Conjunctival vascular lesions. Classification and clinical significance with special reference to diabetes

Summary A simple method for screening and photographing the conjunctival vasculature is described. A practical grading system is presented for the commoner variations such as venular congestion, tortuosity, irregular dilatations and microaneurysms, capillary ischemia and ectasias and arteriolar constriction and red-cell aggregation. The significance of the various vascular anomalies is discussed as they are present in the collecting venules, postcapillary venules, capillaries, and in the terminal and branching arterioles. Special emphasis is laid on conjunctival vascular changes in diabetes.Supported in part by Grants from the U.S. Public Health Service (AM-04146), the John A. Hartford Foundation, and the Massachusetts Lions' Eye Research Fund. Dr. Chazan was holder of an Earl WilsonFight for Sight Award, of the National Council to Combat Blindness, Inc.     

Testicular lesions of periarteritis nodosa,with special reference to diagnosis

Significant morbid changes were found at necropsy in the testes of forty-one of forty-four male patients with periarteritis nodosa. Abnormalities included specific lesions in the arteries, recent and healed infarcts, diffuse parenchymal obliteration, focal degeneration of testicular tubules, hematomas and hemorrhage. The testes in a fourth of the patients were obviously smaller than normal. Testicular arterial lesions diagnostic of periarteritis nodosa were found in thirty-eight of the forty-four patients (86 per cent).Symptomatic or objective abnormalities of the testes were noted clinically in eight of the forty-four patients. The rarity of symptoms and signs of testicular abnormalities in other generalized diseases suggests that careful search for testicular pain, tenderness or swelling, or a decrease in size of one or both testes in the presence of evidence of vascular disease in other organ systems may aid in establishing the diagnosis clinically.It is estimated that the diagnosis of periarteritis nodosa can be made by testicular biopsy in one-fifth of male patients who have that disease. Biopsy of a testis may be considered when a clinical testicular abnormality is apparent in a patient suspected of having periarteritis nodosa who does not present any cutaneous, subcutaneous or muscular lesions. Biopsy should include a portion of the tunica vasculosa and of the underlying parenchyma.     

Transforming events in thyroid tumorigenesis and their association with follicular lesions

Thyroid tumors comprise a broad spectrum of neoplastic phenotypes, and distinct molecular events have been implicated in their pathogenesis. Pituitary tumor transforming gene, originally isolated from GH(4) pituitary cells, is tumorigenic in vivo, regulates basic fibroblast growth factor secretion, and is homologous to a securin inhibitor of chromatid separation. Pituitary tumor transforming gene 1 is expressed at low levels in several normal human tissues and is abundantly expressed in neoplasms, including colorectal carcinoma, where pituitary tumor transforming gene expression correlated highly with tumor invasiveness. As pituitary tumor transforming gene is regulated by E and as thyroid cancer shows a strong female preponderance, we examined pituitary tumor transforming gene 1 expression and action in human thyroid tumors and in normal human and rat thyroid cells. Increased pituitary tumor transforming gene 1 expression was evident early in thyroid tumors and was most abundantly expressed in a subset of thyroid hyperplasia, follicular adenomas, and follicular carcinomas (1.8-fold; P < 0.0001). Pituitary tumor transforming gene 1 overexpression in rat FRTL5 thyroid cells and in primary human thyroid cell cultures causes in vitro transformation and produces a dedifferentiated neoplastic phenotype. As pituitary tumor transforming gene 1 was abundantly overexpressed in follicular adenoma and follicular carcinoma, we propose that pituitary tumor transforming gene overexpression may play a role in the early molecular events leading to divergent development of follicular and papillary carcinoma.     

Diagnostic imaging of peripheral soft tissue tumors with special reference to computed tomography

The further development of modern therapeutical procedures in the treatment of soft tissue tumors requires an improvement of radiological diagnostics. The diagnostic values of X-rays, angiography, sonography and computed tomography is estimated critically. The results of own CT examinations in 120 patients with soft tissue tumors and of 50 ultrasound examinations show the importance of these methods in the extent diagnosis of soft tissue tumors. Ultrasound or CT- guided biopsy are helpful to prove the definitive diagnosis. These methods have reduced the use of angiography.     

2:1 bundle branch block1: Classification with special reference to the critical heart rate

A case of 2:1 bundle branch block is described. All 138 consecutive ventricular complexes recorded in the routine twelve lead electrocardiogram were of this pattern. Only twelve other acceptable cases of 2:1 bundle branch block were found in a review of the literature. A synopsis of these is given. The mechanism of production of 2:1 bundle branch block is discussed, especially in regard to critical rate phenomena, theories of the site of delay in bundle branch block and especially in regard to the great rarity of 2:1 bundle branch block. The cases of 2:1 bundle branch block are classified into three groups on the basis of specified changes in cardiac rate.     

Early sequential lesions during development of experimental gastric cancer with special reference to dysplasias

Summary The early sequential development of gastric cancer was studied with experimental animals and examined with respect to what conclusions can be drawn for understanding carcinogenesis in man. After limited oral administration of N-methyl-Nnitro-N-nitrosoguanidine to 174 rats carcinomas developed in most cases directly from the otherwise unchanged mucosa through various successive stages of transformation, without passing through a benignappearing proliferative or neoplastic epithelial lesion. Focal dysplasia grade I was the first recognizable change observed by light microscopy, followed by dysplasia grade II, and subsequently dysplasia grade III. In spite of very similar morphological characteristics, the experimentally induced dysplasias cannot be simply equated in their etiology and biological behavior with the dysplasias of the human stomach. Dysplasias of grade I and II commonly found in man are usually associated with a chronic gastritis; they are located in the upper third of the mucosa and are for the most part reversible. The experimental dysplasias occuring in the proliferative zone of an otherwise undisturbed mucosa must be considered potentially premalignant, as they are irreversible and develop progressively. This finding points out that in man dysplasias grade III within the regenerative zone of non-inflammatory mucosa should be considered particularly as possible precursors of gastric carcinomas.This work was supported in part by a research grant from the Buettner Foundation (Göttingen) This work was reported in part at the Third International Symposium on Detection and Prevention of Cancer, New York, USA, 1976, and at the 62nd meeting of the Deutsche Gesellschaft für Pathologie, Vienna, Austria, 1978     

Esophageal squamous cell carcinoma with special reference to its early stage

The term ‘early squamous cell carcinoma of the oesophagus’, which was previously restricted to superficial carcinoma with no lymph node metastasis, now encompasses intramucosal carcinoma regardless of the nodal status. Such lesions are rare in Western countries, where the experience is limited. In recent years, the development and greater use of chromoendoscopy and narrow band imaging (NBI), both of which facilitate the evaluation of mucosal morphology, have played an important role in the detection of early esophageal squamous cell carcinoma. In addition, the techniques and indications of endoscopic resection (mucosal resection [EMR] and mucosal dissection [ESD]) are still being refined. In the present article, we will discuss the clinical and pathologic features of esophageal early squamous cell carcinoma, as well as the epidemiology and aetiology of esophageal cancer in general. In addition, we will provide a therapeutic decision tree taking into account endoscopic and surgical modalities as they apply to early esophageal squamous cell carcinoma.     

Genetic markers differentiating follicular thyroid carcinoma from benign lesions

Thyroid nodules are commonly encountered during routine medical care. The main problem established by a discovery of a thyroid nodule is to discriminate between a benign and malignant lesion. Fine-needle aspiration (FNA) is the most widely used and cost-effective preoperative test for initial evaluation of a thyroid nodule. While the overall accuracy of FNA for classical papillary thyroid carcinoma (PTC) approaches 100%, it has limited accuracy with follicular lesions. Patients with a cytological report of indeterminate or follicular lesions are referred to surgery for a more accurate diagnosis. A more acute molecular-based test for thyroid nodules is needed not only to improve treatment decisions, but also to potentially reduce the long-term health costs. Several studies have looked into biologic markers that could be used as an adjuvant to distinguish the benign from malignant nodules. This review will focus on those biomarkers that are potentially useful in the diagnosis of thyroid lesions commonly classified as indeterminate.     

Genetic predisposition to clinical manifestations in familial adenomatous polyposis with special reference to duodenal lesions

OBJECTIVES: In familial adenomatous polyposis (FAP), genetic predisposition for duodenal adenomatosis has not been investigated precisely. The aim of this study was to investigate the correlation between adenomatous polyposis coli (APC) gene mutation and duodenal adenomatosis in FAP. METHODS: APC gene mutation was determined by means of a protein truncation test in 34 patients from 25 families with FAP. The prevalence and grade of duodenal adenomatosis were compared among the proximal mutation group (exons 1-9), the distal mutation group (exons 10-15), and the undetermined groups. The correlation between the course of duodenal adenomatosis and APC gene mutation was retrospectively investigated in 19 patients. RESULTS: The prevalence of duodenal adenomatosis was lower in the proximal mutation group (44%) than in the distal mutation (100%) and undetermined (83%) groups. In patients with positive duodenal adenomatosis, the endoscopic grade did not differ among the groups. The endoscopic grade increased in two of the four patients with the proximal mutation group (50%), in three of 10 patients with the distal mutation group (30%), and in two of five patients (40%) with the undetermined group. CONCLUSIONS: Truncating APC gene mutation proximal to exon 9 may contribute to the less frequent development of duodenal adenomatosis in FAP, but severity and progression of duodenal adenomatosis do not seem to be determined by APC gene mutation alone.