Biomedical subjects
Publications and source records attributed to S Fleming.
Oncocytic renal tumour is an uncommon tumour of the kidney, previously associated with a good outcome. Twenty-two patients are described in whom the incidence of metastatic disease was 18% and the overall 5-year survival rate 65%.
Urinary tract involvement by non-Hodgkin's lymphoma is uncommon and whilst extranodal disease may be the first manifestation of NHL in 15% of patients, the primary site of origin of NHL in the urinary tract is very rare. At the time of diagnosis, apparently primary urogenital lymphoma is often widely disseminated, with a correspondingly poor prognosis.
Gastric carcinoma may rarely be the cause of tumour-associated hypoglycaemia. We report the case of an elderly woman who presented in hypoglycaemic coma, and who was found subsequently to have an adenocarcinoma of the stomach. Hypoglycaemia persisted despite prednisolone, diazoxide, and a high concentration dextrose infusion. The few published cases are reviewed in which an association was established between gastric carcinoma and hypoglycaemia, and the possible aetiology of the hypoglycaemia is discussed.
A retrospective study was undertaken to determine the type and frequency of genital tract anomalies that occur in female children with imperforate anus. The functional outcome and optimal management of the genital tract anomalies were also studied. Primary vaginal anomalies occurred in 22 of 72 patients assessed, and uterine anomalies occurred in 18 of 51 patients assessed. For 17 patients, who were 13 years of age or older, information was available on genital tract function. Of these 17 patients, five had severe vaginal scarring. A previous vaginoplasty or cloacal abnormality was a predictor of poor vaginal function. It is suggested that vaginoplasty, in cases in which it is possible, be delayed until puberty.
The incidence, bacterial characteristics, disease syndromes, diagnosis, treatment, and prevention of enterotoxemia of neonatal calves caused by Clostridium perfringens (Types A, B, C, D, and E) are reviewed.
The optic nerves of all mice infected with Semliki Forest virus (SFV) showed patchy demyelination, although the extent of demyelination varied between animals. There was a significant increase in small diameter unmyelinated fibres in the optic nerves of SFV infected mice, paralleled by a loss of small myelinated fibres, suggesting that the smaller myelinated fibres may be more susceptible to virus-induced demyelination. The small unmyelinated fibres were more numerous in the peripheral region of the optic nerve trunk, where blood vessels are found in greater numbers. In addition, a particularly large increase in the proportion of unmyelinated fibres which had diameters of less than 0.2 microns suggested the possibility of axonal sprouting.
Forty-four patients were evaluated for ototoxicity following treatment with the chemotherapeutic agent cis-platinum. Statistically significant hearing changes at 2,000 Hz (p less than 0.001); 4,000 Hz (p less than 0.05); and 8,000 Hz (p less than 0.001) were observed. Chi-square analysis demonstrated that at 8,000 Hz patients who had lower than average thresholds prior to chemotherapy were more likely to experience greater threshold shift than those patients whose pre-chemotherapy thresholds were higher than average. In this patient sample, there was no significant correlation shown between serum creatinine levels and ototoxicity.
The distribution of epithelial membrane antigen (EMA) in the kidney and its tumours has been studied using a polyclonal anti-EMA antiserum and the immunoperoxidase-antiperoxidase technique (PAP). Twelve fetal and 10 adult kidneys examined showed EMA to be confined to the distal tubular or collecting duct epithelium or their embryological precursors. The examination of 55 primary renal tumours showed EMA to be present on the epithelial tumours, on tubular epithelium in nephroblastoma, but not on mesenchymal tumour cells nor on undifferentiated areas of nephroblastoma.
One hundred ninety-one patients were treated by one of three cisplatin-containing multidrug protocols. The initial 77 patients received two courses of cisplatin and vincristine plus bleomycin. The next 26 patients received two courses of 5-fluorouracil and cisplatin, and the final 88 patients were placed on a three course 5-fluorouracil and cisplatin protocol. Overall response rates were similar for each of the three protocols. The complete response rate, however, was much better (54 percent) for three course 5-fluorouracil and cisplatin versus cisplatin vincristine, and bleomycin (29 percent) and two course 5-fluorouracil and cisplatin (19 percent). Survival curves were also better for the three course 5-fluorouracil and cisplatin segment of this nonrandomized pilot study.
Pentoxifylline, a phosphodiesterase inhibitor, produces a marked reversal of an age-dependent spatial memory deficit in Fischer 344 strain male rats. Performance of 26-month-old animals treated chronically with pentoxifylline approached that of 3-month-old controls. The effect was not dependent upon concurrent administration of the acetylcholine precursor choline chloride. It is concluded that the pentoxifylline-induced reversal of the age-dependent memory decline is not dependent on any presumed facilitation of acetylation and utilization of exogenously supplied transmitter substrate.
Fischer 344 rats, 3 and 26 months of age, were first tested in an eight-arm spatial maze to assess memory function behaviorally. The same animals were then subjected to hippocampal kindling to examine alterations in neuronal plasticity as a function of aging. The results indicated that spatial memory was poorer and hippocampal kindling slower in aged rats than in young ones. Furthermore, there was a striking positive relation between performance in the eight-arm spatial maze and speed of kindling. This finding suggests that age-related deficits in spatial memory and hippocampal kindling reflect decreased efficacy of synaptic transmission in a common neuroanatomical substrate.
Proper cleansing of the bowel is essential to ensure an adequate colonoscopic examination. The experience of 24 children and adolescents with Golytely, a new colonic lavage solution, is presented. Oral Golytely was found to be less inconvenient for patients, safe, and more cost-effective because it decreased hospitalization time.
We have studied a series of 19 primary renal cell carcinomas using an antibody to pure human renin and the indirect PAP technique. Seven tumours contained immunoreactive renin. No renin was identified in seven cases of metastatic tumour within the kidney, but immunoreactive renin was present in two out of seven metastatic renal cell carcinomas in other organs. None of the subjects had clinical, biochemical or histological evidence of excess renin secretion. We suggest that renal cell carcinoma may commonly secrete renin and that the hormone may be biologically inactive.
An antibody to pure human renin and an immunoperoxidase technique were used to stain immunoreactive renin in nephroblastomas. In an unselected series of surgically removed nephroblastomas immunoreactive renin was found in 10 of 19 tumours (53%). Tissue obtained at necropsy from 12 cases of disseminated nephroblastoma was also studied, and immunoreactive renin in metastatic tumours was found in three cases. Patients' blood pressures and serum potassium concentrations showed no evidence of excess renin activity. It is therefore suggested that if nephroblastomas contain renin as commonly as this study suggests, then any hormone secreted may be biologically inactive.
This paper summarizes a number of considerations in the areas of technique, structure, diagnosis and formulation for candidates attempting to qualify in the psychiatry oral examination.
The author summarizes the history of the Kaiser-Permanente Program, describes some major Kaiser-Permanente principles and policies, and briefly reviews the current status of the program. He projects continuing successful growth for Kaiser-Permanente and other organized health care delivery systems which provide alternatives to the traditional fee-for-service health care systems.
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