Biomedical subjects
Publications and source records attributed to T R Smith.
An unusual case of congenital cervico-mediastinal thymic cyst with vocal cord paralysis is presented together with a brief history and classification of these cysts. A discussion of thymic cyst symptomatology and the surgical approach to these lesions is included. Simple thymic cysts should be considered in the differential diagnosis of cervico-mediastinal masses, particularly in children and young adults.
The posterior surface of the proximal transverse colon and the anterior surface of the descending duodenum are intimately related. The clinical importance of this apposition is re-emphasized with presentation of two cases which had the uncommon phenomenon of benign duodenocolic fistula. These two rare cases of duodenocolic fistulas secondary to Crohn's disease are added to the literature. It is also suggested that in some cases, duodenal mucosal alterations with adjacent Crohn's disease of the colon might be the result of reactive inflammatory changes, and do not necessarily indicate continuous extension of the granulomatous disease.
One of us (T.R.S.) operated on 24 patients with 26 retinal detachments caused by giant tears between 1969 and 1975 with the use of a broad silicone implant and diathermy. Minimum follow-up was six months. The technique included a scleral dissection extending at least three circumferential rows of diathermy posterior to the folded edge of the retinal flap, up onto the ora serrata, and two hours of the clock beyond each end of the tear. The retina was intentionally incarcerated on the buckle when subretinal fluid was drained. Sixty-nine percent of the cases were successfully reattached. If those patients with radial tears extending from the circumferential tears to the disk were excluded, the success rate rose to 75%. Seventeen percent of the successful reattachments required a second scleral buckle operation. Giant tears with radial tears extending to the disk, tears greater than 180 degrees, and immobile posteriorly everted flaps were poor prognostic signs. Thirty-five percent of the eyes with giant tears and a detachment had other holes or tears in the retina of that eye.
An isolated cellular blue nevus of the sclera was discovered and removed during a retinal detachment operation. Such benign tumors may be misdiagnosed clinically as an extension of a melanoma of the choroid or histologically as melanoma.
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Review of inpatient records at the Massachusetts Eye and Ear Infirmary for ten years and the inpatient and outpatient records at the Children's Hospital Medical Center for eight years revealed no diagnosed cases of synchysis scintillans. The pathology reports from the Ophthalmic Pathology Laboratory at the Massachusetts Eye and Ear Infirmary for the last ten years revealed 12 eyes with cholesterol crystals in the vitreous cavities or subretinal spaces, or both. All were blind, long-term damaged eyes; there were no vitreous cholesterol crystals observable clinically. This study corroborates previous reports and suggests that synchysis scintillans occurs only in severely damaged, blind eyes not visible to observation. Both the current concept and terminology of synchysis scintillans are inaccurate. Cholesterosis bulbi is a more appropriate term. Cholesterol crystals are clinically different from asteroid bodies since the former occurs only in a damaged, functionless eye.
Malignant colonic polyps on substantial stalks were seen in 3 patients. In each case the base of the pedicle was free of tumor. The author suggests that these were initially benign adenomatous polyps but subsequently became malignant. These findings suggest that initially benign colonic polyps can become malignant over a period of time and that the presence of a substantial stalk may not always be pathognomonic of benignity.
Ethacrynic acid (ECA), a sulfhydryl group inhibiting diuretic was examined for positive inotropic effects. These were found to be present in isolated guinea pig left atria studied in 0.9 and 1.8 mM Ca bathing solutions and were partially dependent upon adrenergic mechanisms (presumably secondary to norepinephrine release from sympathetic nerve endings) and partly independent of such mechanisms as demonstrated by propranolol induced beta-blockade and reserpine-induced catecholamine depletion. The mechanism of the non-beta adrenergic inotropism is unclear but may relate to the ability of ECA to inhibit the sarcolemmal Na-K-Mg-dependent ATPase. ECA-induced premature contractile failure occurred in all atria as well as a late increase in diastolic tension, the latter being comparable to that described for toxic doses of cardiac glycosides in similar preparations.
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