Oncocytic Schneiderian papilloma: a reappraisal of cylindrical cell papilloma of the sinonasal tract

Cylindrical cell papilloma (CCP) is the rarest of three morphologically distinct papillomas that occur in the nose and paranasal sinuses. Because it is unfamiliar to many pathologists, it is often mistaken histologically for papillary adenocarcinoma or even rhinosporidiosis. The clinical and pathologic features of six new cases are reported and compared with those of 14 others reported in the literature. The results of the light microscopic, histochemical, immunocytochemical (cytochrome c oxidase), and ultrastructural studies described here provide conclusive evidence that the swollen, granular, eosinophilic epithelial cells that compose CCP are true oncocytes that arise primarily, or perhaps exclusively, from the respiratory (Schneiderian) epithelium of the sinonasal passages rather than from minor salivary glands. Continued designation of the CCP as such should therefore be discouraged in favor of a more precise term reflecting this derivation. The phrase "oncocytic Schneiderian papilloma" is proposed.     

Calcium metabolism in renal failure

Osteodystrophy is almost universally present in chronic renal failure. Mild, but detectable, abnormalities—especially in parathyroid hormone (PTH) secretion—occur even when the glomerular filtration rate is greater than 30 cc/min. Osteomalacia is common in areas in which vitamin D intake and exposure to sunlight are minimal; when these factors are plentiful, osteitis fibrosa predominates. Osteoporosis is seen with increasing frequency in hemodialyzed patients. Nonosseous complications of secondary hyperparathyroidism include hypercalcemia, metastatic calcification and pruritus. The most important factor in the medical therapy of Osteodystrophy is control of serum phosphate levels. Next, a positive calcium balance must be provided either by giving vitamin D as dihydrotachysterol, raising dialysate calcium or administering calcium orally. Parathyroidectomy is sometimes indicated, especially when the patients are transplant candidates and manifest hypercalcemia. Whether or not transplant is contemplated, patients with persistently high calcium-phosphate products, severe metastatic calcification or rapidly progressive Osteodystrophy should be considered for parathyroidectomy. Newer, experimental vitamin D preparations, such as 1,25-dihydroxycholecalciferol or 1-alpha-hydroxycholecalciferol, should improve the management of patients with renal Osteodystrophy and decrease the need for parathyroidectomies.     

QT interval measurement by a computer assisted program: a potentially useful clinical parameter

The duration of electrical systole (QT interval) was measured in 72 subjects (48 women and 24 men) who had normal coronary arteries and left ventricular function at cardiac catheterization (group 1). The same measurements were obtained in 100 patients with a normal ECG (from 40 women and 60 men referred to our institution and found normal on a noninvasive clinical basis) and compared to a double independent manual calculation (group 2). The computer assisted program was found reliable in QT interval measurements. In both study groups women showed longer QTc. No difference in QTc duration was seen in subjects taking beta-blockers prior to angiography. As compared to group 1, subjects of group 2 showed similar average QTc values. However, 9 out of 100 subjects of group 2 had abnormal QTc as compared with none of group 1 (p less than 0.05). QTc calculations may improve the usefulness of computer assisted programs in ECG interpretation. Present data can be used as reference values for normality. They stress in addition the necessity of introducing the heart rate correction for the interpretation of QT interval. This can help in stimulating prospective clinical studies to assess the value of QTc as an index of risk for cardiac dysrhythmias.     

Preservation of sight after complete destruction of the eyelids by burning

The destruction of the upper and lower eyelids by burning may present the surgeon with an urgent problem of preparing skin flaps to save the eyes. The outlook will become more serious if the eyes themselves are damaged, but even if the corneas become severely scarred it may be possible to restore sight by the use of a keratoprosthesis. A successful, illustrative case is reported.     

Analysis of the differential diagnosis and assessment of pleuritic chest pain in young adults

The most important problem in the approach to young patients with acute pleurisy is distinguishing those with idiopathic or viral pleurisy from patients with pulmonary embolism. Three clinical features are helpful in making this distinction: (1) pleural effusion(s) present on chest roentgenography, (2) history of predisposing factors for or past history of veno-occlusive disease, and (3) physical signs indicative of phlebitis. Lung scanning should be performed in patients with these findings. If results of scanning are highly characteristic of pulmonary embolism (segmental or lobar defect with ventilation/perfusion mismatch) in such a patient, anticoagulation may be considered immediately. Patients in whom scanning reveals indeterminate characteristics or abnormalities not characteristic of pulmonary embolism should undergo pulmonary angiography if other clinical features suggest that the probability of pulmonary embolism remains at least moderately high.     

Right atrial ultrastructure in congenital heart disease. I. Comparison of ventricular septal defect and endocardial cushion defect

Ultrastructural studies were performed on portions of the operatively resected right atrium from six patients with a ventricular septal defect and six patients with an endocardial cushion defect. The six patients with a ventricular septal defect had normal right atrial mean pressure and no evidence of right atrial volume overload. Ultrastructurally, the atrial muscle cells in these patients appeared normal and measured 6 to 12 μ in diameter. The six patients with an endocardial cushion defect had elevated right atrial mean pressure and evidence of right atrial volume overload. Ultrastructurally, the atrial muscle cells in these patients were generally larger than 12 μ in diameter. The cells were irregular and had multiple and occasionally widened intercalated discs. In addition, there were degenerative changes in two patients with markedly increased atrial pressure. These changes included extensive loss of contractile elements, aggregation of small irregular mitochondria and proliferation of tubules of the sarcoplasmic reticulum. The structural changes suggest that hypertrophy of the right atrium may be secondary to volume overload of the atrium, whereas degenerative changes may be secondary to increased right atrial pressure.     

Musical murmurs: An echo-phonocardiographic study

Five patients with musical murmurs were studied noninvasively with simultaneous echocardiography and phonocardiography. Three patients had aortic regurgitation, one mitral regurgitation and one tricuspid regurgitation. The frequency of the musical murmurs ranged from 40 to 158 cycles/sec. The patient with tricuspid regurgitation manifested an inspiratory honk. Simultaneous echo-phonocardiography revealed regular valve leaflet flutter (aortic, mitral or tricuspid) at a frequency identical to that of the simultaneously recorded musical murmur. This study demonstrates that echocardiography is a useful noninvasive tool in identifying the site of origin of musical murmurs.