Anal gland carcinoma.

BACKGROUND: Anal gland carcinoma is a rare entity. The authors conducted a joint study of cases coded as definite or possible anal gland carcinoma from the archives of the Armed Forces Institute of Pathology and the Canadian Reference Center for Cancer Pathology. METHODS: Seven cases of potential anal gland carcinoma were identified from the Canadian files and 12 from the Armed Forces Institute of Pathology archives. Of these 19 cases, 14 had adequate material to allow clinical, histologic, and immunohistochemical analysis. RESULTS: Seven of these 14 cases met a modified World Health Organization (WHO) definition of anal gland carcinoma. The mean age of these patients was 66 years (range, 60-72 years), with a male-to-female ratio of 6:1. The tumors were composed of haphazardly dispersed, small glands with scant mucin production that invaded the wall of the anorectal area with no obvious intraluminal component observed clinically or microscopically. Immunohistochemical studies were performed on all seven of these cases, revealing cytokeratin (CK) 7+/CK 20- expression in six cases, and CK 7+/CK 20+ expression in one case. The remaining seven cases showed no intraluminal component but did not meet a modified WHO definition of anal gland carcinoma. This group included three mucinous adenocarcinomas (two clinically arising in anal fistulas), all of which were CK 7+/CK 20+, and a rectal-type adenocarcinoma that was CK 7-/CK 20+. There was also a tumor interpreted as probable rectal-type adenocarcinoma that was CK 7+/CK 20+, and a tumor interpreted as probable squamous cell carcinoma that was CK 7-/CK 20-. The seventh tumor in this group, which could not be classified, was CK 7+/CK 20-. CONCLUSIONS: A useful and discriminating definition of anal gland carcinoma is an anal canal tumor composed of haphazardly dispersed, small glands with scant mucin production invading the wall of the anorectal area without an intraluminal component. The glands are positive for CK 7.

Do adenoids regrow after excision?

OBJECTIVE: The goal was to determine the incidence of symptomatic adenoidal regrowth after adenoidectomy. STUDY DESIGN: A cross-sectional follow-up study was done in a randomly selected group of 175 children who had undergone adenoidectomy 2 to 5 years earlier. Nasopharyngoscopy was performed in those children who still had symptoms of nasal obstruction. SETTING: All surgery was performed at an academic hospital-based practice in the northeastern United States by a single surgeon using a consistent operative technique. RESULTS: Forty-six (26%) patients had nasal airway obstruction symptoms at follow-up. Of the 35 who agreed to undergo nasopharyngoscopy, not a single one had adenoids occupying more than 40% of the nasopharynx, and most (71%) were found to have either no or only trace amounts of adenoidal tissue (usually in the pharyngeal recess). CONCLUSION: Adenoids rarely, if ever, regrow enough to cause symptoms of nasal obstruction after adenoidectomy that includes visualization and electrocautery of the adenoid bed.

Treatment of the macrophage-like P388D.1 cells with bacterial lipopolysaccharide and interferon-gamma causes long-term alterations in calcium metabolism.

The intracellular calcium concentrations ([Ca2+]i) of P338D.1 macrophage-like cells, activated with interferon-gamma (IFN-gamma) and/or bacterial lipopolysaccharide (LPS) were determined using fura-2/AM and ratiometric imaging techniques. Treatment of macrophages with IFN-gamma and LPS resulted in significant downward shift in [Ca2+]i, 8, 16 and 24 h but not at 1 and 4 h after treatment. The decrease in [Ca2+]i also occurred when macrophages were treated with LPS only, but not after exposure of the cells to recombinant IFN-gamma, indicating that LPS was an essential signal in the observed changes in [Ca2+]i of activated macrophages. The IFN-gamma and/or LPS alteration in the [Ca2+]i, paralleled the in vitro nitric oxide production of the activated macrophages, 8, 16 and 24 h after treatment. The decrease in the [Ca2+]i may be caused by vigorous buffering and storing of Ca2+ by macrophages to below the normal resting quantities, following the reported transient increase in Ca2+ during the priming stage of macrophage activation. Thus, the downward shift in [Ca2+]I may play a physiological role in the activation processes of macrophages for antimicrobial responses.

Primary malignant melanoma of the esophagus: radiographic findings in seven patients.

PURPOSE: To evaluate the radiographic findings in a series of patients with primary malignant melanoma of the esophagus. MATERIALS AND METHODS: Seven cases of primary esophageal melanoma were collected from the Hospital of the University of Pennsylvania and the radiologic archives of the Armed Forces Institute of Pathology. All patients underwent esophagography (double-contrast esophagograms in four patients, single-contrast esophagograms in three patients). Medical, endoscopic, and pathology reports were also reviewed. RESULTS: Six patients presented with dysphagia (average duration, 5 months). The remaining patient had recent onset of melena. In all patients, barium studies revealed bulky, polypoid intraluminal masses that focally expanded the esophagus without causing obstruction. The tumors were located in the distal third of the thoracic esophagus in four patients, the middle third in two, and the proximal third in one. Tumor pigmentation was noted at endoscopy in only one patient. All patients underwent extensive esophageal resection. Of four patients with clinical follow-up findings, two were alive and well 2 and 6 months after surgery; the other two had metastases to the lung and liver within 2 months of surgery. CONCLUSION: Primary esophageal melanomas have strikingly similar barium study findings, appearing as bulky, polypoid intraluminal masses that focally expand the esophagus without causing obstruction. Despite its rarity, primary esophageal melanoma should be considered when characteristic findings are present on barium studies.

Induction of nitric oxide (NO) synthesis in murine macrophages requires potassium channel activity.

The activation of macrophages for antimicrobial responses is a multistage event involving numerous intracellular signalling cascades that makes possible target cell destruction by these effector cells. This study examined the effects of different potassium channel inhibitors and activators on the NO production of murine macrophage-like cell lines P388D.1 and B10-4(S). We found that the potassium channel inhibitors tetraethylammonium, 4-aminopyridine, and quinine caused dose-dependent reductions in the NO production of macrophages, and that the potassium channel activator, minoxidol, caused a dose-dependent enhancement of NO production. The inhibition of NO production was due to involvement of potassium channels in the priming stage of macrophage activation, since pretreatment with the priming agent interferon-gamma partially restored the NO response of the macrophages. The results of this study demonstrate a link between potassium channel activity and the activation of anitimicrobial functions of murine macrophages.

Small-cell carcinoma of the esophagus: radiographic findings.

PURPOSE: To determine the radiographic findings of small-cell carcinoma of the esophagus. MATERIALS AND METHODS: The authors retrospectively reviewed barium studies as well as medical and pathologic records for three cases of small-cell carcinoma of the esophagus contributed to the radiologic archives of the Armed Forces Institute of Pathology. RESULTS: Two patients presented with dysphagia and one with chest pain. In all three patients, barium studies revealed a smoothly marginated, sessile mass with a relatively flat central ulcer on the right postero-lateral wall of the midesophagus below the level of the carina. The masses all were 4-5 cm in diameter, and the ulcers were 2-3 cm in diameter. In all three patients, the results of endoscopy confirmed the presence of a sessile mass with central ulceration in the midesophagus. CONCLUSION: Small-cell carcinomas of the esophagus can have similar findings on barium studies. Although these findings are more likely to be caused by squamous-cell carcinoma, it is important to obtain endoscopic biopsy specimens, because preoperative histologic diagnosis of small-cell carcinoma can dramatically alter the management of these cases.

Esophageal leiomyomatosis.

PURPOSE: To reassess the clinical and radiologic findings in patients with esophageal leiomyomatosis. MATERIALS AND METHODS: A search of the authors' radiologic archives revealed six cases of esophageal leiomyomatosis in a 22-year period. The clinical findings and radiologic images were reviewed retrospectively. RESULTS: The average age of the patients was 10.8 years (range, 6-18 years). Five patients presented with slowly progressive dysphagia. Barium studies revealed smooth, tapered narrowing of the distal esophagus in five patients and characteristic defects on the superomedial aspect of the gastric fundus abutting the cardia, presumably due to bulging of this thickened mass of muscle into the stomach, in four patients. In two patients, computed tomography (CT) revealed marked thickening of the distal esophageal wall. CONCLUSION: Esophageal leiomyomatosis can be suggested in a pediatric patient with long-standing dysphagia in whom smooth, tapered distal esophageal narrowing is seen at barium study and circumferential esophageal wall thickening is seen at CT.

A case of tungiasis.

Tunga penetrans is a burrowing flea that is prevalent in Central and South America, the Caribbean, tropical Africa, India, and Pakistan, and rarely is imported to the United States. Tungiasis results from the cutaneous infestation of humans by the gravid female flea, T. penetrans. We report a case of tungiasis in a female who had been on a missionary expedition along the Brazilian Amazon River. The clinical presentation, life cycle, differential diagnosis, military and historical aspects, and treatment are discussed.

Fluoxetine treatment of depression and associated self-injury in two adults with mental retardation.

The use of fluoxetine to treat chronic depression and associated self-injurious behaviour (SIB) in a woman with severe mental retardation and a man with profound mental retardation is reported. In the first case, behavioural monitoring of treatment response revealed a dramatic decrease in SIB and a normalization of the woman's sleep disturbance. In the second case, SIB and the use of mechanical restraint decreased substantially. In both cases, anecdotal reports also indicated a diminution of other depressive symptoms. These cases highlight the need to consider an affective disorder as a cause of SIB in persons with severe and profound developmental disabilities. The behaviour monitoring system proved to be a practical aid in the diagnosis of depression and evaluation of antidepressant treatment in individuals who were incapable of self-report.

Experimental observations on adipocere formation.

Adipocere, "grave wax," is a waxy or greasy decomposition product formed by hydrolysis and hydrogenation of tissue fats. Once formed, it appears stable for extended periods. Adipocere has generally been considered to result from bacterial action, commonly in warm, damp, anaerobic environments. However, its frequency, rate of formation, factors affecting its formation and physical characteristics are not well defined. To study the frequency, time course, and effects of temperature and clothing on adipocere formation, we submerged human adipose tissue samples in aquaria under controlled conditions and conducted serial observations. Adipocere formed with high frequency, within a few months, in tissues submerged in warm tap water; similar changes took longer, 12 to 18 months in cold water submersion. Presence of clothing over the tissue appeared to accelerate adipocere formation.

Dermatobia hominis infestation: a case report.

The hazards presented by the Central American tropical environment are myriad. We report a case of cutaneous myiasis caused by the human botfly, Dermatobia hominis, in a soldier who had participated in military operations in Central America. The clinical presentation, treatment, and unique life cycle of the human botfly is discussed.

Severe behaviour problems associated with rapid cycling bipolar disorder in two adults with profound mental retardation.

The authors report the clinical histories of two adults with profound mental retardation, features of rapid cycling bipolar disorder, and periodic maladaptive behaviour. In each case, primary features of mania and depression were identified, operationally defined and measured with an ongoing data system, which was used to track SIB and aggression. In the first case, data analysis across days showed that 1-week episodes of depressive features alternated with 2-week episodes of manic features and that SIB was only associated with the depressive features. In the second case, episodes of manic and depressive features alternated every few days, and aggression was only associated with the manic features. These cases suggest that severe behaviour problems can be a state-dependent phenomenon of bipolar disorder. The behaviour monitoring system provided an objective methodology for aiding in the diagnosis of bipolar disorder with profoundly handicapped adults.

Can animals help earthquake predictors?

Most great earthquakes leave in their wake stories of unusual animal behaviour that preceded the main event, often by an interval long enough to be useful for warning purposes. Although much of this reported behaviour has perhaps been classified as unusual only with the benefit of hindsight, a residue of convincing stories remains and it does seem possible that animals sometimes respond to certain geophysical changes associated with the approach of rock failure, that are not monitored by instruments. Anomalous animal behaviour is difficult to interpret, because it may arise from various causes. But this is a defect shared with other short-term precursors of great earthquakes, so study of the subject as a possible part of an imminent danger warning scheme should not be neglected on that ground alone. Mankind;s past success in exploiting animal sensitivities, even before learning to understand them fully, encourages the hope that useful results will emerge.