Nucleolar organizer regions in transitional cell tumors of the bladder.

The traditional silver staining technique that identifies nucleolar organizer region-associated proteins has recently been adapted and applied to paraffin sections, and used to examine changes in nucleolar organizer region numbers in a variety of benign and malignant conditions. We describe herein the enumeration of nucleolar organizer regions in a variety of benign and malignant conditions of the transitional epithelium of the urinary bladder. While there is a statistical separation between normal and neoplastic groups, there is a degree of overlap between normal, inflammatory, dysplastic, and neoplastic urothelium.

The fine structure of the human fetal urinary bladder. Development and maturation. A light, transmission and scanning electron microscopic study.

The urinary bladders of 27 human fetuses, aged 7 weeks to full term, were studied by light, transmission and scanning electron microscopy to establish the sequence of events in the development and maturation of the organ during fetal life. In the early specimens, 7-12 weeks old, the urinary bladder was lined by a bilayered, cuboidal and glycogen-rich epithelium. During the 13-17th weeks the epithelium thickened, a third layer developed and by light microscopy it now resembled urothelium.

Central haemodynamic changes during lower body positive pressure in patients with congestive cardiac failure.

Fifteen patients with moderately severe and severe chronic congestive heart failure were studied to determine the central haemodynamic results of short term increases in lower body positive pressure. Central haemodynamic variables were determined by Swan-Ganz thermodilution catheterisation and arterial cannulation. Graded increases in lower body positive pressure were applied to supine patients using Medical Anti-Shock Trousers (MAST).

Significance of venous and lymphatic invasion in malignant polyps of the colon and rectum.

Three hundred and sixty seven neoplastic colorectal polyps removed at endoscopy of which 34 were complicated by invasive carcinoma, were reviewed clinically and histologically to assess the prevalence and clinical significance of venous and or lymphatic invasion. Traditional stains for histological assessment were supplemented by immunohistochemical methods. Venous and or lymphatic invasion was present in six cases (17.

The immunogenetics of insulin-dependent (Type I) diabetes.

Insulin-dependent diabetes develops when a genetically predisposed individual is exposed to an as-yet-unknown environmental insult. A major part of genetic susceptibility to the disorder is encoded close to or within the HLA-DQ region, but non-HLA-linked genes are also implicated.

Emergency subtotal oesophagectomy.

From 1981 to 1987 nine patients have undergone resection and reconstruction of the oesophagus as an emergency, using a two-part left-sided approach with oesophagogastric anastomosis in the neck. Five patients had oesophageal perforation with a carcinoma; one had spontaneous perforation of an intrathoracic stomach; two had severe haemorrhage; and one had acute sterile mediastinitis. Following operation there was one postoperative death (11 per cent) and no major complications.

How to insert a chest drain.

Collections of air or liquid in the pleural space are pathological and their prompt complete evacuation by safe satisfactory insertion of a chest drain will relieve symptoms and prevent complications.

Proliferation indices in malignant lymphomas.

In view of the importance of adjusting therapy to prognostic groups in malignant lymphomas, there have been numerous attempts over the past two decades to assess proliferation rates in these neoplasms. The techniques employed include radiolabelled thymidine uptake, DNA flow cytometry, the application of antibodies to proliferation-associated antigens and the enumeration of nucleolar organizer regions. The evolution of these methods is reviewed and their usefulness is evaluated.

Colopleural fistula due to strangulated Bochdalek hernia in an adult.

An elderly patient presented with a right sided pneumothorax due to strangulation of part of the colon through a congenital Bochdalek hernia. Congenital posterolateral diaphragmatic hernia of Bochdalek is rare in an adult and strangulation with pneumothorax has not been reported before.

Treatment of oesophageal small cell carcinoma by combined chemotherapy and surgical resection: report of two cases and review of published cases.

Two patients with primary small cell carcinoma of the oesophagus were treated by multidrug chemotherapy followed by surgical resection. A partial response to chemotherapy was observed in both patients.

Purification of human blood eosinophils by negative selection using immunomagnetic beads.

A simple method for isolating highly purified eosinophils from human blood is described. Buffy coats from normal individuals (eosinophil counts less than 0.4 x 10(9)/litre) were centrifuged through a two layer Percoll density gradient, to produce a granulocyte fraction containing neutrophils and eosinophils.

How to insert a Minitrach.

Minitracheotomy is a technique of cricothyroid cannulation to allow efficient tracheobronchial toilet and the application of other techniques for respiratory support. Indications and contraindications for the procedure are reviewed. Two methods of insertion are described with their potential difficulties.

Pneumatosis cystoides intestinalis. Histological mucosal changes mimicking inflammatory bowel disease.

In 10 cases of pneumatosis cystoides intestinalis affecting the colon in adults, the overlying mucosa exhibited abnormal glandular architecture. The importance of this feature lies in the possible confusion histologically with inflammatory bowel disease, especially Crohn's disease.

Review article: antibiotics and the gut.

Antibiotics have an important place in the management of gastrointestinal disease. Recent studies have demonstrated efficacy in acute bacterial gastroenteritis caused by salmonellae and campylobacteriaceae, shigellae and enterotoxigenic strains of E coli (ETEC). Tetracycline remains effective in cholera.

Prospective and retrospective data compared in patients with PTFE femoropopliteal bypass grafts.

Twenty-four patients with PTFE, femoropopliteal grafts were studied using two different methods. A prospective study was carried out as part of a clinical trial and later the same patients were identified as part of a retrospective study. Comparison of the details obtained independently showed marked differences in patients' ages, indications for surgery, angiographic runoff, operative detail, risk factors and subgroup patency.

Assessing cardiac pumping capability by exercise testing and inotropic stimulation.

In heart failure both functional capacity and prognosis are primarily determined by the degree of pump dysfunction. Although data on haemodynamic function at rest may indicate impaired cardiac function, they do not assess the capacity of the heart to respond to stress. Maximal bicycle ergometry and incremental intravenous inotropic stimulation in 31 patients with moderately severe heart failure were evaluated as methods of stressing the heart to determine cardiac pumping capability, which is defined as the cardiac power obtained during maximal stimulation.

Malignant carcinoid tumour of the oesophagus.

A patient with a carcinoid tumour of the oesophagus developed widespread metastases within three years of a successful local resection. Of the seven patients with oesophageal carcinoid tumours so far reported, four have died with widespread metastases.

Doppler characterization of the immediate blood flow velocity pattern after release of prolonged venous occlusion of the forearm.

1. There is a biphasic flow response measured plethysmographically after release of prolonged venous occlusion of the forearm. 2.

Recent experience in the control and management of tuberculosis in a mental handicap hospital.

Sixteen cases of tuberculosis (14 in inmates, only one of whom was female) occurred in a mental handicap hospital of some 400 inmates during the period 1973-85. This represents an annual incidence of 269 per 100,000, substantially higher than that in the surrounding community. In 1980, 29% of inmates had Grade 3 or 4 positive Heaf tests.

Origin and behaviour of emphysematous bullae.

Giant emphysematous bullae are believed to produce symptoms of pulmonary compression and collapse by containing gas under pressure that has been generated through valvular feeding airways. To examine this hypothesis, we have measured oxygen and carbon dioxide tensions (PO2, PCO2) in four patients and pressure within the bullae in three patients immediately before surgery. During spontaneous tidal respiration PO2 in the bulla was higher than arterial PO2 but did not rise as fast during the breathing of oxygen.

Are three views necessary to examine acute ankle injuries?

In a retrospective review of the radiographs of 945 patients whose ankles were X-rayed for acute trauma over a 6 month period 95.3% of the 128 fractures identified were seen on anteroposterior and lateral films. The identification of six additional minor fractures by means of the 15 degrees internal oblique radiograph did not alter the management of individual patients and it is concluded that the routine use of oblique views is not justified.

How should we count AgNORS? Proposals for a standardized approach.

There is interest currently in the AgNOR technique, for NOR-associated proteins. In some cases, this technique enables the distinction to be made between certain grades of malignancy and may enable prognostic assessment. This paper attempts to suggest a standardized means for the enumeration of NORs in histological sections.

Nasal surgery: does the type of nasal pack influence the results?

A prospective study was performed on 106 patients undergoing routine nasal surgery to compare the influence of three different packing methods on the final outcome. Pneumatic balloons were found to cause persistent nasal obstruction and an increased incidence of adhesion formation, while lubricated ribbon gauze was more uncomfortable for the patient. Glove finger packs were associated with the least problems.