Pathological Examination Of Specimen Research Articles

Paper chromatography of phenolic derivatives of phenylethylamine and some other diazo-reactive bases in urine

Some of the conditions governing successful paper chromatography of phenolic derivatives of phenylethylamine have been investigated. Methods of isolating these amines from urine are described and compounds which may be simultaneously detected on chromatograms using diazonium reagents have been chromatographically characterised. Examination of pathological specimens has suggested that the methods should be particularly useful in the detection of amine-releasing tumours and of “stress”.

Vascular lesions affecting the visual pathways.

There is no better means of acquiring an understanding of the subject of neuro-ophthalmology than by firsthand examination of pathologic specimens. For the ophthalmologist it is a most enlightening experience to see the great frequency with which sections of the brain contain lesions that affect, in a variety of interesting ways, the visual pathways. The autopsy material on which this discussion is based was selected by me from a large number of brain sections inspected at the neuropathology conferences conducted by Dr. J. M. Nielsen, of Los Angeles. The present discussion will deal primarily with involvement of the visual pathways through lesions in the temporal isthmus and in the occipital lobes. When the ophthalmologist is confronted with a cerebral defect producing a homonymous hemianopia without optic atrophy or impairment of the pupillary light reflex, he knows that the lesion is situated somewhere posterior to the lateral geniculate bodies. But for

PERITENDINOUS FIBROSIS OF THE DORSUM OF THE HAND

Two cases are presented of soldiers who suffered from recurrent, disabling, hard swelling on the dorsum of the hand, following a severe initial blow. In each case operative exploration and examination of pathological specimens revealed evidence of old and recent hemorrhage, with fibrous-tissue proliferation and organization in the hemorrhagic area. Infiltration of the extensor tendon by the fibrous tissue gives explanation for the clinical finding of local pain and limitation of movement during flexion of the fingers: also, it is evident that, with extremes of motion of the tendon, disruption of the attached fibrous tissue occurs with further hemorrhage, clotting, fibroblastic organization, and increased fibrosis deep to the superficial fascia. This explains the recurrent, localized, and hard character of the swelling. In such cases it would appear that the treatment of choice is early operative evacuation of the primary hematoma and ligation of any evident bleeding vessels, followed by a firm compression dressing. Involvement of the extensor tendons during the fibroblastic organization of the adjacent hematoma cannot otherwise be avoided with certainty. In late cases, evacuation of the hematoma should probably be followed by prolonged immobilization, in order to allow maturation of the fibrous tissue and obliteration of the hematoma cavity. The authors are not prepared as yet to state the value in advanced cases of excision of the involved tendons, subcutaneous tissue, and skin, with replacement by a pedicle skin graft and tendon transplants. Such procedures are certainly contra-indicated in cases with a factitial etiology, in old cases with severe joint contracture and marked loss of function, and in those with marked secondary sympathetic-nerve phenomena. Probably not all cases of peritendinous fibrosis of the dorsum of the hand have a similar basis. In our opinion this present hemorrhagic type constitutes a definite subdivision of a group of ill-defined cases which follow a definite syndrome and are resistant to the usual treatment. The presence or absence of this hemorrhagic type should always be established before other operative procedures, such as various types of cervical sympathectomies, are performed. Permanent good results cannot logically be anticipated with cervical sympathetic procedures in those cases in which fibroblastic infiltration and fixation of the extensor tendons have occurred.

Diverticulitis of the Colon, with Especial Attention to the Diagnosis

DIVERTICULITIS of the large bowel is of interest to the surgeon because of its ability to simulate other inflammatory conditions in the abdomen, including appendicitis, cholecystitis and acute pelvic inflammatory disease, as well as on account of its not infrequent demand for operative relief or radical cure. It is of interest to the internist because it requires to be differentiated from other causes of vague chronic or recurrent abdominal distress, and because it responds well, in its less acute phases, to medical treatment. It is, however, of even more interest to the roentgenologist, since only he is capable of making a definite diagnosis of this condition in the living patient and since this diagnosis often gives an unexpected and thoroughly satisfying solution to what may have been a puzzling clinical problem. In the recognition of this disease, as in other phases of abdominal X-ray diagnosis, the profession owes a considerable debt to Carman, who was the first roentgenologist to report a series of cases examined by the roentgen ray and the first to formulate a scheme for the recognition and differential diagnosis of diverticulosis. This condition was described from the pathological standpoint by Graser in 1899. In 1907, Mayo, Wilson and Giffin reported five cases which had been treated surgically. The first reported case examined by X-ray was one described by Abbe and examined roentgenologically by LeWald, reported in 1915. Carman's first report was published in 1915 and detailed three cases examined at the Mayo Clinic by X-ray. In the first two of these cases the condition was not recognized from the X-ray films, as Carman had concluded after examination of pathological specimens that it would be impossible to demonstrate diverticula by means of an opaque enema or meal. The characteristic shadows were, however, noted on the films and when the cases subsequently came to operation an extensive multiple diverticulosis was found in both patients. Carman promptly concluded that the small round extralumenal shadows noted must have been due to filled diverticula. The third case of this series had not come to operation at the time of the report, but showed perfectly typical shadows. Since that report, roentgenologists have been finding diverticulosis in an increasing percentage of patients undergoing routine gastro-intestinal examinations, as well as in patients having suggestive symptoms. Case estimates that one in eighty of his routine gastro-intestinal examinations shows diverticula, and our own records show at least as common an incidence as this. As with other more or less rare pathological conditions, the worker who is most zealous in the search for diverticulosis and most open to suggestions of its presence encounters it most frequently. True and false, acquired and congenital, diverticula are described in the literature.