Congenital hypertrophy of the retinal pigment epithelium. Electron microscopic and morphometric observations

Congenital hypertrophy of the retinal pigment epithelium (CHRPE) is a well-circumscribed, flat, pigmented fundus lesion that is stable and generally nonprogressive. Light and electron microscopy and morphometric analysis was used to study a lesion with the clinical characteristics of CHRPE found in an eye enucleated for a posterior segment malignant melanoma. These studies showed that the lesion was composed of tall, maximally pigmented RPE cells that had a density 1.7 times greater than the density of the adjacent normal peripheral RPE. These observations suggested that cellular hyperplasia and hypertrophy may contribute to CHRPE. Ultraviolet fluorescence microscopy showed no autofluorescent granules of lipofuscin in the CHRPE, suggesting that the lesion's constituent cells lack the capacity to phagocytose and digest photoreceptor outer segments. Photoreceptor degeneration in the overlying retina consequent to this functional defect could be responsible for the localized visual field defects that typically occur in patients with CHRPE.     

Iopamidol and meglumine diatrizoate: comparison of effects on patient discomfort during aortofemoral arteriography

Iopamidol was compared with Renografin-60 (meglumine diatrizoate, Squibb) in a controlled, randomized double-blind study of 40 patients undergoing peripheral arteriography for arteriosclerotic occlusive disease to determine which agent caused less discomfort. Each patient was evaluated for objective signs of discomfort and subjective feelings of pain and heat. Monitoring was achieved by multiple physical examinations, chemical tests, electrocardiograms, and intra-arterial pressure recordings. It is concluded that iopamidol is safe and causes significantly less patient discomfort than Renografin-60.     

Plasma prolactin and its relationship to risk factors in human breast cancer

The prolactin concentration has been determined in plasma from ostensibly healthy women living on the Island of Guernsey. There were 102, 42 and 41 women who had a mother, sister or maternal aunt, respectively, with breast cancer. The remaining 184 women in this study claimed to have no known family history of breast cancer and were used as a control group. The increased risk of breast cancer due to familial history was not associated with a raised mean prolactin level compared to the control group. However, in the luteal phase of the menstrual cycle, daughters of breast cancer patients had significantly raised levels of prolactin at 19.00 h. There were no abnormalities in the mean plasma prolactin levels for the above groups associated with differences in age at first child, age at menarche, interval between age at menarche and first child, and body weight of post-menopausal women. (All these factors have been reported to influence breast cancer risk). It is concluded that prolactin has no obvious function in the aetiology of breast cancer. If it is involved, the mechanism by which it acts must be subtle and concerned with the homeostatic control governing nycthemeral prolactin rhythms.     

Some aspects of pituitary function after neuroadenolysis in patients with metastatic cancer

The effects of neuroadenolysis on plasma titres of beta-endorphin, beta-lipotropin, ACTH, TSH and prolactin have been investigated in five patients with metastatic cancer who responded to the treatment and have been in remission for more than four years and in five others who were undergoing the treatment for the first time for pain due to cancer metastases. beta-Endorphin, beta-lipotropin and ACTH titres were within the normal ranges of values in both categories of patients but post-neuroadenolysis titres of these peptides were higher than those before the treatment. The ability to secrete TSH and prolactin and to respond to thyroid stimulating hormone releasing hormone (TRH) remains intact following the treatment. However, whereas basal TSH titres and response to TRH was lower in the majority of patients, no such effect was observed on prolactin secretion. Plasma titres of prolactin and TSH were below the sensitivity of the method in the five patients who are in remission for more than four years. These preliminary findings suggest that neuroadenolysis probably affects some mechanism(s) associated with the control of beta-endorphin, beta-lipotropin and ACTH synthesis.     

Early results of local application of 13-cis retinoic acid in the treatment of leukoplakia of the vulva

A group of 35 patients with leukoplakia of the vulva was treated with 13-cis retinoic acid applied topically. Complete or partial remission occurred in 17 patients. Parallel determination of retinol level in sera revealed its increased value as compared to healthy persons.     

Legalized abortion: the Singapore experience

Abortion has been legal since 1970 in Singapore. This report traces the events leading to the liberalization of abortion laws and examines women's changing attitudes toward abortion, in Singapore. The method of abortion practiced by obstetricians, postabortal sterilization, and the effect of legalized abortion on the incidence of illegal abortion in the country are also examined.     

Does preoperative needle localization lead to an increase in local breast cancer recurrence?

Between 1978 and 1981, 74 women with nonpalpable breast cancer underwent surgery after localization guides were placed. In 72 patients, guides were introduced parallel to the chest wall; in two the needle was positioned anteroposteriorly under computed tomographic guidance. Fifty-six cases (76%) were infiltrating cancer; 13 (17%), intraductal cancers; two (3%), inflammatory; and three (4%), lobular carcinoma in situ. Surgery was not used to treat the latter five patients. In the remaining 69 women, 42 (61%) were treated by means of modified radical mastectomy; six (9%), total mastectomy; 12 (17%), local excision and radiation therapy; and seven (10%), local excision alone; exact therapy for two women (3%) was unknown. At a minimum follow-up of 5 years, none of the 67 women in whom the parallel approach was used had a local recurrence. The authors conclude that preoperative placement of guides parallel to the chest wall does not appear to increase the risk of local breast cancer recurrence.     

A review of distal ulnar hemi-resection arthroplasty.

15 patients with pain and disability on the ulnar side of the wrist were treated by distal ulnar hemiresection arthroplasty. The patients' diagnoses fell into three groups, namely ulnocarpal impingement, primary osteoarthritis of the distal radio-ulnar joint and traumatic disruption of the distal radioulnar joint. Patients were assessed pre- and post-operatively on the basis of pain and forearm rotation. Grip strength was assessed and compared with the unaffected side. Their subjective view of the operation was also sought. The best results were seen in those patients with osteoarthritis or traumatic disruption, although all patients were improved and none made worse. No patient complained of weakness although three were assessed to have a weak grip. Subjectively, 14 of the 15 were pleased or very pleased. The procedure was well tolerated and had low morbidity.