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Ultrasonic evaluation of the pancreas.

With the advent of new gray scale imaging techniques, ultrasound plays a major role in the diagnosis of pancreatic lesions. As a noninvasive, nonionizing, accurate, and inexpensive diagnostic modality that directly images the pancreatic gland, ultrasound can be used as a primary screening tool. It is helpful in confirming the diagnosis of acute pancreatitis and in detecting and following pseudocysts and other complications. Neoplasms can be detected with a high rate of accuracy, and by assessing the presence of ascites or metastatic foci in the liver, ultrasound can aid in the staging of the neoplastic process. Bowel gas and obesity remain serious limitations to adequate examination, and in these patients computed tomography offers a complementary modality.

Acute Disease

Persistence of nucleolar RNA-rich structures and Ph1 duplication in the blastic crisis of chronic myeloid leukaemia.

Nucleolar persistence in metaphase plates is a feature observed in most of the cells in neoplastic processes. Pathological persistence or fragmentation of the nucleoli is thought to be the cause of some numerical chromosomal aberrations due to non-disjunction of the chromatids, with particular involvement of the satellite chromosomes. Thus, a combined selective staining of both the nucleoli (amido black 10B according to Mundkur and Brauer's cytochemical technique) and the chromosomes (neutral red) was applied to the metaphase plates of patients with chronic myeloid leukaemia in the blastic crisis. Duplicated Ph1 was associated with amido black-stained areas at a very high rate in some cases. Since the blastic crisis in chronic myeloid leukaemia is characterized by the appearance of an increased number of immature, highly nucleolated cells, these findings lend support to the hypothesis that the duplication of the Ph1 represents a feature possibly favoured by the pathological persistence of nucleolar RNA-rich structures in the metaphase.

Adult

Role of nurse clinician in urologic oncology.

The incorporation of single and combination chemotherapy into the therapeutic regimen for some advanced genitourinary tumors has greatly added to the myriad of medical and psychologic problems already present in these patients. Working closely with a urologist, a nurse clinician can be of significant help in the total care of this group of patients. Due to the seriousness and chronicity of the neoplastic process, the emotional and social impact as well as physical factors affect all phases of the patient's life, as well as the lives of family members. The incorporation of traditional nursing values into the medical education of nurse clinicians helps to prepare them to deal with these problems, and their participation serves to make the medical team more complete.

Aged

Mesothelial hyperplasia in hernia sacs.

Mesothelial hyperplasia is a benign condition, which simulates a neoplastic process. Since it may occur in hernia sacs this entity must be recognized by the urologist to prevent over-treatment.

Child, Preschool

Microenvironmental influences on the in vivo behavior of neoplastic lymphocytes.

A transplantable hamster lymphocytic neoplasma of probable monoclonal derivation, induced by the oncogenic DNA simian virus 40, has been adapted to grow in the allogeneic host either as leukemia (characterized by dissemination and poor prognosis) or as lymphoma (characterized by localization and favorable prognosis) [Diamandopoulos, G. Th. (1978) Proc. Natl. Acad. Sci. USA 75, 2011-2015]. In the present experiments the circumstances under which neoplastic lymphocytes that are transplanted in allogeneic animals retain, lose, or regain the capacity for dissemination or localization are assessed. Results indicate that the in vivo behavior of neoplastic lymphocytes is not a stable, irreversible characteristic that is transmitted to the cell progeny. On the contrary, it can be altered by the origin/tissue microenvironment in which the cells proliferate. It is suggested that, whereas neoplastic cell mutation followed by host selection could be responsible for changes in cell behavior, a more likely explanation is that the proliferating neoplastic lymphocytes acquire reversible nonmutational phenotypic characteristics during their interaction with the host microenvironment, which modify their behavior and, as a result, the prognosis of the neoplastic process.

Animals

Gastrocolic fistula secondary to benign gastric ulcer not operated upon: case report and review of literature.

A case report and review of the literature of benign gastric ulcer complicated by gastrocolic fistula are presented. Twenty-seven percent of patients were found to be receiving ulcerogenic medications. Only 15% of patients had previous histories of ulcer disease. Parameters most suggestive of a neoplastic process included palpable abdominal mass and unexplained anemia. Diagnosis is established by barium enema. Endoscopic biopsy and cytologic studies are useful in differentiating benign from malignant processes. Surgical management of benign ulcers complicated by fistula results in more than 90% survival.

Aged

Sarcoidosis presenting as a unilateral hilar mass.

Sarcoidosis has been characterized by a variety of clinical presentations ranging from complete lack of symptoms to incapacitating multisystem disease. Bilateral thoracic lymph node enlargement with or without pulmonary disease is the most common presentation. An elderly woman with eye pain, visual disturbance, nonproductive cough, and weight loss was found to have unilateral hilar enlargement on roentgenographic examination of the chest. An aggressive search for a neoplastic process disclosed only noncaseating granulomas consistent with sarcoidosis. The patient completely recovered on corticosteroid therapy alone.

Adrenal Cortex Hormones

Cutaneous manifestation of internal malignancies (I). Acanthosis nigricans.

Skin changes may be the first clue to a neoplastic process at a stage when it still is treatable (Such as the development of Acanthosis Nigrican (AN) in an otherwise healthy adult). Ninety percent of the neoplasm responsible for the development of AN originate in the abdomen. The tumor, even in a subclinical state, seems to possess unidentified properties that activate the dermatosis.

Acanthosis Nigricans

Suppression of in vitro antibody response by spleen cells of mice infected with Friend-associated lymphatic leukemia virus.

The ability of spleen cells of mice infected with oncornaviruses to depress the in vitro antibody responsiveness of normal lymphoid cells was exploited in an attempt to clarify the role played by the lymphatic leukemia virus (LLV) component in the immunodepressive properties of the Friend leukemia complex. Spleen cells of mice infected with LLV or, for comparison, with the entire complex were added to cultures of sheep erythrocyte-primed uninfected spleen cells, and the antibody-forming cells produced by the latter, after antigen restimulation, were assayed. The addition within 2 days from culture initiation of low numbers of cells infected with either virus preparation suppressed all stages of the response affecting the production of both immunoglobulin M and immunoglobulin G antibody. The activity of infected cells resisted doses of ultraviolet radiation which inhibit cell multiplication but was abolished by disrupting the cells and was prevented by the presence of anti-LLV antibodies. The LLV-infected spleen cells responsible for suppression were not removed by treatments which selectively remove or kill macrophages and exhibited surface properties of B lymphocytes. These results were interpreted as indicating that the effect is due to virus (or viral products) released by B cells. The suppressing cells in the spleens of mice in the early days of Friend leukemia complex infection presented superimposable properties, supporting the concept that their activity is also due to the LLV they release in large quantities. However, in later stages of infection, the spleens of Friend leukemia complex-infected mice also contained non-B-suppressing cells possibly derived from the proliferation of nonlymphoid LLV-producing cells caused by the neoplastic process.

Animals

Computed tomography in white-matter disease.

CT scans of 11 patients with proved white-matter disease were reviewed and divided into three categories. The demyelinating (secondary) and diffuse sclerosis groups frequently exhibited abnormal intravenous enhancement and mass shift. This made differentiation from inflammatory and neoplastic processes difficult. In the dysmyelinating disorders, pathologically noted diffuse loss of white matter and absence of inflammatory response appeared on the scans as areas of diffuse and decreased density in the centrum semiovale. There was no evidence of abnormal contrast enhancement.

Adult

Infiltrating neoplasms of the kidney.

Some neoplastic processes which involve the kidney develop not as a distinct localized mass, but rather as an infiltrating process which replaces the renal parenchyma, causes little or no mass effect, and contains little if any neovascularity. These neoplasms include (1) carcinoma of the renal pelvis when it invades the parenchyma (transitional cell and squamous cell); (2) blood-borne metastatic squamous cell carcinoma to the kidney (most frequently from the lung): (3) renal lymphoma of the infiltrating variety; and (4) infiltrating sarcomatous type of hypernephroma. While the urographic and angiographic appearance of these infiltrating lesions can be similar, clinical aspects are usually sufficient to differentiate them. Radiographic findings include amputation of portions of the collecting system on urography and encasement of vessels with a loss of nephrogram on angiography.

Adenocarcinoma

Treatment of Paget's disease of bone with mithramycin.

The hypothesis that Paget's disease of bone is a low grade neoplastic process led us to use the cytotoxic antibiotic mithramycin in its treatment. The dramatic effects observed on the serum calcium and alkaline phosphatase, and urinary hydroxyproline are compatible with the concept that mithramycin is primarily toxic to osteoclasts. Subjective and objective clinical effects establish this agent as useful in the treatment of Paget's disease despite its observed toxicity to other organ systems.

Chemical and Drug Induced Liver Injury

Influence of carbon tetrachloride or riboflavin on liver carcinogenesis with a single dose of aflatoxin b1.

Liver carcinogenesis with a single dose of aflatoxin B1 (7 mg/kg body weight) has been investigated in a group of female Wistar strain rats by repeated biopsies and necropsies. Another group received a subsequent intoxication with carbon tetrachloride by inhalation (approximately 200 doses) and another one was overloaded with riboflavin (25 parts/10(6) in drinking water). The frequency of hepatomata was almost equal in the aflatoxin and aflatoxin-carbon tetrachloride group. It was lowere in the riboflavin-aflatoxin group. In these 3 groups cirrhosis was never present in neoplastic livers. Megalocytosis was the first lesion observed. All tumoral livers had previous or concomitant megalocytosis. This modification was about as frequent, intense and widespread in aflatoxin-CCl4 and aflatoxin groups but appeared much earlier, as did the first hepatoma, in the aflatoxin-CCl4 group. It was less frequent, less intense and less widespread in the riboflavin-aflatoxin group than in the aflatoxin group. There was also a lower frequency of hepatomata in the riboflavin-aflatoxin group, but the difference was not significant due to the too small number of animals involved. The facts are not a proof of the existence of an obligatory link between megalocytosis and carcinogenesis since a slight megalocytosis was observed in the riboflavin group not affected by the neoplastic process. However, the simplest explanation of our results would be to consider that the potential tumour cells are located among the megalocytic cells, without admitting that every megalocyte is obligatorily a precancerous cell. CCl4 seems to act in shortening the time of appearance of megalocytosis. The protective effect of riboflavine should be regarded with more caution.

Aflatoxins

[Etiological role of the herpes simplex virus in causing cervical cancer].

The results of the composite virological and immunological examinations of 46 patients with cervical carcinoma (CC) attest to the association of herpes simplex virus (HSV) with neoplastic processes. HSV strains were isolated from the tumour tissue as well as from the cervical canal secretions and blood of 4 patients. A higher level of virus-neutralizing and complement-fixing antibodies to HSV was found in sera from CC patients as compared with the control group of normal women. Antibody to HSV type 2 was found in 38.8% of sera from the patients and 12.6% in the control group. Lymphocytes from CC patients induced blasttransformation reaction to HSV twice as frequently as those from healthy subjects. The virus-specific antigen was found in tumour cells of 36% CC patients in immunofluorescent examinations of smears from the cervix. The presented results are related to the determination of the etiological role of HSV in cervical carcinoma.

Adult

Histological and histochemical studies of oral cancer.

Increasing attempts are now being made to measure and to assess the relative importance of histologic features in oral premalignant and malignant conditions in order to improve the accuracy of diagnosis and prognosis. Though certain individual features, such as DNA content of cell nuclei, or stereological parameters like nuclear : cytoplasmic ration or desmosome density can be very accurately quantified, no single feature can completely characterize the neoplastic process. Multifactorial studies are thus of great importance, even though it is not practicable to measure all the parameters included with the sam accuracy; in such studies retrospective computation of the relative importance of individual parameters is of greater value than arbitarily assigned weights. So far as early prediction of malignant transformation in oral premalignant lesions is concerned, great interest is now being shown in the reactivity of glucose-6-phosphate dehydrogenase in epithelial cells. For predicting the prognosis of patients with established squamous cell carcinoma of the mouth, it is now realized that thenature and intensity of the host immune inflammatory response seen in the connective tissue within the surrounding the tumour and in affected regional lymph nodes, is at least as important as are the features of the tumour cells themselves.

Cell Division

Antineoplaston A in cancer therapy. (I).

Twenty-one patients with advanced cancer or leukemia were treated with antineoplaston A and followed for up to nine months. Dosage by intravenous, intramuscular, subcutaneous, rectal, intrapleural, intravesical and/or topical administration ranged from 0.6 to 33 U/m2/24 h. Treatment was well tolerated, although side effects included fever of short duration and elevation of platelet and white blood count. In 18 cases some degree of clinical improvement was observed. Complete remission occurred in 4 cases. More than 50% remission occurred in 4 other cases which, along with another 6 cases, are continuing the treatment with high doses of antineoplaston A and show a continuing regression of the tumors although not yet achieving the criteria for complete remission; 2 of these 6 cases seem unlikely to achieve remission. Two patients temporarily discontinued treatment. During treatment, 5 patients expired; in 2 of them, however, was seen significant regression of the neoplastic process. The deaths were not due to cancer or to any toxicity incurred by the treatment.

Administration, Topical

Local reaction to gingival injections of MER/BCG in guinea pigs.

The local reaction to gingival injections of methanol extraction residue of BCG (MER/BCG) was investigated in guinea pigs to help determine the potential of this agent in treating oral carcinoma. The drug was used in a standard and diluted form. Both concentrations were well tolerated and caused no ulceration or necrosis. Histological examinations performed at predetermined intervals showed an inflammatory response to the standard and the diluted solution. This reaction was more pronounced when the higher concentration was used. No changes in the alveolar bone were found in either of the groups. Complete healing with scar formation was evident four to six weeks later. The absence of severe reactions after injections of MER should encourage further investigations of this agent in the local treatment of neoplastic processes in the oral cavity.

Animals

["Primary" reticulum-cellsarcoma of the retina. I. Clinico-pathologic study of 5 patients (author's transl)].

Between 1964 and 1974 a primary reticulum-cellsarcoma of the retina was diagnosed histologically in 5 patients (between 44 and 71 years), in one already clinically. The initial diagnosis had been "uveitis" (2), "panuveitis" (1), "iridocyclitis with central retinal artery occlusion" (1), and "chorioretinitis" (1). The usual antiinflammatory therapy was without effect in every instance. All patients showed neurological symptoms with cerebral manifestations. Twice the cerebral biopsies had been misinterpreted initially as "atypical glioblastoma multiforme", once as Neuro-Behçet. The disease progressed over a course of 2--10 years from the initial ophthalmic symptoms to death. A review of the literature is given and the differential-diagnosis to necrotizing forms of retinitis, dissiminated chorioiditis neoplastic processes of retina and uvea and degenerative diseases are discussed. The primary reticulum-cellsarcoma of the retina must be considered in the differential-diagnosis of uveitis or panuveitis if 1. there is progression in spite of the usual antiinflammatory therapy, 2. the initial infiltrations are seen in the deep layers of the sensory retina.

Adult