Biomedical subjects
Publications and source records attributed to R W Laing.
An intracranial germ cell tumour (GCT) in a patient with cryptorchidism is presented. The known association between testicular GCTs and cryptorchidism suggests a possible common predisposition for gonadal and extragonadal tumours. To confirm this the frequency of the reported association needs to be defined.
We report a case of a patient who at the age of 32 developed a squamous carcinoma arising in the thorax. At 7 years of age he had received aggressive treatment with 131I for a thyroid carcinoma with multiple pulmonary metastases. Radiation induced malignancy, in sites such as the bone marrow or bladder, after 131I therapy is recognized; however, tumours arising in the thorax after such treatment have not been described.
A giant cellular blue naevus of the scalp is described in a man with presentation in the third decade of life. In contrast with previous reports of children with this condition, there was no abnormality of the underlying skull bones and no evidence of malignancy.
An 84-year-old woman presented with an acute onset of violent bilateral ballism-chorea. She was admitted to the local neurology unit, but not definite diagnosis could be made of the underlying condition, although she did appear to have bronchopneumonia. At autopsy the stomach wall was thickened, and the lesser curve lymph nodes were firm and enlarged. A single nodule was noted in the liver while the lungs appeared consolidated. Histology revealed a moderate-to-poorly differentiated gastric adenocarcinoma with extensive intravascular dissemination which included the central nervous system (CNS). Numerous small infarcts related to vessels occluded by tumour were present throughout the brain, and we feel that this was the underlying mechanism for the acute onset of ballism.
An example of a Thorotrast granuloma (thorotrastoma) occurred in the neck of a patient 44 years after a carotid angiogram in which Thorotrast was used as radiological contrast medium. The lesion had produced a "cold" abscess and the patient was undergoing treatment for retropharyngeal tuberculosis. Thorotrast leakage can produce unusual clinical symptoms and signs which are frequently misdiagnosed.
Twenty-six patients with arteriovenous malformations (AVMs) were treated between 1965 and 1986 with conventional fractionated radiotherapy at the Royal Marsden Hospital. There were 14 male patients and 12 female, aged 11 to 57 years (median, 24 yr). Twenty-five patients completed radiotherapy with a localized treatment target volume of a dose of 40 to 54 Gy. The median follow-up was 14.5 years. Eleven patients had an additional hemorrhage. The actuarial annual risk of bleeding was 2.3%, which is similar to that found in untreated patients. Follow-up angiograms were performed in 11 patients, and 10 showed persistence of AVM. The results suggest that fractionated radiotherapy in conventional doses does not make a large impact on the risk of hemorrhage in patients with inoperable AVMs, and, where possible, stereotactic external beam radiotherapy/radiosurgery should be employed.
We have evaluated, in an in-vitro study, the thermal effects of the neodymium:YAG (Nd:YAG) contact laser on meniscal tissue. There was no significant difference with regard to time taken to divide the meniscus or depth of necrosis between the two power settings used (25 and 30 W). A significantly greater (p less than 0.005) amount of energy, however, was expended at the higher power setting. The heat from the laser probe dissipated rapidly into the surrounding water without causing significant lateral thermal tissue damage. The Nd:YAG contact laser has features such as the ability to be transmitted through aqueous solutions, fiberoptic delivery, precise thermal tissue effects, and tactile feedback that would be beneficial in arthroscopic surgery. Although experimental, we suggest further clinical evaluation of its potential.
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Sixty slides from 60 blocks taken from 30 colonic carcinomas were circulated twice to six histopathologists of varying experience. Five of the six pathologists showed a good to excellent intraobserver agreement for assessment of the character of the invasive margin (0.44 less than kappa less than 0.82), which was not significantly affected by sampling (0.40 less than kappa less than 0.56, comparing both slides from each tumour) or observer (five of six pathologists agreeing on 46 of 60 slides). Pathologists were unreliable in assessing peritumoural lymphocytic infiltrates, with only two pathologists achieving moderate levels of intraobserver agreement (-0.03 less than kappa less than 0.52). The interobserver agreement for peritumoural lymphocytic infiltrates was also low (kappa less than 0.29) between the three most experienced pathologists. The assessment of peritumoural lymphocytic infiltrates was significantly affected by sampling, the two pathologists with the lowest intraobserver variation achieving kappa values of 0.21 and 0.10 between the 30 paired slides from each tumour. The character of the invasive margin was reliably assessed, was not dependent on sample, and added useful prognostic information, but peritumoural lymphocytic infiltration is not a reproducible observation and may therefore not add useful prognostic information in routine use.
We report the 2nd case of titanium balanitis reported in the world literature. Clinically the patient presented with phimosis: histologically the titanium was surrounded by a mixed granulomatous inflammatory reaction. Topical titanium preparations may lead to phimosis and therefore we thought it important to bring this potential iatrogenic complication to further notice.