[Malignant adenolymphoma-oncocytic adenocarcinoma of the parotid gland]. / Gruczolak limfatyczny zlosliwy--gruczolakorak kwasochlonny slinianki przyusznej.

The authors present an extremely rare case of a malignant form of parotid gland adenolymphoma treated by surgical intervention. Further, diagnostic problems and methods of treatment are discussed as well as unsuccessful course of the disease, due to extensive, distant metastases.

[Brief history of the otolaryngology department in the Air-Force Institute of aviation medicine]. / Rys historyczny Kliniki Otolaryngologicznej WIML.

Air Force Institute of Aviation Medicine with Clinics, celebrating its 67th anniversary, continues the traditions of research institute of Aeromedical Studies Centre, established in 1928. In 1936 it was renamed in to Leibnitz Institute of Medical Studies. The activity of aeromedical service was interrupted by the outbreak of World War II and continued in the Laboratory of Aviation Physiology and Hygiene. In 1946, Central Laboratory of Aviation Medicine was established, together with the Clinic and Aeromedical Commission, converted into Central Institute of Aeromedical Studies in 1947 and then, into Military Scientific Research and Experimental Institute of Aviation Medicine. In 1958 it was given the name of Air Force Institute of Aviation Medicine-in 1972-with Clinics. Simultaneously with scientific-research activity, aviation medicine developed, dealing with specifics factors affecting pilots during flights. As far otolaryngology is concerned, it deals, apart from the treatment being the domain of otolaryngologists, with histopathology of the equilibrium system and auditory organ, effects of rapid changes, barometric pressure and acceleration on human organism, the influence of weightlessness, the phenomenon of habituation and the effect of Coriolis acceleration on the equilibrium system.

Rapidly progressing atrophy of medial temporal lobe in Alzheimer's disease.

The symptoms of Alzheimer's disease are associated with pathological change and loss of neurons in the medial temporal lobe. By yearly temporal-lobe-oriented computed tomograms the average rate of atrophy of the medial temporal lobe was 15.1% per year (95% CI 10.0, 20.2) in 20 patients with histopathologically, confirmed Alzheimer's disease and 1.5% (0.2, 2.8) in 47 healthy ageing controls. Such excessive atrophy presumably reflects the vulnerability of the medial temporal lobe to a catastrophic event, probably a pathological cascade process. Thus, Alzheimer's disease may not be due simply to an acceleration of normal ageing but, rather, is the consequence of a true disease process.

Detection in life of confirmed Alzheimer's disease using a simple measurement of medial temporal lobe atrophy by computed tomography.

The medial temporal lobe of the brain is important for normal cognitive function, notably for memory, and is the region with the most extensive pathological change in Alzheimer's disease (AD). We wanted to find out if atrophy of the medial temporal lobe could be detected in life in patients in whom a diagnosis of AD was subsequently established histopathologically. The minimum width of the medial temporal lobe, measured by temporal-lobe-oriented computed tomography (CT) about one year before death, in 44 patients with a histopathological diagnosis of AD (cases) was nearly half (0.56 of the median) that in 75 controls of the same age with no clinical evidence of dementia (95% confidence interval 0.51-0.61). There was little overlap between the distributions of measurements in cases and controls. A cut-off (< 0.79 MoM) selected to yield a 5% false-positive rate gave an expected detection rate of 92%. A cut-off selected to yield a false-positive rate of 1% (< 0.70 MoM) yielded a 79% detection rate. 20 of the 44 patients with histopathologically diagnosed AD had been scanned more than once before death, and the test (cut-off < 0.79 MoM) was positive in all 20 more than a year before and in 9/10 more than 2 years before death. In 10 subjects with dementia but with histopathology excluding AD, the mean minimum width of the medial temporal lobe was significantly greater than that in the cases with AD, but was not significantly different from that in controls. Medial temporal lobe CT is a non-invasive, rapid, simple and effective test for AD which could have immediate application firstly in improving the accuracy of prevalence and incidence studies and, secondly, for the identification of groups of high-risk patients in the evaluation of novel treatments for AD. In the future, it could be applied as a screening test.

Spontaneous rupture of renal allografts: the importance of renal vein thrombosis in the cyclosporin era.

Spontaneous renal allograft rupture occurring within 14 days of transplantation occurred in 15 patients from 791 consecutive transplants. In each of eight patients treated with azathioprine and prednisolone there was pathological evidence of rejection and only two patients had thrombosis of the renal vein. Of the seven cases occurring in patients treated with triple therapy regimen (low dose cyclosporin, prednisolone and azathioprine), histological evidence of rejection was present in only three cases, but renal vein thrombosis was found in all seven. Spontaneous rupture of a transplanted kidney, a relatively uncommon complication, is more likely to be due to renal vein thrombosis than to rejection in the cyclosporin era.

Urological complications in 600 consecutive renal transplants.

The results of 600 consecutive renal transplant operations (540 cadaver and 60 living related donor) in 491 patients were assessed with respect to urological complications. In nearly all cases the ureter was inserted into the bladder using a Leadbetter-Politano ureteroneocystostomy technique. The bladder was drained by Foley catheter for 5 days and the operation site by vacuum drain for a variable period. After 26 operations in 26 patients, 27 episodes of ureteric obstruction were identified (one reobstruction). These occurred between 1 day and 45 months after transplantation and involved the lowest third of the ureter 19 times, the middle third 3 times and the proximal third 4 times. They were due to stricture (11), pelvic collection (7), redundant or twisted ureter (3) or other cause (5). An anatomical predisposing factor in either patient or graft was identified in 31 per cent of these caes. After 18 operations in 18 patients, 21 episodes of urine leakage were identified (three re-leakages). These occurred between 1 day and 6 months after transplantation and an anatomical predisposing factor in either patient or graft was present in 59 per cent. Thus, overall, 7 per cent of patients developed a urological complication in this series. This rate has declined in recent years in parallel with a general reduction in steroid dose for immunosuppression. This last feature, combined with the surgical technique described, has resulted in a low incidence of urological complication after transplantation, being now between 1 and 2 per cent.