Sessile Base Research Articles

Juvenile fibromas of the nasopharynx.

Juvenile nasopharyngeal fibromas are rare and benign. There would be no need to discuss them again were it not for the fact that they produce such alarming symptoms and present such serious problems in treatment. Injudicious surgical or radiologic treatment of such lesions can cause frightening hemorrhages, intracranial disturbances, and even death. The mere removal of a small piece of tissue from this type of lesion for microscopic examination occasionally can produce bleeding so profuse that ligation of the external carotid artery and the administration of blood are necessary. These tumors often are referred to as "nasopharyngeal angiofibromas," which is a good term in view of the fact that the vascular elements in many of these neoplasms are more prominent than the fibrous component. Juvenile fibromas arise from the base of the skull and are attached to the vault of the nasopharynx, usually by a broad, sessile base. Although they

A New Technic for the Radium Treatment of Carcinoma of the Bladder

Treatment of cancer of the urinary bladder entails not only eradication of the primary tumor by methods tolerable to the patient, but also prevention of recurrent and new tumor growths. The high incidence of new growths following local resection, fulguration, or irradiation, and the necessity of relentlessly guarding against recurrence by periodic examination, are evidence of the inadequacy of the present methods of treatment. To meet these problems, a new radium technic was devised and first used at Walter Reed General Hospital on July 18, 1945. Favorable experience with the first 13 cases warrants this preliminary report. The Walter Reed technic entails isoirradiation of the lower two-thirds of the bladder wall with fractionated exposures of penetrative gamma rays from a focal source of radium, radon, or radioactive cobalt fixed at the center of the bladder cavity. With this procedure certain disadvantages of other methods of irradiation are circumvented. Interstitial irradiation with radium needles or radon implants often results in focal radionecrotic ulceration attended by intractable pain, fistula, and fibrosis. Surface application of radium through a cystoscope is inaccurate and ineffective. External irradiation with x-rays, especially supervoltage irradiation, is occasionally effective, but may injure the bladder and adjacent bowel, and is frequently followed by a fibrosed contracted bladder of small capacity. The Walter Reed Technic Preoperative Diagnosis and Delineation of the Tumor: It is first necessary to ascertain as accurately as possible the geometric size, location, and type of the tumor to be treated. This is done by cystoscopy, biopsy, and pyelography and cystography with an opaque medium or air. Radiographic examination should include anteroposterior and postero-anterior as well as lateral and oblique views of the bladder, for occasionally these may yield more information as to infiltration and extravesical extension than direct observation and palpation of the opened organ. Cystotomy: At the time of the first radium insertion, the bladder is opened by suprapubic cystotomy and the tumor carefully inspected and classified. A papillary tumor with a narrow pedicle is totally resected with scissors, and the mucosa is sutured (Fig. 1). A bulky papillary tumor with a pedunculated or broad base is removed by electrosurgery, care being taken to cut down to the base only and not into the bladder wall, leaving a flat, slightly elevated sessile base of partly coagulated tissue about 3 or 4 mm. thick. If coagulation is carried down to the level of or into the bladder wall, secondary infection plus subsequent irradiation will unduly retard healing and result in an indolent ulcer requiring several months to heal, attended by painful cystitis. If the tumor is flat or sessile (Case 8) coagulation is unnecessary.

Two Spontaneous Uterine Tumors in a Rabbit: An Hormonal Investigation

There have been recorded in the literature between 90 and 100 spontaneous tumors in the rabbit, of which 42 were located in the uterus. The present report of two spontaneous uterine neoplasms in a female rabbit brings this latter number to 43. The literature has been reviewed and references are given by Cutler (1), Heiman (2), and, most recently, by Orr and Polson (3). The uterine tumors here described were observed June 9, 1937, in a mature female black and white rabbit between eight months and one year old, weighing 2520 gm. The past history of the rabbit was not obtainable. The animal was being used for immunological sera studies, and as it was thought to be pregnant, since two masses could be felt in its abdomen, it was discarded for that purpose and operated upon to obtain some fetal tissue. Upon opening the abdomen two tumors were encountered. One was located at the bifurcation of the uterine horns, extending more to the right side than to the left. It was of a deep purplish color with dilated veins on its surface; it measured 5 × 3 × 3 cm. and on section showed extreme proliferation of the endometrium, which completely obliterated the lumen. The second tumor was at the mid-point of the left horn and measured about 2 × 2 × 2 cm. When the uterine wall over this tumor was cut through, an endometrial mass, attached to the wall of the horn by a sessile base, extruded itself. On gross examination both ovaries showed fresh corpora lutea. No metastatic nodules were present in the retroperitoneal lymph nodes and lungs, nor was any abdominal organ invaded by neoplasm. Unfortunately neither adrenal glands, breasts, nor the hypophysis were removed for microscopic study. Grossly there was no evidence of pregnancy in either uterine horn.

TWISTED PEDICLE OF ACCESSORY LOBE OF THE LUNG

Accessory or supernumerary lobes of the lungs are usually unimportant from a pathologic point of view. Either lung may have one or two extra lobes or rudimentary fissures; the extra lobes when present are usually small but may be quite large. They are generally located posteriorly, near the hilus, and have a broad or sessile base. Occasionally, as in our case, they are located anteriorly and are pedunculated, in which event they usually arise from the free margin of a standard type of lobe. Rudimentary fissures are sometimes seen; one happened to be present in our case, both abnormalities being in the left upper lobe. The remarkable feature of our case was made possible by the simultaneous presence of a hydrothorax. The accessory lobe had floated in the hydrothorax and because of respiratory movements had made two and one-half turns from left to right. This had resulted in a high

NEW SPECIES OF CYNIPIDAE

Cynips (Q. Californica, n. sp.Galls: Polythalamous, sessile on the branches of the Californian White Oak (Quercus Hindsii ?) Sub-globular, but varying much in form and size. A common form is what may be termed balloon-shaped, the upper part perfectly globular, the lower tapering more or less to the sessile base. They often occur of a long compressed oval form: these are placed longitudinally on the branch and the length is two or three times their breadth or thickness.