A late complication of pectus excavatum repair.

We report a late complication of pectus excavatum repair which highlights the importance of a chest X-ray in evaluating chest pain in patients who have had previous chest surgery. It also raises the question of whether or not implanted wires should be electively removed following bony union.     

A sensitive and specific assay for 5-methoxytryptophol in plasma.

5-Methoxytryptophol (ML) is found in the pineal gland and is known to have biological activity especially as an antigonadotrophic agent, but methods have been lacking for its measurement in the circulation. A gas chromatography-mass spectrometry assay using a trimethylsilyl derivative has been developed for the routine measurement of ML in plasma. The assay is of great specificity and has a sensitivity of 20 pmol/l. Studies on the levels of pineal indoles in the circulation, however, have been hampered by the possibility that extraneous compounds are being cross-measured. Thus the specificity of the routine assay has been further validated by comparing it with an alternative assay system where all the major parameters were changed, i.e. derivatizing reagent, internal standard and mass number. Results that were obtained using both assay systems were closely comparable.     

Oral urea in the treatment of colo-rectal liver metastases

A consecutive series of 10 patients with hepatic metastases from colo-rectal carcinoma have been treated with oral urea. This substance has been reported to produce regression of hepatic secondaries from a variety of primary sources including colon. Although well tolerated, and leading to subjective improvement in some patients, no objective benefit has been confirmed from the treatment in this study.     

PYOGENIC OSTEOMYELITIS OF THE SPINE

The records of 30 patients who had suffered from vertebral osteomyelitis were reviewed. They conformed to a constant pattern, though varying in terms of: (i) the severity of the disease, due to host-organism interrelationship; and (ii) age distribution. Causative organisms could not always be identified, though all lesions settled with conservative measures of rest and antibiotics. A high proportion of the patients who were followed up for more than one year were back at work. The anatomical distribution of the lesions can be explained by our knowledge of the vascular supply to the vertebral bodies.     

Epigenetic carcinogens: problems with identification and risk estimation

The mechanisms of carcinogenesis are just beginning to be understood. There is recent interest in the broad classification of carcinogens into two categories based upon their mechanism of action: those that interact with DNA via a genetic mechanism are termed genetic carcinogens; and those that do not directly interact with DNA, but may cause changes in DNA tertiary structure or methylation patterns, and are termed epigenetic carcinogens. Present knowledge is inadequate to justify separate risk assessment methods for genetic vs. epigenetic carcinogens. Quantitative estimates of carcinogenic risk are currently best made using non-threshold models.     

Computer Diagnosis of Thyroid Carcinoma*,†

Summary: This paper describes a retrospective study comparing the probabilities of thyroid carcinoma occurring as calculated by a computer with the histopathological diagnosis. In a series of patients subjected to thyroidectomy for nontoxic goitre, the computer calculated probability of thyroid carcinoma correlated well with the final diagnosis. The predicted probability of carcinoma of the thyroid was arbitrarily grouped into five ranges, varying from low probability of less than 5% to high, greater than 75%. The incidence of carcinoma in the low probability group was 1.5% while in the high probability group it was 42.9%.