From Horus the child to Hephaestus who limps: a romp through history.

The question of why Hephaestus, the Greek god of smiths, limped has been the subject of much debate, mainly on mythological grounds. This debate extended also into the field of medical diagnosis, with attempts at defining the nature of the deformity that made the crippled Hephaestus the buffoon of the other Olympic gods. One problem encountered in these debates was the changes to which the ugly young Hephaestus was subjected with the passing of time-from a limping deformed youth to the later dignified and normal man. While some authors, largely influenced by poetic Greek texts and vase paintings, attributed the limp to talipes (club-feet), others pointed to certain features suggestive of achondroplasia. Since the image of the early Hephaestus is based mainly on the much earlier concept of the Egyptian god Ptah, who as the triune god of the resurrection sometimes is depicted as an achondroplastic dwarf (Ptah-Pataikos), the suggestion of the possible achondroplastic dwarf-like nature of the early Hephaestus is not implausible. It is supported by similarities in the image of Hephaestus to some features in other Egyptian gods, such as the domestic god Bes, the guardian of the new-born, and the Horus the Child or Harpocrates (Greek), yet another protector of youth and "the symbol of everything that is young and vigorous" [Budge, 1969: The Gods of the Egyptians, or Studies in Egyptian Mythology. Volume I.]. The characteristic feature of this child-god is the "lock of Harpocrates" on the right side of his head. That this lock can sometimes also be seen not only on the head of Ptah-Pataikos and of Bes but also on the young Hephaestus is highly suggestive of the Egyptian influence on his image. Recently, however, another interesting explanation of Hephaestus's limp has been suggested that may explain why the Egyptian influenced image of the early achondroplastic Hephaestus changed to the later, more Grecian view of the smith-god who hobbled because of club-feet. Improvements in composition-analysis of samples from antique statues and various utensils have led to the suggestion that the introduction of new smelting techniques in antique times may have exposed ancient metal workers to the effects of various toxic metals causing, for instance, chronic lead poisoning or, more relevant here, chronic arsenic poisoning causing peripheral neuritis with weakness and lameness of one or both lower extremities. Later changes in smelting technique, and recognition or guess-work of a possible connection between these techniques and toxic effects, may explain the change from the buffoon-like achondroplastic walk to the club-footed limp and eventual normal behaviour of Hephaestus, the Smith. In other words: Did Hephaestus limp because of his arsen-neuritis?

The stem cells of the liver--a selective review.

The current status of the much-debated question of the still-hypothetical stem cells of the liver is reviewed, with an emphasis on their role in hepatocarcinogenesis. The widely held view of the primacy of the hepatocyte, notably of the mononuclear diploid type, in this process--the "hepatocytic theory"--has been compared with variants of the "stem cell hypothesis" based on the "non-parenchymal epithelial cells" of the liver--the "oval" or biliary ductular cells, the "nondescript periductular" cells and the "primitive" bipotential epithelial cells. An attempt has been made to concentrate mainly on the more recent publications, in an effort to balance the conflicting opinions expressed by comparing results obtained by the newer procedures currently in use. Despite some interesting and relevant findings it appears that the evidence in favour of the stem-cell hypothesis is still circumstantial and that the hepatocytic theory has not been invalidated. Presumably the question of the hepatic stem cells will be answered when the riddle of hepatocarcinogenesis has been solved.

Pronephros and mesonephros--Cohnheim revisited.

Erroneous quotations in the literature and Cohnheim's statement, in his Lectures on General Pathology, that the Wolffian body or mesonephros is the first anlage of the urogenital system prompted this description of the growth of our knowledge of the early development of the kidney. Some of the pertinent older literature is reviewed, and the concept of the holonephros, as opposed to the trinephric view of kidney development, is discussed. Emphasis is placed on the decreasing functional significance of the pronephros with evolutionary development, to the extent that the role of the pronephros in the human is questioned. Cohnheim's seemingly erroneous reference to the development of the kidney is shown to be merely a reflection of the views current at his time.

Extrarenal nephroblastomas.

The cases of extrarenal nephroblastoma published in the world literature have been tabulated and reviewed, and are discussed from a historical point of view.

Karl Touton and his "xanthelasmatic giant cell." A selective review of multinucleated giant cells.

The position of the Touton giant cell in relation to the foreign body and Langhans type of giant cell is considered. (A short account of Karl Touton's life is also included.) After reviewing the historical development of the concept of giant cells and current interpretations of their nature, the unitarian view of polykaryons now favored by workers in the field is extended to include also the "xanthelasmatic giant cell" of Touton, whose characteristic appearance is determined merely by the presence of demonstrable lipid in the cytoplasm. It is proposed that Touton cells develop when the stimulus to cell fusion is accompanied also by a factor stimulating lipid uptake. This factor is missing in the development of the other two giant cell "types," but apart from that there are no other significant differences.

The response of poorly differentiated prostatic tumors to staining for prostate specific antigen and prostatic acid phosphatase: a comparative study.

A comparative study was done of the usefulness of immunohistochemical stains for prostate specific antigen and prostatic acid phosphatase in 20 poorly differentiated prostatic tumors. The stain for prostatic acid phosphatase was preferable to the prostate specific antigen stain not only because it was more intense and, therefore, more visible but also because it often was positive in areas in which an equivocal or negative stain was obtained with prostate specific antigen.

Localized hepatocarcinogenesis: the response of the liver and kidney to implanted carcinogens.

Attempts by early workers to induce liver tumours by the local implantation of carcinogens had by and large not been successful, so that the liver came to be viewed as being "resistant" to tumourigenesis by this means. A review of these early studies showed not only that fibrosarcomas could be easily induced by the local application of 3-methylcholanthrene (3-M.C.), but that there were also reasons why the apparently low susceptibility of the liver to the localised induction of hepatocellular tumours should not be accepted as established dogma. In an attempt to re-investigate this problem pellets made of cholesterol (CHOL), anthracene (ANT), alpha-naphthylisothiocyanate (ANIT), 3-M.C. or 4-dimethylaminoazobenzene (DAB) were implanted into the livers of male litter-mate weanling rats. The evolution of the response was studied by histological examination of the implantation site at varying intervals. In each instance the liver responded with the formation of a firm, complete connective tissue capsule which, however, did not prevent the gradual degradation of the implants. No tumours or other significant changes were observed with the control implants of CHOL or ANT. ANIT, known to damage biliary ducts, elicited what appeared to be an intense serous exudation which was separated from the adjacent parenchyma by a shell-like deposition of calcium in the connective tissue capsule. No significant biliary changes were observed, however, and no tumours were produced. Attention should be drawn to this reproducible, regularly occurring, in vivo model of extra-osseous calcification. The 3-M.C. induced a high incidence of large solitary bosselated tumours associated with the carcinogenic pellet which was found embedded in the tumour mass. The architectural arrangement and bizarre cytological appearance of the tumours led to the currently widely used diagnosis of malignant fibrous histiocytoma (M.F.H.) rather than the fibrosarcoma or rhabdomyosarcoma of the early workers. Some tumours produced large numbers of implantation metastases in the peritoneal cavity, but no distant metastases were observed in this series. Of particular interest is the fact that it was not possible to determine the site of origin of these tumours despite histological sampling at intervals of the site of implantation of the pellets. In contrast to these pleomorphic, clearly mesenchymal tumours reliably produced by 3-M.C., the implantation of pellets of DAB produced fewer tumours which were classified as large, singly occurring hepatocellular carcinomas (H.C.C.).(ABSTRACT TRUNCATED AT 400 WORDS)

Stenosis of individual pulmonary veins: radiologic findings.

Congenital stenosis of individual pulmonary veins is uncommon. Of the 49 cases reported, four were seen at the IWK Hospital for Children and are reported here. Plain radiographs show a shift of the heart toward the side of major involvement, Kerley B lines, fluid in the fissures, and interstitial edema of the affected lobes. These findings, while subtle, should nevertheless suggest stenosis. Technetium-99m macro-aggregate lung perfusion scans show absence of or diminished perfusion of the affected lobes. The diagnosis can usually be confirmed with angiography. Congenital stenosis of individual pulmonary veins should be considered in children with repeated pulmonary infections, dyspnea, failure to thrive, hemoptysis, or unexplained pulmonary hypertension.