Mina Ben-Bassat

A study of the ultrastructural features of the cut margin of skin and mucous membrane specimens excised by carbon dioxide laser

Abstract Electron microscopic examination was performed on the cut edge of three surgical specimens of skin and mucous membrane lesions to measure more precisely the depth of damage of the laser beams, appearing on light microscopy as “burn” rim. Serial sections of this material revealed that the “burn” rim extended to a depth of 200–250 μm, but damage was not equal for all tissue. Most sensitive to the laser beams are the epithelial cells and their organelles, which showed signs of necrosis to a distance of 250 μm from the cut edge. Desmosomes, cell nuclei collagen fibers, and erythrocytes are less sensitive to the laser beams and started showing some preservation of their structure on the ultrasections cut at a depth of 30–50 μm from the periphery. Capillaries revealed swollen endothelial cells with a marked narrowing of their lumen. The importance of these findings and the significance of the application of the laser in clinical surgery were discussed.

Primary malignant melanoma in the parotid gland

Reports of primary malignant melanoma arising from the parotid salivary gland are extremely rare and, to date, have been sporadic. We report a pertinent case, and tabulate and correlate the clinical findings of the 13 cases reported thus far in the literature. The most common symptom is a progressively enlarging, asymptomatic, firm, and fixed mass. Total excision has been the established treatment of choice. The contribution of radiotherapy, chemotherapy, and immunotherapy remains unclear, and it is not possible at present to predict the outcome of treatment in individual patients. Although rare, primary malignant melanoma should be considered in the differential diagnosis of parotid tumors. The clinical significance of establishing the diagnosis of primary malignant melanoma of the parotid gland is emphasized.

Pleural effusion--presenting sign in multiple myeloma.

A patient with multiple myeloma in whom recurrent right pleural effusion was the presenting sign of the disease is reported. An IgA (k) monoclonal component was found in both the pleural effusion and the serum. The bone marrow specimen was interpreted as typical for multiple myeloma and the pleural fluid contained numerous plasma cells. Treatment with cyclophosphamide was followed by clinical improvement and the disappearance of the pleural effusion.

Small skin blood vessel occlusions by cryoglobulin aggregates in ulcerative lesions in IgM‐IgG cryglobulinemia

The skin biopsy specimens from six patients with primary mixed IgM‐IgG cryoglo‐bulinemia were examined by immunofluorescence, light and electron microscopy. The biopsy taken from the involved skin of one patient with leg ulcers revealed small blood vessel occlusions by cryoglobulin aggregates. Since a similar finding was not observed in the biopsy material taken from the other five patients who had no ulcerative skin lesions, it seems that the cryoglobulin aggregates play a role in the development of the skin ulcerations in primary mixed IgM‐IgG cryoglobulinemia.

The State of Leukocyte Adhesiveness/Aggregation in the Peripheral Blood of Patients with Respiratory Tract Infections

The state of leukocyte adhesiveness/aggregation (LAA) in the peripheral blood has been employed as a marker of inflammation. In the present study we examined patients with varying intensities of inflammation caused by respiratory tract infections to further investigate the reliability of the state of LAA for the detection and assessment of the severity of disease activity. The study includes 140 controls, 46 patients with upper respiratory tract infection, 30 with bronchitis, 27 with suspicion of pulmonary infiltrate, and 39 with small and 18 with large pulmonary infiltrate. Assessment was based on assuming an increasing severity of inflammation from the 1st to the 6th diagnostic category and by making use of discriminant analysis. It was found that the state of LAA proved to be the best variable to classify the patients into their diagnostic category (F to enter 27), followed by erythrocyte sedimentation rate at the 1st h (F to enter 20.8) and total white blood cell count (F to enter 8.3). These studies were followed by animal experimentation. A highly significant correlation (p = 0.005) was found between the state of LAA in the peripheral blood and the degree of pulmonary leukostasis in a model of endotoxemia in rabbits. These results suggest that the state of LAA is not an epiphenomenon and represents the tendency of the white blood cells to stick to the endothelium which facilitates their migration into the tissues.

Persistent Hyponatremia and Inappropriate Antidiuretic Hormone Secretion in Children With Extensive Burns

Three children aged 2 1/2 to 5 1/2 yr, with burns covering 30%--45% of body surface area, developed hyponatremia and serum hypotonicity on the 5th--6th day following the burn injury. The hyponatremia persisted for 10--15 days. During this period, all three passed inappropriately concentrated urines. One child also demonstrated marked and inappropriate thirst. All three children demonstrated persistent respiratory alkalosis, which appeared and disappeared concomitantly with the hyponatremia. There were no signs of dehydration, and plasma volumes, measured in two children, were normal to high. These children are believed to show evidence of inappropriate antidiuretic hormone (ADH) secretion. In the absence of those conditions known to produce this syndrome, it is postulated that in these children it may have resulted from prolonged pain, anxiety, and/or pyrexia.

Olfactory neuroblastoma: Report of a case and review of the literature

Abstract Olfactory neuroblastoma is a rare malignant tumor of neuroectodermal origin, first described by Berger et al.1 It emanates from specialized neuroepithelial cells in the olfactory membrane of the nasal vault.2–8 The olfactory membrane is found in the cribriform region, the upper third of the nasal septum, superior turbinate, and the upper surface of the middle turbinate.9 It is, therefore, almost inevitable that the tumor appears primarily in the nasal cavity and its adjacent paranasal sinuses, and that the orbit or anterior cranial fossa are involved secondarily.10–12 The purpose of this article is to report a case of olfactory neuroblastoma and review the biologic and clinical behavior of this tumor.

Value of Routine Electron Microscopy in the Differential Diagnosis of the Nephrotic Syndrome

Routine electron microscopic examination of renal biopsies was performed in 37 nephrotic patients with primary glomerular lesions. These cases were classified according to the following pathological p

Generalized Pruritus in Metastatic Adenocarcinoma of the Stomach

Generalized pruritus appeared 2 years following resection of an adenocarcinoma of the stomach. The appearance of the pruritus was the presenting symptom of recurrence of the malignant process in the stomach as well as of its metastatic spread to the liver and to the lungs.

Gaucher's disease and mesangiocapillary glomerulonephritis in childhood — a coincidence?

A 6-year-old boy, presenting with a nephritic syndrome, was diagnosed as suffering from Gauchers disease (GD) and mesangiocapillary glomerulonephritis (MCGN). GD was suspected because of aseptic necrosis of the femoral heads on X-ray and later confirmed by bone marrow aspiration and a lack of glucocerebrosidase activity in white blood cells; MCGN was documented on renal biopsy. The child was treated with prednisone, dipyridamole and aspirin, and recovered completely clinically. A second biopsy was not performed. The connection between these two rare diseases, and between nephritis and GD in general, is discussed.