Longer Survival Period Research Articles

Studies on the survival of the non-parasitic stages of the cattle tick Boophilus microplus in three climatically dissimilar districts of North Queensland

Survival of the non-parasitic stages of the cattle tick, Boophilus microplus (Canestrini), has been investigated over a period of 5 years in 25, 40, and 80 in. rainfall districts of north Queensland. Engorged ticks were exposed regularly in field plots and in Stevenson screens, and the times of egg hatchmg (prehatch period) and periods of survival of the larvae were observed. The prehatch period in the three districts followed the same pattern and was related to seasonal temperature changes, varying from less than 4 weeks in midsummer to over 13 weeks in midwinter. A relationship between minimum prehatch period and mean air temperature for ticks exposed in screens was established, but the data from ticks exposed in the field were too variable to establish a relationship between prehatch periods and soil temperatures. Hatching was recorded in every month of the year from all districts, but during the driest months in the 25 in. rainfall areas many ticks in exposed situations failed to reproduce. Larval survival and total longevity also followed a similar pattern in all districts. The longest survival periods were recorded for the progeny of ticks exposed late in the wet season from March to April, and the shortest survival periods for the progeny of ticks exposed during the dry season from August to September. Mean maximum total longevity for ticks exposed in field plots in the 25 in. rainfall district varied from 10 to 22 weeks, in the 40 in. rainfall district from 14 to 22 weeks, and in the 80 in. rainfall district from 15 to 26 weeks. The data on prehatch and survival periods are a suitable basis for formulating recommendations for tick control by pasture spelling and planned dipping.

COMPLETE TRANSPOSITION OF THE GREAT VESSELS. UNUSUAL LONGEVITY IN A CASE WITH SUBPULMONARY STENOSIS.

A case of survival to the age of 11 years is reported in a patient with complete transposition of the great vessels. Additional malformations in the form of subpulmonary stenosis, ventricular septal defect, and patent ductcus arteriosus may have contributed to the unusually long period of survival. Surgical creation of an atrial septal defect and of a subclavian-pulmonary arterial anastomosis when the patient was 3 years old may have augmented the beneficial effects of the existing associated malformations.

PROGNOSIS OF COR PULMONALE.

DURING the past decade many aspects of the pathophysiology of pulmonary heart failure have been extensively studied. However, very little attention has been paid to prognosis, once the peripheral signs of congestive heart failure have appeared.Pulmonary heart failure is a common complication and a major cause of death in obstructive pulmonary diseases.1 As such, its appearance portends a grave outcome.2 However, several patients seen recently have had remarkably long periods of survival after the initial episode of heart failure. A review of all patients admitted in recent years to the Massachusetts General Hospital with a diagnosis of chronic cor . . .

Carcinoma of the thyroid gland in children and adolescents.

Thirty-six children and adolescents were treated for carcinoma of the thyroid gland over a 30-year period. The average age at the time of histological diagnosis was 11.8 years. Seventeen patients (47%) gave a history of previous exposure to ionizing radiation for benign disorders in the head and neck area. Two patients died from neoplasm. The longest period of survival has been 26 years after diagnosis. Twenty-six carcinomas were a mixed papillary and follicular type, 5 were pure papillary, and 5 were wholly follicular. Thirty-two patients had regional lymph node metastases. Nine patients had roentgenographic evidence of pulmonary metastases. Two of this group died; of the remaining 7 patients, all but 1 have had complete resolution after administration of radioactive iodine. This study supports the impression of an increasing incidence of thyroid carcinoma, which may be related to exposure to previous irradiation.

Stereotaxic irradiation-procedure of brain tumors and pituitary adenomas by means of radio-isotopes and its results.

The techniques, results, and complications of stereotactic implantation of P/sup 32/, Co/sup 60/, Ta/sup 182/, Ir/sup 192/, and Au/sup 198/ in the brain of 196 patients for radiotherapy of intracranial tumors are described. A stereotactic instrument is described and illustrated which permits implantation of the radioisotopes to within 0.5 mm of the desired site. There was a clear relation between the length of survival and the kind of radioisotope applied, localization of the tumor, and amount of the tumor dosage. With glioblastomas, for instance, longest survival was noted in those with frontal localization, following Co/sup 60/ irradiation, and an average tumor dosage of 10000 to 13000 r showed best results. Similar results, with even longer survival periods, were achieved in other dedifferentiated gliomas, in which the combination of intraoperative Ta/sup 182/ or Ir/sup 192/ implantation with a postoperative interstitial Co/sup 60/ irradiation achieved the best results, in comparison with a combination of operation and x-ray therapy. The survival rate, which is nearly twice as high as in x-ray treatment, shows a significant relation to the average tumor dosage and tumor localization. The period of treatment was also shortened by 65-75% compared to the time required for fractionated x-ray therapy. Inmore » 68% of the stereotaxic hypophysis operations, according to the size of the tumor, a total activity of 25 to 55 mc of a macromolecular suspension of Au/sup 198/ was implanted which was adsorbed on small graphite particles (50 to 60 mu ). In the other cases small seeds of P/sup 32/ were placed in the tumor. The long-term results show that visual acuity had improved significantly following secondary stereotaxic irradiation, or remained unaltered without change, in comparison to those patients that had been treated by operation only. On the other hand, the percentage of unimproved and deteriorated cases is much higher in the operated group. The operative mortality with primary stereotaxic punctures was nil, whereas surgical operative mortality totaled 19%. The survival rates of 90.4% of the patients with secondary stereotaxic irradiation and 76.1% with primary stereotaxic irradiation, in compari-son with only 62% of patients with operation only, prove significantly that effectively implanted interstitial irradiation can prolong life. Among operative complications, damage to the neighboring structures was not caused by stereotaxic puncture, but was caused secondarily by radiation, above all by gamma radiation. In six of the patients, therefore, an open decompression operation was necessary. There were some general transitory reactions in the first days, especially headache and cerebrospinal fluid pressure increase among recurrent and long-term complications, in 11.5%, visual acuity grew worse and the visual field was narrowed after 0.3 to 3 yr. It was concluded that primary, and especially secondary stereotaxic irradiation of hypophysis adenomas is clearly superior to surgical operation as concerns operative mortality as well as survival rate and rate of recurrence. The rate of improvement of visual acuity was 26 to 44% higher and that of the visual field 17 to 29% higher than following surgical operation only. However, one problem not yet solved satisfactorily is the long-term radiation damage of the chiasma and optic nerve. Perhaps filling the basal cisterns with x-ray contrast medium by means of the target needle, before the placing of the isotopes, may be of help in preventing this. (BBB)« less

Rate of growth of Entamoeba histolytica in different culture media

Six different culture media for E. histolytica were prepared as described above. Three attempts at culturing E. hartmanni in five media were made, but growth was not maintained. The P + A 1 strain of E. histolytica was maintained for 22 transplants in Dobell's and Da Silva's media. Using the Fuchs-Rosenthal counting chamber, the rate of growth of this strain was studied in all media. It was found that the growth cycle differs with the medium used. The greatest number of organisms was found in Dobell's medium, while Nelson's medium did not support the growth at all. These two extreme results were again obtained after repeating the experiment. The longest period of survival appeared in St. John's medium. The results in Balamuth's, Da Silva's and McQuay's media were intermediate between the mentioned extremes. It was found that a short lag phase was present in the first few hours of incubation in Dobell's medium, and that this phase lasted for 60 hours in McQuay's. A review of the literature on the growth of E. histolytica in culture media and on the methods of counting amoebae in cultures is included.

Intrathecal Administration of Amethopterin in Leukemic Encephalopathy of Young Adults

THE neurologic manifestations of Central-nervous-system involvement in acute leukemia have been very well described.1 2 3 4 5 6 7 Although involvement of the brain is not rare7 , 8 greater emphasis has been placed on its occurrence in young children than in adults. This may well be related to the general view that children are more responsive to antileukemic therapy than adults9 and that their longer periods of survival may allow for the more frequent appearance of complications. Of particular interest is the fact that leukemic encephalopathy may develop in the face of complete hematologic remission, frequently in association with 6-mercaptopurine or antifolic acid therapy.10 This can . . .

Adenocarcinoma; unusually long survival time in case of known tumor recurrence.

The behavior pattern of adenocarcinoma (hypernephroid carcinoma) is often bizarre. 1 It is not unusual for the tumor to become manifest by virtue of metastatic spread with the original lesion quiescent. We have seen two patients in whom biopsy of a bone tumor showed presence of adenocarcinoma, with the original lesion so small that it could not be revealed by intravenous or retrograde pyelography. Cases have been reported in which a solitary nodule appeared in the lung 2 and the disease was arrested for years by the removal of the original lesion and the metastasic growth. Within the past few years we have removed a carcinoma of the kidney with multiple metastases in the lungs and one tibia. Aided by roentgenologic therapy to the bone, there has been partial regression of the metastases, enabling the patient to walk with the aid of a cane and to resume a gainful occupation. The disease seems to have become quiescent. The case reported on here we believe worthy of attention because of an extremely long period of survival in the presence of known

Melanosarcoma of the choroid with a long period of survival.

Melanosarcoma of the choroid with a long period of survival.

The In vitro Cultivation of Nippostrongylus muris to the Adult Stage

The cultivation in vitro of nematode parasites of vertebrates should prove to be an important tool which might ultimately be used in the study of many aspects of nematode biology, and in the elucidation of some of the complex factors which are involved in the parasite-host relationship. The reviews by Lapage (1937), Hoeppli, Feng and Chu (1938), Hobson (1948), and von Brand (1952) summarized many of the early studies which were concerned primarily with survival of larval or adult nematodes under various conditions. More recently, with the development of axenic procedures, progress has been made in achieving growth and prolonged survival of several species. Glaser and Stoll (1938a, b) and Stoll (1940) were able to cultivate the free-living stages of Haeimonchus contortus, and also obtained partial differentiation of the stages of this organism. The axenic cultivation of the free-living stages of five other strongyles was subsequently reported: Ancylostoma braziliense by Lawrence (1948), and A. caninum, A. duodenale, Nippostrongylus muris, and Necator americanus by Weinstein (1949, 1953, 1954). Using roller tube tissue culture as a tool, Weller (1943) found that Trichinella spiralis larvae underwent molting, and some worms showed differentiation comparable to early development in the gut. Extremely long periods of survival have been attained for the larva of Eustrongylides ignotus by von Brand and Simpson (1945), some remaining alive for as long as 4 years. Pitts and Ball (1955) have reported slight growth of the newly hatched larvae of Ascaris lumbricoides. The studies on Neoaplectana glaseri (Glaser, 1940; Stoll, 1953) and N. chresima (Glaser, McCoy and Girth, 1942), nematode parasites of insects, and on the freeliving organisms, Rhabditis pellio and R. briggsae (Dougherty and Calhoun, 1948b; Dougherty, 1950; Dougherty and Keith, 1953) have contributed considerably to the fundamental understanding of the nutritional requirements of nematodes. The present study reports the axenic development of Nippostrongylus muris from the egg to the adult, with primary emphasis on the cultivation of the stages corresponding to the parasitic part of the cycle. Although some information will be presented on the development of the free-living stages, a more detailed account of this phase will be given in a separate publication.

Optimism in the treatment of gastrointestinal carcinoma.

In order that patients with gastrointestinal carcinoma achieve a maximum survival rate, it is necessary to adopt a prudent attitude of optimism, not only toward those with early lesions but also those who appear to have advanced disease. Eight cases are reviewed in which the patients, following radical surgery, are enjoying long periods of survival, even though the initial clinical picture seemed hopeless.

Prolonged posteclamptic aphasia; report of a case.

A CASE OF posteclamptic aphasia of seven years' duration is reported. This is the longest survival period on record, and the case is the only one in which improvement beyond a vegetative level has been reported. REPORT OF CASE History.— W. G., a white woman aged 24, was admitted to the psychiatric division of the Illinois Neuropsychiatric Institute on April 10, 1950, for study and evaluation. She had been brought to the outpatient clinic for a routine check. Her present condition dated from the birth of her only child, seven years before. When she was seen in the fifth month of pregnancy the family physician noted considerable ankle edema. There were no other abnormal findings at that time; the blood pressure was 120/75, and the urine contained no albumin. A day or so before the baby's birth the patient began to have convulsions. There is no record of blood pressure

The effect of streptomycin on tuberculous meningitis.

The recent literature contains many detailed reports on the therapeutic effects of streptomycin in tuberculosis in its various clinical forms, but pathological studies of streptomycin-treated tuberculosis. are fewer, the first detailed account being that by Baggenstoss and his coworkers (1) (five cases). In this work we have studied the pathologic findings in tuberculous meningitis and the associated generalized miliary tuberculosis in 26 cases in which streptomycin was therapeutically employed. From February, 1947 to February 1949, 38 infants and children with tuberculous meningitis were treated with streptomycin at the Children's Division of Cook County Hospital (Chicago). Seven of these made apparent recoveries; complicated by hemiparesis in one case and deafness in two. One patient whose treatment was started on February 23, 1947, is still alive and represents the longest survival period in this series. Of the 38 children in this series, 23 came to necropsy, and with the addition of three other cases (two being adults) treated in another division of the Cook County Hospital, form the basis of this study. Treatment consisted of intramuscularly administered streptomycin, usually 0.2 Gm. every three hours. No intrathecal therapy was given except to our firstpatient (Case 10) who received nine intraspinal injections, and two patients (Cases 19 and 25) who had received previous treatment at other Chicago hospitals, including 23 and 24 intrathecal injections, respectively. Treatment was continued for at least 90 days unless the patient did not survive that long; in addition, if a relapse occurred, further streptomycin was given until death.

BRAIN TUMORS IN CHILDREN

Twenty-four per cent of brain tumors of children aged less than 15 years were found to be astrocytomas, 20% were medulloblastomas and 11% were ependymomas. If the astroblastomas (3%) and ependymoblastomas (3%) are added to these, these groups of tumors comprise 61% of all brain tumors of children. Gliomas constituted 84% of all the tumors in children. Six tumors were found in infants 1 year of age or less. The youngest infants were 2 months old. Astrocytomas were slightly more common in children aged 5 years or less than in the older group. Medulloblastomas and ependymomas were distinctly more common in the younger group than in the older group. Seventy-one per cent of tumors in the age group from birth through 5 years of age were infratentorial; 28% were supratentorial; 1 tumor (1%) was both infratentorial and supratentorial. In the group 6 through 14 years of age, 64% were infratentorial and 36% were supratentorial. Thirty per cent of infratentorial tumors were astrocytomas and 30% were medulloblastomas. Sixteen per cent of supratentorial tumors were craniopharyngiomas, 12% were astrocytomas and 12% were glioblastoma multiforme. Under present conditions at the Mayo Clinic, 54% of all children who undergo operation for tumor of the brain survive for six months or more. Of 256 patients observed for five years or more after operation, 13.3% survive for at least five years. The longest survival period was 20 years after operation. This patient had had an astrocytoma removed in 1926.

Sarcoma of the uterus: Review of cases at the Elizabeth Steel Magee Hospital

1.1. A twenty-five year survey of the gynecologic service at the Elizabeth Steel Magee Hospital yields sixteen cases of sarcoma of the uterus, giving an incidence of 2.6 per cent of all malignancies of the uterus. The comparative incidence of sarcoma of all fibroid uterine tumors in this series was 0.8 per cent.2.2. Only seven of the sixteen were histologically leiomyosarcomas, and ten of the sixteen originated in fibroids. Three originated in the stroma of six endometrium, and can be considered round cell sarcomas.3.3. Five of the sixteen patients are still living, and longest survival period being fifteen years. It must be remembered that in all of the five surviving, sarcoma was an accidental finding in uteri removed for fibroids.4.4. In one case of sarcoma complicating pregnancy the metastases were extensive and rapid. rapid.

LIFE EXPECTANCY AFTER AN ATTACK OF MYOCARDIAL INFARCTION

Initially, myocardial infarction resulting from coronary occlusion was regarded as a rapidly fatal condition. This impression was probably well substantiated by the diagnoses of preelectrocardiographic days, seldom made except in cases of the most severe form. This attitude persists despite the numerous more optimistic prognosticators; perhaps it is best that all clinicians have a wholesome respect for this serious disease and that therefore they be more than ordinarily cautious in its treatment. On the other hand, one must realize the virtue of presenting a favorable life expectancy to the patient recovering from myocardial infarction. Herrick 1 was the first (1912) to lend a gleam of hope to the situation by assuming the possibility of a long period of survival after recovery. Electrocardiography clarified the diagnostic difficulty; the development of the method was rapid, and its accuracy has been proved, so that statistical evaluation of the life expectancy after recovery from

Survival of Two Depancreatized Dogs Treated with Insulin.

Soon after the discovery of insulin, attempts were made to maintain completely depancreatized dogs with insulin. Macleod1, 2, 3 found that dogs receiving insulin and a diet of meat and sucrose survived for 8 months, whereas the addition of raw pancreas to their diets permitted the survival of 2 completely depancreatized dogs for about 4 years. Although the diets employed were deficient, Macleod concluded that raw pancreas was essential for the survival of the depancreatized dogs for periods longer than 8 months. More recently Hershey4 reported that lecithin was of value in this connection. Hershey and Soskin5 state that the ingestion of lecithin supplements enables depancreatized dogs to live indefinitely and that it cures the hepatic insufficiency that appears from 6 weeks to 11 months after pancreatectomy. However, the longest period of survival reported by these workers was 1 year and 3 months. Later, Best and Hershey6 and Best, Ferguson and Hershey7 found that the essential factor in lecithin was chol...

SURGICAL CONSIDERATIONS OF CARCINOMATOUS METASTASES TO THE BRAIN

In 1926, Francis Grant, 1 in a review of the forty-nine cases of intracranial malignant metastases which had been seen in the service of Dr. Harvey Cushing up to that year, concluded that Surgery, whether radical or palliative, is of no ultimate benefit to these patients so far as prolongation of life is concerned. He felt justified in making this conclusion because his statistics showed that the average period of survival from hospitalization to death of persons afflicted with such lesions was three months, irrespective of whether the metastases were treated, decompressed or left alone. A further study from the same clinic in 1931 by Meagher and Eisenhardt 2 lent weight to his figures by showing that of the ten cases in which the primary focus lay in the breast, the longest period of survival following operation was five months, the average being six weeks. Since the publication of these