary bladder tumors from 1879 to the present were reviewed. RESULTS: Edwin Beer discovered that papillary bladder tumors could be destroyed through the ordinary cystoscope with high frequency current by electro-coagulation. This therapy revolutionized the treatment of bladder tumors. CONCLUSIONS: The legacy of Edwin Beer is that office fulguration of recurrent papillary bladder tumors has now become a practical reality due to recent changes in the histological classification of papillary tumors, better definition of their biological behavior and improved endoscopic equipment.

Noninvasive papillary proliferations.

The diagnosis of noninvasive papillary tumors begins with categorization of the lesions as macropapillary or micropapillary. Macropapillary lesions include papilloma, papillary carcinoma, and papilloma harboring carcinoma. Papillomas consist of a few broad fronds, abundant stroma, and an epithelium containing both luminal and myoepithelial cells. Papillary carcinomas have many irregular fronds, small amounts of stroma, and a uniform population of malignant glandular cells. Papillomas can give rise to both conventional ductal hyperplasia and carcinomas. One analyzes proliferations on the surface of a papilloma as one would analyze those in a duct. Proliferations within the stalk of a papilloma require especially careful attention; one must observe large masses of cells demonstrating both cytological and architectural atypicality and devoid of intervening stroma to make the diagnosis of low-grade ductal carcinoma in-situ involving the stalk of a papilloma. Micropapillary proliferations represent either ductal hyperplasia or ductal carcinoma in situ. The former shows slight dilatation of ducts, micropapillae of similar size and shape, maturation of cells, lack of dishesion and necrosis, and lack of cytological atypicality. Micropapillary ductal carcinoma in situ exhibits extreme dilatation of ducts and lobules, micropapillae varying in size and shape, lack of maturation, dishesion and necrosis, and cytological atypicality.

Office-based treatment of glottal dysplasia and papillomatosis with the 585-nm pulsed dye laser and local anesthesia.

Treatment of glottal papillomatosis and dysplasia was mirror-guided and performed in surgeons' offices in the 19th century. It migrated to the operating room in the 20th century to accommodate direct laryngoscopic surgery, which required assistants to administer anesthesia and procedural support. Presently, the primary treatment goals, which are disease regression and voice restoration or maintenance, are tempered by the morbidity of general anesthesia and potential treatment-induced vocal deterioration. In fact, general anesthesia has been appropriately considered to be an acceptable source of morbidity for the promise of a precise procedure, which usually ensures airway safety and an optimal vocal outcome. However, patients with recurrent glottal papillomatosis and keratosis with dysplasia are typically monitored with various degrees of watchful waiting until there is a subjective judgment (on the part of the patient and surgeon) that the disease is more of a liability than is the procedure to treat it. Innovations in the 585-nm pulsed dye laser delivery system have allowed for its use in the clinic with local anesthesia through the working channel of a flexible fiberoptic laryngoscope. A prospective assessment was done on 51 patients in 82 cases of recurrent glottal papillomatosis (30) and dysplasia (52). All individuals had previously undergone microlaryngoscopic management with histopathologic evaluation. Five procedures could not be completed because of impaired exposure (2) or discomfort (3). Of those patients who could be treated, there was at least a 50% disease involution in 68 of 77 cases (88%) and 25% to 50% disease regression in the remaining 9 (12%). Patient self-assessment of the voice revealed that 34 of 77 were improved, 39 were unchanged, 4 were slightly worse, and none were substantially worse. These data confirm that diseased mucosa can be normalized without resection or substantial loss of vocal function. The putative mechanisms, which vary according to the fluence (energy) delivered by the laser, are photoangiolysis of sublesional microcirculation. denaturing of epithelial basement membrane linking proteins, and cellular destruction. Furthermore, this relatively safe, effective technique allowed for treatment of many patients (in a clinic setting) in whom classic surgery-related morbidity would have often delayed intervention.

Una innovación terapéutica en papilomatosis laríngea / A therapeutic innovation in laringeal papillomatosis

El autor ha tratado diez casos de Papilomatosis Laríngea, asociando la técnica del Prof. O. Kleinssaser, de una meticulosa resección con microcirugía laríngea, con los conceptos de terapia neural segmentaria de acuerdo a la técnica de Huneke. Los resultados han sido sorprendentemente satisfactorios. El primer caso tratado, lleva diez años sin presentar recurrencias. Por ser un procedimiento agregado tan inocuo, de fácil aplicación en Latinoamérica, no solo por las obvias razones económicas, sino fundamentalmente, por las razones humanas de proporcionar bienestar a los pacientes que adolecen de una enfermedad, que en muchos casos, es rebelde a los tratamientos clásicos

Arthur Purdy Stout and papilloma of the breast. Comments on the occasion of his 100th birthday.

In 1951 Haagensen, Stout, and Phillips described a series of patients treated for benign intraductal papillary breast lesions. They emphasized the importance of distinguishing between "microscopic papillomas" and "gross papillomas." While the former tended to be multicentric and potentially precancerous, follow-up of 108 women who had solitary papillomas revealed no subsequent carcinomas. Four women had additional papillomas in the ipsilateral breast and one patient developed a papilloma of the contralateral breast. Review of the literature since 1927 reveals a total of 612 patients who reportedly had a papilloma treated by excision. Subsequent carcinoma was described in 23 cases (11 or 2% ipsilateral; 10 or 2% contralateral; two or 0.3% bilateral). These data indicate that excision of a solitary papilloma from the breast does not indicate that the breast is predisposed to develop carcinoma at a later date.