The Use of Computer Mapping in Health Research

Display of quantitative data characterizing geographic regions is often most graphically accomplished by the use of outline maps, with enclosed regions shaded or toned to represent data associated with them. Such maps are of considerable value to hospital or regional health planners in demonstrating geographic and demographic characteristics of their service area, as well as health needs and patterns of use of health services. A method is described for the rapid automatic generation of finished flat-tone maps for such purposes by computer techniques, which by virtue of their economy, make such displays available for investigative use as well as for display of final results. Application of the method to study of utilization patterns for inpatient services at the Massachusetts General Hospital is described.     

Side-to-side portacaval shunt versus nonsurgical treatment of Budd-Chiari syndrome

Although a side-to-side portacaval shunt will relieve some patients with Budd-Chiari syndrome, distinction between relief as a result of operation and spontaneous recovery may be inexact. A nonshunting operation relieved one of two patients as much as a side-to-side portacaval shunt did. In these two patients and one additional patient, streptokinase therapy may have been beneficial.     

Cardiac rhabdomyoma: A clinicopathologic and electron microscopic study

Cardiac rhabdomyomas are rare tumors of infancy. In a series of 36 patients 78 percent were under 1 year of age, and only one patient was over age 15 years. Ninety percent of the rhabdomyomas were multiple and occurred with nearly equal frequency in the right and left ventricles. Although reportedly infrequent in the atria, rhabdomyomas involved either one or both atria in 30 percent of patients. In 50 percent of patients at least one of the tumor masses was intracavitary and obstructed 50 percent or more of one of the cardiac chambers or valve orifices. Symptoms referable to obstruction of intracardiac blood flow were present in nine patients, none of whom had tuberous sclerosis, and all of whom would appear to have been good surgical candidates. Histologically the rhabdomyomas were composed of classic “spider cells.” Electron microscopic studies revealed scattered bundles of myofibrils ringing these cells and radiating toward the center; glycogen was present both free in the cytoplasm and within mitochondria. Distinct intercellular junctions resembling intercalated discs with well defined desmosomes and nexuses were present. Many of the cells contained leptofibrils, arranged either peripherally or in spiraled clusters in the center of the cell. Rhabdomyomas derive from cardiac muscle cells and appear to represent hamartomas rather than true tumors.     

The dilemma of Crohn's disease: Ileosigmoidal fistula complicating Crohn's disease

Summary Between 1965 and 1975, 27 patients underwent surgical treatment for ileosigmoidal fistulas complicating Crohn's disease at the Cleveland Clinic. There was no death and no anastomotic leak. The preferred procedure is resection of the ileocecal area involved by Crohn's disease with ileocolic anastomosis and a separate segmental resection of the sigmoid colon with colocolic anastomosis. A covering temporary loop ileostomy is used when there is associated pelvic sepsis or small-bowel obstruction.     

Transposition of the great arteries with posterior aorta, anterior pulmonary artery, subpulmonary conus and fibrous continuity between aortic and atrioventricular valves

A newly recognized type of complete d-transposition of the great arteries is presented. The aortic valve was posterior and inferior to the pulmonary valve in 4 postmortem cases. Deficiency of the subaortic muscular conus permitted tenuous aortic-tricuspid fibrous continuity in 3 of 4 cases and tenuous aortic-mitral fibrous continuity in all by means of a high ventricular septal defect. The crista supraventricularis (parietal band) was entirely above the morphologically left ventricle and was much shorter than normal (average length 3 mm, normal average length 7 mm).

The morphogenesis of these transpositions cannot be explained by the straight truncal septum hypothesis because the truncal septum in these cases was spiral, not straight. These new findings can readily be explained by the conal growth hypothesis, and they indicate the desirability of a literal (accurate) definition of transposition of the great arteries: aorta arising above the morphologically right ventricle and pulmonary artery originating above the morphologically left ventricle. Malpositions of the great arteries include transposition, double-outlet right ventricle, double-outlet left ventricle and anatomically corrected malposition (“transposition”).

Transposition of the great arteries is a relation, not an entity. It is 3 different entities in terms of conal malformations (on the basis of these 4 cases plus a control study of 100 unselected autopsy cases of transposition, accurately defined): (1) subaortic conus with pulmonary-mitral fibrous continuity, 92 percent; (2) subaortic and subpulmonary (bilateral) conus without semilunar-atrioventricular fibrous continuity, 8 per cent; and (3) markedly foreshortened subpulmonary conus with tenuous aortic-atrioventricular fibrous continuity, as in these 4 cases, much less than 1 percent.     

An Inherited Small Extra Chromosome: A Mother with 46,XX,t(17;22) (p1;q1) and a Son with 47,XY,+der(22) mat

A boy with multiple congenital anomalies was found to have a small extra chromosome. This small chromosome was interpreted as a der(22)mat because his mother was a balanced carrier with 46,XX,t(17;22) (p1;q1) chromosomes. It is hoped that with the use of the banding techniques many karyotypes will be revaluated and reinterpreted. The mother's karyotype was erroneously interpreted earlier as a 21/22 translocation.