William B. Buckingham

Metaplastic squamous cell carcinoma of bronchus simulating giant cell tumor of bone.

A 57‐year‐old man underwent a right pneumonectomy for a bronchogenic carcinoma following bronchoscopy and bronchial biopsy. The tumor was a polypoid mass arising from the lower lobe bronchus. Microscopically it was characterized by mononuclear cells mixed with randomly distributed multinucleated giant cells similar to those seen in giant‐cell tumor of bone. Also found were portions showing typical squamous cell and spindle cell carcinoma. Based on the light and electron microscopic findings, we suggest that the current case represents a metaplastic squamous carcinoma showing mesenchymal cell differentiation. A hypothesis on the histogenesis of pleomorphic carcinomas was presented. The problems of histological diagnosis generated by such a tumor should be emphasized.

A clinical evualation of the treatment of hypertension with dihydrogenated ergotoxine alkaloids

Abstract 1. 1. CCK-179 was administered orally to thirty-four symptomatic hypertensive men. 2. 2. A marked drop of blood pressure occurred during the first thirty days of hospitalization plus therapy. This was shown by placebo substitution to be due to hospitalization, not the drug. 3. 3. Parenteral administration produced a definite but transient drop in blood pressure in all cases to whom it was given.

Interpretation of the velocity measurement ballistocardiogram.

Abstract 1. 1. A portable electromagnetic ballistocardiograph was used to study three groups of individuals: normal persons, patients confined to a hospital and convalescing from noncardiac disease, and patients with obvious cardiac disease. 2. 2. The records were analyzed by four methods: (a) presence of so-called early M or late M pattern, (b) JK:IJ ratio, (c) H-K time interval and its variation, (d) Brown, Hoffman, and de Lalla criteria. 3. 3. Precise determination of the limits of the early and late M patterns could not be made. 4. 4. Observations that the JK:IJ ratio is materially increased by use of the electromagnetic machine are confirmed. 5. 5. The JK:IJ ratio and the H-K interval and its variation failed to distinguish the three groups. Within the cardiac group those with hypertensive and luetic heart disease had a higher JK:IJ ratio, but some of these individuals had normal ratios. 6. 6. Records with some degree of variation (1, 2, 3, or 4) were found in 66 per cent of the individuals with frank cardiac disease, in 55 per cent of the patients convalescing from noncardiac disease, and in 14 per cent of the normal persons. Grade 4 ballistocardiograms were found in 31 per cent, 18 per cent, and 0.9 per cent of these three groups, respectively. These results emphasize that abnormality of the ballistocardiogram was not necessarily associated with cardiac disease. 7. 7. It is emphasized that 34 per cent of the individuals with frank heart disease had normal ballistocardiograms.

Clinical skills and cose of good care.

Excerpt To the editor: Brook, Williams, and Avery (Ann Iniern Med85:809-817, 1976) have incisively assessed the problems surrounding quality assurance, particularly in terms of its methods, problem...

Studies on whole blood and muscle creatine levels: Effect of systemic and local anoxia, of cardiac failure and compensation, and of alphatocopherol administration☆☆☆

Abstract 1. 1. Values for the creatine content of whole blood have been determined for: (a) normal individuals, (b) patients suffering from various illnesses, (c) those with cyanosis or anemia, and (d) cases of cardiac failure before and after compensation. 2. 2. The elevation of creatine values in heart failure bore a relation to the degree of decompensation. Decreasing values indicated improvement, while stationary, high, or increasing values indicated severe cardiac failure, often impending death. On this basis serial levels may be of prognostic value. 3. 3. Fatigue, an important early symptom of impending cardiac decompensation, may be due to a decrease of elements essential to muscle contraction, of which creatine is one. The values of biopsied muscle creatine showed a similar but opposite variation to those observed in blood, i.e., cardiac failure is accompanied by increase of creatine in the blood and decrease in the muscle. With return of compensation, this relationship is reversed. Vitamin E caused an increase of muscle creatine above that resulting from compensation only.