Frank M. Hirose

Abnormal Papanicolaou smears: Evaluation by colposcopy, biopsies, and endocervical curettage

Abstract A prospective study of 76 patients with persistently abnormal Papanicolaou smears was performed. Histologic comparison of colposcopically directed punch biopsies and endocervical canal curettings and conization was carried out in all patients. Forty-eight patients had hysterectomy after conization. The results indicated that, when the endocervical canal curettings do not contain neoplastic tissue, colposcopically directed biopsies are sufficiently accurate in determining the cause of the abnormal Papanicolaou smear without the need for conization. Of additional significance, no patient without disease in the endocervical canal as proved by endocervical curettage had invasive carcinoma.

Human chorionic gonadotropin-like material: Presence in normal human tissues

With the use of radioreceptor assay for gonadotropin and a beta-chain radioimmunoassay for human chorionic gonadotropin (hCG), we have been able to demonstrate the presence of hCG-like material in all normal human tissues tested. This activity was completely absorbed by a hCHG-antibody affinity column and was demonstrated to have altered carbohydrate content by studies showing this material did not bind to concanavalin A (con A)-Sepharose affinity columns. In identical studies greater than 90% of placental hCG was bound to con A. However, if placental hCG is rendered carbohydrate free it also does not bind to con A. It is known that carbohydrate-free hCG is cleared rapidly from the circulation and thus possesses little or no biological potency in vivo. Accordingly, we hypothesize: (1) that this hCG-like material in normal tissues has the protein structure of hCG but does not possess the carbohydrate moieties of placental hCG and probably has little or no bioactivity in vivo and (2) that the trophoblastic cell is not unique in its ability to synthesize hCG but has developed the ability to glycosylate hCG, transforming a ubiquitous cellular protein into a hormone, hCG might better be called human cellular gonadotropin.

Myelolipoma of the adrenal gland: Angiographic findings and review of the literature

Myelolipoma of the adrenal gland is a rare tumor. It has been surgically excised in only five cases, including the one described in this report. However, review of the literature reveals a total of one hundred thirty cases. Although more than 96 per cent of these lesions were found incidentally at autopsy and more than half could be appreciated only microscopically, it is clear that these tumors can grow sufficiently to become symptomatic, undergo hemorrhage, and require operation. The clinical angiographic and pathologic features of myelolipoma are described. Although endocrine function of this tumor has never been demonstrated, related experimental evidence of others is summarized because it suggests that complete endocrinologic evaluation of patients with suspected myelolipoma is indicated. Despite the rarity of the tumor, we believe that the radiologic and clinical features of myelolipoma that we have described may allow preoperative diagnosis in the future.

Ectopic production of lipotropin by cancer

Lipotropin (LPH) has been evaluated as a potential tumor marker using a sensitive beta melanocyte-stimulating hormone (beta MSH) radioimmunoassay. All 79 acetic acid extracts of carcinomas of lung, colon, stomach, esophagus and breast contained LPH in concentrations greater than blood; 61 of 79 extracts contained LPH in larger amounts than control tissues from patients without cancer. In a blind prospective study, plasma LPH was quantified in 107 patients admitted for work-up because of an abnormality on a chest roentgenogram. Thirty-one of 33 patients subsequently diagnosed as having benign lesions had plasma LPH within the 95 per cent confidence limits of normal subjects whereas 28 (36 per cent) of the 74 patients subsequently diagnosed histologically as having primary lung carcinoma had elevated levels. In control studies, 13 of 100 patients with chronic obstructive pulmonary disease had elevated plasma LPH levels; three of the 13 with elevated levels and four with normal levels have been diagnosed, during the two years of follow-up, as having lung carcinoma. In control studies of 23 patients with granulomatous lung disease, 22 had normal levels of LPH. In those with carcinoma of the colon elevated plasma LPH levels were observed in two of 21 untreated patients and in 11 of 61 patients receiving noncurative chemotherapy. Elevated plasma LPH levels were also observed in 10 of 59 patients with breast cancer, eight of 28 with pancreatic cancer, eight of 22 with gastric or esophageal cancer, six of 16 with renal cancer, four of eight with prostatic cancer, one of seven with cervical cancer and one of six with ovarian cancer. We conclude, an elevated LPH level is frequently observed in blood and tumor tissue from patients with various types of carcinoma.

Cardiac pathology of transvenous pacemakers in dogs.

Transvenous right ventricular pacemaker catheters were implanted in 18 mongrel dogs for periods of 2 to 18 months (average 4.9 months). Heart block was produced in 15 of these dogs by injection of 37 per cent formaldehyde into the interatrial septum. In the other three dogs which served as controls, no heart block was produced and no electrical stimulation was applied to the implanted catheters. After the animals had been put to death, gross and microscopic examination of the hearts revealed four categories of morphological changes: (1) connective tissue sheath formation around the catheters, (2) endocardial papillary thickening, (3) interatrial septal changes, and (4) myocardial damage. Changes 1, 2, and 4 occurred in one or more intracardiac locations in all 18 dogs. Change 3 occurred only in the 15 dogs in which heart block was produced. The most striking histologic findings were areas of cartilagenous metaplasia in endocardium an underlying myocardium and areas of marked cellular proliferation of the endocardial cells both in the endothelium and underlying stroma. Chronic implantation of transvenous intracardiac pacemaker catheters in dogs consistently produces morphologic changes which may interfere with cardiac and pacemaker function and may hinder attempts to remove nonfunctional or unneeded catheter electrodes. The changes observed appear to be related to the presence of foreign material per se and not external electrical stimulation of the heart.

Multiple adenomas of the liver

A 39‐year‐old woman was seen because of abdominal pain. The patient died, and at autopsy she was found to have massive replacement of the liver with multiple hepatic adenomas and intraheptic hemorrhaging, despite the absence of a previous history of oral contraceptive use.

Treatment of chronic cervicitis by cryotherapy

Abstract The preliminary experience with the use of cold cauterization for the treatment of 102 patients with cervicitis is reported. Cautery was achieved by the use of liquid nitrogen as the refrigerant which was delivered through a special cervical probe. Treatment was carried out in the outpatient department without analgesia or anesthesia. The typical case required freezing at −160° C. for 120 seconds to treat an area of cervicitis of approximately 4 cm. 2 . Significantly, the majority of patients experienced only mild discomfort during the freezing process. Changes in parameters such as coital pain, postcoital bleeding, vaginal discharge, and systemic symptomatology were noted. The surface of the cervix was measured, and the diameter of the cervical canal determined before treatment and after completion of healing. No serious complications have occurred, and no patients have complained of systemic symptomatology. Healing was virtually complete in nearly all patients 8 weeks after freezing. Cryosurgery seems to have a place in the treatment of cervicitis.

Incontinentia Pigmenti A Systemic Genodermatosis with Striking Cutaneous Findings

An infant with IP, here presented, typifies the early course of this syn drome. Diagnosis can and should be made in the first stage by a combina tion of the clinical appearance and the characteristic histology. The physician must be aware of the frequent associated manifestations, so that he may deal as effectively as possible with them. He should inform and reassure the parents as to the future self-limited course of all of the cutaneous lesions. Genetic counseling is another important responsibility.

Capillary leak syndrome with massive intestinal edema after appendectomy

Abstract Ileus and ascites developed in a previously healthy thirty-six year old man after appendectomy for acute appendicitis. Re-exploration revealed a grossly gangrenous appearing segment of terminal ileum and proximal colon that histologically showed only massive acellular submucosal edema with dilatation of lymphatics and serosal hyperemia without necrosis. Severe anasarca developed and the patient died after this second operation. Necropsy revealed submucosal edema of the remaining large and small intestines, anasarca, and pulmonary atelectasis. Regional enteritis, acute nonspecific ileitis, infectious enterocolitis, iatrogenic accident, and allergic phenomena were considered in the differential diagnosis. We believe this case is an example of the rare “capillary leak syndrome,” which has not been reported previously after appendectomy.

The treatment of chronic cervicitis by cryotherapy: A preliminary report

Summary The preliminary experience with the use of cold cauterization for the treatment of 75 patients with cervicitis is reported. Cautery was achieved by using liquid nitrogen, which was delivered through a special cervical probe. Treatment was carried out in the outpatient department without analgesia or anesthesia. The typical case required freezing at −160° C to treat an area of cervicitis of approximately 4 cm. 2 Significantly, the majority of patients experienced only mild discomfort during the freezing process. Changes in parameters such as coital pain, postcoital bleeding, vaginal discharge, and systemic symptomatology were noted. The surface area of the cervix was measured, and the diameter of the cervical canal determined before treatment and after completion of healing. No serious complications have occurred, and no patients have complained of systemic symptomatology. Healing was virtually complete in nearly all patients 8 weeks after freezing. Cryosurgery seems to have a place in the treatment of cervicitis.