PARTIAL CYSTECTOMY DURING RADICAL SURGERY FOR NONUROLOGICAL MALIGNANCY

PURPOSE: It is not uncommon for a locally advanced, nonurological malignancy to invade the bladder. Partial cystectomy may be required to ensure complete tumor eradication. To our knowledge the true benefit of this procedure is unknown. MATERIALS AND METHODS: A total of 45 patients underwent partial cystectomy as part of radical surgery for a nonurological malignancy. We retrospectively reviewed these cases to determine which malignancies are prone to invade the bladder, the incidence of malignant invasion, the complication rate and the prognosis after wide en bloc resection. RESULTS: Colorectal adenocarcinoma accounted for the majority of cases. Tumor invaded only 11 bladder specimens (21.5%). Radical surgery was performed with curative intent in 30 patients, of whom 23 had negative surgical margins. At a mean followup of 30.7 months 16 of these 23 patients (69.6%) were free of disease or died of other disease processes. Disease progression and/or cancer related death occurred in 14 of the 15 patients (93.3%) who underwent surgery for palliation and in 16 of the 17 (94.1%) with positive margins at a mean of 21.7 months. Overall disease specific survival in those with malignant invasion was 27.3% compared to 41.2% when the bladder was fixed by a dense fibrous reaction only. No reported complications were related to partial cystectomy at followup. CONCLUSIONS: Advanced primary and recurrent nonurological malignancies often involve the bladder. Partial cystectomy may be necessary due to a dense fibrous reaction or direct tumor extension. While this distinction is made only after formal pathological results are reviewed, wide en bloc resection is necessary to ensure complete excision. When radical surgery is performed with curative intent and negative surgical margins are achieved, patients are likely to experience prolonged disease-free survival.     

FENCLOFENAC-INDUCED SELECTIVE IGA DEFICIENCY IN RHEUMATOID ARTHRITIS

A 35-year-old man with seropositive rheumatoid arthritis developedselective IgA deficiency during treatment with fenclofenac.His arthritis remained quiescent while taking the drug and followingits withdrawal his condition relapsed and his serum IgA levelreturned to normal. This case demonstrates the association ofselective IgA deficiency with remission in rheumatoid arthritisinduced by fenclofenac as well as aurothiomalate and sulphasalazine.It also shows severe relapse after withdrawal of fenclofenac. KEY WORDS: Rheumatoid arthritis, Selective IgA deficiency, Fenclofenac     

Impaired macrophage leishmanicidal activity at cutaneous temperature

Summary Temperature is one of the primary influences upon the pathogenesis of cutaneous leishmaniasis. In this study, we measured the temperature of murine leishmanial lesions and determined the ability of lymphokine (LK) activated macrophages to kill Leishmania major at these temperatures. The temperature of leishmanial lesions in BALB/c and C3H/HeN mice ranged from 27°C to 32°C. We found that LK activated resident or inflammatory macrophages exhibited significantly less leishmanicidal activity in vitro at temperatures closer to those measured in vivo . The decrease in microbicidal activity was not due to the enhanced growth of the parasites at lower temperatures, since impaired killing was also observed against non-replicating radiation attenuated amastigotes. Finally, the tumoricidal activity of macrophages was found to be significantly depressed at temperatures below 37°C, indicating a generalized impairment of macrophage function at these temperatures. These findings suggest that impaired macrophage microbicidal activity at cutaneous temperatures may contribute to parasite survival, and imply that healing of leishmanial lesions, as well as other cutaneous infections, may require an exceptionally potent local LK response.     

Morphology of the Cardiac Conduction System in Patientswith Electrophysiologically Proven Dual Atrioventricular Nodal Pathways

Conduction System in Dual AV Nodal Pathways. Introduction: Although the electrophysiologic criteria for dual atrioventricular nodal pathways are well established, the anatomical substrate is still unclear.
Methods and Results: We examined the hearts from 10 patients who had been studied electrophysiologically prior to cardiac transplantation. All 10 patients were male, aged 22 to 60years. Nine of the 10 patients had dual atrioventricular nodal pathways according to acceptedcriteria. Histologic studies of the atrioventricular conduction system showed normal structureof the atrioventricular node in all 10 hearts, with minor variations within the node in 3 cases, within the penetrating bundle in 3 cases, and within the nonbranching bundle in 3 cases. Theatrial approaches to the atrioventricular node were generally scanty in 6 hearts. The solitarycase that was shown electrophysiologically to lack dual pathways had no obvious difference inthe structure of the nodal area other than sparsity of transitional cells. We were unable tolocate any extranodal atrial tracts as described by other investigators.
Conclusion: The anatomical substrate for conduction over dual pathways may he too subtleto be detected by gross morphologic studies. Since dual pathways were unmasked in allpatients but one during electrophysiologic studies, it may be that the potential for these pathways is ubiquitous.     

The Impact of Increased Availability of Wine in Grocery Stores on Consumption: four case histories

Regression analyses were performed on per capita wine consumption in four states of the U.S.A. where the availability of wines was increased. In three of four states, wine consumption was found to be significantly greater in the years of the changes than one would expect, based on the regression trends of the previous eight to thirteen years. Differences in findings were probably a reflection of differences in the nature and extent of the increased availability among the four stales. Consumption of beer and spirits was also analysed for the years in question, and substitution from beer or spirits to wine was not found. Finally, alternative explanations for the patterns of increases were examined and considered unlikely.