The plague at Granada, 1348-1349: Ibn Al-Khatib and ideas of contagion.
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Biomedical subjects
Publications and source records attributed to W B Ober.
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Review of a world literature of 93 reported cases of choriocarcinoma primary in the fallopian tube yields 58 acceptable cases, to which 18 are added from the files of the Armed Forces Institute of Pathology. Patients ranged from 16 to 56 years old, with a mean age of 33. About 66% presented with acute symptoms consistent with banal ectopic pregnancy. The remainder usually presented with a gradually expanding adnexal mass clinically indistinguishable from an ovarian tumor. Grossly, the tumor is usually a hemorrhagic friable mass, occasionally containing spongy tissue resembling placenta. Smaller tubal choriocarcinomas are difficult to distinguish on gross inspection from common ectopic pregnancy, ruptured or not. Histopathological features and distribution of metastases are similar to gestational choriocarcinoma arising in the uterus. Chorionic villi were found in two cases, an uncommon observation in primary uterine choriocarcinoma. Of 47 acceptable cases treated prior to modern chemotherapy, 41 died, a mortality of 87%. Of 16 cases treated with modern chemotherapy, 15 survive, a salvage of 94%. Five cases in the world literature, plus three in the present series, were cured by unilateral salpingectomy or salpingo-oophorectomy alone.
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A clinico-pathological study of 48 malignant Brenner tumors (MBT) includes three new cases and 45 cases from the literature since 1945. Construction of a profile of this neoplasm was undertaken. The mean age of patients was 60 years, and most were postmenopausal with abdominal symptoms and a unilateral abdominopelvic mass. Only one case had bilateral tumors. The pattern of spread of this tumor is usually regional with only occasional distant metastases. Diffuse peritoneal seeding is not a characteristic feature of MBT. 56% of the patients with MBT died of their tumor, usually within 3 years of initial diagnosis. Mean survival in fatal cases was 1 year. Microscopically, foci of characteristic benign Brenner tumor may or may not be seen in individual examples of MBT. Admixture of adenocarcinoma (often mucinous carcinoma) and squamous carcinoma may also be seen. diagnostic problems can arise when a mixture of histologic patterns is present. In order to establish the diagnosis of malignant Brenner tumor a prominent histologic pattern of malignant urothelium is usually necessary.
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Combined regimen contraceptive steroids produce precocious endometrial secretion, followed by involution leading to a suppressed endometrium with small tubular glands and failure of spiral arterioles to develop; decidua-like stromal changes are dose related as is dilatation of venules. Thrombosis of the latter, perhaps estrogen mediated, leads to local tissue infarction and is the proximate cause of "breakthrough bleeding". Sequential regimen contraceptive steroids lead to retarded endometrial secretion, failure of spiral arterioles to develop, and a weak decidua-like stromal transformation. Contraceptive steroids occasionally produce polypoid lesions of the endocervix with atypical microglandular hyperplasia. There are conflicting reports about the effects of contraceptive steroids on the squamous epithelium of the exocervix, but they neither protect against cancer nor cause it in the usually accepted sense. Uterine leiomyomas may exhibit increased cellularity and bizarre, hyperchromatic nuclei or mutinucleation in women receiving contraceptive steroids. Both polyethylene and metal-containing intrauterine devices may initiate inflammatory responses in the endometrium varying from mild to severe, related to the time the device has been in contact with the mucosa. Salpingitis and ectopic pregnancy are increased in frequency in device users.
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Unlike the normal human placenta, the normal rabbit placenta, near term, is essentially free of such stigmas of aging as infarcts and syncytial knots. When experimental toxemia is produced in the pregnant rabbit by ligating the terminal aorta to a specific degree of stricture, placental lesions resembling those found in human toxemia are observed; namely, diffuse congestion, old and recent infarcts, and syncytial knots. All the treated animals who exhibited anatomical and clinical signs of toxemia presented, in association, obvious placental lesions; there were, however, some animals which showed infarct but no other signs of toxemia.