Chronic treatment with tin normalizes blood pressure in spontaneously hypertensive rats.

We have reported that short-term treatment of spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto (WKY) rats with stannous chloride (SnCl2), which selectively depletes renal cytochrome P450, restores blood pressure to normal in young but not in adult SHR, and is without effect on blood pressure of either young or adult WKY rats. We report in the present study that chronic treatment with SnCl2, begun at age 5 weeks, prevented the development of hypertension in SHR over a period of 15 weeks at which time they were killed. Suspension of SnCl2 treatment after 8 weeks (i.e., at age 13 weeks) did not result in return of blood pressure to hypertensive levels in SHR. Age-matched WKY rats were not affected by tin treatment. These findings provide additional evidence that administration of tin, which stimulates heme oxygenase, thereby producing depletion of cytochrome P450, restores blood pressure to normal levels in SHR.

Persistence of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. Evaluation of therapy by follow-up transbronchial lung biopsy.

The effectiveness of therapy with trimethoprim-sulfamethoxazole and/or pentamidine has not been fully evaluated in AIDS patients with Pneumocystis carinii pneumonia (PCP). Since recurrence of PCP is common, follow-up lung biopsy (15 transbronchial, one open) was performed as part of the clinical evaluation of 16 episodes of PCP. All patients had shown evidence of clinical improvement during treatment and had received a mean duration of therapy of 17.6 days. In six of 16 episodes (38 percent), however, a repeat biopsy remained positive for PCP an average of 25.2 days after initial diagnosis. Retrospective comparison of standard clinical parameters (fever response, arterial blood gas results, roentgenographic characteristics) could not adequately distinguish episodes with positive follow-up biopsies from those with negative biopsies. Persistence of PCP after conventional treatment may be an important factor in recurrences of this infection in AIDS patients.

Adenocarcinoma of the urethra during pregnancy: report of a case.

The first case of adenocarcinoma of the urethra occurring during pregnancy is discussed. The patient was in her second trimester, and the pregnancy was allowed to continue to term. The patient was delivered vaginally of a healthy infant. Following delivery, she was treated with radiotherapy. After completion of the radiotherapy, the distal half of the urethra was excised. The patient has been followed for 7 years, and there is no evidence of recurrence.

Establishment of new human prostatic cancer cell line (JCA-1).

The establishment of a new human prostatic cancer cell line is described. This cell line was derived from a poorly to moderately differentiated prostatic adenocarcinoma. It has been maintained in tissue culture for fourteen months and has been passed fifty-two times. This cell line has an ability to form colonies in soft agar suspension cultures, and also is transplantable to nude mice. Tumors grown in nude mice revealed a poorly differentiated adenocarcinoma with positive PSA staining. Acid phosphatase activity was detected in freeze-thawed cells by enzymatic assay. A karyotype analysis demonstrated aneuploidy with a model chromosomal number of 69 and six marker chromosomes.

Microsurgical transplantation of nonvascularized segments of the fallopian tube in the rabbit.

Microsurgical nonvascularized transplantation of a 1-cm segment of fallopian tube was performed using the rabbit as a model. Autograft experiments showed survival of a 1-cm tubal segment for as long as 10 months postoperatively. Allografts survived equally as well, and one rabbit became pregnant.

Endobronchial tuberculosis simulating bronchogenic carcinoma in a patient with the acquired immunodeficiency syndrome.

A patient with the acquired immunodeficiency syndrome (AIDS) had tuberculosis present as an endobronchial mass simulating bronchogenic carcinoma. Endobronchial tuberculosis may be another unusual manifestation of tuberculosis in patients with AIDS. This manifestation of tuberculosis may be missed unless there is a high degree of suspicion. Proper cultures and biopsy specimens should be taken from sites where endobronchial abnormalities are noted in patients at risk for AIDS.

Hyperrugosity in gastric carcinoma: radiographic, endoscopic, and pathologic features.

The morphology of the rugal folds in carcinoma of the stomach is reviewed, with emphasis on the hyperrugosity of the diffusely infiltrating lesions. Six of the 27 patients with diffuse infiltrating lesions demonstrated atypical features and were misdiagnosed as benign gastropathies or lymphomas. In these six patients there was enlargement, irregularity, and tortuosity of the rugal folds with the preservation of a relatively normal gastric volume, distensibility, and peristaltic activity. The involvement was segmental or diffuse and ulcerations were observed on endoscopic and radiographic examinations in two of the cases. Deep endoscopic biopsies were successful in establishing a correct diagnosis in most of the cases. The pathologic correlation, pitfalls in the radiologic and endoscopic diagnosis, and a short review of the pertinent literature are presented.

Scirrhous carcinoma of the pyloric channel and distal antrum.

The clinical, endoscopic, and pathologic features of 13 cases of scirrhous carcinoma of the pyloric channel and distal antrum are described and correlated with the radiographic findings. The lesions appear as smooth concentric narrowings, rigid and generally short. They are associated with outlet obstruction but without gastric or duodenal ulcerations. Features highly suggestive of pyloric muscular hypertrophy, such as indentation at the base of the duodenal cap and pyloric notch, may occur. Almost all cases had serosal invasion and lymphatic spread at surgery. The differential diagnosis and a short review of the pertinent literature is presented.

Carcinoma of the esophagogastric junction.

We have reviewed and analyzed the clinical and radiographic features of 38 patients with proven carcinoma involving the esophagogastric junction. There were 29 cases of adenocarcinoma and nine of squamous cell carcinoma presenting with similar symptoms, surgical findings and radiographic characteristics. Features that suggest adenocarcinoma are: 1. mass or distortion of the gastric fundus; 2. short lesion; 3. smooth submucosal contour defect representing tumor undermining mucosa. Hiatus hernia was present in 17% of adenocarcinomas and 44% of epidermoid carcinomas but the association appears to be coincidental. Atypical forms of presentation such as lesions involving almost the entire esophagus or mimicking peptic esophagitis and achalasia are discussed and illustrated. Pertinent data from the literature is reviewed. In order to avoid errors in the roentgenographic diagnosis routine careful examination of the esophagogastric junction is recommended.

Primary and metastatic scirrrhous carcinoma of the rectum.

Eight cases of scirrhous carcinoma of the rectum are described. Five patients had primary lesions and three had metastases from stomach and breast. Radiographic features were severe rectal narrowing, rigidity, and smooth contours or, more commonly, moderate narrowing, distorted nodular folds, and an irregular serrated contour mimicking inflammatory disease. Difficulties in the radiologic and histologic diagnosis and a short review of pertinent literature are reported.

Hepatic amyloidosis presenting as severe intrahepatic cholestasis: a case report and review of the literature.

Although hepatic involvement is common in all forms of amyloidosis, jaundice is infrequent and usually mild. We report a case of a 74-yr-old man with severe intrahepatic cholestasis and hepatic amyloid. The topography of amyloid deposition was unusual, in that deposits were confined predominantly to the portal tract. They appeared as a dense eosinophilic infiltrate that stained with congo red. A review of the English-language literature revealed only 18 prior patients with hepatic amyloid associated with severe intrahepatic cholestasis. The histology of only one of these patients showed a similar distribution of amyloid deposits.

Significance of the "maturation" of metastases from Wilms' tumor after therapy.

Several metastatic nodules were discovered in the lungs of a 4-year-old boy two years after surgical excision of Wilms' tumor with subsequent chemotherapy and local irradiation. All these metastatic nodules were composed of differentiated mesenchymal elements similar to those encountered in the primary neoplasm. Similar "mature" metastases have been observed by pathologists in other tumors of embryonic origin. Review of available literature and clinical and experimental data supports the notion that "reversion" of malignant cells into phenotypically benign counterparts may take place spontaneously or under the influence of environmental factors. Anticancer agents (cytostatics, radiation) selectively destroy the more anaplastic cells present in a malignant tumor (or its metastatic implants), thus allowing the "benign" revertants to predominate. Although such lesions are benign-appearing, it is recommended that they be completely excised; however, but further chemo- or radiotherapy may not be necessary.

Solid variant of aneurysmal bone cyst in a patient with cyclic neutropenia.

A 16-year-old female with cyclic neutropenia (CN) was incidentally found to have a thoracic vertebral mass during the preoperative work-up for maxillary sinus surgery. An exploratory thoracotomy revealed a very vascular tumor involving T-10 and T-11 vertebral bodies. Gross total resection of the tumor was achieved. Pathology revealed a solid variant of aneurysmal bone cyst. This is a rare benign neoplasm of bone more commonly seen in the mandible and facial bones as well as involving the small tubular bones of the hands and feet. Because of its rarity, location, and an unknown association with CN, we found this case worthwhile to publish.

Hypercalcemia in childhood renal tumors.

Hypercalcemia is an uncommon complication of childhood renal tumors. It is exclusively seen in infants 6 months of age or younger with malignant rhabdoid tumor of the kidney (MRTK) or congenital mesoblastic nephroma (CMN). Secretion of parathormone or prostaglandin E2 by the tumor cells is responsible for the hypercalcemia in most of these patients. Bone metastasis has been notably absent in these patients, and the hypercalcemia completely resolves with the removal of the tumor. Hypercalcemia in itself probably does not have any prognostic significance; however, it may serve as a tumor marker in some patients. Early recognition and effective management of this complication may prevent the acute life-threatening as well as the longstanding complications of this serious metabolic disorder.

Initial results of reteplase in the treatment of acute lower extremity arterial occlusions.

PURPOSE: To assess the feasibility and efficacy of reteplase in transcatheter arterial thrombolysis for lower extremity occlusive disease. MATERIALS AND METHODS: Fifteen consecutive patients with acute lower extremity ischemia due to occlusive disease were treated by means of catheter-directed thrombolysis with reteplase. Following diagnostic angiography, thrombolysis was started either from an antegrade puncture site in cases of femoropopliteal occlusions, or from the contralateral groin in cases of thrombosis of the iliac artery, common femoral artery, or infrainguinal bypass grafts. Reteplase was infused at a rate of either 0.5 U/h (six patients) or 1.0 U/h (nine patients). RESULTS: Complete thrombolysis was achieved in all of the nine (100%) patients in the 1.0 U/h group and in four of six (66%) patients in the 0.5 U/h group for a combined success rate of 13 of 15 (87%). Clinical success was achieved in 11 of 15 patients overall (73%). Major bleeding complications occurred in none of the 9 patients in the 1.0 U/h group and in one (16%) of the six patients in the 0.5 U/h group for an overall rate of 6%. CONCLUSIONS: Reteplase shows promise as an alternative to urokinase in the treatment of lower extremity ischemia due to arterial occlusive disease.

Recurrent benign intracranial hypertension due to iron deficiency anemia. Case report and review of the literature.

PURPOSE: Iron deficiency anemia (IDA) causes benign intracranial hypertension (BIH). PATIENTS AND METHODS: A case of an 11-year-old girl with severe IDA and benign intracranial hypertension is presented. RESULTS: Treatment of iron deficiency resulted in the resolution of BIH. Recurrence of BIH is observed with the recurrence of IDA. Chronic intermittent blood loss from the intestinal polyps was the etiology of recurrent IDA. CONCLUSIONS: A thorough search to determine the etiology of IDA is essential for proper treatment. Although BIH is a rare complication of IDA, its association with IDA should be recognized for prompt treatment before an extensive and costly workup for BIH is done.