Pathways of tumor spread through the lung: radiologic correlations with anatomy and pathology

The pathways of tumor spread through the lung are described and their significance for radiographic interpretation is illustrated. A key to understanding the spread of bronchogenic carcinoma is the realization that although the normal flow of lymph in the pulmonary lymphatics is centripetal, lymphatic obstruction can cause reversal of flow. As a result, tumor cells are commonly carried centrifugally to the periphery in lymphatics or the connective tissue around them, and remote pleural involvement, secondary parenchymal masses, or satellite nodules may develop. Failure to appreciate peripheral spread of tumor has negative consequences for tumor staging, surgery, and radiotherapy. In the absence of hilar node involvement causing obstruction, long line shadows more than 0.5 inch (1.25 cm) in length proximal to a peripheral mass very infrequently represent tumor.     

Malignant melanoma of the vulva: Report of 18 cases

Eighteen patients with melanoma of the vulva are reported, 16 with a primary tumor and 2 with a recurrent tumor. Radical vulvectomy with en bloc inguinal and femoral lymph node dissection seems to be the best treatment, though prognosis for patients with positive nodes is poor. Nine of 16 patients with primary tumor were eligible for 5-yr survival. Five of them had no evidence of disease, but a 5-yr survival does not mean a cure.     

Induction of lysosomal storage by suramin

Summary Isolated livers of rats injected with saline or with suramin (250 mg per kg body weight) 24 h previously were perfused with a medium containing radioactively labeled formaldehyde-treated albumin. Suramin-loaded livers released breakdown products at a much lower rate than controls and contained about the double amount of undigested radioactive protein up to about 3 h after the start of the perfusion. These results show that inhibition of proteolysis by suramin as reported previously (Davies et al., 1971; Buys et al., 1973) is not caused by binding of the drug to the substrate in the bloodstream.Electron micrographs of liver sections of suramintreated rats showed that lysosomes of sinusoidal cells resembled those seen in certain lysosomal storage diseases.The effect of suramin on lysosomal enzymes was studied in vitro. When used at a concentration corresponding to the putative concentration in lysosomes in vivo, the drug inhibited the lysosomal endopeptidases cathepsin Bl and D as well as acid phosphatase. Inhibition of acid phosphatase by suramin in vivo could also be demonstrated by histochemical methods. These results suggest that the observed storage phenomena may be mainly caused by inhibition of lysosomal enzymes.     

Differences in total tooth extraction between an urban and a rural area in the Netherlands

Differences in total tooth loss between an urban and a rural area (dentist-patient ratio 1:2500 and 1:5700 respectively) have been studied. Patients who participated in this study were those who received total tooth extraction during the calendar yr 1982 (urban area) and 1983 (rural area). The overall dentist response was 90%, the combined patient response was 75%. During the year, in the urban area 137 cases of total tooth extraction were recorded; in the rural area this was 237. This frequency is equivalent to 109 and 226 total tooth extractions per 100,000 inhabitants, respectively. The age and sex distribution of the urban and rural population could not account for this difference. The rural population had a lower educational level and more people insured in a State Health Scheme, which is related to income. The frequency of symptomatic attenders was highest in the rural area among those who were insured in a State Health Scheme. It is concluded that differences in numbers of total extractions between the rural and urban areas cannot be explained entirely by differences in population characteristics.     

Immunoperoxidase localization of apolipoprotein D in human enterocytes and hepatocytes

In this study we prepared a pure apolipoprotein D and obtained a specific antiserum to it. The purified apolipoprotein D migrated as a single band of Mr = 29,000 but appeared as five isoforms on isoelectrofocusing. The antiserum did not cross-react with other apolipoproteins. Immunoenzymatic staining revealed the presence of apolipoprotein D in the perinuclear area of the cytoplasm of isolated normal hepatocytes and HepG2 cells. Apolipoprotein D was also localized in intestinal epithelium and in liver cells. The intracellular distribution of apolipoprotein D was similar to that of apolipoprotein B. Our results indicated that apolipoprotein D, like many other circulating apolipoproteins, is synthesized in enterocytes and hepatocytes.     

The willingness of general practitioners to be involved in the follow-up of adult survivors of childhood cancer

Background Long-term follow-up of childhood cancer survivors is mainly organised by paediatric oncologists and until now general practitioners (GPs) are rarely involved. To ensure appropriate follow-up for all survivors into adulthood, a combined effort of paediatric oncologists and general practitioners might be the solution. We investigated the willingness of GPs, who had followed a postgraduate course on late effects of cancer treatment, to participate in a shared care model for follow-up of adult childhood cancer survivors as well as what their requirements would be in case of participation. Methods From the Northern Netherlands, 358 GPs participated in a postgraduate course on late effects in paediatric cancer survivors. After the course, they were asked to complete a 10-item questionnaire on motivation to participate in the regular follow-up of adult childhood cancer survivors as well as their conditions to participate. Results The response rate was 65%. Of the responders, 97% were willing to participate in a shared care model for follow-up and 64% felt that it was their responsibility to be in charge of childhood cancer survivors. The main requirements for participation were the availability of guidelines (64%), sufficient information about the patient’s medical history (37%), and short communication lines (45%). The main barriers to participate were workload (16%), lack of knowledge (15%), and lack of communication (13%). Conclusion A significant number of GPs are ready to participate in the long-term follow-up of adult childhood cancer survivors if adequate guidelines and medical information is provided and communication lines are clear.     

Clinical signs of pneumonia in infants under 2 months

To determine clinical signs that can predict pneumonia (confirmed by radiography) in infants under 2 months of age, 101 infants with pneumonia and 150 with an upper respiratory infection (but not pneumonia) were studied. Ten infants with pneumonia and 15 with an upper respiratory infection did not have the cough and/or difficult (or rapid) breathing that are recommended as 'entry criteria' by the World Health Organisation (WHO). The remaining infants met WHO entry criteria; in them sensitivity and specificity of respiratory rate > or = 60/min and/or severe chest indrawing to diagnose pneumonia was 85% and 97% respectively. Addition of four non-specific signs (stopped feeding well, looked sick, temperature < or = 38 degrees C, and abdominal distension) to respiratory rate > or = 60/min and/or chest indrawing for case identification resulted in a 7% gain in sensitivity but 22% loss of specificity. Addition of nasal flaring improved the sensitivity by 6% without loss of specificity. However, the non-specific signs were the only clue to diagnosis in five infants weighing < or = 2500 g. At age < 7 days, a weight < or = 2500 g and cyanosis were associated with significantly higher risk of mortality. These findings support the use of a respiratory rate > or = 60/min and/or chest indrawing for identification of pneumonia, and suggest addition of nasal flaring to the criteria for case identification in infants under 2 months with cough and/or difficult or rapid breathing.