Biomedical subjects
Publications and source records attributed to G F Gray.
Hemangioendothelial sarcoma of the penis in a 44-year-old man was treated by preoperative radiation, penectomy, and chemotherapy. The patient was free of evident disease 2 years later. Electronmicroscopy showed differentiated vascular structures at the periphery of the lesion and anaplastic cells throughout the remainder of the tumor.
Four separate renal neoplasms were removed from a 64-year-old man during a period of 8 months. A lesion was first identified in the left kidney and the nephrectomy specimen had 2 separate adenocarcinomas. A third adenocarcinoma and a papillary urothelial pelvic carcinoma were found subsequently and segmentally resected from the right kidney. The patient died 9 years later with local recurrence of the urothelial neoplasm but no evidence of metastatic carcinoma.
A year-long double-blind study of 2,3-dihydroxybenzoic acid (2,3-DHB) given orally at a dose of 25 mg/kg four times per day was undertaken in 15 patients with beta-thalassemia major. 2,3-DHB and placebo (mannitol) were tolerated to an equal degree and there were no signs of drug toxicity at the end of 1 year. Efficacy in terms of retardation of iron accumulation could be documented using serial liver biopsies, serum ferritin determinations, or clinical laboratory assessment. Serum iron values increased, as did the iron binding capacity, in the group receiving 2,3-DHB. The increase in iron binding capacity was due to drug interference with the method of determination. Because of the greater efficacy of slow infusions of desferrioxamine in chelating iron when administered slowly, the clinic has shifted its emphasis toward further evaluation of that compound. Nevertheless, in view of the minimal toxicity of 2,3-DHB, further work appears warranted to define its role in the treatment of iron-overload.
Endothelial pigmentation does not usually interfere with vision. This case report documents a dense and extensive deposition of uveal pigment in corneal endothelial cells of a patient who had undergone 2 previous grafts subsequent to an alkali burn injury. The previous graft in which the pigmentation occurred remained compensated, but vision was impaired secondary to dense endothelial pigmentation. A combination of the initial chemical injury, recurrent iritis, chronic glaucoma, and multiple intraocular procedures may have resulted in the stimulus for the uveal tract to disperse a large amount of pigment onto the cornea and its subsequent phagocytosis by the endothelium. Endothelial pigmentation may become a more commonly seen complication in attempts to treat the severely damaged anterior segment.
In 54 patients with thymoma, the factors having the greatest bearing on prognosis were presence or absence of gross tumor invasion or an associated clinical syndrome of myasthenia gravis, anemia due to erythrocytic hypoplasia or hypogammaglobulinemia. Of 17 patients with invasive tumors, 14 were either dead of tumor or living with disease, while 34 of 37 patients with encapsulated tumors were either living or dead of other causes without evidence of neoplasm. A clinical syndrome associated with thymoma was present in 15 patients. Thymectomy appeared to have little if any effect on the syndrome; in three instances the syndrome appeared after removal of the thymoma. Analysis of the histological findings, including type of epithelium, degree of lymphocytic infiltration and presence of other patterns such as rosettes, perivascular spaces and germinal centers, showed that there was no consistent relationship between the microscopic appearance of thymomas and their clinical behavior. Knowledge of the striking variations in histopathologic features is necessary in differential diagnosis.
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A well-differentiated, oncocytic adenocarcinoma of the lacrimal sac recurred locally in a patient during a period of 13 years. This appears to be the second documented instance of such a neoplasm.
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An aggressive anaplastic tumor of the thyroid with osteoclastoma-like giant cells was studied by electron microscopy. The lack of junctional complexes or other obvious epithelial elements suggested mesenchymal origin. The giant cells resembled osteoclasts with respect to mitochondria, rough endoplastic reticulum, lysosomes, ribosome complexes and vacuoles, but the prominent nuclear golgi apparatus of giant cell tumors of bone was absent.
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An embryonal rhabdomyosarcoma that initially was seen as a polyp in the external auditory canal underwent uncontrollable direct extension along the facial nerve through the internal auditory meatus, with encasement of the base of the brain and entire spinal cord despite radical surgery, supervoltage irradiation, and multidrug chemotherapy. This degree of massive neuraxial spread without systemic metastases appears to be unique.
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Six patients with surgically treated Menetrier's disease are presented. Diffuse or focal cystic hyperplasia of mucous secreting epithelium of the fundus with antral sparing characterized the stomachs in all of these cases. In most instances the disorder was found during evaluation of non-specific complaints of pain, nausea and diarrhea. Only one patient had sufficient loss of albumin to produce server ankle edema and four of the others had below normal serum albumin levels without associated symptoms. One patient presented with life threatening bleeding from the hyperplastic mucosa. None of the patients had an associated endocrine neoplasm. All of the patients are living and without symptoms of disease for periods ranging from three to twelve years after resection of all or part of the hyperplastic mucosa. The rationale for surgical therapy in this condition is presented.
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A case of scleral tuberculosis was successfully treated by combined systemic and local therapy. The importance of biopsy for early diagnosis and initiation of curative treatment is stressed.