The potential value of the demonstration of thyroglobulin by immunoperoxidase techniques in fine needle aspiration cytology

The peroxidase-antiperoxidase method for the demonstration of thyroglobulin was performed on 30 fine needle aspiration smears. All of the benign thyroid lesions plus the papillary and follicular carcinomas of the thyroid were positive for thyroglobulin. Two cases of metastatic thyroid carcinoma in lymph nodes were also positive. Medullary carcinoma of the thyroid and ten control smears from various other tissues were negative. This proves the sensitivity and the specificity of the method, which may be used in routine cytology and may add to the accuracy of diagnosing metastatic tumors suspected of being of thyroid origin. The intranuclear cytoplasmic vacuoles in papillary carcinoma of the thyroid were negative for thyroglobulin. This unexpected finding is demonstrated, and a possible explanation is offered.

Michaelis-Gutmann bodies in a healing brain infarct

A case of Michaelis-Gutmann bodies in a healing brain infarct is described. Morphologically this was consistent with cerebral malacoplakia. There are only 6 previously reported cases of cerebral malacoplakia, and only 1 of them was a consequence of postpartum stroke. The histologic and ultrastructural features of the malacoplakia lesion are reported and compared with the previously reported cases.

Cytodiagnosis of a spindle-cell tumor of the breast using antisera to epithelial membrane antigen

A case of an unusual breast tumor is described in which the smear from a fine needle aspiration (FNA) biopsy caused difficulty in differentiating between a spindle-cell carcinoma and a sarcoma. The problem was resolved by the immunoperoxidase demonstration of epithelial membrane antigen (EMA) in the cells, thus enabling a definitive diagnosis of spindle-cell carcinoma to be made. This case further demonstrates the utility of demonstrating EMA in FNA specimens to distinguish between epithelial and nonepithelial neoplasms.

Radionuclide angiography in congenitally corrected transposition of the great vessels in an adult

The case of a 34-yr-old man with congenitally corrected transposition of the great vessels is described. Both first-pass and equilibrium radionuclide angiographic data were acquired and demonstrate the value of both studies in delineating the ventricular inversion and the transposed great vessels that are characteristic of this disorder. In addition to the anatomic information, the ejection fractions of the venous and systemic ventricles at rest and during exercise, the lack of any left to right shunt, and the presence of systemic A-V valve insufficiency can all be obtained from the scintigraphic data.

Adenomyomatous hamartoma of the small intestine: a rare cause of intussusception in an adult

A case of small intestinal obstruction in an 82-yr-old woman caused by an ileoileal intussusception is reported. At the leading point of the intussusceptum an adenomyomatous hamartoma was found. In a review of the literature we were unable to find a similar case.

Lymphoid hypophysitis associated with sudden maternal death: report of a case review of the literature

A case of lymphoid hypophysitis in a woman who died during labor is presented. From a review of the 14 previously reported cases it is apparent that this is a specific disease entity, that it involves only woman, especially in association with pregnancy, and that it may have a fatal outcome. The clinical manifestations are either related to hypopituitarism, or those of a space occupying lesion. Attention drawn to the possible occurrence of the disease may result in earlier recognition of the disease and a better outcome of this potentially fatal disease.

Budd-Chiari-like syndrome in Caroli's disease

Caroli's disease was complicated by a Budd-Chiari-like syndrome as a result of enlarged lymph nodes that compressed the vena cava. Histologically the picture was compatible with "sinus histiocytosis with massive lymphadenopathy." We discuss the combination of these two rare disorders.

Background correction in first-pass radionuclide angiography: comparison of several approaches

This study was designed to test the comparative accuracy of several commonly used background correction techniques in first-pass radionuclide angiography (FPRNA). Thirty patients underwent FPRNA and single plane contrast angiography (CA) within 1 hr of each other. The left ventricular ejection fractions (LVEF) calculated from the different background subtraction approaches to FPRNA were compared to the CA LVEF. When applied to a representative cycle, a horseshoe-shaped background region of interest (BKROI) underestimated LVEF (p less than 0.005, r = 0.91, s.e.e. = 0.06) while a ring shaped BKROI adjusted at end-systole for aortic valve motion insignificantly overestimated LVEF (p = NS, r = 0.91, s.e.e. = 0.07). A lung background approach applied to a representative cycle gave the best correlation with CA (p = NS, r = 0.96, s.e.e. = 0.04). Without using a representative cycle, time-activity curves from a horseshoe-shaped BKROI and the LV ROI were created and the LV curve was normalized to the peak counts in the BKROI curve. LVEF calculated from the normalized curve correlated favorably with CA LVEF (p = NS, r = 0.91, s.e.e. = 0.08). The influence of some recently described improvements in representative cycle generation are also documented.

Arm vein uptake of thallium-201 during exercise: incidence and clinical significance

We prospectively analyzed several clinical and technical variables that might be associated with arm vein uptake of 201Tl during stress thallium scintigraphy in 63 patients. The influence of site (medial antecubital vs. other vein) and technique (with or without a 15-cc saline flush) were examined. Arm vein uptake was not seen after medial antecubital injections except in one case injected through a 24-hr-old indwelling catheter. Arm vein uptake was seen in 24/45 (53%) of cases injected into veins other than the medial antecubital. A saline flush did not reduce the incidence of arm uptake. In patients with normal myocardial studies, those with positive arm uptake had 33% lower net myocardial counts on the postexercise images (p = 0.00008) and 20% lower net myocardial counts on the delayed images (p = 0.04). Myocardial washout of thallium was significantly (p = 0.009) slower in those with arm uptake.

High count rate first-pass radionuclide angiography using a digital gamma camera

In this study, first-pass radionuclide angiography (FPRNA) was performed using a digital single-crystal gamma camera. Twenty-nine men and six women (ages 43-80, mean 61 yr) underwent FPRNA in the supine position immediately prior to cardiac catheterization. Total counts/sec in the whole field-of-view in the right ventricular phase were 150,352 +/- 26,006. Background uncorrected counts in the representative cycle were 7,651 +/- 2,527 at end-diastolie and 4,904 +/- 2,314 at end-systolie. A linear correlation between FPRNA left ventricular (LV) ejection fraction and contrast LV ejection fraction gave an r = 0.95 with an s.e.e. of 0.05. Analyses of intra- and interobserver variability gave r = 0.99 and 0.98 and an s.e.e. of 0.02 and 0.03, respectively. Spearman-Rank correlation coefficients between FPRNA and contrast angiographic wall-motion scores were greater than 0.8 for all walls, while sensitivity/specificity were 0.86/0.90, 0.76/1.00, 0.76/1.00 for anterior, apical, and inferior wall-motion abnormalities, respectively. We conclude that satisfactory counting statistics for FPRNA can be obtained with a digital gamma camera, and that accurate and reproducible measurements of global and regional left ventricular function can be obtained with this technique.

Liver granulomas: a possible paraneoplastic manifestation of hypernephroma

A patient with hypernephroma presented with signs of liver dysfunction. Liver biopsy disclosed the presence of granulomas. Extensive search for a known cause of hepatic granulomas was negative. The presence of granulomas in lymph nodes draining the neoplasm, the improvement of liver dysfunction after nephrectomy, and its aggravation preceding overt metastatic manifestation support the existence of a cause and effect relationship between the renal cell carcinoma and the liver granulomatous disease.

Diagnostic use of the immunoperoxidase technique for cutaneous plasma cell lesions

Distinguishing cutaneous neoplastic plasma cell infiltrations from inflammatory reactions containing predominantly plasma cells can present diagnostic problems when conventional histological techniques are used. Eight cases of cutaneous lesions, composed almost exclusively of plasma cells, are presented. We discuss the use of the peroxidase-antiperoxidase technique to distinguish malignant plasma cells that produce only one type of immunoglobulin from benign lesions that are polyclonal and produce several immunoglobulins.

Metastatic carcinoma of oral soft tissue

Metastatic carcinomas to the oral region are rare. Most of the lesions are located in the bones of the jaw. The medical literature contains quite a few examples of metastatic lesions located strictly in the oral soft tissue. We present two cases of oral soft tissue metastatic carcinoma of urogenital origin.

Salivary duct carcinoma of the parotid gland. Cytologic and histopathologic study

Ductal carcinoma is an uncommon tumor of the salivary glands. Histopathologically, it is characterized by the presence of intraductal and infiltrative neoplastic components, morphologically resembling mammary carcinoma. A case of ductal carcinoma of the parotid gland, in which preoperative fine needle aspiration biopsy was performed, is presented. Cytologic examination of the aspirate revealed naked nuclei featuring anisokaryosis, chromatin clumps and clear vacuolar zones.

The effect of lithium chloride on tumour appearance and survival of melanoma-bearing mice

The possible effect of lithium chloride, a compound which reduces the incidence of infection in cancer patients, was investigated on murine melanoma. C57 BL syngeneic mice were inoculated i.p. with B16 melanoma cells. The animals were divided into 4 groups, receiving daily i.p. treatment with saline--group 1, controls; lithium chloride--group 2, bleomycin and vinblastine--group 3, and lithium chloride with bleomycin and vinblastine--group 4. Animals in group 4 had a significant delay in tumour appearance, a higher degree of tumour necrosis, and a longer survival rate. In addition a significant reduction of serum lithium concentration was noted in animals of this group in comparison with animals in group 2, treated with lithium chloride alone. There was no lithium-induced leukocytosis.

Demonstration of AA-protein in formalin-fixed, paraffin-embedded tissues

AA-protein was identified by SDS-acrylamide electrophoresis in amyloid fibrils fixed in formalin after isolation from fresh-frozen tissues obtained from patients with familial Mediterranean fever (FMF) amyloidosis and idiopathic AA-amyloidosis and, following deparaffination, rehydration and homogenization of embedded formalin-fixed tissues of old autopsy cases of the hereditary amyloidosis of FMF and amyloidosis acquired in association with tuberculosis, bronchiectasis, and rheumatoid arthritis. That AA-protein is unaltered by formalin was firmly established by agar gel diffusion using specific rabbit anti-AA serum. By contrast, AL proteins could not be demonstrated either in formalin-fixed amyloid fibrils derived from fresh-frozen tissues of a patient with presumably AL-amyloidosis dominated by cardiomegaly and one with AL-kappa amyloidosis or in blocks of cases of familial neuropathic amyloidosis, multiple myeloma, and idiopathic amyloidosis with cardiopathy. AA-protein is not denatured by formalin and retains its typical electrophoretic, chromatographic, and immunologic characteristics even 30 years after fixation and paraffin-embedding.

The role of activity in anticipating and confronting stressful situations

This paper is an analytical review of studies comparing stress reactions in threatening situations during which the person can or cannot take action. The studies reviewed were conducted mainly in real-life situations and involved diverse forms of coping activities under various conditions of danger and distress. To achieve a better understanding of the effect of activity on stress reactions, several distinctions are made: between various types of stress reactions; between various indices and measurements of stress reactions; between activity which is directly related to the source of threat and activity which is not; and between various personality dimensions. The adaptive potential of activity in stressful situations is discussed in terms of: the sense of mastery and control provided by activity; activity as a means of attention diversion; and activity as a means of discharging energy generated by mobilization. It is suggested that taking action under stressful conditions, as opposed to remaining passive, is a powerful coping tool.

Assessment of seasickness and its consequences by a method of peer evaluation

A Seasickness Questionnaire, based on a peer-rating technique, was administered to 172 Israeli Navy sailors. Use of interrater agreement as a reliability index and two cutoff points for the partition of the sample resulted in the elimination of about one-third of the initial sampl and the formation of two subsamples-the "sick" (N equals 45) and "not sick" (N equals 73) sailors. By using differentially weighted scores for various intensities of seasickness, it was demonstrated that two normally confounded aspects of seasickness can be assessed independently: physical symptoms, which constitute the apparent severity of the sickness (A.S.S.), and level of actual performance (A.P.), which reflects the individual's attempts to cope with the sickness. A.S.S. and A.P. showed differential relationships with variables such as personality disposition of active coping, military rank, and sociometric status.