Malignant schwannoma of the medial plantar branch of the posterior tibial nerve.

Malignant schwannoma in the foot is extremely rare. The authors present a case involving the medial plantar branch of the posterior tibial nerve in a patient with neurofibromatosis, without previous history of malignant degeneration. Following full excisional biopsy, the diagnosis was made using immunohistochemical studies and electron microscopy. A review of the literature also is presented.

Erroneous results with routine laboratory testing for immunoglobulins due to interference from circulating immune complexes in a case of hyperviscosity syndrome associated with autoimmune disease.

A patient with the hyperviscosity syndrome exhibited very high concentrations of intermediate to small circulating immune complexes (CIC), involving 40-50% of the IgG present, with IgG rheumatoid factor activity. We demonstrate that precipitation of CIC by polyethylene glycol in the reaction mixture caused interference with nephelometric methods for measuring IgM and IgA, and that failure of immunoglobulins to migrate, owing to molecular interactions, caused interference with radial immunodiffusion methods. Semiquantitative values for immunoglobulins were difficult to interpret on immunoelectrophoresis. As a result, IgM and IgA could only be quantitatively estimated by an end-point nephelometric approach that included a serum blank. Immunoelectrophoresis indicated that a large proportion of the immunoglobulins behaved as aggregates. Immunofixation electrophoresis did not reveal the presence of aggregates. The polyethylene glycol-IgG test provided an accurate assessment of the CIC concentration; the Raji cell and C1q-binding assays did not. Evidently, special techniques may be necessary for accurate determination of immunoglobulin concentrations when CIC concentrations are very high.

Laser vasovasostomy. A comparative retrospective study, using bioquantum microsurgical carbon dioxide laser.

Microsurgical carbon dioxide (CO2) vasovasostomy was successfully achieved by fusion coagulation of protein with power densities of 40 W/cm2. When 20 and 32 W/cm2 were used, the histologic picture was found to be a uniform leakage of sperm with secondary granuloma formation, suggesting that at this power density, unsuccessful attempts at welding the vas deferens will result.

Inaccurate measurement of a polymeric IgA myeloma protein by nephelometric and fluorometric instrumentation.

The concentration of IgA in a serum was 5.99 g/L as assayed nephelometrically with reagent from one company, but varied between 5 and 3 g/L (for sixfold and 36-fold dilutions, respectively) without giving a definitive answer when assayed with reagent from another source. Immunofixation electrophoresis indicated an IgA lambda monoclonal protein of 45 g/L. Radial immunodiffusion showed two components, having a total concentration of 41 g/L. By fluorometry the IgA was 3.1 g/L. Increasing the dilution caused the (dilution-corrected) lower values to increase. Although the most frequent cause of such discrepant findings is an IgA2 myeloma, which occurs in about one of every 100 myeloma cases, Ouchterlony double diffusion indicated the major component to be IgA1. A polymer, Mr 670,000, was identified by column chromatography. Contrary to the usual behavior of polymers assayed with radial immunodiffusion, which underestimates their concentration, this polymer reached equivalency in agreement with its true concentration as assayed by the Mancini-Heremans technique.

Papillary cystic neoplasm of the pancreas: report of two cases of a surgically curable tumor.

This is a report of two cases of papillary cystic neoplasm of the pancreas, a recently described, relatively benign tumor of the pancreas that occurs predominantly in young women. The clinical presentation, radiographic features, and gross and microscopic pathologic findings along with immunohistochemical and electron microscopic studies are described. A brief review of the literature is cited and surgical significance is discussed.

Intramuscular hemangioma of the tongue.

A case of intramuscular hemangioma of the tongue originally suspected to be an epidermoid or dermoid cyst was presented. The correct diagnosis was discovered during surgery, when uncontrollable bleeding and the results from a frozen section revealed the true nature of the lesion.

Carbon dioxide laser microsurgical vasovasostomy.

Microsurgical carbon dioxide (CO2) laser vasovasostomy was successfully achieved by fusion coagulation of protein under similar laboratory conditions as those seen in the operating room. Speed of performance, patent lumen, and lack of granuloma formation support the CO2 laser's ability to simplify this technique.

Nasolabial cyst: presentation of a case with a review of the literature.

This report presents the clinical and histologic features and treatment of a classic nasolabial (nasoalveolar) cyst. Review of the literature confirms the fact that this lesion is a benign developmental cyst that may arise from epithelium of the nasolacrimal duct. The lesion is usually unilateral, but may be bilateral, is located beneath the ala of the nose, and occurs more frequently in females. Histologically, it is most frequently lined by a pseudostratified columnar epithelium, although both stratified squamous and cuboidal epithelium and goblet cells may be found. The cyst responds well to conservative enucleation.

Two-dimensional echocardiographic detection and diagnostic features of tricuspid papillary fibroelastoma.

Cardiac papillary fibroelastomas are rare and benign primary tumors in the cardiac valves or occasionally the mural endocardium. Before 1977, these tumors were diagnosed exclusively at postmortem examination. Over the last few years, a handful of cases have been diagnosed in vivo by echocardiography. In this report, we describe the first tricuspid valve papillary fibroelastoma detected by echocardiography in an adult. Clinical and echocardiographic features are discussed.

Congenital epithelial cysts of the iris stroma.

Although epithelial implantation cysts in the anterior chamber and iris have often been described, spontaneous congenital epithelial cysts of the iris stroma are not common. A cyst large enough to obstruct vision and cause amblyopia was removed surgically from a 6-month-old infant. The presence of goblet cells in th epithelium may be related to the embryologic source or the cells.

Placental tissue registry. Analysis of the first 500 cases.

An analysis has been given of the first 500 cases submitted to the Placental Tissue Registry. Placental lesions were studied in a variety of clinical situations other than the usual complications of pregnancy. There were more infant deaths than infants with a good outcome in the cases of absence of one umbilical artery, amnion nodosum, atheromatosis of the decidual vessels, and acute and chronic villitis. The etiology of chronic villitis remains obscure.

Carbon dioxide laser surgery of the eye and adnexa.

A carbon dioxide laser which functions in both rapid superpulsed and continuous wave mode for use in ophthalmic surgery is described. Rapid superpulsed mode was found more effective in the creation of trabeculectomy-like procedures in glaucomatous human eyes with satisfactory results in 12 of 14 eyes treated. Continuous wave energy was found to be superior when full thickness eye wall resection was performed. The carbon dioxide laser was found to be effective in hemostatic resection and ablation of skin lesions about the eye. Rapid superpulse was found to be more effective when puckering and tissue loss were to be minimized, while continuous wave was found to be effective when shrinkage of tissue, as in the performance of a Ziegler cautery type repair for ectropion, was preferred. Rapid superpulse was found to be more controllable in experimental phacovaporization in cats with anterior capsulotomy being easily performed. Continuous wave was found to be a more efficacious modality for corneal shrinkage although attempts at present to create permanent corneal alterations have been fruitless.

Facilitated healing of osseous lesions in the canine mandible after electrical stimulation.

A study was performed to investigate the effect of electrical stimulation on the repair of osseous lesions in the canine mandible. Results showed considerably more osteoblastic activity on the electrically stimulated side, with maximal growth nearest the negative electrode. Histologic examination showed healing consisted of the production of intramembranous bone, with no evidence of neoplastic changes. The practical uses of electrical stimulation in the practice of oral and maxillofacial surgery are discussed.