Negro Female Research Articles

Alcoholism, hypercortisonism, fat embolism and osseous avascular necrosis. 1971.

Alcoholism, hypercortisonism, fat embolism and osseous avascular necrosis. 1971.

Fibrinogen Baltimore III: Congenital dysfibrinogenemia with a shortened γ-subunit

An abnormal fibrinogen has been found in an asymptomatic Negro female. Clinical laboratory findings were normal, except for a prolonged thrombin time which was corrected by addition of calcium. Fibrinopeptide release by thrombin and crosslinking by factor XIII also occurred normally, but fibrin monomer polymerization was delayed. Sodium dodecylsulfate-polyacrylamide gel electrophoresis disclosed that 50% of the γ-subunits migrated with an apparent M r of 45,500, approximately 1,500 Da smaller than normal. The evidence suggests that an internal sequence of 10–15 residues is missing from the γ-subunit of the abnormal fibrinogen.

Sclerotic vertebral bodies: an unusual manifestation of disseminated coccidioidomycosis.

Dense Vertebral bodies are well known in conditions such as metastatic carcinoma, lymphoma, osteopetrosis, Paget's disease, and various forms of granulomatous osteitis. They are also known to occur in primary osteosarcoma of the spine, osteoid osteoma, osteosclerotic form of multiple myeloma, hyperparathyroidism, and occasionally as an isolated finding with no evidence of disease. However, there are no known reports of this finding occurring in coccidioidomycosis unless accompanied by marked destruction of the vertebra. Recently, a patient presented with this abnormality as one manifestation of disseminated disease. Case Report A 29-year-old Negro female, who had been born and lived a number of years in southern Texas, noted lower back pain and a lump on the sternum early in 1964. In June 1964 the lesion ruptured spontaneously and failed to heal. This lesion, along with an extensive retromanubrial sinus tract, was excised in December. Examination of the specimen revealed coccidioidomycosis. The patient was treated with amphotericin B from December 1964 to September 1965. The chest film had been normal, but a pleural effusion developed in January 1965. At this time sclerotic changes in the vertebral bodies of T-10, T-11, and L-4 were first noted. There was an associated paraspinal mass (Fig. 1). The pleural effusion cleared in July, but in October additional destructive changes of the manubrium and sterno-clavicular joints became evident. Because of toxi-city, the amphotericin-B therapy was temporarily discontinued. The patient was readmitted in January 1966 for resection of the manubrium and proximal ends of both clavicles. During subsequent months the serum complement fixation titer for coccidioidomycosis remained at 1: 256. A total of 5 g of amphotericin B had been administered since December 1964. In June 1966 draining abscesses developed in the neck and over the upper lumbar region. On culture, these were positive for coccidioidomycosis. At this time there was also a diffuse nodular infiltrate in both lungs and partial consolidation of the right middle and lower lobes. The serum titer was 1: 1024, and amphotericin-B therapy was reinstituted. The sclerotic vertebrae remained unchanged. By the end of December 1966, an additional 3.7 g of amphotericin-B had been given. The chest film was normal, the draining sinuses had healed, and the serum titer was 1:256. The patient was maintained on amphotericin B as an outpatient. By April 1968 the paraspinal mass was nearly gone, but the vertebrae remained dense. A strontium-85 bone scan was positive over the abnormal bones. The chest remained clear. In April 1969 the vertebrae had returned to nearly normal density, the para-spinal mass was gone, and the chest remained clear.

The "hot" renal tumor. Scanning and angiographic characteristics of a solid renal tubular adenoma.

THE SCANNING characteristics of renal tubular adenomas have not previously been reported. It is the purpose of this case report to illustrate the potential value of the renal scan in the diagnosis of this adenoma ; to our knowledge this represents the first case report of a “hot” renal tumor. Interesting angiographic characteristics are also described. Clinical Summary A 35-year-old Negro female was admitted to Memorial Medical Center with a four-day history of gross, painless hematuria. Her past history revealed that she had had a similar episode eighteen years previously, at which time urological evaluation revealed a mild displacement of the calyceal systems in the midportion of the left kidney, and at cystoscopi examination bleeding from the left ureter was observed. This cleared spontaneously within a few days without recurrence of symptoms, and at that time the patient refused a left renal exploration. There was no history of trauma on either occasion, nor was there evidence of an infectious process. On this admission her physical examination was within normal limits, as was all laboratory work including hematologic and urologic studies. Incidentally, the hematuria subsided spontaneously, exactly as it had eighteen years previously. Pertinent radiologic observations included: (a) displacement of the calyces in the left kidney, (b) persistent area of increased uptake over the suspect mass on serial scans, (c) vascular displacement around the mass, and (d) persistent “blush” in the mass. A preoperative diagnosis of a renal tubular adenoma was made, and this was confirmed at surgery. Discussion The specificity of chlormerodrin for renal tubular tissue is of course well documented (1). In the presence of a functioning solid renal tubular adenoma, one would therefore expect, purely on a physiologic basis, increased uptake over the tumor, rather than decreased uptake which would be encountered with any other space-occupying lesion of the kidney. It is our opinion that this increased uptake is diagnostic of and specific for a solid renal tubular adenoma. Since most radiologists are accustomed to looking for areas of decreased uptake on renal scans, it is quite possible that areas of relatively increased uptake have been overlooked in the past. Delayed scanning should be performed when a renal mass is encountered that does not show a definite reduction in the uptake of isotope. The renal arteriogram in this patient does not show the presence of abnormal vessels. There is definite stretching and displacement of vessels around the tumor mass and a persistent “blush” for at least ten and a half seconds. The angiographic appearance of malignant neoplasms of the kidney is well known and does not resemble the findings in this case (2, 3). Cysts, benign vascular tumors, and other benign neoplasms, such as angiomyolipoma (4), likewise do not present the angiographic findings seen in this case.

Three rare causes of unilateral exophthalmos.

Unilateral exophthalmos may be caused by a wide variety of intra- and extraorbital diseases (3, 7, 13, 22, 23, 27). We have recently seen 3 unusual cases of unilateral exophthalmos, one due to a papilloma of the frontal sinus, the second to an orbital epidermoid tumor (cholesteatoma), and the third to myeloma. All three are here reported with a brief review of the literature. Case Reports Case I: The patient, a 54-year-old white female, was admitted to Jersey City Medical Center in May 1965 because of progressive proptosis of the right eye, double vision, and bifrontal headache for three years. Eye Examination: There was conspicuous exophthalmos of the right eye. Vision in the right eye was 20/50 and in the left 20/25. Exophthalmometer readings were 28 mm in the right eye and 16 mm in the left. Intraocular tension as measured by a Schiøtz tonometer with 5.5 g weight was 20 mm Hg (right) and 17.3 mm Hg (left). There were striae throughout the fundus, but disk and macula were spared. Roentgen Examination: The skull radiographs showed an expanding lesion arising in the frontal sinus, destroying the superior orbital wall on the right side (Fig. 1). Despite the fact that no mucosal thickening of the sinuses was evident, the lesion was thought to be a mucocele which originated in the frontal sinus and was destroying the orbital roof. A lateral projection air orbitotomogram revealed a 4 × 5-cm oval mass which arose from the frontal sinus and extended to involve the superior portion of the right orbit, causing marked proptosis (Fig. 2). Operative Findings: The orbit contained a gelatinous material and multiple thin bony plaques representing bony debris from the superior orbital wall, which was almost totally destroyed. Further exploration revealed a large granulomatous cauliflower-like tumor, arising from the frontal sinus and extending downward to displace the globe forward and down. There was no direct invasion of the globe. The pathologic diagnosis was papilloma arising in the frontal sinus (Fig. 3). Case II: The patient, an obese, 38-year-old Negro female, was admitted to Jersey City Medical Center in September 1965 with a six-month history of progressive protrusion of the left eye. Eye Examination: In the right eye vision was 20/50; in the left 20/25. The fundi were clear. Exophthalmometer readings were 17 and 27 mm in the right and the left eye, respectively. Intraocular tension with 5.5 g weight was 14.6 mm Hg on the right and 17.3 mm Hg on the left. Roentgen Examination: Routine skull radiographs and tomograms showed considerable sclerosis of the left orbit with a localized bony defect or dehiscence, suggestive of a dermoid or epidermoid tumor (Figs. 4 and 5). During the air orbitotomography, about 6 cc of dark brownish, oily fluid was aspirated from the cystic mass, which was well delineated by air (Fig. 6). The aspirated fluid contained large quantities of cholesterol crystals.

Renal papillary necrosis in hemoglobin SC disease.

Sickle cell disease was first described by Herrick (9) in 1910. In 1949, Pauling (13) documented the anemia's molecular basis with the development of hemoglobin electrophoresis. Other hemoglobins have been discovered since then. Itano (10) in 1951 described hemoglobin C, which produces no symptoms when combined with the normal hemoglobin A but when combined with sickle cell hemoglobin S may produce hemoglobin SC disease, an established clinical and radiographic entity. Renal papillary necrosis was originally ascribed to infection and was thought to be associated with rapid uremia and death. It is now considered to be a complication in many disorders, including diabetes mellitus, obstructive uropathy, phenacetin toxicity, renal vein thrombosis, alcoholism, pyelonephritis, and sickle cell trait or disease (17). While hematuria is common in hemoglobin SC disease, several reports state that there are no radiographic findings in the urinary tract (2, 14). There is only one radiological report demonstrating renal medullary necrosis in this condition (17). Other radiographic findings in hemoglobin SC disease have been described previously (1, 2, 6, 11, 14–16). It is our purpose to present a case of both renal papillary necrosis and osseous changes in a patient with hemoglobin SC disease. Case Report I.C., a 29-year-old Negro female, presented with a three-week history of hematuria. She passed clots in her urine one week prior to admission, at which time right paralumbar and right upper quadrant pain developed. There was no past history of hematuria or calculus. The patient complained of moderate chronic exertional dyspnea. No history of bone or joint pains was elicited, but there has been intermittent swelling of the left ankle. The patient recalled receiving blood transfusions for anemia when she contracted meningitis at thirteen years of age. Her mother has diabetes mellitus, and one brother is known to have anemia, as do two of her children. Physical examination revealed an afebrile female in no acute distress. Blood pressure was 112/70, and the pulse rate was 98 per minute. She had a Grade 2 systolic murmur. The spleen was palpable. The liver was not enlarged. Hemoglobin was 7.2 g per 100 cc. The white blood cell count was 7,000, with a normal differential distribution. The erythrocytes were hypochromic, and target cells and sickling were observed on the peripheral smear. The serum iron was 40 µg per 100 cc. Blood glucose and blood urea nitrogen were normal. Nonhemolytic streptococci were cultured from the urine on one occasion and were felt to be a contaminant. Repeat urine cultures were sterile. Hemoglobin electrophoresis was performed by two independent laboratories and revealed the presence of hemoglobin SC. The patient's mother had hemoglobin CA. Two sons available for testing had types SC and CA respectively.

Anatomical factors relative to the racial selectivity of femoral neck fracture.

AbstractA comparative racial study of 200 femora from 50 American White and 50 American Negro female skeletons was carried out to determine whether any anatomical differences in femoral from exist between these groups which might account for the racial selectivity of hip fracture, Significant racial differences were found in neck‐shaft angle, angle of inclination and oblique length. Negro females have longer femora, larger neck‐shaft angles and a smaller angle of inclination than have White females. These differences in femoral morphology may, in some measure, contribute to the greater incidence of hip fracture in female Whites.

Reversible vascular occlusion of the colon.

The patient of this report had apparent reversible vascular disease of the colon. The case is of interest because: (a) the lesion occurred in the distribution of the inferior mesenteric system, an area with a low incidence of vascular disease; (b) the disorder could not be accurately differentiated from carcinoma; and (c) neither occlusion of a vessel nor an episode of hypotension could be identified. Case Report R. W., a 60-year-old Negro female, was admitted on Jan. 1, 1965, with complaints of passing clotted blood per rectum for the past two days. During the previous year there had been intermittent episodes of rectal bleeding. There was no other history of illness except for a “stroke” which had occurred one year previously without loss of consciousness. Blood pressure on admission was 120/70. The only abnormal physical findings were residual left hemi-paresis and arteriovenous nicking of the retinal vessels. The stool contained guaiac-positive material. No lesions were visualized on proctoscopic exam...

Colonic Intramural Barium: A Complication of the Barium-Enema Examination

An unusual complication of the roentgen examination of the colon results from mucosal rupture which allows some of the barium to dissect into the colonic wall. Usually, no symptoms are associated with the initial mucosal tear itself. Pain and local tenderness do not occur until minutes or hours later. The roentgen appearance of intramural or submucosal barium may be quite characteristic and easily recognized. An outstanding feature is a transverse striated pattern, probably produced by the inner circular layer of muscle fibers. Our experience with 3 patients with this complication is presented. Case I: H. A., a 63-year-old Negro female, was a frequent visitor to the Outpatient Department because of discoid lupus erythematosus and rheumatoid arthritis. For two and a half years an asymptomatic rectal prolapse of 1 to 1 1/2 inches had been observed. In April 1966, findings on sigmoidoscopy to 25 cm were negative except for a pedunculated polyp 1.2 cm in length, at 15 cm. On microscopic examination this was proved to be a benign adenomatous polyp. A barium-enema examination was performed three weeks later, using a rectal tube without a balloon. The barium flowed in freely, and no discomfort was noted by the patient. On the first spot-film, taken when the head of the barium column had reached only the distal sigmoid colon, a striated appearance of the posterior wall of the distal rectum could be observed (Fig. 1). Several hours later the patient complained of rectal pain and tenderness around the anus; the temperature was 102° F. A diagnosis of intramural dissection of barium was made after review of the radiographs, and antibiotic therapy was instituted. Abdominal palpation revealed no tenderness or spasm. Examination of the rectum two days after the barium enema disclosed marked edema with minimal perianal induration. Although the sedimentation rate rose to 117 in an hour, there was no leukocytosis and the fever gradually subsided during the subsequent four days. No abscess ever developed. Proctoscopy three weeks later showed some lessening of the degree of rectal prolapse. Follow-up films forty-six days later demonstrated no change in the appearance of the retained intramural barium. Case II3: M. D., a 71-year-old male, entered the hospital because of acute urinary retention. During a cleansing enema the evening before examination, he experienced rectal pain which he attributed to hemorrhoids. The barium-enema study was performed without incident. Several hours later a temperature of 101° F was recorded, and the patient complained of rectal pain and tenderness. Examination disclosed no tenderness externally, but the examiner thought he could feel thrombosed internal hemorrhoids. The following day a moderately tender, indurated submucosal mass in the supralevator area just to the right of the prostate could be palpated. The pain and tenderness gradually subsided and one week later had disappeared completely.

Incidence and treatment variations between negroes and caucasians in mental illness

In explorations that compare racial groups, great difficulties are encountered due to lack of similarities in familial structures, demographic variations, and anxiety in the Negro group engendered by prejudicial attitudes of other groups.As compared to the Caucasian group, there is a disparity of knowledge with regard to causes and cures, with much more reluctance on the part of the Negro group to seek treatment. Once admitted to a hospital, Negroes are not released at a comparable rate and final release rates are lower than for other patients. The Negro male is held longer than the Negro female, and in hospitals Negroes are treated as if less accessible to psychotherapy. Therapists' attitudes are colored by impressions and surplus meanings attached to certain labels, and they may be overly sympathetic, patronizing, or hostile to these patients. Following reorganization, acceptance by his own peer group and reintegration into his own milieu is greater for Negroes, but is much less so when the overall social structure is considered.

Liver regeneration following hepatectomy, evaluated by scintillation scanning.

In 1952, Lortat-Jacob and Robert reported in the French literature on a method of controlled right hepatic lobectomy (7), and at about the same time Quattlebaum in this country described a similar technic (15). At the present time lobectomies are commonly performed for liver fracture, primary or secondary tumors, and cysts (2, 5, 11). Extensive hepatic resection is possible because of the liver's remarkable regenerative ability. The purpose of this paper is to report 3 cases from the Los Angeles County General Hospital, Los Angeles, Calif., in which hepatic resections and follow-up studies, including liver scans, were performed. Case Reports Case I: H. W., a 20-year-old Negro female, was admitted to the hospital on April 10, 1964, with blunt abdominal trauma following an automobile accident. The abdomen was distended, tender, and silent, and the patient was in shock. At laparotomy she was under anesthesia for seven hours and twenty minutes. Lacerations of the spleen and the right lobe of the liver were disclosed, and an 80 per cent right hepatic lobectomy and splenectomy were carried out. Two episodes of cardiac arrest on the table were managed by open heart massage. Twenty-two units of whole blood and 8 liters of miscellaneous fluids were required during surgery. The postoperative course was stormy, with pneumothorax, hypotension, low-grade fever, electrolyte imbalance, traumatic pancreatitis, wound infection, and bleeding tendency. The patient was treated with antibiotics, vitamin K, fibrinogen, blood, plasma, and intravenous fluids. Liver function tests were abnormal in the immediate postoperative period, but returned to normal or near normal in four to six weeks. Liver scans were obtained two and a half months, nine months, and eighteen months after hepatectomy (Figs. 1–3), using 150–170 microcuries of gold 198 and a 3-inch-crystal photoscanner. At the time of her last scan, the patient was clinically well, and the findings on her laboratory tests were normal. Case II: M. C, a 35-year-old Caucasian female, was admitted to the hospital Nov. 12, 1965, after suffering blunt abdominal trauma in an automobile accident. She was in mild shock, and the abdomen was silent and tender. At laparotomy a fracture of the hepatic right lobe was found, and 80 per cent of it was resected. The patient was under anesthesia for three hours and fifteen minutes. Postoperatively, she went into shock and required re-exploration and splenectomy for bleeding. Liver function tests returned to normal by three weeks, and recovery was fairly smooth. The liver scans in Figures 4 and 5 were obtained two months after hepatectomy. When the patient, was last seen in March 1966, liver function tests including Bromsulphalein retention were normal, and she felt well. Case III: Y. K., a 72-year-old Japanese male, underwent a 75 per cent gastrectomy for carcinoma in 1958.

Eversion of the eyelids in the newborn without an apparent cause

Case 1. The patient, a Negro female, was born after an uncomplicated pregnancy and 13 hours of labor, weighing 7 pounds and 13 ounces, with no evidence of fetal distress. At birth, it was noted that both lower and upper lids were everted, presenting chemotic and hyperemic fornix and bulbar conjunctivae (Fig. 1). Owing to exposure of the inner surfaces of all lids, the hyperemia increased rapidly and the surface tended to dry and thicken. A Desmarres retractor was slipped under the conjunctival folds and revealed the eye and orbit to be free of any other pathologic change. The infant was treated by copious application of terramycin ophthalmic ointment to the exposed conjunctival surfaces. With slow absorption of the edema, the lower lids returned to normal on the tenth day and the upper lids resumed normal position on the twenty-third day (Fig. 2). A follow-up study was undertaken on the infant for 11 years. She now has 20/20 vision in each eye and no ocular abnormality has been noted. Case 2. A Negro female was born to a 21year-old mother following an uneventful pregnancy and delivery. Forceps were not used in delivery and the exact length of labor was unknown. Apparently there were no previous miscarriages, bleeding, nor were there any congenital anomalies of the skull or eyes in other members of the family. At birth, both the upper and lower eyelids were everted, exposed, and chemotic. The hyperemia increased when the baby cried or strained. The patient was treated with an ophthalmic antibiotic ointment and sterile gauze. No pressure dressings were used. The patient made an uneventful recovery in 3 weeks. There was no scarring of the cornea nor were there anomalies of the eyeball. Case 3. A Negro female, weighing 7 pounds and 4 ounces, was born following an uneventful pregnancy and delivery. Forceps were not used. At birth it was noted that both upper lids were everted and the whole inner surface of these lids and the large part of the upper retrotarsal conjunctivae lay exposed (Fig. 3). The eversion resulted in boggy, edematous conjunctivae. The edema and hyperemia increased when the child cried. The lower lids were completely normal. There were no stigmas of mongolism or evidence of birth trauma. The rest of the physical examination was completely normal. Treatment consisted of moistened sterile gauze

ACUTE MONARTICULAR ARTHRITIS AFTER VACCINATION. REPORT OF A CASE WITH ISOLATION OF VACCINIA VIRUS FROM SYNOVIAL FLUID.

Case Studies1 February 1965Acute Monarticular Arthritis After VaccinationReport of a Case with Isolation of Vaccinia Virus from Synovial FluidHOWARD M. SILBY, M.D., ROGER FARBER, M.D., CORNELIUS J. O'CONNELL, M.D., JULIAN ASCHER, M.D., EDWARD J. MARINE, M.D.HOWARD M. SILBY, M.D.Search for more papers by this author, ROGER FARBER, M.D.Search for more papers by this author, CORNELIUS J. O'CONNELL, M.D.Search for more papers by this author, JULIAN ASCHER, M.D.Search for more papers by this author, EDWARD J. MARINE, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-62-2-347 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptArthritis has been described as an occasional complication of several viral diseases. However, to the authors' knowledge, the isolation of a specific virus from human synovial fluid in such cases has not been reported previously. The present report documents a case of acute monarticular arthritis after smallpox vaccination in which vaccinia virus was recovered from the synovial fluid.CASE REPORTE. J. (BGH 293446), a 65-year-old Negro female, was admitted to the Buffalo General Hospital on June 25, 1963, because of fever and a painful swelling of the right knee. Twelve days previously, at her request, she had been vaccinated...

HYPERPLASIA OF BRUNNER'S GLANDS.

Hyperplasia of the duodenal glands of Brunner was first described by pathologic anatomists in 1876 and introduced as a radiologic entity by Erb and Johnson (2) in 1948. In 1934 Feyrter (3) classified hyperplasia of Brunner's glands into three types. The first is diffuse nodular hyperplasia consisting of coarse mucosal folds and irregularly circumscribed nodules composed of duodenal glands which are distributed throughout the greater portion of the duodenum. The second type is the circumscribed nodular hyperplasia in which isolated nodules of Brunner's glands are located in the suprapapillary portion of the duodenum, often accompanied by atrophy of the intervening glands. The third type is the single nodule of adenomatous hyperplasia varying in size up to several centimeters. The solitary nodule is usually located in the duodenal bulb and may be either sessile or pedunculated. Robertson (6) did extensive investigative work on the duodenum and concurred with Feyrter's classification although he used the term hypertrophy rather than hyperplasia to designate the changes. The purpose of this report is to describe the roentgenologic appearance of hyperplasia of Brunner's glands as encountered and proved in 2 patients. Case Reports Case I:A 77-year-old, Negro female was admitted to Michael Reese Hospital with the chief complaint of left lower abdominal pain of one month duration. The pain occurred intermittently with no apparent relation to food intake. On two occasions during the week prior to admission the patient noted black stools. In recent months generalized weakness and a weight loss of 12 pounds had occurred. Physical examination was unremarkable except for a palpably enlarged liver and minimal tenderness in the left lower quadrant of the abdomen. Significant laboratory findings were as follows: hemoglobin: 8.6 g per 100 ml; hematocrit: 25 per cent; guaiac-positive stools; total protein: 5.9 g per 100 ml with albumin/globulin ratio of 2.2/3.7; and a tetracycline fluorescence test suspicious but not positive for gastric carcinoma. Liver function tests were reported as normal, as was a barium enema study. An upper gastrointestinal roentgen examination revealed irregularity and rigidity of the body of the stomach with an intraluminal ulcer crater just above the incisura. A large round filling defect was demonstrated in the duodenal bulb (Fig. 1). At surgery a round ulcerated tumor measuring 8 × 8 cm. was found in the body of the stomach, arising from the posterior wall and extending over the greater curvature for a distance of 1 cm. Projecting from the mucosa of the duodenum at a point 1 cm from the pyloric sphincter was an ovoid nodule measuring 3.5 × 3 × 2.5 cm, completely covered with a slightly hyperemic smooth mucosa (Fig. 2). A subtotal gastric resection with a Billroth-I procedure was performed.

MULTIPLE HEMANGIOMAS IN AN INFANT WITH CARDIAC HYPERTROPHY

A case of multiple benign hemangiomas in a 10-week-old Negro female is presented. At autopsy, numerous cutaneous and visceral sites of involvement were found. The hemangiomas are believed to arise from a multicentric developmental abnormality but appear capable of limited independent growth and tissue destruction. Postmortem angiograms demonstrate the existence of numerous arteriovenous shunts, which are believed responsible for the marked cardiac enlargement and early congestive heart failure in this case, as well as in previously reported cases of infantile hemangioendothelioma of the liver. Visceral hemangiomatosis should be considered as a possible extra-cardiac cause of infantile cardiac hypertrophy or failure of unknown etiology, especially in the infant with cutaneous hemangiomas. Angiographic techniques may be of help in the diagnosis and determination of extent of visceral hemangiomas.

Gout in the Negro Female.

s1 February 1964Gout in the Negro Female.William E. Reefe, M.D., F.A.C.P.William E. Reefe, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-60-2-330_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptGouty arthritis is generally considered to be a disease of middle-aged white men and uncommon in women. It has been considered even rarer in the Negro female. Since 1953, only 25 cases have been reported in the literature. It is the purpose of this report to present 10 cases of gout in Negro females seen in a general hospital over a 3-year period. The clinical findings in these cases are compared to the classical historical description of gout in women, namely its occurrence in the postmenopausal state, the relative sterility of women with gout, and the older age of onset... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Washington, D. C. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 February 1964Volume 60, Issue 2_Part_1Page: 330-330KeywordsArthritisGoutInfertility Issue Published: 1 February 1964 PDF downloadLoading ...

Congenital Gastric Obstruction

The stomach is the least frequent site of congenital intestinal obstruction in the infant. We have found only 12 cases of complete congenital gastric obstruction reported in the English literature.1-10,26-28Incomplete congenital gastric obstruction is more common, and various causes have been described. Although the incomplete congenital gastric obstruction may be less of an emergency than the complete obstruction, it does present a more difficult diagnostic problem. The purpose of this publication is to present a case of gastric obstruction in the newborn and review the various pathological entities leading to gastric obstruction, which have been reported in the literature. Report of Case A 2,700 gm (6 lb) Negro female was the product of a full-term pregnancy of an 18-year-old preeclamptic Negro female with polyhydramnios. Delivery was performed by low forceps extraction. The infant was discharged 48 hours after birth. Family history revealed the mother to have been operated

TUMORS OF THE POSTERIOR FOSSA IN CHILDHOOD AND ADOLESCENCE. THEIR DIAGNOSTIC AND RADIOTHERAPEUTIC PATTERNS.

Children with tumors of the posterior fossa are quite often referred to a radiotherapy department for some phase of management. Only a very few highly specialized institutions, however, have enough cases to permit evaluation of the effect of treatment and observation of the full course of the disease. As is well known, two features distinguish brain tumors of children from those of adults. The most significant is the higher percentage of gliomas in children. Figures range from 60 to 80 per cent for children and from about 40 to 60 per cent for adults. This difference is due to the greater frequency of cerebellar gliomas in children and to the infrequent occurrence of three common tumors usually found in adults; namely, meningiomas, acoustic neurinomas, and pituitary adenomas. The other important feature is that childhood neoplasms occur in the infratentorial region in about 65 to 75 per cent of the cases, whereas meningeal tumors of adults occur in the supratentorial region. Astrocytomas and medulloblastomas of children have a predilection for the infratentorial region (1, 2). To obtain a better orientation of the problem of posterior fossa tumors of childhood, we have reviewed our material from the years 1938 to 1960. These patients were seen in the Radiotherapy Department, Research and Educational Hospitals, University of Illinois, and of course are not the total census of brain tumors seen by this department. We have tried to correlate the clinical, diagnostic, and therapeutic aspects of the 67 children with posterior fossa tumors. Early in the study, it was noted that three rather distinct patterns were recognizable. Table I presents the number in each group with the histological diagnosis and anatomical site. Group I: The Medulloblastoma-Sarcoma In 19 cases the histological diagnosis was medulloblastoma of the cerebellum, and 6 of these children came to autopsy. Sarcoma was reported upon surgical biopsy in 14 children, of whom 5 were later autopsied. Since sarcoma of the cerebellum and leptomeninges is difficult to differentiate both clinically and histologically from medulloblastoma, these patients are in included in the medulloblastoma group. Thirteen of the 19 medulloblastomas occurred in white males, and the remaining 6 in females, 2 of whom were Negroes. The ages ranged from two to twenty years, with 10 patients under ten, giving a mean age of nine and three-tenths years. In 13 cases the tumor had originated in the midline or vermis of the cerebellum, in the remainder it extended into either hemisphere. The sarcoma division had an equal number of males and females, with a single Negro female. Their ages ranged from nineteen months to twenty years, with 9 patients under ten years, and a mean age of nine and eight-tenths years. Only 5 lesions were reported in the midline of the cerebellum.

STEROID THERAPY IN CHRONIC HEPATITIS.

Chronic hepatitis has recently received considerable attention1-19under various designations including chronic viral hepatitis,2lupoid hepatitis,7,12,14,16plasma cell hepatitis,10progressive hepatitis,15or subacute hepatitis19. Although there appears to be general agreement as to the clinical and pathologic features of this disorder, there are controversial views on the efficacy of steroid therapy.10,12,14,16,20-29This study was undertaken to assess the effect of longterm steroid therapy by means of liver function tests and serial liver biopsy specimens. Steroids were withheld for short in- tervals to determine the permanency of their effects and for purposes of control. Report of a Case The patient, a 56-year-old Negro female, was first admitted to the Cincinnati General Hospital on June 13, 1961. The onset of her illness was insidious with gradual progression of symptoms for a period of six weeks during which she noted vague epigastric pain, dyspepsia, and progressive anorexia

PERIVASCULAR EXTRAVASATION OF THORIUM DIOXIDE PREPARATION. TWENTY-ONE-YEAR FOLLOW-UP.

IN 1960, a 30-year-old Negro female was first admitted to Hahnemann Hospital because of massive swelling of an amputation stump of the left arm. Radiographic studies at that time revealed what was initially interpreted as calcification of the spleen. The roentgen characteristics were so unusual, however, that extensive inquiries were carried out. The following case report is a recapitulation of clinical events leading to the present syndrome. Report of a Case At 12 years of age the patient was first seen at another hospital (1942) because of a congential, progressive enlargement of the left arm and shoulder region and a slight enlargement of the left leg. After routine studies were completed an arteriogram was attempted on the left arm by the percutaneous method. This was unsuccesful and most of the thorium dioxide preparation (Thorotrast) was extravasated into the soft tissues of the arm. She was discharged without being given definitive