Dynamic radionuclide imaging as a means of evaluating vascular perfusion of the upper extremity: a preliminary report

Vascular competence in the upper extremities of 44 patients was evaluated by three-phase bone scans consisting of rapid sequence dynamic radionuclide imaging (DRI), an immediate postinjection "blood pool" image, and a 3- to 4-hour delayed image. Findings were correlated with definitive anatomy determined by arteriography, operative findings, or both, in 50 extremities. DRI provided the correct diagnosis in all but four extremities (92%). Limited resolution precluded precise anatomic definition of aneurysms in three limbs and of digital artery occlusion, with adequate collateral circulation in the fourth limb. The greatest value of DRI was its provision of quantitative information about relative blood flow and preferential perfusion in every instance. We believe DRI to be a useful adjunct to preoperative and postoperative assessment of arterial perfusion.     

Thymic irradiation. An approach to chronic lymphocytic leukemia

Twenty-two patients with active chronic lymphocytic leukemia were treated with thymic irradiation; a full remission was achieved in 14 and a partial response in 7. In a similar group of 28 patients treated with chlorambucil, there were 7 full remissions, 5 partial responses, 6 with white cell control and 10 with no response. Thymic irradiation restored the leukocyte count to normal in 76 per cent of the cases (16 of 21) and the differential in 32 per cent (7 of 22), with complete resolution of lymphadenopathy in 81 per cent (17 of 21), hepatomegaly in 75 per cent (12 of 16), splenomegaly in 76 per cent (11 of 14) and symptoms in 100 per cent (20 of 20). Chlorambucil restored the leukocyte count to normal in 50 per cent (14 of 28) and the differential in 7 per cent (2 of 28), with complete resolution of lymphadenopathy in 43 per cent (9 of 21), hepatomegaly in 43 per cent (9 of 21), splenomegaly in 24 per cent (4 of 22) and symptoms in 64 per cent (16 of 25). Thymic irradiation produced a more rapid response even in patients resistant to chemotherapy and was more effective (11 of 12 or 92 per cent) than chlorambucil (7 of 22 or 33 per cent) in patients with hematocrit readings of less than 30 per cent and/or greater than 75 per cent infiltration of the bone marrow and a leukocyte count of more than 40,000 cells/mm³ and in patients with splenomegaly. Anemia was corrected in all three patients and thrombocytopenia in two of six patients treated with thymic irradiation. Chlorambucil corrected anemia in 2 of 11 patients and thrombocytopenia in 2 of 5 patients. Anemia developed in 5 of 17 patients and thrombocytopenia in 4 of 23 patients treated with chlorambucil and in no patients treated with thymic irradiation.     

Cross-validation of the factor structure of the McGill Pain Questionnaire

Low back pain patients' responses to the McGill Pain Questionnaire (MPQ) were factor analyzed using the principal factor method and direct oblique rotation procedures. Four factors were extracted that accounted for 55% of the total variance. Coefficients of congruence were computed in order to relate the current factors with those extracted in a previous factor analytic investigation. The results provided positive evidence that the sensory pressure, evaluative, and affective-sensory factors that were previously identified are stable dimensions underlying the MPQ responses of low back pain patients. However, it is necessary to conduct further cross-validation studies using patients from a wide variety of treatment settings.     

Second primary bronchogenic carcinomas after small cell carcinoma. Report of two cases and review of the literature

Second primary carcinomas of the lung are well described. However, their occurrence following initial diagnosis of small cell lung carcinoma is rare. The development and antemortem diagnosis of metachronous second primary bronchogenic carcinomas in two long-term (more than four years) survivors of small cell lung cancer is described. The histologic types of the second carcinomas were mucoepidermoid and bronchoalveolar. On the basis of a review of the literature, only eight similar cases have been reported; none of the second primaries was mucoepidermoid or bronchoalveolar. The question of whether second primaries after small cell lung cancer represent true metachronous carcinomas, different degrees of differentiation of the same tumor, or the emergence of a previously unrecognized synchronous tumor is discussed. The need for awareness of this complication and the necessity for life-long follow-up in long-term survivors of small cell lung cancer is emphasized.     

An analysis of Streptococcus pneumoniae identification using biochemical and serological procedures

Five methods for identification of Streptococcus pneumoniae were evaluated with stock strains representing all 83 capsular types and 130 fresh clinical isolates of alpha-hemolytic streptococci. The identification methods included bile solubility, optochin sensitivity, countercurrent-immunoelectrophoresis (CIEP), and coagglutination (CoA) using laboratory-prepared reagents (LPR) and the Phadebact Pneumococcus Test (Phadebact). The Quellung reaction was performed on the 83 capsular types of S. pneumoniae and on the clinical isolates that produced serological cross reactions with the three serological tests and those that were bile-soluble and optochin-sensitive. All 83 pneumococcal types were in complete agreement with each of the different test methods. Of the 130 alpha-hemolytic streptococci, 26 were identified as S. pneumoniae, and 104 isolates were identified as viridans streptococci using biochemical, physiologic, Quellung, or mouse virulence tests. All 104 viridans streptococci were bile-insoluble and optochin-resistant; however, 63 reacted with either one, both, or all three serological methods. Our data suggest that bile solubility and optochin tests are more reliable for pneumococcal identification than serological methods currently available.     

Herpesvirus infection of the esophagus and other visceral organs in adults. Incidence and clinical significance.

An autopsy review covering a 10 year period revealed 56 adult patients with histocytologic evidence of herpesvirus (herpes simplex or varicella-zoster) infection involving nongenital viscera. Review of the clinical records of these patients disclosed that herpesvirus infections were clinically suspected in only seven of them: three patients with cutaneous herpes zoster, two patients with herpetic keratitis and two patients with gingivostomatitis. Nine additional patients also had ulcerative gingivostomatitis, but this was attributed to either fungal organisms or chemotherapy. Forty patients showed no apparent clinical signs or symptoms of herpetic infection. Visceral involvement was not suspected clinically in any of the 56 patients. The most common underlying disease process afflicting these patients was a malignant neoplasm, usually involving the hematopoietic or lymphoreticular systems, but almost one-third had a variety of nonmalignant diseases. The presence of an associated infectious process involving bacterial, fungal or protozoal organisms, or additional viral agents, was confirmed by culture studies or autopsy microscopic findings in all but two patients. The viscus most commonly involved by herpetic infection was the esophagus. Herpetic esophageal ulcers were found in 50 cases, and in 41 cases no other organs appeared involved. Because esophageal ulcers are usually asymptomatic, antemortem diagnosis is extremely difficult. The data derived from this and previous studies indicate that herpetic ulcers frequently become secondarily infected with bacteria and/or fungi and that the greatest clinical significance of these ulcers is as a site of secondary infection, particularly in patients who have undergone immunosuppression (immunosuppressed patients). The advent of effective antiherpesvirus drugs and greater clinical awareness of the disease should serve as a stimulus to establish a clinical diagnosis of visceral herpesvirus infection more frequently.