Malignant hepatoma associated with acquired hepatic cutaneous porphyria.

A 60-year-old woman with a three-year history of an acquired hepatic cutaneous porphyria was discovered to have a porphyrin-producing malignant hepatoma. An attempt was made to treat her with fluorouracil perfused through a hepatic artery catheter. It did not produce shrinkage of the tumor, but the patient remains alive and ambulant a year after the infusion, although her skin lesions (scarring, bulla formation, and hyperpigmentation) on the fingers, back of hands, and face persist and she continues to excrete abnormally high quantities of porphyrin in her feces.     

Multislice proton magnetic resonance spectroscopic imaging in X-linked adrenoleukodystrophy

Multislice proton magnetic resonance spectroscopic imaging permits metabolic analysis of brain tissue in vivo by data acquisition in four oblique axial slices, each 15-mm thick and divided into 0.8-ml single-volume elements. We applied this technique to the systematic study of 25 patients with adrenoleukodystrophy: 3 with the severe childhood or adult cerebral form of the disease, 5 with adrenomyeloneuropathy, 12 with no demonstrable neurological involvement, and 5 women heterozygous for adrenoleukodystrophy who had some degree of neurological disability. Abnormalities on magnetic resonance spectroscopic imaging included a reduction in N-acetyl aspartate, an increase in cholin-containing compounds, and at times, an increase in lactate. Five patients showed abnormalities in the presence of normal-appearing magnetic resonance images, and in 8 other patients the alterations on spectroscopic images were more severe than those demonstrable by magnetic resonance imaging. Correlation with clinical course suggests that an increase in the choline-containing compounds is associated with an active demyelinative process, whereas such compounds are not elevated in lesions that are stable. We conclude that magnetic resonance spectroscopic imaging is a more sensitive indicator of early neurological involvement thatn is magnetic resonance imaging, and that the character of abnormalities detected by the former technique may serve as a gauge of the degree of activity of the demyelinating process and as a guide to the selection and evaluation of therapeutic approaches.     

Endoscopically defined treatment strategies in patients with locally advanced esophageal cancer

Sixty-five consecutive, locally advanced esophageal cancer patients were treated by the West Side Medical Center Esophageal Service at the Cook County and University of Illinois hospitals. Each patient was prospectively evaluated with multiple endoscopies including esophagogastroduodenoscopy, bronchoscopy, nasopharyngoscopy, and laryngoscopy. Twenty-four patients (37%) had endoscopic findings that significantly altered therapeutic regimens. Patients identified as having an obvious or impending esophageal fistula or poor performance status were treated in a palliative fashion. Forty (61.5%) patients were considered candidates for treatment with multimodal therapy which included radiation, chemotherapy, and surgery. There was a response rate of 82.5% and a 1-year disease-free survival of 88.9% which was statistically significant when compared to the other patient treatment groups. These data illustrate the necessity of multiple endoscopic evaluation of locally advanced esophageal cancer patients for stratification into appropriate treatment groups. Aggressive treatment afforded selected patients excellent relief of presenting symptomatology, as well as an improved, more acceptable, disease-free survival.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Phoenix, Arizona, USA, 3 April 1993     

Ameloblastic fibrosarcoma

Ameloblastic fibrosarcoma is an extremely rare tumor. To date only 43 cases have been reported in the literature. An additional case of ameloblastic fibrosarcoma is presented; the clinical features, histologic characteristics, treatment, and the relevance of the presence of dental hard tissue are discussed.     

Inhibition of adenosine accumulation into guinea pig ventricle by benzodiazepines

Several benzodiazepines were compared with dipyridamole for their ability to inhibit the nucleoside transporter specific accumulation of [³H]adenosine into guinea pig ventricle. Diazepam inhibited adenosine accumulation but was considerably less potent than dipyridamole. Lorazepam and flurazepam also inhibited accumulation, but were less potent than diazepam. Coronary vasodilation by diazepam or by dipyridamole probably is mediated via potentiation of adenosine following inhibition of the nucleoside transport system.     

Antibody to the hepatitis B surface antigen in immune serum globulin

A collection of 1,278 lots of immune serum globulin (ISG) prepared by 19 United States manufacturers between 1962 and 1974 were tested for the hepatitis B surface antigen (HBSAg) and antibody (anti-HBS). Ten lots (0.8%), all of which were produced between 1962 and 1965 by two different manufacturers, were weakly positive for HBSAg (by radioimmunoassay). Seven hundred and seven lots (55.3%) were positive for anti-HBS (by passive hemagglutination). In general, titers of anti- HBS in lots of ISG were low, and the prevalence of anti HBS positive lots varied considerably among different manufacturers. ISG prepared from placental material was more commonly positive for anti-HBS than was ISG prepared from plasma. There was a striking overall increase in prevalence and titer of anti-HBS in ISG lots prepared during 1973 and 1974. This probably reflects the effect of elimination of strongly HBSAg-positive plasma units with the onset of routine screening for HBSAg which began in 1972.     

Narcotic antagonists: a reasonable method of treating narcotic dependency.

Historically, narcotic dependence has been treated primarily by substituting one narcotic drug for another. One alternative chemical treatment for narcotic dependency is through the use of a narcotic antagonist. The present study involves the observed side effects and outcome results of treating 40 male heroin addicts with the narcotic antagonist, cyclazocine, in the context of a comprehensive psychotherapeutic program. It is concluded that the side effects of cyclazocine are minimal, that cyclazocine is not diverted to the streets, and that it is an effective tool in the context of a comprehensive treatment program for narcotic-dependent individuals.     

'Changing image': the reduction of self-stimulatory behavior in four profoundly retarded males.

This paper describes the specific programmes devised to reduce the incidence of stereotypic and maladaptive behaviours classified as ‘self-stimulatory’. A brief review of the relevant literature is given and details of the techniques used in the project.