Primary gallbladder melanoma in dysplastic nevus syndrome: report of case and literature review

A case of gallbladder malignant melanoma in a 62-year-old woman is reported. The gallbladder, resected for tumor mass seen on ultrasound examination, revealed neoplastic epithelioid cells with dark granules in the cytoplasm. These cells with pigment were positive immunohistochemically for S-100, HMB45 and vimentin. The patient, affected by dysplastic nevus syndrome, had a history of a melanoma in situ in her left upper arm that was excised 11 years ago. This is only the second case reported to date of primary malignant melanoma in dysplastic nevus syndrome.     

Liver transplant for giant cell hepatitis with autoimmune haemolytic anaemia

Giant cell hepatitis (CGH) with autoimmune haemolytic anaemia (AHA) is a distinct entity with an aggressive course. Immunosuppression may help early disease. A case is reported of a child with GCH and AHA with early disease recurrence after liver transplantation for end stage liver disease.     

Liver transplantation for homozygous familial hypercholesterolaemia

Homozygous familial hypercholesterolaemia is a rare inherited condition with an incidence of approximately one in a million. It is associated with severe premature atherosclerosis and early death from cardiovascular complications. The results of liver transplantation reported to date have suggested only partially effective reduction of the hypercholesterolaemia. Three boys with familial hypercholesterolaemia, aged 10.0 to 15.1 years, received liver grafts at Addenbrooke's Hospital. Their untreated fasting lipid concentrations were grossly raised. All three had angiographic evidence of coronary atheroma and two had exertional angina. One child had such severe atheroma that coronary artery bypass surgery was considered necessary before liver transplantation. All three had straightforward operative and postoperative courses and their lipid concentrations returned rapidly to normal. One boy developed chronic rejection requiring retransplantation. Currently all three boys are well, on normal diets, and with normal liver function. It is concluded that (1) liver transplantation offers highly effective treatment for this lethal condition, (2) timing the operation is difficult but it should be undertaken before coronary artery disease has progressed too far (when combined liver and heart transplantation may be the only possibility), and (3) in well grown children with no previous abdominal surgery the immediate risks of liver transplantation are low but chronic rejection remains a danger.     

Stapedectomy and vertigo

The relationship between vestibular and cochlear function in Stapedectomy was investigated in 722 patients (925 ears). There were no differences in hearing between patients with and without pre-operative complaints of vertigo. Post-operatively patients with long lasting vertigo obtained equally good hearing results as the others. The direction of spontaneous nystagmus post-operatively in relation to the operated ear was of no prognostic significance regarding short term hearing results. However, at follow-up an average of 15 years after the operation, hearing was somewhat poorer in those having spontaneous nystagmus towards the operated ear. At follow-up 17% had an abnormal caloric test.     

Spontaneous osteonecrosis of the knee and medial meniscal tears

Several factors may play a role in the etiology of "spontaneous" osteonecrosis of the medial femoral condyle. Corticosteroids are known to induce osteonecrosis, and 45% of the patients in this study received steroids parenterally or by intra-articular injection. Another factor, heretofore given little attention, is the association of medial meniscal tears and "spontaneous" osteonecrosis. Twenty-one (78%) of 27 knees examined by arthrography demonstrated meniscal tears. Stress concentration over the edge of the meniscal fragment may result in ischemic necrosis of the femoral condyle. Early detection of a medial meniscal tear by arthrography in older patients and prompt treatment may be important in avoiding the late changes of "spontaneous" osteonecrosis.     

Lung function and immunological changes in poultry breeders

Summary The results of the study of 61 persons occupationally exposed to the inhalation of dust from waste materials in chicken breeding are presented. The subjects were divided into three groups: 1. females in permanent exposure, 2. males in permanent exposure, 3. males in intermittent exposure. The following examinations were performed: case histories with special reference to symptoms of allergic alveolitis and/or chronic nonspecific lung disease, testing of skin hypersensitivity to allergens prepared from material collected in working places, blood analysis for the precipitins against chicken dropping and cock serum, testing of ventilatory lung function including measurements of residual volume, and testing of lung diffusion capacity. A very high prevalence of positive early and late skin reaction was found with no large differences between different groups of subjects. The highest percentage of precipitins was found in permanently exposed women. FVC, FEV₁ and MEF 25% values were significantly lower than predicted normal values. A statistically significant increase of the residual volume was recorded in all subjects in permanent exposure. Lung diffusion capacity in all the subjects was normal. The prevalence of acute respiratory symptoms indicative of allergic alveolitis was significantly higher in subjects in permanent than in those in intermittent exposure.     

Morphological changes in experimental duodenogastric reflux

The model of a total duodenal-gastric reflux was developed in 20 dogs and morphological changes in the stomach were studied. 5 dogs served as control. Histologic changes occurred 3.5 months and 1 year after the operation were characterized by metachromasia, increased mucus formation, proliferation of epithelial and parietal cells, moderate inflammation. Process of the disease had fluctuations. 6 months after the operation 5 dogs were reoperated for the elimination of reflux and were observed for another 6 months. A complete reversibility of all changes was established. Bacteriological studies showed a considerable increase of bacteria population in the stomach and a pH increase. The authors suggest the term 'reflux gastropathy" to replace the term "alkaline reflux-gastritis".