Osteosarcoma of the esophagus.

The case of a 70-year-old man who underwent esophagectomy for a large polypoid sarcoma is described. Detailed examination of the surgical specimen established a diagnosis of osteosarcoma. Although osteosarcomas of the esophagus have been described in dogs, such tumors in humans do not appear to have been previously reported.

Acinar cell neoplasms of the exocrine pancreas.

The pathological features of 12 acinar cell neoplasms of the pancreas are described; these comprise 11 carcinomas, of which seven were pure acinar cell growths and four were mixed acinar and ductal carcinomas, and one adenoma. These tumors occurred in a series of 105 during the period 162-75. Thrombotic endocarditis developed in three out the 11 carcinoma cases. The distinctive histological features of these neoplasms and the means of differentiating them from anaplastic carcinomas and certain other carcinomas, for example, islet cell carcinoma, oat cell carcinomas, and carcinoid tumours, are discussed. The poor prognosis of pancreatic cancers is emphasized, and reasons are put forward for believing that future epidemiological studies may need to take account of the histological types of pancreatic carcinoma.

Rectal biopsy as a prognostic guide in Crohn's colitis.

In a retrospective study, 64 rectal biopsies from 27 patients with Crohn's disease limited to the large bowel have been reviewed using a semiquantitative grading of histological abnormality. The subsequent clinical course was assessed independently, and patients were included in one of four categories: (1) remaining asymptomatic; (2) showing continued moderate inflammatory activity; (3) requiring colectomy; and (4) dying as a direct result of colonic disease. Biopsies from group (4) showed a greater degree of histological abnormality than those in the other three groups. This difference was statistically significant for first biopsies ((4)-(1) p less than 0-05; (4)-(2) p less than 0-05). In any one patient the histological appearances were relatively constant from one biopsy to the next. The presence of either fissuring or ulceration suggested a poor prognosis.

Prospective study of quantitative aspects of audit in a large general histopathology laboratory.

A non-computerised method of accurate prospective analysis of the quantitative aspects of the work of a general histopathology laboratory was devised. The method entails monitoring the progress of all biopsy and cytology specimens through the laboratory during selected monthly periods of study. The data collected include details of specimen type, block/section/stain details for each specimen, and information about the timed progress through technical, medical, and secretarial stages of specimen/report handling. The results give a detailed breakdown of the biopsy and cytology workload of this department. They give information about the rate of passage of specimens through the system and identify reasons for delay in the reporting of some cases. The method is easy to operate and will allow for the analysis of specific effects--for example, staff changes--on the efficiency of the department. The data will also provide some of the information required for the costing of histopathology laboratory services, and the type of information obtained will probably become a necessary requirement for laboratory accreditation.

Randomised trial comparing prednimustine with combination chemotherapy in advanced ovarian carcinoma.

A total of 76 patients with advanced epithelial ovarian carcinoma were randomised to receive 6 months of treatment with either a combination of hexamethylmelamine, 5-fluorouracil, cisplatin and prednimustine or prednimustine alone following initial surgery. Pathologically confirmed response rates were 35% for combination chemotherapy and 28% for prednimustine, and the overall survival was identical for the two groups. Seven patients achieved a pathologically defined complete response, one of whom relapsed at 8 months; the others remain disease-free 18-36 months (median, 23 months) after presentation. The extent of initial surgery significantly affected the survival of patients receiving prednimustine but not of those receiving combination chemotherapy. Prednimustine can produce durable responses in advanced ovarian cancer using a schedule that results in negligible toxicity.

Stability of subtilisin and lysozyme under high hydrostatic pressure.

The stabilities of subtilisin and lysozyme under hydrostatic pressures up to 200 MPa were investigated for up to 7 days at 25 degrees C. Methods were chosen to assess changes in tertiary and secondary protein structure as well as aggregation state. Tertiary structure was monitored in situ with second derivative UV spectroscopy and after pressure treatment by dynamic light scattering and second derivative UV spectroscopy. Secondary structure and potential secondary structural changes were characterized by second derivative FTIR spectroscopy. Changes in aggregation state were assessed using dynamic light scattering. Additionally, protein concentration balances were carried out to detect any loss of protein as a function of pressure. For the conditions tested, neither protein shows measurable changes in tertiary or secondary structure or signs of aggregation. Lysozyme concentration balances show no dependence on pressure. Subtilisin concentration balances at high protein concentration (4 mg/mL and higher) do not show pressure dependence. However, the concentration balances carried out at 0.4 mg/mL show a clear sign of pressure dependence. These results may be explained by protein interaction with the vial surface and appear to be rate limited by the equilibrium between active and inactive protein on the surface. Pressure increases protein loss, and the estimated partial molar volume change between the two states is estimated to be -20 +/- 10 mL/mol.

Factors influencing manual muscle tests in physical therapy.

To determine whether it is the amount or the duration of the force applied manually by the tester, or both, that determines the tester's perception of the strength of the hip flexor or abductor muscles, an electromechanical device was designed which was placed between the tester's hand and the subject's limb. With the device we measured the force applied to the limb, the time interval during which it was applied, and the angular position of the limb during the entire test. In 240 such tests, the testers' ratings of the differences in strength between the right and left sides were correlated with seven variables involving force and time. It was found statistically that the impluse--that is, the duration of the tester's effort multiplied by the average applied force during each test--was the factor that most influenced the tester in the ratings.

Recurrent dislocation of the patella. Histochemical and electromyographic evidence of primary muscle pathology.

The role of muscle function in the aetiology of recurrent dislocation of the patella has been examined. Eleven of the 12 patients we studied had joint hypermobility. Muscle biopsies from eight of nine patients treated by surgery had a predominance of abnormal Type 2C fibres, and three of six patients whose quadriceps muscles were studied by electromyography also had abnormal results. Our preliminary findings suggest that there may be a primary muscular defect in many cases of recurrent dislocation of the patella.

Pain Control via the Dorso-Lumbar Sympathetic Outflow.

No acceptable scientific explanation has yet been found to account for the success of such remote treatments as acupuncture and connective tissue massage which do not conform to the recognized distribution of segmental reference. This paper is the result of clinical observations over the past seven years, revealing previously unsuspected effects from applying various treatments to the area of the sympathetic dorso-lumbar outflow for a wide variety of painful conditions. An hypothesis is offered which may account for those remote effects hitherto poorly understood.

Primary hyperparathyroidism diagnosed at autopsy. A study of eight cases.

This paper describes the clinical and pathological findings of eight cases of primary hyperparathyroidism first diagnosed at autopsy. The eight cases were obtained from the autopsy files of the Western General Hospital, Edinburgh over a decade (1971-80). The duration of the final hospital admission was very short in the majority of cases but analysis of the clinical history, in which gastro-intestinal and neuro-psychiatric disturbances figured prominently, showed that symptoms of the disease may have been present for very much longer--perhaps years in some instances. Details of the main autopsy findings and cause of death are also presented.

Isokinetic Evaluation Following Leg Injuries.

Isokinetic strength testing, an objective method of quantifying a muscle's dynamic strength throughout its range of motion, is useful for diagnosis and for determining when an athlete can return to competition after injury.

The histogenesis of nerve sheath myxoma: report of a case with electron microscopy.

The case is described of a 71-yr-old female with a tumour in the pulp of the left index finger. The histology was that of a myxoma of nerve sheath or Pacinian neurofibroma. Electron microscopy of the tumour provides convincing evidence for an origin from the perineural cells. The location of these tumours, suggestive histology and perineural origin provides support for the belief that they arise from sensory nerve endings.

The ultra-structure of a melanotic schwannoma of the skin.

The case is described of a 53-year-old female with a pigmented tumour of the skin of the foot. The light and electron-microscopic findings established that the tumour was a melanotic Schwannoma. The ultra-structural features indicated that the Schwann cells, which contained melanosomes in varying stages of maturation, were producing melanin. A second type of cell within the tumour with features of a mesenchymal cell also contained melanosomes. The interrelationships of nerve sheath tumours, their relationship to pigment cells of neural crest origin and to other pigmented tumours of uncertain histogenesis, is discussed in the light of the findings described in the paper.

Cell death in developing skeletal muscle: histochemistry and ultrastructure.

The histological, histochemical and ultrastructural features of cell death in the normal human foetus are described. The age range of the foetuses was 7 to 16 wk. Cell death was observed in all foetuses between 10 and 16 wk. On the basis of these findings it is suggested that disintegration of cell membrane may be a crucial factor in this process. Acid phosphatase activity and phagocytosis of cell debris are evidently not the main means of disposal of degenerate cell products. The possible relevance of cell death in embryogenesis for dystrophic processes is discussed.

Adenocarcinoma of the oesophagus and of the oesophagogastric junction.

The clinical and pathological features of 52 adenocarcinomas invading the oesophagus and the oesophagogastric junction are reviewed. The relationship of these tumours to the presence of a concomitant hiatal hernia and the histogenesis of primary oesophageal adenocarcinomas are discussed. Adenocarcinomas of the cardio-oesophageal junction appear to have distinctive prognostic and pathological features and there may be a case for their classification into a separate category of alimentary neoplasms.

Malignant chondroid syringoma of the thigh. Report of a case with electron microscopy of the tumour.

A case of malignant chondroid syringoma occurring in a 52-year-old female is reported. The tumour presented as a large, cystic lesion of the thigh. Local recurrence and secondary deposits in the inguinal region occurred at an early stage. The rarity of these malignant tumours and metastasising sweat gland tumours in general is emphasised.

Tumours arising in skeletal muscle in adults.

A review has been made of 30 cases of tumours arising in skeletal muscle seen over a 21-yr period (1954-74) in the Department of Pathology, Western General Hospital, Edinburgh. There were 17 females and 13 males in the series. The age range was 15 to 88 yr. The commonest site was thigh muscles (18 cases). Seven of the 14 benign tumours were myxomas: the other benign tumours included two solitary myositis ossificans, two haemangiomas and three lipomas. The three tumours which might be considered as being of borderline malignancy were two haemangiopericytomas and one desmoid tumour. There were 13 malignant tumours in the series: five fibrosarcomas, five liposarcomas, two rhabdomyosarcomas and one undifferentiated (pleomorphic) sarcoma. The average length of survival of the nine patients with malignant tumours who have died was only 15 mth. The fibrosarcomas in particular behaved in a highly malignant fashion. These 13 intramuscular sarcomas accounted for approximately 11 per cent, of all mesenchymal (non-lymphoid) sarcomas seen during the period of study.