Malignant melanoma of the external auditory canal.

Malignant melanoma of the ear, other than the pinna, rarely occurs. This is the first report of a melanoma confined to the external auditory canal. The case presented is of a 75-year-old man with a malignant melanoma confined to the external auditory canal. Excision of the tumor and surrounding lymphatics was accomplished with a lateral temporal bone resection, superficial parotidectomy, and selective neck dissection. The patient initially refused postoperative radiation therapy. Histologic evaluation documented a 17-mm thick malignant melanoma. All margins were clear and none of the nodes was positive. Eight months later, he returned with local, regional, and distant recurrence. Despite attempts at salvage with external radiation, brachytherapy, and chemotherapy, he died 13 months postoperatively with widespread disease. Melanoma confined to the external auditory canal has not been previously reported. A 17-mm thick melanoma carries a dismal prognosis. Despite initial negative surgical margins and lack of regional metastases, this patient developed a rapid, widespread pattern of recurrence.

The nasolabial fold: an anatomic and histologic reappraisal.

The nasolabial fold was analyzed by anatomic and histologic evaluation of the tissue planes that create and surround the fold. A fascial-fatty layer exists in the superficial subdermal space extending from the upper lip across the nasolabial fold to the cheek mass. The SMAS is present in the upper lip as the superficial portion of the orbicularis oris muscle. Traction on the SMAS or periosteum lateral to the nasolabial fold can deepen the fold, while traction on the fascial-fatty layer lessens the fold. The fascial-fatty layer and skin of the cheek mass are suggested as the primary ptotic elements responsible for facial aging.

Surgical anatomy of the SMAS: a reinvestigation.

There has been considerable disagreement in descriptions of the SMAS. Fresh cadaver dissection, combining anatomic dissection done with the aid of the operating microscope and histologic cross section of facial tissues, was performed in 24 facial halves. Histologic preparation was made on tissue macrosections, each 10 cm in length. Consistent findings include the following: (1) Although the SMAS is closely applied to the superficial surface of the parotid gland, a thin but distinct parotid fascia can be identified between parotid gland and SMAS. (2) The SMAS terminates superiorly within 1 cm below the zygomatic arch, and is not continuous with the temporoparietal fascia. (3) The SMAS in the cheek lies in continuity with the orbicularis oculi muscle of the lower eyelid. (4) Considerable variability exists in the histologic appearance of the SMAS in different facial regions within a single cadaver, as well as in a given facial region between cadavers. Because of its variability, histologic identification of the SMAS should be made in continuity with known reference structures, such as the platysma.

Atypical ovarian hyperthecosis in a virilized postmenopausal woman.

Ovarian venous concentrations of testosterone (18.7 ng/mL and 8.2 ng/mL) were three to six times higher than the peripheral concentrations (2.8 ng/mL) in a hirsute postmenopausal woman. She had cystic hyperplasia of the endometrium and atypical hyperthecosis of the ovary. Postoperatively, the testosterone levels returned to normal. From the results of the immunoperoxidase reaction, the luteinized stromal cells of the ovaries were the site of increased production of the testosterone and estradiol. By the same technic, these cells were negative for LH but strongly positive for FSH. From these data, the authors conclude that the luteinized cells were the primary source of the excessive testosterone, that the same cells were the direct and indirect (by peripheral testosterone conversion) source of estradiol, that LH was very likely not involved in the process of steroid hormone production, and that FSH may be the trophic stimulus responsible for the functional activity of the luteinized stromal cells in this virilized postmenopausal woman.

Examination of a competitive enzyme-linked immunoassay (CELIA) technique and a laser nephelometric immunoassay technique for the measurement of apolipoprotein B.

A competitive enzyme-linked immunoassay (CELIA) technique for quantitative measurement of apolipoprotein B (Apo B) was developed. The method is a non-isotopic immunoassay that utilizes a soluble enzyme/antibody complex as a universal labeling reagent. The method was characterized according to precision, sensitivity, recovery and parallelism. The CELIA Apo B method was compared to a commercially available laser nephelometric immunoassay. We found that the nephelometric results were highly correlated with triglyceride levels and the nephelometric assay was susceptible to interference from lipemia or turbidity. The range of values obtained on 56 apparently healthy, fasting young adults was 0.35-1.25 g/l by the CELIA method and 0.40-1.00 g/l by the nephelometric immunoassay. The nephelometric method was more precise (coefficient of variation 5%) than the CELIA technique (CV 10%); however, the CELIA method seems to be less sensitive to interferences.

Rhabdomyoma of the abdominal wall: resection based upon computerized tomographic characteristics.

A unique report of an abdominal wall rhabdomyoma is presented. The rarity of this tumor may lead to confusion with a malignant neoplasm. Computerized axial tomography localized the tumor to a specific muscle group and demonstrated absence of invasion into surrounding tissues. Computerized tomography is valuable in the assessment of abdominal wall tumors and provides useful information in planning an operative approach.

Ameloblastoma of the maxilla with distant metastases and hypercalcemia.

A case of metastatic ameloblastoma of the maxilla with secondary hypercalcemia in a 54-year-old man is presented. After treatment with surgery, chemotherapy, and radiotherapy, the patient was found to have multiple metastases and severe hypercalcemia associated with high levels of parathormone-like substance in the peripheral blood. At autopsy he was found to have widespread metastases and nephrocalcinosis.

Air bubbles and temperature effect on blood gas analysis.

The effect of temperature, time of storage, and presence of air bubbles in specimens for blood gas analysis was studied. The results show that air bubbles in a 10% proportion are undesirable because of significant elevation in the PO2, and the storage of anaerobic blood samples at room temperature (25 degrees C) is acceptable when measurements are done within the first 20 minutes.

Partial characterization of the atypical creatine kinase isoenzyme fraction in three cases.

The atypical creatine kinase isoenzyme fraction in the sera of three patients was studied utilizing the technic of crossed immunoelectrophoresis. The findings provide strong evidence that in these clinically unrelated patients the atpical isoenzyme fraction is a complex of creatine kinase and IgG.