Biomedical subjects
Publications and source records attributed to U Schmid.
A 24-year-old Hispanic patient underwent surgery for multicentric granulocytic sarcomas. 17 days after reduction of the tumors he developed severe acute lactic acidosis, which responded only to aggressive chemotherapy but in a surprisingly short lapse of time.
The development of malignant lymphoma in myoepithelial sialadenitis with and without Sjögren's syndrome was investigated. At first, prelymphomatous proliferation areas showing a polytypic immunoglobulin (Ig) pattern were seen. These transformed into malignant lymphoma with a monotypic Ig pattern, at first in small, circumscribed proliferation areas ("early lymphoma") and later in large, confluent proliferation area ("manifest lymphoma"). The lymphomas were classified as LP immunocytoma. In some cases they transformed into high-grade malignant lymphomas of the same category, namely, B-immunoblastic lymphoma. The same types of lymphoma have been found in NZB mice and chronic graft-versus-host reactions. "Primary" malignant lymphomas of salivary glands that did not show myoepithelial sialadenitis were also studied. These lymphomas were mostly germinal center cell tumors and probably developed primarily in lymph nodes within parotid glands in most, if not all, cases.
Epithelioid sarcoma is a malignant soft tissue tumor characterized by its propensity to occur in the distal extremities as a nodular lesion and its slow and asymptomatic growth. Microscopically, the diagnosis is difficult. Therefore the interval between onset of symptoms and diagnosis averages one to three years. 10 years survival after onset are not uncommon whatever the treatment chosen. Having to treat such a tumor of a hand, 8 years after onset, we decided a local radical excision by micro-surgery instead of amputation or mutilating excision. Long standing clinical follow-up will add valuable information as to the cure of the upper extremity.
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Biopsies from 25 patients with primary malignant lymphoma in the salivary region were investigated morphologically and the clinical findings were analysed. Cases showing myoepithelial sialadenitis or Sjögren's syndrome were not included. The tumour was localized in the parotid region in 21 cases and to the submandibular region in four cases. Non-Hodgkin's lymphoma was diagnosed on 21 biopsies and Hodgkin's disease on four: all patients were of stages I or II. The most frequent type of malignant lymphoma was the centroblastic-centrocytic type; sclerosis was found in all but one of these 15 cases. Polymorphic immunocytoma was diagnosed in two cases, centroblastic lymphoma in two cases and immunoblastic lymphoma in two cases. In eight patients, the lymphomas definitely originated in intraglandular lymph nodes; in 10 other patients, the lymphomas might have developed in intraglandular lymph nodes. It was not possible to determine the origin of the lymphoma in the other seven cases. The prognosis was relatively favourable.
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Between 1970 and 1978 467 malignant non-Hodgkin lymphomas were newly registered by the St. Gallen-Appenzell cancer registry. Among these 23 (4.9%) were primary gastric lymphomas. Among the necropsy material between 1970 and 1978 23 patients (15.6%) were observed with secondary gastric involvement among 147 generalised malignant non-Hodgkin lymphomas. Among the 23 patients whose malignant lymphomas were investigated by use of gastric resection specimens 10 were in clinical stage IE at the time of operation, the other 13 were in stage IIE. Macroscopically there was an uncharacteristic picture of these tumours which were frequently localised in the antrum and ulcerated in most cases. Histologically 19 cases had diffusely growing malignancy. Four tumours showed nodular or follicular structures. Histiocytic and immunoblastic (n = 14 and 13, respectively) forms were the most frequently occurring malignant lymphomas. The diagnosis of malignant lymphoma in biopsy material could only be verified in 4 out of 12 patients investigated preoperatively by gastroscopy. Histological typing of the lymphomas was not possible in most cases. When there is a suspicion of malignant lymphoma macroparticle biopsies should be performed.
In a retrospective analysis of 25 cases of primary non-Hodgkin's lymphoma of the gastrointestinal tract, tumors with diffuse histologic pattern predominated. Among the lymphomas of the small and large bowel there was an increased percentage of tumors of lympho-plasmocytoid type. The course of gastric lymphomas is less favourable than that of intestinal lymphomas. No correlation was found in this study, between histologic type and initial stage on the one hand, and the course of the disease on the other.
Whereas the contribution of exploratory laparotomy in Hodgkin's disease is well characterized, its value in Non-Hodgkin lymphoma (NHL) is not yet defined. This retrospective analysis of 31 cases is a contribution to the ongoing discussion. Laparotomy/splenectomy (LS) was done in 17 patients for diagnostic reasons and in 14 with therapeutic intent. Perioperative morbidity was low. In 17 cases the NHL had infiltrated the spleen. Indications for therapeutic LS were hemolytic anemia, pancytopenia and excessive lymphocytosis with granulocytopenia. The therapeutic benefit from splenectomy was satisfactory, especially in patients with well-differentiated lymphocytic leukemia of type CLL. In contrast, the diagnostic value of LS was minimal, except in patients with first diagnosis of NHL through LS. There was no change in tumor stage in any case. However, 4 false-negative findings contrast with the rapidly adverse course in these patients. Routine LS in patients with NHL does not appear to be justified, but has its value in NHL with primary abdominal localization. Therapeutic splenectomy is of benefit for the majority of patients, particularly those with CLL.
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33 years after carotid arteriography with thorotrast a 69-year-old patient died from osteomyelofibrosis with severe hematopoietic hypoplasia and myeloid metaplasia detected in liver, lymph nodes, kidney and epicardium. Twenty years before death he underwent "prophylactic" splenectomy; histologically the spleen merely showed hypoplasia, fibrosis and deposits of thorotrast. It is assumed that the osteomyelofibrosis syndrome is a specific complication of thorotrast application which has only rarely been described in the past. This suggestion is supported by observations suggesting that osteomyelofibrosis syndrome may be induced by radiation and by the fact that thorotrast gives rise to foreign body reactions associated with subsequent severe fibrosis. The development of myeloid metaplasia is assumed to be secondary to chronic hematopoietic insufficiency.
The effectiveness of Shampoo containing benzoyl peroxide against oily hair and dandruff has been studied in a clinical trial. The shampoo has proved a precious therpeutic adjunct for these conditions. The probable mechanism of action is summarized on the basis of references.
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