Desmoid tumor in a male breast in the context of Gardner's syndrome. Case report

Fibromatosis (Desmoid tumor) of the male breast is an exceptional location. We present a case of such a tumor, in the context of Gardner's syndrome. A palpable mass was discovered in the right breast of a 52 years old man, with a history of rectocolic adenomatous polyposis. Mammography ant thoracic CT scan showed a stellar tumor, mimicking a breast cancer. Treatment consisted of wide excision and histology revealed a desmoid tumor. Desmoid tumors of the breast are benign lesions; they should be widely excised because of a high risk of recurrence. Coloscopy is indicated in the presence of mammary fibromatosis, to look for associated multiple polyps, confirming the diagnosis of Gardner's syndrome.     

The relationship of cholecystectomy and taurocholic acid feeding to bile composition and hepatocyte function in prairie dogs

The prairie dog was used as a model for human gallstone formation. Stones formed in the gallbladder of all animals on a lithogenic diet. Hepatic bile was nonlithogenic, whereas gallbladder bile promoted cholesterol precipitation. Addition of taurocholate to the diet reduced the number of stones and lithogenicity. Cholecystectomy resulted in an increased bile flow and reduced secretion of cholesterol in the animals on a high cholesterol diet. Reduction of cholesterol and bile acid synthesis by negative feedback was demonstrated in isolated hepatocyte culture. The shift of bile salt production to chenodeoxycholates on a high cholesterol intake was demonstrated both in vivo and in vitro. A theory of gallstone formation is presented which hypothesizes a defect in hepatocyte storage of cholesterol rather than bile acid synthesis as the primary effect, relegating the problems to one of a disease of lipid metabolism.     

Analysis of survival versus patient and doctor delay of treatment in gastrointestinal cancer

Three hundred twenty-eight patienta with gastrointestinal cancer were reviewed. Coefficients of correlation between patient or doctor delay prior to treatment and survival were not significant at p < 0.05. No significant relation between delay and whether patients were ward or private was found.Although this report represents no evidence that early diagnosis is or is not beneficial, the concept of early diagnosis needs to be re-evaluated to include primarily asymptomatic patients. Once symptoms have occurred, factors inherent in the tumor-host relationship play a more significant role in survival than does time.     

Stroke following coronary artery bypass grafting: a ten-year study

To identify possible risk factors for the occurrence of stroke during coronary artery bypass grafting (CABG), the cases of 3,279 consecutive patients having isolated CABG from 1974 to 1983 were reviewed. During this period, the risk of death fell from 3.9% to 2.6%. The stroke rate, however, fell initially but then rose from 0.57% in 1979 to 2.4% in 1983. Adjustment of these data for age clearly demonstrated that the risk of stroke has increased largely because of an increase in the mean age of patients undergoing CABG procedures. A case-control study involving all 56 stroke victims and 112 control patients was used to identify those risk factors significantly associated with the development of stroke in univariate analysis: increased age (63 versus 57 years in stroke patients and controls, respectively; p less than 0.0001); preexisting cerebrovascular disease (20% versus 8%; p less than 0.03); severe atherosclerosis of the ascending aorta (14% versus 3%; p less than 0.005); protracted cardiopulmonary bypass time (122 minutes versus 105 minutes; p less than 0.005); and severe perioperative hypotension (23% versus 4%; p less than 0.0001). Other variables not found to correlate with postoperative stroke included previous myocardial infarction, hypertension, diabetes mellitus, lower extremity vascular disease, preoperative left ventricular function, and intraoperative perfusion techniques. Elderly patients who have preexisting cerebrovascular disease or severe atherosclerosis of the ascending aorta or who require extensive revascularization procedures have a significantly increased risk of postoperative stroke.     

Non-syndromic multiple supernumerary teeth transmitted as an autosomal dominant trait

Supernumerary teeth are common in the general population and occur more frequently in-patients with family history of such teeth. Multiple supernumerary teeth are associated with cleidocranial dyplasia and Gardner syndrome. However it is rare to find multiple supernumeraries in individuals with no other associated disease or syndrome. We describe the occurrence of multiple supernumerary teeth in a family occurring as a non-syndromal trait. The autosomal dominant transmission of non-syndromal multiple supernumerary teeth is new.     

Current status of heparin dissolution of gallstones. Experimental and clinical observations.

Investigation of the use of heparin in bile indicates that it has the ability to disperse suspended particles. Clinical experience using a heparinized saline flush in forty-three patients with retained gallstones demonstrated disappearance of the stones in thirty-one of the patients. On this basis we would recommend this treatment for further clinical trials in patients with retained common duct stones.     

Monocyte function in ageing humans

Peripheral blood monocytes from hospitalised patients >60 years of age and <35 yeras, and those from healthy normal controls <35 years, were tested for a range of functional and physiological properties, comprising chemotaxis under agarose, the ability to phagocytose and kill Candida albicans, adhesion to glass and spreading on glass. No significant difference was found between young and old groups, nor between hospitalized and non-hospitalized groups in respect of any parameter. There was some decline in phagocytosis and in spreading in a very old subgroup (>75 years), but this was not statistically significant. This study showed that phagocytic cell function in the elderly does not decline at the same rate as the specific immune response and thus cannot directly account for the increased incidence of infection in the aged.