Acute surgical abdomen and myelofibrosis.

Extramedullary hematopoiesis associated with fibrosis is found frequently in the liver and spleen, but seldom in other organs. Acute abdomen due to extramedullary hematopoiesis has been reported in two patients with intestinal obstruction because of heavy infiltration of the terminal ileum. This report describes the case of a 71-year-old woman with myeloid metaplasia involving the gallbladder mimicking acute cholecystitis. As far as we know, involvement of the gallbladder by extramedullary hematopoiesis has never been reported before.

Mesenteric cyst-ovarian implant syndrome.

Primary tumors and cysts of the mesentery are quite rare. The cysts are said to be from embryonic, traumatic, or neoplastic origin. Mesenteric cysts of ovarian tissue origin, which, to our knowledge, have been reported only three times, appear under the term ovarian remnant syndrome, and involved patients with previous oophorectomies. It appears that the incidental implantation and growth of the minute portions of the ovarian tissue in the pelvis or lower abdomen is the origin of the syndrome. We describe two cases of the mesenteric cyst-ovarian implant syndrome with a brief review of the literature.

Fibrosarcoma mimicking breast fibromatosis.

Fewer than 1% of malignant breast tumors are sarcomas. Lack of correlation between the biologic behavior and histopathologic appearance of these tumors has been reported. A well-differentiated fibrosarcoma could be mistaken for breast fibromatosis, which may be a familial trait and may occur in Gardner syndrome. Forty-three cases of mammary fibromatosis have been reported. Most authors are concerned with misdiagnosis of breast fibromatosis as a malignant lesion leading to unnecessary mastectomy. However, the result can be disastrous when a well-differentiated fibrosarcoma is diagnosed as fibromatosis and the patient develops lung metastases.

Granulomatous coronary arteritis.

Pulseless disease, or Takayasu's arteritis, is usually found in the aorta and its major branches in young female patients. Involvement of the coronary arteries is extremely rare. Fewer than 25 cases have been reported. This report documents a case of a 71-year-old man who died of coronary insufficiency and myocardial infarction. The autopsy disclosed extensive granulomatous coronary arteritis.

Granulomatous appendicitis.

Granulomatous appendicitis as an isolated pathologic entity unassociated with systemic disease is extremely rare. Many such cases in the past have been called "primary tuberculous appendicitis." Others have been called "chronic appendicitis" or "Crohn's disease." Recent information indicates that Yersinia pseudotuberculous bacillus could also cause granulomas in the appendix. Within the past ten years the authors have come across three cases of granulomatous appendicitis. A review of the literature and retrospective study of the authors' cases suggest that the causative agent in many of these could be Yersinia. However, the authors believe that as long as there is no positive proof of the cause, such lesions should be considered granulomatous appendicitis.

Cancer in married couples.

A review of 2,512 charts of cancer admissions in a small community hospital during a ten-year period revealed 19 married couples with cancer. Compared with other studies this number appears small. However, only 2% of our cases mentioned the spouse in the family histories, apparently because emphasis seems to be on genetics, not on environment. It was further noted that two out of 19 couples had the same type of cancer originating from the same organ, and ten pairs had tumors of the same histopathologic type. Cancer manifested itself in the wives a few years before the husbands, though the wives were younger.

Cobalt-induced epilepsy: an ultrastructural study.

Metallic cobalt and aluminum rods were implanted into the cerebral cortices of rats. Almost all the animals with cobalt implantation were found to be epileptic 30 days after the operation. Tissue samples from the cerebral cortices were sampled for electron microscopy. The most significant changes in the cobalt-implanted animals were the disintegration of the rough endoplasmic reticulum in many cortical neurons and the accumulation of neurofilaments within the perikaryon. Such filamentous accumulation was usually found near the perinuclear position, at the periphery of the neurons, and in areas where there was a paucity of regular rough endoplasmic reticulum. Large aggregates of SER-like tubulovesicular structures were also found within many neuronal processes. Some of these neuronal processes could be identified to be postsynaptic dendritic terminals. Large nuclear pseudo-inclusions consisting of cytoplasmic materials were also found in some cortical neurons. These ultrastructural changes could also be occasionally observed in the opposite (cobalt-free) hemisphere of the brain (mirror image) in the cobalt-implanted animals. However, the brains of the aluminum-implanted or blank-control animals were free from any of these changes.

Human infection with Dirofilaria.

Human infection with Dirofilaria is rare. Fewer than 100 cases have been reported in the world's literature. Among the cases reported in the United States, most of the patients have been from Florida and Louisiana. The majority of the patients had a single lesion that involved either the skin or the lung. The case presented here is unusual because the patient had two skin lesions, and because the condition occurred in a patient who lived in the North-Central portion of the United States (Upper Michigan).

Hematological and biochemical paraneoplastic disorders.

Paraneoplastic disorders (PNDs) are remote effects of tumors that are unrelated to the size, location, metastases, or physiological activities of mature tissue of origin. Some of these disorders, such as fever and anemia, have been known for a long time. Other disorders, such as lymphopenia and low serum cholesterol levels, have been described only recently. In a study of 900 patients, including two control groups, some of the PNDs were demonstrated to be good indicators for diagnosis and prognosis in cases of cancer. A number of these disorders, however, may occur in patients suffering from terminal diseases other than cancer.

Diverticular disease of the appendix.

Diverticular disease of the appendix involves about 1 per cent of all appendices removed. Considering the large number, the subject appears to have been neglected in medical literature. Since the symptomatology is similar to that of appendicits and diverticula are frequently very small, they could go unnoticed. A comparison of 30 cases of diverticular disease and 30 cases of acute appendicitis reveals a few fine differences. The patients with diverticular disease are at least a decade older, the duration of pain in these patients is longer, and the diverticula and appendix may or may not be inflamed.

Carotid ligation in gerbils. Influence of age, sex, and gonads.

The ill effects of carotid artery occlusion or ligation vary in man and experimental animals according to surgical techniques, environmental conditions, diet, stress, sex, age, strain of the animal, blood pressure, the state of cardiopulmonary system, and other diverse factors. Unilateral carotid artery ligation in most small laboratory animals is an innocuous procedure. The gerbil, a desert rat, has been found to be quite sensitive to unilateral carotid artery ligation. The present experiments were designed to study the influence of age, sex, and castration on end results of the unilateral carotid artery ligation in gerbils. It appears that the young animals prior to sexual maturity and the sexually mature female are more resistant than the sexually mature male. This difference is assumed to be due to the influence of the gonads on the blood flow of the brain.

Lumbar intraspinal extradural ganglion cyst.

A case is presented of an intraspinal extradural ganglion cyst at the L4-5 level. The clinical picture suggested a herniated nucleus pulposus at this level. A myelogram revealed a round lesion almost completely obstructing the flow of Pantopaque at the L4-5 level. A ganglion cyst with a haemorrhage into it and the surrounding tissue was removed, and surgery was followed by complete recovery.