Supratentorial recurrences of gliomas. Morphological studies in relation to time intervals with astrocytomas

Summary We report 137 recurrent supratentorial astrocytomas. The primary tumours diagnosed on the basis of a grading system with three stages were 72 astrocytomas I and 65 astrocytomas II. In the first group 14% of the recurrences were not changed, 55.5% became astrocytomas II, and 30.5% became glioblastomas. In the second group 55.4% were unchanged, and 44.6% became glioblastomas. The postoperative intervals until reintervention or death were statistically examined. It seems that the recurrence time chiefly depends on the nature of the primary tumour. The transformation of an astrocytoma I to a glioblastoma takes longer than the transformation of an astrocytoma II into a glioblastoma. In about two thirds of all astrocytomas an increase of malignancy is to be expected. From the histological picture it is not possible in an individual case to predict the likelihood or speed of malignant change. With regard to the effect of irradiation the authors conclude that radiotherapy most probably does not produce malignancy.The authors wish to express their gratitude to the founder and organizer of the Institute of Neurosurgery in Budapest, Prof. Dr. L. Zoltán (), for his promotion of these investigations.     

Current therapy of retrolental fibroplasia. Retinopathy of prematurity

Retrolental fibroplasia, frequently referred to now as the "retinopathy of prematurity," has shown an increased incidence in recent years. This is apparently due to advances in neonatal care, which have resulted in a four- to five-fold improvement in the survival of the extremely low birthweight infants and it is these infants who are at the highest risk of developing retrolental fibroplasia. The use of large supplements of vitamin E, a known antioxidant, is discussed along with other forms of therapy.     

Cation exchange contribution to the retention of specific quaternary ammonium compounds in reversed-phase high-performance liquid chromatography

The influence of electrolytes on the retention of organic cationic solutes in reversed-phase high-performance liquid chromatography (RP-HPLC) has been investigated. The effects of the nature and concentration of electrolytes and mobile phase pH on the retention of two model quaternary ammonium compounds were studied on mu-Bondapak C18 stationary phase with aqueous methanolic eluents. The nature and concentration of inorganic cations added to the mobile phase modified the retention of the solutes. The counter anion of the added electrolyte did not perceptibly influence solute retention at constant mobile phase pH, although it did significantly influence solute retention when the electrolytes were added to unbuffered mobile phases. The retention data are consistent with the inclusion of an ion exchange contribution to the retention of cationic solutes in the systems investigated.     

Exercise and heart disease. Epidemiology of the "exercise hypothesis"

The "exercise hypothesis" states that exercise protects against coronary heart disease. Reviewed herein is the epidemiologic evidence for and against the "exercise hypothesis." The weight of evidence supports the view that exercisers have a lower risk of coronary disease, but that vigorous exercise cannot always prevent progression of coronary atherosclerosis and does increase the risk of sudden death in persons with advanced coronary atherosclerosis. It is concluded that the "exercise hypothesis" is plausible, even likely, but still unproved.     

Focal segmental membranous glomerulonephropathy associated with other glomerular diseases

In four patients with the nephrotic syndrome, renal biopsy revealed focal segmental membranous glomerulonephropathy (FSMGN) associated with the histologic patterns of "nil" disease (two cases), hereditary nephritis and diffuse diabetic glomerulosclerosis. The occurrence of FSMGN in association with other glomerular diseases, presumably unrelated to immune complex deposition, is infrequent in our experience. Rather than necessarily representing an early stage or milder form of membranous glomerulonephropathy, it may be an epiphenomenon. This interpretation has prognostic and therapeutic implications and raises important pathogenetic questions. In particular, this study suggests that in some instances, preexisting functional and structural abnormalities may play a role either in the deposition of preformed circulating immune complexes or in the local formation of immune complexes.     

Long-term survival of patients with multiple myeloma and acute renal failure at presentation

Eight patients presented with simultaneous multiple myeloma and acute renal failure requiring hemodialysis. Patients had no known pre-existing renal disease nor exposure to nephrotoxic agents or x-ray contrast dye. Renal failure was attributed to light chain nephropathy in all cases. In 4 of these patients the diagnosis of myeloma was initially unsuspected. Renal biopsies in 3 of these patients, and post-mortem material in a fourth revealed the changes of "myeloma kidney." No patient regained renal function and all required chronic hemodialysis. Among these eight patients, three survived for periods greater than 21 months.     

The sunflower syndrome. A new look at "self-induced" photosensitive epilepsy

The stereotyped, episodic abnormal behaviour manifested by a child and her mother on exposure to a particular sort of sunlight is described in detail. The child is the first fully documented patient with this so-called "self-induced" form of photosensitive epilepsy in whom for several years no electroencephalographic sensitivity to flickering light could be demonstrated. The probability that the cingulate circuit may be the anatomical substrate involved in the pathogenesis of these patients' unusual response to sunlight is discussed. Both patients also exhibited remarkably persistent habit rhythmias--the one common to both being that of circling.     

Subtotal colectomy for obstructing carcinoma of the left colon

This retrospective review of seven patients with completely obstructing cancers of the left half of the colon, in addition to other reports in the literature, suggests that subtotal colectomy with primary ileal

1 Clinical data on seven patients who underwent subtotal colectomy for obstructing carcinoma of the left colon: 1975–1982.

Patient	Age (yr) and Sex	Tumor Location	Hospital Stay	Comments
1	68, F	Decending	10 days	A and W 40 mo postop1
2	71, F	Sigmoid	22 days	A and W 18 mo postop
3	73, F	Sigmoid	…	A and W 5 yr postop
4	66, F	Decending	8 mo	Dead from complications
5	72, M	Sigmoid	11 days	Incidental cecal cancer; A and W 3 mo postop
6	66, M	Sigmoid	28 days	Alive with metastasis 16 mo postop
7	78, M	Left transvers	34 days	Many other polyps; A and W 9 mo postop

1

A and W = alive and well.

proctostomy may be the treatment of choice for those lesions that are technically resectable and located high enough to permit an intraperitoneal ileal proctostomy. The morbidity and mortality is less than that seen with the staged approach and the length of hospitalization is shorter. By eliminating a second or third hospitalization and a temporary colostomy, palliation is better in those patients who ultimately die from recurrent cancer. Furthermore, those patients resected for cure may have increased rates of long-term survival.     

A comparison of digital subtraction angiography and noninvasive testing in the diagnosis of cerebrovascular disease

Among the 1,892 patients who underwent cerebrovascular digital subtraction angiography at our hospital over the past 18 months, there was a subgroup of 34 patients (65 carotid arteries) for whom noninvasive cerebrovascular test results and standard cerebral arteriograms were also available. These patients were reviewed retrospectively and the ability of both methods to detect hemodynamically significant lesions, defined as a greater than 50 percent reduction in the diameter of the carotid artery, was determined using the arteriograms as the "gold standard." Noninvasive cerebrovascular tests had a sensitivity of 81 percent, a specificity of 95 percent, a positive predictive value of 92 percent, a negative prediction value of 88 percent, and an overall accuracy of 89 percent. Digital subtraction angiography had a sensitivity of 84 percent, a specificity of 92 percent, a positive predictive value of 88 percent, a negative predictive value of 89 percent, and an overall accuracy of 89 percent. If the four cases of hemodynamically significant stenosis of the carotid siphon not detected by digital subtraction angiography had been considered as false-negatives, its sensitivity would have been reduced to 72 percent. In patients with hemispheric cerebral ischemia, we found noninvasive cerebrovascular tests neither necessary nor cost-effective. Digital subtraction angiography, on the other hand, often provided definitive diagnostic information in such patients if the intracranial circulation was well defined and the extracranial lesion corresponded to the patients' symptoms. Noninvasive cerebrovascular testing was the safest and most cost-effective technique for screening patients with asymptomatic bruits, atypical, nonhemispheric cerebral symptoms, and those who have undergone carotid endarterectomy. If the noninvasive cerebrovascular test result was positive or equivocal, digital subtraction angiography was performed to localize the responsible lesion and exclude carotid occlusion.     

Miraculous ophthalmological therapies in Byzantium

A series of cures for ophthalmological diseases practised by saints are described, particularly the Saints Cosmas and Damian and the Saints Cyrus and John, the famous Anargyroi. In the xenones of the Byzantine churches and in the hospitals connected to these, therapeutic regimes, cures and surgical interventions took place at night during incubation, following the example of the ancient Asclepieia. This conclusion stands in spite of the fact that the authors describing the lives of the saints were often clergy who frequently cloak the true therapeutical cures by presenting them in a supernatural manner in order to stress the divine intervention of the saints. From the operations mentioned, it is clear that cataract surgery was among the operations most frequently practised.