Caseous Mass Research Articles

Streptomycin in the Treatment of Miliary and Meningeal Tuberculosis Based on a Study of 30 Cases

1)Streptomycin seems effective in the treatment of uncomplicated cases of miliary tuberculosis. This could be accounted for by the small size of the individual tubercle which may permit the drug to readily penetrate throughout the lesion in therapeutic concentration and to come in direct contact with all the organisms, a condition which probably does not exist where larger areas of caseation are present. 2)Streptomycin did not prevent the development of tuberculous meningitis in patients while they were under treatment with the same drug for other tuberculous conditions. 3)It seems possible that the main obstacles to successful therapy of tuberculous meningitis may be: (a) a factor in the brain, presumably, yet unidentified, which has the property of inhibiting streptomycin and thus rendering it ineffective; and (b) the relative inability of streptomycin to penetrate the larger caseous foci. 4)Until a more effective antibacterial agent against tuberculosis may be discovered, efforts will undoubtedly be continued to identify the streptomycin inhibiting factor in the brain, and to find means of combating it. Further search is also indicated for some means of more effectively carrying the therapeutic agent into the caseous masses. 5)Our experiences thus far lead us to believe that higher doses of streptomycin would probably not materially improve the results in tuberculous meningitis and in combined miliary and meningeal tuberculosis. It does not seem likely that the streptomycin inhibiting factor in the brain and the conditions which seem to prevent the drug from entering the caseo-necrotic mass in therapeutic concentration, could be overcome with relative safety by sheer volume of this antibiotic.

Complex tridermal teratoma of the stomach (benign): Case report

T RIDERMAL teratoma of the stomach is a very rare condition and extensive search of the Iiterature fails to record such a case. Boyd,l Ewing2 and BaIIantine3 fail to report a single instance. Eustermann and Balfour,4 discussing nonmaIignant tumors of the stomach found at the Mayo Clinic, report twenty-six benign tumors, none of which was a teratoma. Lexer,5 Askanasy,6 Hosmer,’ Marchand,* Ahrens,g and EngIander lo have reported cases of triderma1 teratomas of the peritoneum but these tumors were either situated behind the Iiver or Iocated in the transverse mesocoIon. Some of the Iatter were diffIcuIt to distinguish from retroperitonea tumors. Brouha,” and SchonhoIzer12 describe severa unattached triderma1 teratomas occurring retroperitoneaIIy. Borst13 and BoIzana14 describe severa cases derived from the ovary and aIso retroperitonea1. PoIony I5 described a case of exogastric teratoma occurring in a six year oId child. Covered by the gastrocolic Iigament, the tumor was attached to the stomach by a pedicIe. It consisted of numerous cysts containing a stringy fIuid and geIatinous, puruIent or caseous masses. Many of the cysts were secondariIy infected. HistoIogicaIIy, the cysts were cIosed and many were Iined with epitheIium of a digestive type but without gIands. The stroMa and intracystic septa were composed of connective tissue and muscIe fibers. Differentiating it from a Schwannoma by the absence of neuro tissue he made the diagnosis of simpIe teratoma with secondary infection. the Iiterature of a case of compIex triderma1 teratoma of the stomach (benign) and the fact that it was successfuIIy removed from a chiId four months of age, is the purpose of this report.

RHINITIS CASEOSA

Rhinitis caseosa has been defined as a rare type of unilateral nasal disease characterized by the accumulation in the nose and paranasal sinuses of an extremely offensive, cheeselike mass, by the presence of a seropurulent nasal discharge and other manifestations of chronic suppurative sinusitis and, lastly, by intranasal, and frequently external, deformities which result from pressure exerted by the caseous mass. <h3>REPORT OF CASE</h3> R. P., a 13 year old farmer's son from near Ionia, Mich., was admitted to the University Hospital onNov. 28, 1939 with the complaint of complete nasal obstruction and copious foul nasal discharge. He had never been susceptible to colds and had had no nasal symptoms prior to the fall of 1938. At that time he had an acute infection of the upper respiratory tract, which was followed by a copious mucopurulent nasal discharge. The patient stated that he had used three handkerchiefs a day

THE HISTOLOGICAL EXPRESSION OF THE NATURAL RESISTANCE OF RABBITS TO INFECTION WITH HUMAN AND BOVINE TYPE TUBERCLE BACILLI

THE HISTOLOGICAL EXPRESSION OF THE NATURAL RESISTANCE OF RABBITS TO INFECTION WITH HUMAN AND BOVINE TYPE TUBERCLE BACILLI

THE PATHOLOGY OF ACTIVE TUBERCULOSIS OF THE PERICARDIUM.

A number of cases of tuberculosis of the pericardium having been observed in the autopsies studied in the pathological laboratory of Rush Medical College, during the past six years, at the suggesion of Professor Hektoen I have collected the reports and specimens for study, including among them the cases observed at autopsy at the Cook County Hospital during the past 3½ years. Altogether the material has been drawn from 1048 autopsies on the bodies of adults. Tuberculosis may produce in the pericardium distinctly tuberculous processes, with miliary tubercles or caseous masses, which may be shown by microscopic and bacteriologic investigation to be positively tuberculous; again it produces simply a fibroplastic process in which the adhesions and the pericardial membranes contain no anatomical evidences of tuberculosis. This latter form is often difficult to distinguish from any fibrous pericardial synechia of other origin, and will not come into consideration in this paper,