Experimental St - Cancer Research [PDF]

The abstracts which follow have been classifled for the convenience of the reader under the following headings : Experimental Studies, Animal Tumors Nature of Cancer, Etiologic Theories General Clinical Observations, Blood Studies Diagnosis and Treatment Tumors of the Skin and Muscles The Oral Cavity, Nose and Paranasal Sinuses, Throat, S a l i v a r y Glands, Carotid Body The Eye The Ear The Thyroid Gland The Breast Intrathoracic Tumors

The Digestive Tract The Liver The Pancreas Retroperitoneal Tumors, Cysts and Tumors of the Mesentery The Spleen The Female Genital Tract The Genito-Urinary System The Adrenal Glands The Nervous System The Bones and Joints The Lymphatic System Statistics Education

As with any such scheme of classification, overlapping has been unavoidable. Shall an article on " Cutaneous Melanoma, an Histological Study " be grouped with the articles on Histology or with the Skin Tumors? Shall Traumatic Cerebral Tumors go under Trauma or The Nervous System? The reader's choice is likely to depend upon his personal interests; an editor may be governed by no such considerations. The attempt has been made, therefore, to put such articles in the group where they would seem most likely to be sought by the greatest number. It is hoped that this aim has not been entirely missed. As abstractors are never perfect, and as the opinions expressed may on occasion seem to an author not to represent adequately his position, opportunity is offered any such to submit his own views for publication. The JOURNAL will not only welcome correspondence of this nature but hopes in the future to have a large number of author abstracts, so that the writer of a paper may present his subject in his own way.

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Production of Tumours in the Fowl by Carcinogenic Agents: (1) Tar; (2) 1: 2: 5: 6Dibenzanthracene-lard, P. R. PEACOCK.J. Path. & Bact. 36: 141-152, 1933. The recent experiments by Kennaway and his co-workers (Am. J. Cancer 16: 57, 1932) have shown that 1: 2: 5: 6-dibenzanthracene is not only carcinogenic for mice when painted on the skin, but when injected in solution in lard or emulsified with olive oil has produced connective-tissue sarcomata in rats and mice. Tumors of the fowl produced by this agent or by tar would, therefore, have an equal claim to recognition as true neoplasms with these experimental mammalian tumors. The author refers to attempts that have been made in recent years to produce tumors in fowls by injecting tar and other agents, but points out that the number of successes has been small and that much of the work has been criticized on the score that the results might be attributed to contamination of the apparatus used by traces of the infective agent of non-filterable tumors. His own experiments were free from this objection because no experimental work on fowl tumors had been done previously in the laboratory used. In the first part of his paper the author describes his experiments with three kinds of tar. I n the largest of these series he used an emulsion of tar in soap solution. The birds were one-month-old Plymouth Rock chicks. Seventy-three of these were inoculated in the right breast with minced eightday embryo tissue. Thirty-eight were then given injections of the tar emulsion, and 35 were given injections of soap solution only. The injections were repeated weekly for seven weeks. Out of 31 tar-injected birds that survived for a year or more, 13 developed tumors, 8 being sarcomas and 5 fibromas. Of the former, 3 have metastasized freely, and two have grown on as autotransplants. I n the two other, smaller, tar-injected series the results were very similar. I n the experiments with 1 : 2 : 5 : 6-dibenzanthracene, 31 chicks, two to three months old, were given injections of this substance, mixed with lard, into the right breast, and of lard alone into the left breast. After fourteen months 10 birds (of which 5 have died with extensive metastases) had developed tumors, all of spindle-cell sarcoma type, a t the site of the dibenzanthracene-lard injection, while 3 had developed similar tumors a t the site of the control lard injection. The author notes that in these 3 birds the ‘‘ lard tumor ” appeared before the dibenzanthracene tumor, and he believes that the latter substance must have spread to the opposite breast either directly by the connective-tissue spaces or by the blood vessels. The presence of the lard, a foreign substance, may have determined the redeposition of minute traces of dibenzanthracene in the reacting tissue. The quantity of this agent which is actually required to induce sercomatous growth must be extremely small, because the bulk of it appears to remain encapsulated throughout the experiment. Histologically these tumors were similar to the slowly growing filterable fibrosarcomas of fowls. One of the dibenzanthracene tumors is growing in the second generation of transplantation. There are fourF. CAVERR teen illustrations, including some good photomicrographs. DifIerences in the Growth of Transplantable Twnours in Plasma and Serum Culture Media, R. J. LUDFORD.Proc. Roy. SOC.112 (Series B): 250-263, 1933. In a recent study of the behavior of normal and malignant cells in tissue cultures of transplantable tumors, the author found that vital staining showed a 969

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characteristic difference between the two cell types. When a plasma culture undergoes liquefaction, the outgrowth of malignant cells collapses owing to the breaking down of the fibrous network supporting the cells. The malignant cells round off , usually become detached, degenerate, and die. The non-malignant connective-tissue cells remain adherent to the cover-glass and, without renewal of the culture medium, often survive after all the malignant cells have died. From these observations it seemed improbable that any outgrowth of malignant cells would occur in a serum medium. Bits of four transplantable mouse tumors (the mammary carcinomas 63 and 206, Crocker sarcoma 180, sarcoma 37) were explanted in rat serum and rat plasma, also in mouse serum and plasma with or without mouse embryo extract. There was no appreciable difference in growth between rat plasma and mouse plasma or between rat serum and mouse serum. The cultures were vitally stained by adding a drop of 0.5 per cent trypan blue in Ringer’s solution as soon as growth was well established, usually two or three days after explanting. I n each series two or three control cultures received no trypan blue. The author’s conclusions are as follows: ‘‘ I n tissue cultures of tumours there are present (a) the malignant cells; (a) non-malignant cells, consisting of cells of the stroma, and cells of the monocytemacrophage series, which vary in number according to the extent of the resistancc which the animal from which the tumour was removed had opposed to the malignant growth. The malignant cells can be distinguished from the non-malignant cells by the addition of trypan blue to the cultures, since the former do not segregate the dye like the latter. The two types of cells are further distinguishable by vital staining with a basic dye, such as neutral red, and by their general cytological characters, such as sire of nuclei and nucleoli, and cytoplasmic vacuolation. In plasma cultures both malignant and non-malignant cells migrate from the explant, in serum cultures only non-malignant cells do so.” It is suggested that the different behavior of malignant cells in plasma and in serum results from a change in their plasma membrane such that they are unable to adhere to glass, though able to use the fibrin network of a plasma clot for their movement. Such a change might be brought about by an increased amount of fats or lipins in the plasma membrane. To this change may be attributed the failure of malignant cells to segregate the water-soluble acid dyes which may be unable to penetrate such a membrane. The author points out that Lumsden (Am. J. Cancer 15: 563, 1931), having no such method for distinguishing between normal and malignant cells, failed to discover that the cells which migrate from tumor explants in serum are non-malignant and that none of Lumsden’s photomicrographs shows other than the destruction of non-malignant cells. He formulates, from the results of his own work, two tests for any substance for which a specific destructive action on cancer cells i ~ i uitro is claimed. (1) When added to a young, actively growing plasma culture, such a substance should be able to kill the malignant cells, leaving the nonmalignant cells unaffected. The latter can be distinguished by their general cytological characters and their reactions to acid and basic dyes. (2) When added to a young, healthy serum culture, such a substance should destroy the malignant cells within the explant, while leaving intact the cells which have wandered out from it, since the latter are non-malignant cells. The cells of the explant can be examined cytologically in serial sections, by partially crushing it, or by tearing it apart. Four plates of wash drawings and photomicrographs accompany this article. F. CAVERS

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Effect of Bone Marrow from Young Animals on Healthy and Pathological Growth, ROBENSTEIN AND KOHLER. Die Rolle des jugendlichen Knochenmarks beim gesunden und kranken Wachstum, Arch. f. klin. Chir. 173: 239-242, 1932. In a paper presented a t the 56th meeting of the German Surgical Society, Rosenstein and Kohler rehearsed their opinions concerning the part played by the bone marrow of young animals in connection with growth. They removed the bone marrow from the upper and lower extremity of one side of a six-weeks’ old calf, and fourteen days later that on the other side. Since, despite ample feeding, this calf did not grow as well as the control, the authors conclude that the bone marrow contains a hormone which regulates growth and prevents premature senility. As confirmatory evidence they quote the fact that, of two persons to whom bone marrow was given, one observed that a senile deafness had disappeared, and the other that he was able t o read without glasses. I n addition to these remarkable findings, they report four new cancer cases in which administration of bone marrow was of certain clinical benefit. These patients, after from 17 to 34 injections, gained in weight and felt better. In one the tumor disappeared, and in a patient with a carcinoma of the esophagus the ability to swallow was restored. The writers refer for further news to a former paper (abst. in Am. J. Cancer 16: abst. p. 771, 1932) and to a paper by Hoffman on the potassium content of the bone marrow in carcinoma (abst. in Am. J. Cancer 16: abst. p. 1044, 1932). Epithelial Proliferation and Papilloma Formation in the Bladder of Rats, Set Up by a Parasite, Trichosomoides crassicauda, S. WATANABE.Uber die Epithelwucherung und die Papillombildung in der Rattenharnblase, welche die Trichosomoides crassicauda (Bellingham) beherbergt, Acta Dermat. 19: 137149, 1932. A wild rat found in Japan is frequently infested by Trichosomoides crassicauda wliich occurs in the urinary bladder, The author examined the bladders of 38 infested rats and found various changes in the epithelium, ranging from simple proliferation to papilloma formation. In no case were changes of a malignant nature observed. F. CAVERs Tumor Grafts in Epiphysectomized Rats, G. VECCHI. Innesti di tumori in ratti operati di epifisectomia, Cancro 3: 122-125, 1932. Vecchi removed the pineal body in eight rats. When a transplanted osteosarcoma was grafted into these animals it grew in the same manner as it did in normal controls. C. D. HAAGENSEN Action of Fluorescein Derivatives on the Red Blood Cells of Normal Animals and of Those Bearing Tumors, A. H. ROFFOAND 0. CALCAGNO. Los derivados de la fluoresceins y su accidn sobre 10s hematfes de sangre de animal normal y con tumor, Bol. Inst. de med. exper. para el estud. y trat. del chncer 8: 595-643, 1931. English summary pp. 642-643. The 117 fluorescein compounds investigated by the authors differed widely in hemolytic power according to which of 3 halogens (bromine, iodine, chlorine) entered into their composition, but all hemolysed red blood cells from sarcomabearing rats more vigorously than those from normal ones. Readers interested in the chemical problems discussed in this paper must be referred to the original. Certain preliminary phases of the work have already been described by Roffo, who has stated that the procedure is useless as a diagnostic measure in man. For abstracts see Am. J. Cancer 16: abst. pp. 780, 1293, WM. H. WOGLOM 1932.

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Ultraviolet Radiation and Hemolysis Produced by Erythrosin in Erythrocytes from Normal and Tumor-bearing Rats, A. H. ROFFO. Les rayons ultraviolets et I’hBmolyse des hematies normales et nhoplasiques provoquhe par l’hrythrosine, NBoplasmes 11: 351-365, 1932. Also in Bol. Inst. de med. exper. para el estud. y trat. del c&ncer 9: 5-26, 1932; Prensa med. argent. 19: 869, 1932. Ultraviolet radiation caused some slight hemolysis in uitro, which took place more rapidly in the erythrocytes of rats bearing transplanted carcinoma or sarcoma than in those from normal rats. The presence of erythrosin accentuated this hemolysis, but the difference remained. It was not necessary, however, to irradiate corpuscles and erythrosin together, for the same increase of hemolysis was observed when red blood cells were exposed before addition of the dye. Comparable results were obtained with human erythrocytes. Irradiation of the living rat was also effective, and in proportion to the length of radiation. The corpuscles remained sensitive for about forty-eight hours. WM. H. WOGLOM Behavior of Choline During the Development of Mouse Adenocarcinoma, A. BOLAFFI. I1 comportamento della colina durante lo sviluppo dell’adenocarcinoma del topo, Tumori 6: 209-214, 1932. Bolaffii determined the choline content of the tissues in fifteen mice grafted with adenocarcinoma. The determinations were made at successive periods in the growth of the tumor. In another series of 12 animals he made periodic determinations of the amount of choline in the adenocarcinoma itself. He concludes that there is a progressive increase in the choline content of the tumor during its growth, and that it finally reaches a concentration point which is much higher than the normal choline content of mouse tissues. C . D. HAAGENSEN Survival of the Causative Agent of the Chicken Sarcoma Ingested by Mosquitoes, S. MATBUOKA AND Y. YABUCHI.Gann 26: 315-340, 1932. The authors attempted to transmit the causative agent of chicken sarcoma from tumor-bearing chickens to healthy chickens by the bites of mosquitoes. To test for the presence of the tumor agent in blood, the authors injected into healthy chickens the blood taken from chickens bearing Oshima chicken sarcoma of fourteen to eighteen days’ duration. Of 25 chickens inoculated with 2.0 C.C. blood, 62 per cent developed sarcoma, while of 25 chickens inoculated with 0.3 C.C. blood, 38 per cent developed the tumor. When the implanted chicken sarcoma was fully developed, mosquitoes, Aedes togoi Theobald and Culex pipiens pnllena Coquillet, were allowed to suck blood from these chickens for from two to twenty-five minutes. When the mosquitoes were about half full of blood, they were allowed to suck the blood of healthy chickens, in the pectoral muscle region, for from one minute to fifty-three hours. Of 108 chickens none developed tumors a t the site during sixty days’ observation. At autopsy, no metastatic growths in the lungs, liver, or kidneys were found. Fragments of lung, liver, and kidney, as well as the breast skin, were inoculated into healthy chickens, but no tumor development occurred. The authors next sought to determine whether the causative agent could be stored in the body of a mosquito and whether the amount of blood ingested by a mosquito is sufficient to give rise to a tumor. The experiments comprised 90 implantations using from one to five mosquitoes a t each injection. I n the entire series only one chicken, in which three mosquitoes (Aedes togoi Theobald) were used, showed an identical sarcoma in the pectoral muscle twenty-eight days after implantation. This tumor, however, grew very slowly. The experiment would seem to indicate that the causative agent can be stored in the body of a mosquito for from six to seven hours and that an amount of 0.01 C.C. blood (a mosquito sucks about 0.004 C.C. blood) is sufficient for the development of a tumor. K. SUGIURA

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Action Exerted by Extracts of Tumor and of Embryo upon Cell Metabolism, F. PENTIMALLI. Die Wirkung von Krebsextrakten und embryonalen Extrakten auf den Zellstoffwechsel, Biochem. Ztschr. 242 : 233-243, 1931. Extracts of chicken sarcoma or of six-day chick embryos depressed glycolysis in normal or regenerating fowl muscle, uniformly and definitely. The retarding effect upon oxidative respiration, while demonstrable, was less constant and less distinct. These findings do not agree entirely with those of previous investigators. WM. H. WOGLOM Influence of Amino Acids on Tumor Respiration, B. KISCH. Weitere Versuche uber die Beeinflussung der Tumoratmung; Aminosauren, Biochem. Ztschr. 247: 354-364, 1932. The author has measured the rate of respiration of slices of Jensen rat sarcoma kept in Ringer solution a t pH 7.4, after adding to the medium various amino acids. Practically no increase was observed on adding alanin, phenylaminoacetic acid, or sarkosin. The last named, however, caused a rise in the already high respiration of the retina. I n about half of the tests made with serin and with a-aminobutyric acid the respiration rate was raised (by 10 to 25 and 20 to 40 per cent respectively); it was observed that the optimal concentration of a-aminobutyric acid was mo1./500 for tumor tissue and mo1./100 for normal rat kidney. The author concludes from his results that the respiration of tumor tissue does not respond readily to chemical I?. CAVERS stimulation. Proteolysis in Tumors, P. RONDONI.La proteolisi nei tumori, Cancro 3: 96-102, 1932. Also (in English) in Biochem. J. 26: 1477-1487, 1932. Rondoni studied proteolysis occurring in a glycerine extract of mouse carcinoma. The chemical details of his experiment may best be read in the original. He concluded that the characteristic features of proteolysis in tumors have not yet been discovered. C. D. HAAGENSEN Study of the Permeability of the Lymph Nodes in Animals under Various Experimental Conditions, and in Man during the Course of Neoplastic Invasion, A. M. DOGLIOTTI AND S. TENEFF.Studio sulla permeabilith delle linfoghiandole dell’animale in varie condizioni sperimentali e dell’uomo nel corso di invasione neoplastica, Riv. di pat. sper. 8 : 495-526, 1932. By injectin’g various substances into the feet of guinea-pigs, killing the,animals, and studying the diffusion to regional lymphatics, the authors arrived a t the conclusion that india ink is the best substance for injections to determine the permeability of lymphatics, and that cinnabar, because of its irritating action, is the best substance for injections intended to block the regional lymphatics. In an attempt to determine whether or not the regional lymphatics are blocked in cancer, india ink was injected directly into the tumor in a case of mammary cancer. When mastectomy was done a few hours later, the ink had not extended outside of the tumor. In five cases (one cancer of the tongue and four mammary cancers) india ink was injected around but outside of the tumor. The tumors and regional lymphatics were resected fifteen hours later. The nodes which were normal were found to be filled with ink. Those partly replaced by carcinoma contained only a little ink, and that in the non-cancerous portions. Those nodes wholly replaced C. D. HAAGENBEN by tumor cells showed no ink a t all.

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Influence of Electrostatic Conditions on the Appearance of Certain Spontaneous Tumors, A. V L b , AND A. DE COULON. Sur une intervention des conditions dlectrostatiques dans l’apparition de certains cancers spontan6s, Compt. rend. Acad. de sci. 194: 750-752, 1932. The authors state that in a strain of mice they had been using for tarring experiments only one spontaneous tumor had been found in 10,000 animals. They had cage supports made of paraffined wood, and floored each cage with metal (zinc, lead, or copper) or with animal carbon. Of each pair of cages, one was left insulated and the other connected with the soil by a metal wire, that is, “ earthed.” Out of 700 mice kept in the earthed cages, 26 (3.9 per cent), and out of 600 in the insulated cages, only 2 (0.33 per cent) developed tumors. However, a second batch of 600 earthed mice produced no tumors in an experiment started two months later. [The authors make no comment on this difference.] Six tumorbearing mice were insulated with the result that five of the tumors disappeared and the sixth remained stationary in size. [These results might be easier to understand if the authors had given more information about their mice; they do not, for instance, mention the ages of animals in the different groups.] 3’. CAVERS Concerning Mitogenetic Induction, P. LEMAY. A propos de I’induction mitog6n6tique1 Neoplasmes 11: 90-94, 1932. The paper is largely a discussion of some experimental work of J. Magrou, the results of which seem to point to the fact that bacteria emit radiations which produce abnormal larvae in the exposed sea-urchin eggs. Lemay thinks this phenomenon is not necessarily due to irradiation, such as Gurwitsch assurned, but that it may be due t o some tropism or possible galvanotropism. No proof is offered for these various hypotheses. Problem of Mitogenetic Radiation: Studies on Onion Root, Cancer Tissue, and AND M. NAKAIDZUMI.Untersuchungen iiber das mitoBlood, H. SCHREIBER genetische Strahlungsproblem; Beitrag zur Frage der Zwiebel-, Carcinom- und Blutstrahlung, Bioohem. Ztschr. 247: 161-170, 1932. Gurwitsch and his co-workers asserted some years ago that when living tumor tissue was brought into the vicinity of growing yeast cells the latter showed greater increase in growth and more rapid mitosis, that is, more active budding and cell division, than when other living animal tissues were brought near, or in control experiments. Hence it was stated that growing tumors give off mitogenetic, or more accurately, mitosis-favoring, rays. When the obvious objection to this theory of radiation from tumor tissue was made, that if such rays existed they must be capable of being photographed, Gurwitsch and his co-workers set to work and emerged with the discovery that these rays had indeed been located in the spectrum, and photographed; they lay in the region between wavelengths of 2,000 and 2,400 angstroms. It was then objected that absorption lines of undetermined origin are found to exist normally in that region. If this be true, the ‘ I mitogenetic ray ” controversy, which has produced a very considerable literature, is narrowed down to the question whether tumor cells have any modifying influence on these absorption lines, that is, in making them more numerous, wider, or darker. Schreiber and Nakaidzumi have made a careful and detailed study of this question and give their results in elaborate tabular form. Apart from details, they find that the addition of extracts of Ehrlich mouse carcinoma and of mouse sarcoma S 37 to growing colonies of yeast (Saccharomyces ellipsoideus), with incubation for four hours, brings about no appreciable difference either way in the number or width of the absorption lines lying around wavelength 2,200 angstroms. That is, their repetition of the work of Gurwitsch and his school has given negative results for these two types of animal tumors. F. CAVERS

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Neoplasms in Fish: A Report of Six Cases with a Summary of the Literature, A. HADDOW, AND I. BLAKE. J. Path. & Bact. 36: 41-47, 1933. The authors give a tabulated list, selected from recent literature, of tumors in fish, and describe six histologically studied cases of their own. The latter are as follows: lymphosarcoma in a salmon (Salmo salar), apparently arising in t h e lymphatic tissue of the anterior portion of the kidney; hepatoma in a rainbow trout (Salmo irideus) ; retroperitoneal ganglioneuroma in a megrim (Lepidorhombus megastoma); two cutaneous melanomas in a thornback ray (Raia clnunta), which were practically identical in gross and microscopic structure with the melanomas described and figured by Feldman (Neoplasms of Domesticated Animals, 1932) as occurring in the skin of hogs; multiple subcutaneous tumors in the fins and mouth of a pike (Esox Zucius), probably lymphoblastomas, though the tissues were not well preserved; ovarian adenocarcinoma in a pike. Fourteen illustrations are given, and a useful bibliography. F. CAVERS Neuroepithelioma of Olfactory Plate in a Dory, I,. THOMAS.Sur un cas de stiboneuro6pith6lioblastome chez une Daurade, Bull. de I’ASSOC.frang. p. 1’6tude du cancer 21 : 385-396, 1932. The author adds another instance t o the growing list of tumors, especially frequent in the nervous tissue, of fish. An adult dory, aged about twelve years, showed a tumor, measuring 5.5 X 3.5 X 3.0 cm., on the upper part of its snout, as well as two smaller ones close to this and probably metastatic from it. The histologic appearance was that of a neuro-epithelioma derived from the olfactory epithelium and consisting of a connective-tissue stroma in which were embedded masses, often in rosettes, of cells tending to differentiate towards three typesneurocytes, sympathoblasts, and ganglion cells. There are four illustrations. F. CAVERS Physical Methods of Investigating the Physiological Action of Light on Plants, ERICHNURNBERGK.Physikalische Methoden der pflanzlichen Lichtphysiologie, Abderhalden’s Handbuch der biologischen Arbeitsmethoden. Abt. XI, Teil 5, Heft 5: 739, 1932. While this paper does not concern cancer research directly, it affords an excellent example of the care with which the study of the effects of light on living material must be carried out, and the extraordinary number of precautions which are necessary to avoid gross errors. There have appeared in recent years a number of papers on the effect of light on cells of various types, including cancer cells, in which almost every precaution which Niirnbergk lays down has been carefully neglected. There is a mass of information contained in this article on the various types of light filters and their composition which will prove useful to anyone working in this field. Also, the various methods of measuring light intensities are given in full detail. NATURE O F CANCER, ETIOLOGIC THEORIES

Cancer as a Deficiency Phenomenon, ERICHSIMONS.Die Krebsgeschwulst, eine Ausfallerscheinung im Organismus, Schweiz. med. Wchnschr. 23: 92-93, 1932. This paper is largely concerned with Simons’ approval of certain recent papers which support his theory of the genesis of cancer and the cancer prophylaxis which he has developed on the basis of this theory. [An exposition of this theory is given in Schweiz. med. Wchnschr. 61: 662, 1931; also in Ztschr. f . Krebsforsch. 32: 429, 1930, abst. in Am. J. Cancer 15: 925, 1931.1 The experimental facts which he

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quotes from some of these papers have been so thoroughly refuted that they afford but little support for his own ideas.

Cancer, a Parasitic Disease, BREHMER.Krebs eine Erregcrkrankheit, Fortschr. d. med. 50: 697-698, 1932. Cancer: Its Early Diagnosis and Treatment, J. AMAN. Der Krebs, seine Fruhdiagnose und Behandlung, ibid. 50: 909-912, 1932. These two papers are associated here because they are about the most foolish the abstractor has come across, and both appear in a journal which, as its title indicates, professes to deal with the advances of medicine. Brehmer, during less than four years, has discovered no fewer than seven distinct hitherto undescribed organisms in the blood of cancer patients. They arc vaguely classified with the Archimycetes, near the Plasmodiophoraceae, but no illustrations are given. They become visible only after the patient has received subcutaneous injections of a mixture of “ N-Aglukon-Anthracen ” and oxycyanate of mercury, obtainable from a Berlin firm. No statement is made as to number of patients and controls, if any, examined. Brehmer’s contribution may be dismissed as a purely imaginative effort. Aman’s is even worse, being given a totally misleading title, for he says not a word about the early diagnosis and treatment of cancer. Probably he forgot it in the pursuit of his ingenious argument, which, divested of verbosity, is as follows. Some of the cutaneous and mucosal papillomas in man and animals are admittedly infective, but as there are also neoplastic papillomas, why should not all the papillomas result from bacterial infection? And if papillomas, why not all other tumors, benign and malignant? F. CAVERS GENERAL CLINICAL OBSERVATIONS, BLOOD STUDIES, METABOLISM

Frequency of Preceding Morbid Processes in Patients with Malignant Tumors (A Statistical Research), E. CIARANFI. I precedenti morbosi nei portatori di tumori maligni (Ricerche statistiche), Cancro 3: 131-136, 1932. Ciaranfi plotted the frequency of preceding infectious diseases as recorded in the histories of GOO patients with malignant tumors seen during thirty years in the medical clinic of the University of Florence. As compared with data for an equal number of non-cancerous controls, the cancer-bearing patients had an abnormally low incidence of the common infectious diseases, such as pneumonia, typhoid, syphilis, and articular rheumatism. C. D. HAAGENSEN Implantation and Contact Metastases of Malignant Tumors, R. BORRMANN. Zur Frage der Impf- und Abklatschmetastasen bei bosartigen Geschwulsten, Virchows Arch. f. path. Anat. 284: 623-631, 1932. The author discusses two of the methods by which a malignant tumor can spread from one part of the body to another. By the implantation method, grafts may be conveyed from the primary tumor to the site of metastasis by some natural or accidental process; in contact metastasis there is direct spread from the surface of a tumor to an apposed surface. Implantation may produce secondary tumors a t a considerable distance from the primary one; contact metastases are necessarily found close together. The author believes that many cases reported as examples of transplantation metastasis, especially in the skin and the mucosa of the alimentary tract, are not examples of metastasis a t all but of multiple primary tumors. Indeed, he asserts that neither transplantation nor contact metastasis is possible in

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intact skin and alimentary mucosa, since the material shed from the surface of a tumor is practically always necrotic and rarely contains living cancer cells. In view of these considerations, Borrmann would reject absolutely such explanations as were given by Klebs in reporting three cases of carcinoma of the stomach. According to Klebs the gastric cancer was a transplantation metastasis in one case from a rodent ulcer which had penetrated the mouth cavity, in another from an esophageal cancer, and in the third from a tongue cancer. As examples of even more far-fetched explanations the following are cited from recent papers; coexistent cancers of the outer ear and the lower lip, the latter explained as due to conveyance of cancer cells from the ear tumor by the patient’s fingers; carcinoma of the conjunctiva alleged to have been caused by cancer cells transferred from an epithelioma of the back of the hand in wiping the eye. All such cases are to be explained as examples of multiple primary cancer. The author then proceeds to describe two cases illustrating genuine transplantation and contact metastasis respectively. (1) Melanosarcoma, primary in the scalp, with two small deposits on the wall of the right auricle. The pendulum-like appearance of the latter and the histologic details of their area of attachment to the endocardium show that they must have arisen by the deposition of sarcoma cells from the blood stream. (2) Recurrent carcinoma of the left breast, with a secondary deposit just below the pleural surface of the upper lobe of the left lung and a contact metastasis on the pleural surface of the lower lobe where the two surfaces were apposed in the interlobar fissure. The author concludes that implantation and contact metastasis may occur in operative and other wounds and on serous membranes. He does not discuss the rBle of the lymphatic system in metastasis. There are five good photomicrographs. F. CAVERB

On the Significance of Nerve Fibres in Human Neoplasms, G . M. RYRIE. J. Path. & Bact. 36: 13-18, 1933. Examining histologically 11 carcinomas obtained a t operation, the author found considerable difficulty in demonstrating with certainty the presence of axis cylinders. After extensive trial he found the Gross-Bielschowsky silver impregnation method the most satisfactory. When a portion of a nerve is destroyed by the advancing neoplasm, numerous new fibrils grow from the living axis cylinders of the proximal stump of the nerve trunk. These fibrils grow not only within the perineural tube of the proximal portion but also penetrate into the tumor tissue. The process is exactly like that which occurs after section of a peripheral nerve, and there seems no reason to suppose that the newly formed axis cylinders exert any “ trophic ” influence on the neoplastic cells. Six clear illustrations are given. F. CAVERB Degenerative Atrophy of the Inner Ear with Tumors in Other Organs, H. BRUNNER. Zur Frage der degenerativen Atrophie des inneren Ohres bei ohrfernen Tumoren, Ztschr. f. Hals- Nasen- u. Ohrenh. 30: 443-452, 1932. T. Demetriades found in certain cases of carcinoma of other organs a progressive deafness and loss of the normal response of the labyrinth to stimulation. The anatomic basis of these symptoms was an angiopathy and exudation (neuritis and serous labyrinthitis), which in more advanced stages resulted in atrophy of the sensory end-organ and organization of the exudate. Demetriades considered these changes to be due to toxins produced by the tumor, but others have disputed this conclusion. In this connection the author’s case is of interest. A woman, sixty-seven years of age, had an adenocarcinoma of the pylorus. A resection was done, but the patient became very cachectic; loss of certain reflexes, spontaneous nystagmus and bilateral abdu’cens paralysis appeared, which were

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thought to be due to metastases in the cerebellum. No hearing tests were made; but caloric tests showed the labyrinth absolutely without response. At autopsy no carcinomatous metastases were found in the brain, the inner ear, or the labyrinthine capsule. There was marked atrophy of some portions of the cochlear nerve, especially in the basal turn of the cochlea, and less marked atrophy of the nerves in the cristae. There was no exudative labyrinthitis, such as was described by Demetriades. These changes would not account for the lack of response of the labyrinth to the caloric test but did indicate that there was undoubtedly some loss of hearing in this case. The loss of the labyrinthine reflex, the author believes, is to be attributed to the severe cachexia of the patient, as is also the loss of the other reflexes. Aniline Cancer, I. BERENBLUM.Cancer Review 7: 337-355, 1932. Berenblum has made a careful survey of the so-called aniline cancers which are now being observed in considerable numbers in those working with synthetic dyes. The tumors do not differ from those which occur in the bladder spontaneously, that is to say, without any known cause. It has not yet been possible to identify the particular chemical intermediate which is responsible. The recent work of Kennaway has shown that a number of benzanthracene compounds may be carcinogenic, and it may be possible, therefore, that a good many of the dyes or their intermediates have carcinogenic properties. The difficulty is that no one has yet succeeded in finding a susceptible test animal, Schar’s report, being not wholly satisfactory. As to the importance of the subject there can be no question, for recent examinations of apparently normal workmen in dye factories in the United States have shown the presence of a very considerable number of bladder tumors which had given no symptoms. A complete bibliography is appended to this useful survey. Associated Carcinoma and Tuberculosis with Generalized Metastasis Throughout the Osseous System, GEORQES. SPENCE. Med. Bull. Vet. Admin. 7: 10751076, 1931. Report of case in a man of fifty-three with bilateral pulmonary tuberculosis and tuberculosis of the wrist joint with lesions roentgenologically suggestive of osteitis deformans in the pelvic bones, both femora, both scapulae, and the ribs. At autopsy an adenocarcinoma of the prostate was found, with metastases to the bones. Roentgenograms of the lungs and femora and a photomicrograph showing the carcinomatous involvement of the bone are reproduced. Cancer and War Service, C. KLIENEBERGER.‘I Krebsleiden ” und Kriegserleben, Med. Klin. 28: 762-763, 1932. A discussion of a case in which war compensation was claimed by the patient’s widow on the ground that war service had caused or hastened the growth of a sarcoma of the skull involving the nasal sinuses, which caused his death. There is no evidence that the hardships of war service are etiological factors in cancer; and no evidence that the war caused any definite increase in the incidence of cancer. The patient suffered no wound or other direct injury to the head. The claim for compensation was not sustained.

Benign Tumors of the Pelvis, TAVERNIER AND POUZET. Tumeurs bbnignes du bassin, Lyon chir. 29: 9-24, 1932. Six case histories of benign pelvic tumors are given in considerable detail but with poor illustrations. The tumors include bone cysts, a fibroma, a chondroma, and a granuloma of some sort. As the authors point out, the pelvis is a site in

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which such tumors can grow for a long time before becoming large enough to cause symptoms due to pressure or traction. Moreover, these tumors show a tendency to recur locally after operation. Surgery is indicated, therefore, in most cases, only if the tumor is causing really severe disturbances. F. CAVERS

Two Surgically Treated Abdominal Tumors in Infants, H. MARXER. uber zwei operierte Bauchtumoren im Kleinkindesalter, Bruns. Beitr. z. klin. Chir. 156: 480-482, 1932. Marxer reports the histories of two children with intra-abdominal cysts whom he treated surgically. One child was three years old and remained well after the drainage of a mesenteric cyst. The second patient was four years of age and showed a large, thin-walled, unilocular cyst between the stomach and the transverse colon. This was considered to be a pseudopancreatic cyst, the result of severe trauma received two months previously. The cyst was marsupialized through the anterior abdominal wall, and the patient made a good recovery. There are no illustrations. BENJAMIN R. SHORE Xanthoma Tuberosum, S. M. WEINGROW.Arch. Derm. & Syph. 25: 1021-1027, 1932. After reviewing the various opinions regarding the cause of xanthoma tuberosum, the author states that the etiology has not been definitely established. In some cases the familial character of the disease is unquestionable. There may be associated diabetes or syphilis. Four cases are reported. One with extensive tendon involvement, in which the planum variety of lesion was also seen, is described in detail. The sugar, cholesterol and non-protein nitrogen of the blood of this patient were higher than normal. The presence of the same type of lesion in the tendons of a brother and of other relatives, a negative Wassermann reaction, and the absence of evidence of other infectious diseases suggest a familial tendency. Chemical analysis of the blood in two cases revealed cholesteremia, glycemia, and a rise in the non-protein nitrogen. The last has not heretofore been reported in connection with this disease. In two of the cases there was no rise in the sugar content of the blood above normal, and the urine was free from sugar. I n three of the cases there was definite evidence of arteriosclerosis. In the third case, there were hypertension and nephritis, primarily, and diabetes secondarily related W. BAYARD LONG to the xanthoma tuberosum.

Xanthoma Multiplex, Two Cases Involving Larynx and Trachea, and Associated H. MONTGOMERY AND G . B. NEW. with Diabetes Insipidus, W. P. FINNEY, J. A. M. A. 99: 1071-1074, 1932. Two cases of xanthoma multiplex with xanthomatous deposits in the upper part of the respiratory tract are here reported. This type of involvement is rare, although nodules or plaques have been seen on practically every part of the external surface of the body. Most rarely the cornea is affected, only four such cases having been reported. The second of the cases here presented showed a xanthomatous deposit in each cornea. The first patient, a man aged twenty-seven years, noticed about four years ago some yellowish-brown spots in the axillae. One year after this, polyuria suddenly developed. Numerous lesions then appeared on the eyelids, lips, chin, neck, trunk, and groins. In the mouth there were numerous elevated yellowish areas on the mucous membrane of the palate, tonsillar pillars, and posterior pharyngeal wall, extending down to and involving the epiglottis. Because of dyspnea on slight exertion tracheotomy was done, and the disc of cartilage so removed showed xanthomatous plaques, Biopsy of other lesions revealed typical xanthomatous

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ABSTRACTS

changes. The output of urine averaged 6000 C.C. in twenty-four hours with a specific gravity of 1.003 to 1.009. No other lesions were discovered. Case two showed numerous xanthomatous skin lesions but not so marked a polyuria. The larynx and upper part of the trachea showed numerous xanthomatous deposits and in addition there was present a yellow, slightly elevated mass on the upper part of each cornea, covering the upper margin of the iris. These lesions resembled other nodules so closely in appearance that there seemed no reasonable doubt as to their nature. Treatment was without affect on the xanthomatous deposits. W. BAYARD LONG

Observations on Fifty-Seven Cases of Benign Cylindromatous Epithelioma, A. PICCO.Osservazioni su 57 casi di epitelioma benigno cilindromatoso, Cancro 3: 114-121, 1932. This is a short essay on the histogenesis of mixed tumors. From a study of 57 of these tumors occurring in the salivary glands, palate, nasal septum, maxillary sinus, mucosa of the cheek, lower lip, and lacrimal gland, Picco concludes that they arise from epithelium. The cartilaginous, osteoid, and myxomatous elements are derived from epithelium by metaplasia. No details of these cmes are presented. Six photomicrographs are presented. C. D. HAAQENSEN Blood of Cancer Patients, F. H. COLOMBIBS A N D 0. MILETZKY.Le sang des canc6reux, Prat. m6d. frang. 13: 178-183, Feb. (B) 1932. The Rumoral Syndrome in the Development of Cancer, A. CODOUNIS.Le syndrome humoral au cours de 1’6volution du cancer, Paris m6d. 1 :457-463,1932. Colombihs and Miletzky examined the blood of 103 patients with proved cancer, and that of 22 normal persons for comparison. They determined the total protein, urea, total nitrogen, residual nitrogen, uric acid , glucose, cholesterol, hydrogen ion concentration and alkaline reserve. They conclude that in most of these characters the blood of cancer patients scarcely differs quantitatively from normal blood, and that such slight differences as exist seem to depend upon the patient’s general condition (anemia and debility in advanced cancer producing the same changes as anemia and debility due to other chronic diseases) or upon complications due to the nature of the organ affected by the tumor. They make an exception with regard to hydrogen ion concentration and alkaline reserve, and in their experience alkalosis is a constant and important finding in malignant disease. Codounis examined the blood of 22 cancer patients, repeating the tests on an equal number of healthy persons. Although he has not covered exactly the same ground as Colombihs and Miletzky, his findings form an interesting comparison with theirs, His conclusions as to the characters of cancerous as compared with normal blood may be summarized as follows. (1) Lowering of osmotic pressure of the proteins. (2) Fall in total protein content, especially in albumin; the globulins are sometimes increased in amount. (3) Inversion of the albumin: globulin ratio; it is interesting to note that this inversion, which has formed the basis of a multitude of serodiagnostic tests, did not occur in the two cases of intracranial tumor examined. (4) Lipidemia, rather variable but much augmented by cholesterolemia in cases of primary or secondary cancer of the liver. (5) Alkaline reserve normal or subnormal [compare Colombihs and Miletzky’s finding]. (6) Slight increase in total non-protein nitrogen. (7) More or less marked increase in red cell sedimentation rate. (8) Anemia, with general increase in polynuclear white cell count. F. CAVERS

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981

Qualitative Study of the Elevated Leukocyte Counts in Carcinoma, ARNETH. Hohere Leukocytenwerte beim Karzinom, bei qualitativer Betrachtung, Wien. med. Wchnschr. 82: 545-547, 1932. Arneth’s tables show seven blood counts taken over a period of two months on a patient with carcinoma of the stomach with small metastatic lesions in the liver and a perigastric abscess. The leukocyte count was from 15,000 to 29,000, with a shift to the left of the neutrophiles, and a shift to the right of the lymphocytes, that is, an increase in the small forms with well developed azure granules, and diminished monocytes. These qualitative fluctuations depend to some extent upon the size and position of the tumor, but even more upon the complications, small liver metastases not being the cause of either the leukocytosis or the types of cells; but a very large necrotic tumor with opportunity for absorption of toxic products, may cause an elevated count. LEILAC. KNOX Eosinophilia in Malignant Tumors, S. STERLING-OKUNIEWSKI. L’BosinophilBmie au cours des tumeurs malignes, NBoplasmes 11 : 95-99, 1932. According to the author, an increased eosinophile leukocyte count is rarely found in cancer patients, though frequently observed in various other diseases and almost invariably during convalescence from some of the commoner infectious fevers. Several leukocyte counts were made in a twenty-nine-year-old woman with cancer of the uterine cervix which had invaded the parametrial tissues and was obviously advancing. The percentage of eosinophiles rose in the earlier counts and then fell again as the patient’s state became worse. Representative figures in the series were 25, 37, 42, 33, 30, 12, 6. Among recent writers Schmidt has reported 33 per cent eosinophiles in a case of lung cancer, Lefrat 37 per cent in a case of pancreatic cancer, Chiray and Baudoin counts of 19, 41, 70 and 80 per cent in a case of pancreatic cancer. Several writers have described marked eosinophilic infiltration in the tissue immediately adjacent to malignant tumors. F. CAVERS Hyperglycemia of Cancer, G . E. WOODWARD A N D E. G. FRY. Biochem J. 26: 889-897, 1932. Fasting blood-sugar determinations were made by the Hagedorn-Jensen micromethod in 37 normal individuals, 52 untreated cancer cases, 67 treated cancer cases, 35 cases of untreated benign growths, and 32 medical cases. The authors conclude that untreated cancer patients, treated cancer patients, and patients with untreated benign growths all show average fasting blood-sugar values above normal, while medical cases in general do not show high blood-sugar values. They consider that the presence of a high fasting blood sugar is of no value in diagnosis, but of considerable value in prognosis. H. Q . WOODARD Change in the Content of Catalase in the Blood as a Result of Roentgen Treatment of Malignant Tumors, A. LORENZI.Le modificazioni del contenuto di catalasi nel sangue nella rontgenterapia dei tumori maligni, Tumori 6: 201-208, 1932. By an involved technic, based upon the ability of Hz02 to cause hemolysis of red cells, Lorenzi presumes to measure the content of catalase in the blood. On the basis of determinations made on ten patients with various types of malignant disease, he concludes that the catalase content is lower in cancer-bearing individuals than in normals, and that roentgen treatment causes a further diminution. C. D. HAAGENSEN

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ABSTRACTS

Metabolism of Tumors, Phosphatase, 5. EDLBACHER A N D W. KUTSCHER.Uber den Stoffwechsel der Tumoren; Beitrage zur Kenntnis der Phosphatasen, Ztschr. f. physiol. Chem. 207: 1-15, 1932. The authors have studied nucleotidase, an enzyme which hydrolyzes nucleic acid and which is present in the normal liver and other tissues as well as in tumors. During acetone extraction of these the action of nucleotidase is increased; that is, the acetone extract contains a substance which inhibits the action of nucleotidase on dried tissues. This inhibition is also exerted by hydrocyanic acid, cystein, and glutathione, the last named being probably the inhibiting substance actually concerned in the tissues. Again, the finding that liver extract causes activation of nucleotidase on addition of hydrocyanic acid may be explained as a heavy metal reaction, suggesting that nucleotidase, like arginase, belongs to the heavy metal type of enzymes. The results obtained are set forth in a series of detailed tables. F. CAVERB Metabolism of Normal and Tumor Tissue, F. DICKENS AND G. D. GREVILLE. Biochem. J. 26: 1251-1269, 1932. A study has been made of the anaerobic conversion of fructose and glucose into lactic acid by the fetal membranes, the placental tissues, the whole early embryo, and the liver, lung, brain, and skin of the later embryo. Measurements were made throughout a t pH 7.5 in bicarbonate-Ringer solution containing 0.2 per cent of the sugar. Tissues of the rat, mouse, guinea-pig, cat, and ferret a t different stages of pregnancy were examined. While glucose is converted into lactic acid with great readiness by most embryonic tissues, the attack on fructose depends on both the tissue and the species, varying from zero to a value equal to that observed with the same tissue in glucose. It is concluded that in all species in which fructose is known to be present in the fetal fluids, it is a possible source of energy to a t least one of the extra-embryonic fetal tissues. H. Q. WOODARD Cholesterol Content of Cancer Lipoids, R. WILLHEIMAND G . FUCHS.Zur Frage des Cholesteringehalts im Carcinomlipoid, Biochem. Ztschr. 247: 297-305, 1932. The authors and their associates have reported in a series of papers that the breaking up of cancer cells by cytolysis sets free lipoid, a probably complex mixture of fatty substances, and that the amount of lipoid thus set free may afford a means of measuring the rate of cytolysis. [For abstracts of two papers by Willheim and Stern, see Am. J. Cancer 16: abst. pp. 756, 785, 1932.1 They now stress the need of using for analysis carefully prepared, washed and dried actual tumor tissue. They have determined the total lipoid content and the cholesterol content of 18 human tumors and 14 normal organs. I n tumors the percentage of cholesterol in the total lipoid content was found to be higher than in normal tissue; in the former it varied from 7.5 to as much as 20 per cent, in the latter from 5 down to 1 per cent or less. It was no higher in embryonal or fetal than in adult organs. F. CAVERE Brief Preliminary Report on the Lipoid-Globulin Cholesterol Ratios in Cancer, H. COKE. J. State Med. 41: 105-115, 1933. The author has used a process, full details of which are omitted from this preliminary paper, by which a complex lipoid-globulin has been extracted from sera of many types by means of colloidal adsorption to a special mixture of calcium and magnesium salts. The opacity of this colloidal extract, which also contains cholesterol, is estimated by a special, improved photo-electric nephelometer. Coke believes the essential cause of malignant proliferation of cells to be a

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983

stimulation of the latter by an alteration in the colloidal state of the cell membrane and of the intranuclear colloids. He uses a ratio which he terms the dispersion index and defines as the opacity of the hydrolyzed flocculate multiplied by 100 and divided by the flocculate cholesterol in mg. per 100 C.C. of serum. He states that of 43 cases with an index of over 1.0, 74.5 per cent were cancer; of 63 cases with an index under 1.0, only 9.5 per cent were cancer; with an index of over 1.5, 92 per cent were cancer; over 2.0, 99 per cent cancer. [The author does not, however, state the total number of patients and the numbers of those with proved cancer and with other diseases.] F. CAVERS DIAGNOSIS AND TREATMENT

Clinical Significance of the Fuchs Serodiagnostic Reaction, M. VON FALKENHAUSEN. Die klinische Bedeutung der Karzinom-Serum-Reaktion (KaR) nach Fuchs, Deutsche med. Wchnschr. 58: 329-330, 1932. In 1926 Fuchs (Biochem. Ztschr. 175: 185) reported that serum from a cancer patient destroyed fibrin obtained from normal blood, thus leading to increase in rest nitrogen, which was determined by a micro-Kjeldahl method. No such increase occurred on adding serum of a normal person to normal fibrin or on adding serum of one cancer patient to fibrin from another cancer patient. Wright and Wolf (J. Cancer Research 14: 370, 1930) repeated the test on 116 patients and reported results wholly confirming Fuchs’ claims. [Similar results were published by Cadness and Wolf (Abst. in Am. J. Cancer 16: 785, 1932) in the following year.] Falkenhausen now reports on 80 cases. He examined the patients and Fuchs carried out the tests without knowledge of the clinical findings. It is claimed that the test gave a correct result in every case. Notes are given of four cases in which it is asserted that the Fuchs test alone determined the differential diagnosis where F. CAVERS it would otherwise have been impossible. Diagnosis of Skeletal Metastases of Malignant Tumors and Its Practical Application, M A XBERLINER. Zur Diagnose und praktischen Bewertung der Knochenmetastasen maligner Tumoren, Med. Welt. 6: 737-738, 1932. Skeletal metastases are most often associated with carcinomas of the breast, prostate, and thyroid gland and with hypernephromas, but may be observed with almost any of the malignant tumors. The diagnosis is easy if the possibility of these metastatic tumors is kept in mind. Their demonstration in roentgenograms is dependent upon the rate of growth of the tumor and its destructive qualities. Although a cure is not to be expected, considerable relief of pain is often experiBENJAMIN R. SHORE enced following radiation. Study of the Spleen and Liver after Injection of Thorium Dioxide, FRANZ B~~CHNER. Zur Kontrastuntersuchung von Milz und Leber mit Thoriumdioxyd, Klin. Wchnschr. 11: 1058-1060, 1932. The writer sounds a warning against the use of thorium dioxide now frequently employed to render visible changes in the dimensions of the liver and spleen. He points out that the insoluble thorium dioxide is not excreted from the body, as much as 97 per cent remaining for two months. Also, histological studies show that the endothelial cells of the liver, spleen, lymph nodes, adrenals, and bone marrow are stuffed with insoluble particles of this substance; that the subsequent injection of trypan blue in animals which had been given thorium showed that the recticulo-endothelial cells were very fully blocked by the thorium and could not take up the trypan blue. The author points out the possibility of later damage to

984

ABSTRACTS

the organism as a whole from this interference with the functions of an important organ of the body, for there are reasons to think that the reticulo-endothelial system plays a part in the production of protective antibodies. As a side issue he found that in two human beings with metastatic carcinoma in the liver .the tumor absorbed none of the thorium, so that a negative shadow of the growth could be obtained. The writer does not consider the possibility of the radio-active breakdown of the thorium after years of residence in the body and the possible damage which might arise from this occurrence.

Diagnosis of Neoplastic Sediments by means of Culture in Vitro, L. GEDDA. Contributo alla diagnosi dei sedimenti neoplastici mediante la cultura in vitro, Cancro 3: 126-130, 1932. Using tissue culture technic, Gedda failed to get growth of tumor cells from the sediment obtained from ascitic and pleural fluid in cases of metastatic cancer. C. D. HAAGENSEN Use of the Electric Knife in the Treatment of Cancer, HEITZ-BOYER. Action et emploi du bistouri Blectrique dans le traitement du cancer, Bull. et ni6m. SOC. nat. de chir. 58: 449-468, 1932. The author’s chief experience with electrosurgery of tumors has been with neoplasms of the urogenital system, chiefly the bladder, prostate, and penis, and his best results have been in cases of extensive or subtotal cystectomy. During the past three years a careful study has been made of sections of the removed tumors, some of which are reproduced as photomicrographs. Attention is called especially to the evidence of destruction of cancer cells in the peripheral portions of the tumor and the occlusion of blood vessels. That of the lymphatics was not found possible to determine histologically. In a general discussion the author points out that electrosurgery is a highly specialized method requiring a fairly long apprenticeship, and that the application of the electric knife t o tumors raises some special problems. In dealing with cancer, as with non-cancerous lesions, certain advantages over the cold knife are obvious (hemostasis, disinfection, desiccation, diminution of shock), being easily demonstrated by clinical tests made soon after operation. From an experience of over twenty years, Heitz-Boyer considers that the electric knife should not be used in regions where there is a risk of its passing close to large blood vessels, as in the axillary and cervical regions, and that it probably has no advantages over cold steel when it has to pass a t a considerable distance from the actual tumor, as in sharply localized breast cancer. It is especially useful when infection is present in the tumor itself or its surroundings, where removal of a tumor leaves a space likely to become infected; and in diffuse, badly limited tumors which the surgeon finds difficult to dissect safely beyond the apparent limits of the neoplasm, as occurs frequently with bladder tumors. F. CAVERS Results of Treatment of Tumors in the RadiotherapeuticInstitute of the Vienna E. M A ~ EARN D F. MELCHART. Erfolge der TumorHospital, W. SCHLOBS, behandlung im strahlentherapeutischen Institut des Krankenhauses der Stadt Wien, Wien. med. Wchnschr. 82: 976, 1932. Various types of tumors treated with radiotherapy a t the Vienna Hospital are discussed. Of the tumors of the mouth, pharynx, and larynx treated, 40 per cent were carcinoma of the tongue. Of 27 cases not previously treated, 8 were free from symptoms after treatment, 15 were improved, 4 were not traced; of 38 patients previously treated, 7 were free from symptoms, 9 improved, 19 not.traced. The time since these patients were treated is too short to determine the end-results.

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Two patients with laryngeal carcinoma were presented, one treated by laryngofissure with implantation of radium in the tumor and radium to the neck (for palpable glands); the other treated by removal of the tumor and postoperative roentgen therapy. Both patients were entirely relieved of symptoms. One case of tumor of the tonsils is also reported treated with roentgen rays, with regression of the tumor. Of 42 women with uterine carcinoma treated with radium, 2 patients were presented who were entirely free from symptoms (groups I and 11); and 3 patients of group 111, definitely improved, but with the parametrium still infiltrated. Other cases presented included 2 cases of carcinoma of the penis, one case of recurrent tumor of the breast in a boy, and one case of carcinoma of the rectum, all definitely improved by radiotherapy.

A Million Volts for Cancer Treatment, H. HOLTHUSEN.Eine Million Volt gegen den Krebs, Deutsche med. Wchnschr. 58: 1928-1929, 1932. The writer criticizes severely the numerous sensational notices in the press of new high-voltage apparatus for the treatment of cancer based upon the modern experiments on the fragmentation of atoms by high-voltage despatches from condensers. However important such experimental researches may be for the advancement of physics, the popular circulation of these reports on high voltages places a false value on their use in cancer therapy. The writer points out that even with 2,400,000 volts, such as have been used by Brasch and Lange, only a very small percentage of the atoms are fragmented by the electrons. In the meantime, Cockcroft and Walton of the Cavendish Laboratory in Cambridge have shown that voltages as low as 300,000 are effective provided the projectiles consist of hydrogen atoms driven a t high speed. Under these circumstances the atoms, which are much heavier than the electrons, will break up other atoms by their impact. The suggestion which has been made that such technical means in high-voltage apparatus are of great importance in the medical use of radiation is based on a misunderstanding of the problem. There is a vast difference between the breakdown of an atom and the action of radiation on the cell. While the breaking of an atom requires an enormous amount of energy, fatal damage to the protein structures of the cell requires only a minute fraction of this energy, so that roentgen rays of all wavelengths and the gamma rays of radium are able to set free sufficient energy in the cells to cause their destruction and any increase in the elementary quanta carried by the rays will not necessarily increase the therapeutic effect. It is also an error to believe that the cathode rays as produced by Brasch and Lange in their 2,400,000 volt tube have any great therapeutic value, because such rays can penetrate into the tissues only about 7 mm. The advantage of the use of x-rays and gamma rays lies in the fact that they are capable of penetrating the tissues to great depths, and there setting free electrons which act locally, instead of merely burning the surface as would the electrons from the 2,400,000 volt tube. It is wise, therefore, that the public be informed that the question of treating cancer today is not so much the production of x-rays by extraordinary voltages, for we also have x-rays due to from two million to six million volts in the gamma rays of radium, but rather the further investigation of the adaptation of the time of radiation and the intervals between treatments to the rhythm of the processes going on in the cancer tissue with the reparative processes which take place in healthy tissue. I n other words, our present apparatus is amply sufficient to accomplish just as much as a million or two million volt x-ray tube, and there is no evidence that the use of such tubes will a t all advance our treatment of cancer. The problem a t present is a biological rather than a physical one.

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ABSTRACTS

Epithelioma, 0. H. MCCANDLESS.J. Missouri M. A. 29: 111-114, 1932. The author discourages routine dosage in treating epithelioma of the eyes, ears, nose, and mouth, and emphasizes the factors of radiosensitiveness. A lack of response to ordinary dosage is not in itself an indication for heroic roentgen-ray treatment. [It is rather an indication for prompt surgery.] Radiosensitiveness of cancer decreases with each successive irradiation. A local tissue resistance to roentgen treatment is produced if an insufficient dose is given primarily and similar resistance created in the cancer area if the interval between doses is too great, The primary site of growth is of equal if not greater importance than cell type, since metastasis is likely to be a matter of location. Internal Treatment of Cancer, A. NEUMANN.Consid6rations et impressions sur le traitement interne du cancer, NBoplasmes 11 : 129-145, 1932. Method for the Medical Treatment of Cancer, A. LUMIBRE. A la recherche d'une mBthode de traitement medical du cancer, ibid. 11: 65-76, 1932. Neumann begins with a recital of a selection of the hundreds of methods of medical treatment for malignant disease which writers in various countries havc suggested and reported favorably. Needless to say, none of them has received general credence, and many of them have been completely discredited. Neumann deals specially with two such methods which have had a vogue in his own country, Austria. The first is that of giving cancer patients a diet rich in proteins and poor in carbohydrates and fats, as suggested by Freund and Kaminer from experimental work on animal tumors; this dietary treatment is combined with rigorous disinfection of the bowel. The second, to which the chief part of the paper is devoted, is.a purely empirical method, or quack remedy, invented by Salzborn, a village physician, who has attracted large numbers of patients and whose plan consists simply in administering orally a mixture of guiacol valerianicum and olive oil, five drops in a cup of coffee thrice a day after food. There is no indication that the patients are properly examined, but the author seems convinced that in some cases patients with tumors are benefited, both mentally and physically. However, in most of the cases which the author has kept under observation the patient has died within a few months after the beginning of treatment, so that there is no evidence of marked prolongation of life in advanced cases of cancer. LumiBre's paper is, as might be expected, written on more critical lines. He considers that all attempts a t medical treatment, whether consisting in orally administered drugs or tumor extracts or injected extracts of organs or tumors or sera, have given, to say the least, very discouraging results. Indeed, the reported cases of regression of malignant tumors are in his opinion entirely incredible. He then discusses certain possible lines of treatment suggested by animal experimentation, excluding some previously included in his list of mdthodes damnbes [a list which makes rather entertaining reading when we note some of the names of research workers included therein]. Of these lines two are emphasized, though not very hopefully: (1) reduction of nitrogenous substances to the lowest practicable amount in the diet; (2) raising the body temperature of the cancer patient to about 40" and keeping it there for prolonged periods. [But experimental results have been reported which raise no more enthusiasm for these two methods than for some of those which the author rejects, for instance administering acids in order to prevent alkalosis.] F. CAVERB Medical Control of Pathological Cell Proliferation, HANSJANUSCHKE. Arzneiliche Regulierung pathologischer Zellwucherungen, Wien. klin. Wchnschr. 45 : 11761180, 1932. The author believes he has been able to influence favorably a mammary carcinoma in a woman of seventy years by treatment with sodium iodide, with

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987

digitalis, caffeine, and chloral hydrate. The tumor grew steadily, despite the treatment, but the author says that the cystic softening which was found a t the time of what was apparently a very necessary operation is an evidence of the killing and solution of the cancer cells. A surgeon also informed him that the patient should have died a t the end of two and a half years. Inasmuch as she is still living some three and a half years after this statement was made, Januschke considers even on this slender evidence that the therapy must have been effective.

Treatment of Neoplasms by Tumor Extracts by Mouth,G. CUVIER. Le traitement des nboplasies par extractifs de tumeurs (voie buccale), Marseilles m6d. 69: pages A-D (following text page 148), Jan. 25, 1932. Cuvier, by oral administration of tumor extracts, has attempted to develop an immunity in cancer patients. Small doses of tumor extracts appear to have improved the condition of these patients, diminished pain, checked hemorrhage, and in some cases caused disappearance of the tumor. The author regards the extract as a valuable adjunct t o the use of x-ray and surgery, but by no means as replacing the classic methods. [These results are interesting in view of the fact that animals with grafted tumors frequently eat the neoplasms of their cage mates and yet show no curative effects from this diet of their own neoplasms.] WILLIAMJ. HOFFMAN Chordotomy for Relief of Pain in Inoperable Cancer Cases, P. WERTHEIMER. La cordotoinie dans les douleurs de certains cancbreux inopbrables, Lyon chir. 29: 499-505, 1932. The author reports four cases in which he had done chordotomy for relief of pain, all the patients being women in whom recurrence or metastasis had taken place after hysterectomy and radium treatment for cancer of the uterine cervix. He admits that this operation may cause, or aggravate, atrophic and sphincter troubles, but considers these to be of slight importance as compared with the advantages of relief of pain without the drawbacks attending the administration of increasing doses of stupefacient drugs. F. CAVERS TUMORS OF T H E SKIN AND MUSCLES

Results of the Operative and Radiation Treatment of Carcinoma of the Skin and Breast. Report of 2,000 Cases, A. HINTZE. Die Erfolge der operativen und der Bestrahlungsbeliandlung beim Carcinom der Haut und der Brustdruse. Bericht iiber 2000 Cases, Arch. f. klin. Chir. 173: 429444, 1932. This extensive statistical report comprises the cases of cancer of the skin treated in the years 1912-1931 and those of cancer of the breast in the years 19121930 in the Rontgen-Radium Institute of the Surgical University Clinic in Berlin. Over 95 per cent of these cases have been traced. The principal figures are based upon the patients living five years after treatment, while in those with skin cancer special reference is made in addition to the presence or absence of symptoms a t the end of the observation period. The extensive statistical analysis cannot be reproduced in abstract. The roentgen technic is not given in detail, and the only facts as to radium are that in superficial skin lesions it is placed in contact with the skin presumably with some secondary filter, and that with deep lesions a distance of 2 cm. is used. That the treatment should be given in a single dose is emphasized. When bone or cartilage is invaded electrocoagulation is necessary. The cases of cancer of the skin, numbering in all 836, have been divided accord-

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ABSTRACTS

ing to location into eight groups and according to the treatment employed into five, as follows: operation only; operation first and later radiation for recurrence; prophylactic radiation after operation; radiation first and later operation; radiation only. Of the 543 patients treated from five to twenty years ago, 60.8 per cent were alive a t the end of the five-year period and 35.4 per cent were symptom-free a t the end of that period. For the special regional groups the following results were obtained: (1) carcinoma of the scalp, forehead, and temporal region, 63.8 per cent alive after five years, 44.9 per cent symptom-free; (2) carcinoma in the region of the eyes, 73.3 per cent alive, 30.0 per cent symptom-free; (3) carcinoma of the nasal region, 72.8 per cent alive, 46.4 per cent symptom-free; (4) carcinoma of the cheek, 51.1 per cent alive, 33.7 per cent symptom-free; (5) carcinoma of the ear, 50.0 per cent alive, 27.8 per cent symptom-free; (6) carcinoma of the trunk, 26.6 per cent alive, 20.0 per cent symptom-free; (7) carcinoma of the extremities, 50 per cent alive, 24.0 per cent symptom-free; (8) lupus carcinoma, 50 per cent alive, 7.1 per cent symptom-free. When squamous cancer in these regions was strictly localized, the results of treatment were no worse than for basal-cell carcinoma, but the frequent glandular involvement gives the former the more unfavorable prognosis. The 1206 cases of breast cancer are divisible into 1096 in which breast amputation was performed and 110 treated by radiation only. Of the 904 patients treated from five to nineteen years previously, 95.46 per cent have been traced, and of the total, 33.4 per cent survived for four years or more. Of 610 patients treated ten years and longer ago, 18.52 per cent were alive after the ten year period. When the cases are divided into groups according to forms of treatment, the following percentages were found to be alive after five years: Radical operation only. ..................... 367 cases.. . . . . . . . . . 34.0per cent alive Radiation for recurrence (15 with distant metas289 cases. . . . . . . . . . . 25.9 per cent alive tases). .................................. Prophylactically radiated. ................... 183 cases. . . . . . . . . . . 53.0 per cent alive Radiation only (inoperable). ................. 65 cases. .......... 6.1 per ceot alive I n the cases receiving prophylactic radiation in the years 1921-1925 a survival of five years was attained in 60.8 per cent. In comment Hintze states his belief in the value of the radical operation for all operable cases of breast cancer. Operation upon recurrence may succeed, but in this field radiation leads to good results. Distant metastases may be treated with definite palliative effect but with little hope of cure. Prophylactic radiation after radical surgery is of great importance, since the majority of all breast cancers operated upon do eventually recur. In a collection of figures from eleven clinics Hintze shows that with prophylactic radiation the five-year survivals have averaged 37.9 per cent as compared with the 28.4 per cent of those treated only by surgery. For prophylactic radiation Hintze recommends his method of tangential radiation which permits an avoidance of lung injury and is given in three series a t six to eight week intervals. The stage of the disease has a great effect on prognosis but a much smaller relationship to the indications for treatment. Biopsy should always be done in doubtful cases. Prolongation of life in the inoperable cases is possible by means of radiation. In this series the proportion of the inoperable to the operable is as 1 to 10. In discussion Konig of Wurzburg pleads for special care in the performance of operations for cancer and the necessity for special training and continued practice for the production of the best results. [This statistical material is valuable on account of its size and the demonstration of the enormous field which radiation is attaining in the treatment of cancer. The failure to subdivide most of the cases into groups dependent upon extent of disease, and especially the inclusion of basal-cell cancer with others of the skin, '

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makes it difficult to compare the actual success of treatment with previous series. That only one breast case in ten fell in the inoperable group makes it appear either that these cases have been in general considered unsuitable for treatment or that an entirely different standard of operability prevails in Germany than in this country.] HOWARD C. TAYLOR, JR. Treatment of Skin Cancer, H. GOUGEROT.Les traitements des epithdliomas cutan6sJ Bull. g6n. de th6rap. 183: 241-249, 1932. This paper contains nothing more than a list of various methods of treatment of cutaneous cancer, ranging from minor surgical procedures to local applications and the ingestion of a variety of medicinal preparations. The latter include some of the dubious anti-cancer nostrums introduced during recent years with confidence but received in most quarters with entire disbelief. Irradiation methods and dosages are mentioned briefly. I n fact, the paper is simply a condensed catalogue. The author nowhere says he has actually used any of the methods mentioned. F. CAVERS Carcinoma Erysipelatodes, Carcinomatous Lymphangitis, Subepidermoid Carcinoma of the Skin, E. DELBANCO.Zum Carcinoma erysipelatodes, zur krebsigen Lymphangitis, zum subepidermoidalen Carcinom der Haut, Ztschr. f. Krebsforsch. 35: 301-314, 1932. A woman of eighty-four years was admitted to the hospital with a diagnosis of mycosis fungoides, soon changed to that of carcinoma of the skin. She died a few days later. An extensive area of the skin of the left breast, back, and left upper arm showed infarction of the lymph vessels and nodes by carcinomatous cells, but thorough search a t autopsy failed to reveal a primary tumor. The author suggests that carcinoma may have begun to develop a t one or more foci in the epidermis and caused such a vigorous response on the part of the lymphatic system that the cancer cells were transported to the skin in a diffuse manner instead of metastasizing in the usual way. Before admission the patient had received three x-ray treatments consisting in 100 per cent of a skin erythema (600 T ) each to the left breast, axilla, and upper arm. The author suggests that the relatively benign course of carcinomatous lymphangitis may be attributed to weakening of the cancer cells by the production of substances corresponding to Caspari’s “ necrohormones.” Two photographs and three photomicrographs are shown. [For a recent study of this lesion from a somewhat different point of view see abstract of a paper by Rasch in Am. J. Cancer 16: abst. p. 62, 1932.1 F. CAVERS Epithelioma Developing on a Gummatous Osteoperiostitis, F. FERRARI, J. MONTPELLIER A N D R. MORAND.Epith6lioma d6velopp6 sur une ost6o-p6riostite gommeuse syphilitique, Bull. de l’bssoc. franc. p. 1’6tude du cancer 21: 514-517, 1932. The authors state that during twelve months they have observed four cases, occurring in Algerians, of prickle-cell epithelioma arising on the basis of gummatous ulcers of the skin. In each case the syphilitic infection was of long standing and the gummas had been not only neglected and ulcerated, but had been subjected to injuries. The epitheliomas occurred on the badly healed scars of these traumatized ulcers. In the case now reported, that of a man of thirty-four, the first gumma had appeared on the right thigh a t the age of thirteen years, but all the subsequent lesions were situated on the left thigh and shin. The patient had twice been given courses of mercury biniodide, and in the intervals additional gummas had developed, one causing osteoperiostitis of the tibia. Some of the

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ABSTRAOTG

ulcerated, fungating masses had been injured and showed epitheliomatous tumors on the ulcer floor, and all were abominably dirty and discharging. The patient refused both surgery and irradiation, but returned to hospital two months later in a state of cachexia, The whole anterior half of the left shin was an ulcerated mass, and the left crural and inguinal nodes were enormously enlarged. After three blood transfusions the limb was disarticulated a t the hip and the regional lymph nodes were curetted, but death occurred next day from shock. Microscopic examination of a crural node showed prickle-cell epithelioma. The authors state that in their considerable experience cancer in general is of rarer occurrence in the natives than in the European inhabitants of Algeria, but that skin cancer arising on the basis of old wounds and ulcers of various kinds that have been neglected and have failed to scar over, often owing to repeated injuries, is fairly frequent in natives. The four cases reported of cancerization of syphilitic ulcers are not regarded by them as indicating that syphilitic infection and cancer are related as cause and effect. If they were, cases like those reported would be much commoner, since syphilis is a t least four times more frequent among the natives than among the Europeans. F. CAVERS

Three Cases of Flat Cicatricial Epitheliomas, A. H. ROFFOA N D S. ROSNER. Tres casos de epiteliomas planos cicatriciales, Prensa med. argent. 18: 1018-10, 1031. Three short case reports; no pictures; no photomicrographs. Radium Implantation in the Treatment of Capillary and Cavernous Naevi, C. C. ANDERSON.M. J. Australia 1: 768-769, 1932. The author presents the results of his experience in the treatment of capillary and cavernous nevi with radium implantation. While admitting the success attending the use of surface application of radium in these cases, he prefers implantation because of the much more rapid results to be obtained. His technic consists in the use of steel needles 29 mm. long, with a wall 0.3 mm. thick, and containing 10 mg. of radium element. These are sterilized and ‘‘ inserted to produce an even irradiation throughout the growth,” remaining in silu two to three hours. The needles are then withdrawn and the wounds sealed with collodion. The results in seven cases so treated were excellent. W. BAYARD LONG

Hyaline Substance in Cyliidromas of the Skin, FR.KOGOJ. Uber das Verhalten des Hyalins in Cylindromen, Arch. f. Dermat. u. Syph. 166: 515-524, 1932. The author discusses the recent changes in the nomenclature of the cylindromas. He describes a case of cylindroma capitis (which has also been termed nevus epithelioma-cylindromatosus) in a man of forty whose scalp was covered by scores of tumors of various sizes. By using a variety of staining reagents he found that the hyaline substance, the most striking feature of these tumors, extended through the interlobular trabeculae so as to form a continuous mass with the outer and inner hyaline coats. [Patches showing typical cylindromatous structure have been found associated with and even intermingled in the substance of tumors of other types in various parts of the body other than the skin, e.g., in the ear, jaw, nasal and paranasal sinuses, and palate. For abstract of a recent paper by Nussbaum on cylindroma of the mastoid see Am. J. Cancer 15: 1008, 1931.1 F. CAVERS Kaposi’s Multiple Idiopathic Sarcoma, H. MIERZECKI.Sarcoma idiopathicum multiplex Kaposi, Arch. f. Dermat. u. Syph. 165: 577-584, 1932. The author reports seven cases of Kaposi’s sarcoma, with the histological findings in four. One, which came to autopsy, was definitely sarcomatous, with metastases in the lungs and kidneys. The others are not so fully described. Chief

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stress is laid on the presence of proliferation of fibrous tissue, in one case suggesting sarcoma, old and recent hemorrhages, and infiltrations of varied types. The author agrees with Miescher that Kaposi’s disease begins as a spindle-cell sarcoma, but the young neoplastic cells usually undergo disintegration owing to stromal hemorrhage, and the degenerating sarcomatous tissue is more or less largely replaced by vascular granulation tissue. In one of the four cases the author observed such a transition from sarcoma-like to granulation-like tissue; the nodule showing this mixed character was of twenty-four years standing. He admits that though this form of skin sarcomatosis has emerged from the careful studies of recent years as a well marked clinical entity, many points in its histology and pathogenesis remain still unsettled. [He does not mention the view taken by several recent writers that Kaposi’s disease is essentially an angiomatous tumor. See Hudelo and Cailliau: Ann. de dermat. et syph. 2: 417-445, 1931 (abst. in Am. J. Cancer 16: abst. p. 1315,1932), and Dorffel: Arch. Derm. & Syph. 26: 608-634, 1932 (abst. in Am. J. Cancer 17: 821, 1933).] Case of Kaposi’s Idiopathic Multiple Hemorrhagic Sarcoma of the Skin Treated by Roentgen Therapy, K. SCHIRMUNSKAJA AND K. TSCHOTSCHIA. Ein Fall von idiopathischem multiplem hamorrhagischem Hautsarkom Kaposi und dessen Rontgenbehandlung, Dermat. Wchnschr. 94: 705-708, 1932. A man of twenty-two years had numerous nodules and infiltrations, some ulcerated, of the typical Kaposi appearance. Biopsy showed in the subepidermal connective tissue numerous young thin-walled blood vessels, densely surrounded by small round lymphocyte-like cells mixed with spindle cells. In the deeper layers the connective tissue showed hyalinization and even denser perivascular infiltration. Since this disease has proved intractable to other forms of treatment, a few attempts have been made with radiotherapy, especially with x-ray, and improvement has been reported in some cases. The author gave his patient a series of roentgen treatments over twenty fields, each field receiving 1.5 erythema dose, At the time of the report some of the less dense infiltrations showed signs of clearing up. F. CAVERS Adenoma Sebaceum, N. E. ARONSTAM.Amer. Med. 27: 320-321, 1932. I n discussing the etiology of adenoma sebaceum the author states that in his opinion too much stress has been laid upon mental disease as an etiologic factor. I n the series of cases coming under his observation [number not mentioned] the condition occurred in mentally sound individuals some of whom were even above the normal in intelligence. He reports a single case with clinical description. No biopsy was done, and treatment was unavailing. W. BAYARD LONG Verruca Senilis and Keratoma Senile, H. MONTGOMERY AND J. D ~ R F F E L Verruca . senilis und Keratoma senile, Arch. f. Dermat. u. Syph. 166: 286-296, 1932. Using practically the same (Mayo Clinic) material, with some additions, the authors cover much the same ground as Hookey’s paper on the subject (Arch. Derm. & Syph. 23: 946, 1931). They deal with 100 cases of verruca senilis and 40 of keratoma senile (Hookey’s numbers were 52 and 31). The two lesions are contrasted clinically and histologically. The senile verruca is regarded as an epithelial nevus arising late in life. It shows little or no dyskeratosis, only mild inflammatory reaction, and usually increased pigmentation; it only rarely, and then usually after trauma or chronic irritation, undergoes malignant change (two cases observed in the hundred). The senile keratoma shows hyperkeratosis and irregular acanthosk associated with dyskeratosis and secondary inflammation, and is a much more decidedly precancerous lesion; in no less than 10 of the 40 cases studied

992 malignant change occurred. micrographs.

ABSTRACTS

The illustrations include some excellent photoF. CAVERS

Trichobasalioma Cysticum Anulare, L. N. MASCHKILLEISSON AND M. I. PER. Dermat. Wchnschr. 95: 1479-1481, 1932. Trichobasalioma cysticum anulare is one of the varieties into which the group of benign skin tumors formerly called Brooke’s cystic adenoid epithelioma has been split, frequently on the basis of only slight histologic differences. There seems to be no sound reason for founding the variety Trichobasalioma a t all; the tumors so named are more accurately termed Trichoepithelioma. The three tumors described by the authors are practically ring-shaped forms of Brooke’s epithelioma, or a t any rate of trichoepithelioma, and in some sections the origin of the cysts from hair follicles could be traced clearly. In two cases the tumor occupied the forehead, in the third the chin. These tumors are much more translucent than syringocystadenoma and adenoma sebaceum. The tumor grows in the corium, the epidermis being left almost unchanged, and consists of round, ovoid, or branched masses of columnar epithelial cells, among which are cyst-like cavities containing granular d6bris. F. CAVERS Leiomyoma of the Skin, P. PHOTINOS.Zur Kenntnis und Histologie des Leiomyoms der Haut, Dermat. Wchnschr. 95: 1053-1056, 1932. The author gives a brief review of cutaneous leiomyomas, the first case of which, he states, was described by Besnier in 1880. [His bibliography would liavc been really useful had he inserted references to all the authors whose names he cites, instead of only a small minority of these.] In the case now reported thc author removed from the right shin of a woman of twenty-nine a superficial nodule which she had first noticed about ten years previously. The tumor showed signs of having been derived mainly from the muscle coats of the larger cutaneous blood vessels. An unusual constituent of the tumor was hemosiderin, present as granules occurring chiefly in the oldest central part of the growth; it was contained in fine spaces, evidently representing the remains of blood vessels. F. CAVERS Diffuse Angiomatosis of the Lower Extremity, E. SORREL. Angiome diffus du membre inf6rieur droit, Bull. et m6m. SOC.nat. de chir. 58: 758-761, 1932. The author reports a case of congenital angiomatosis of the lower limb, extending from the dorsum of the foot to the groin and apparently into the pelvis. The entire limb was swollen, the surface presenting bunches of varicose vessels, with generalized bluish black skin coloration; the muscles were atrophied. An unusual feature was that the whole limb was painful to touch, and this together with the fact that the pat,ient was a little girl of only three years made the problem of treatment a difficult one. The author discusses the possibilities and, after dismissing several methods as impracticable, states his intention of trying injections of quinine salts, starting with the foot. To ligate and remove the larger varices would, he considers, be unsatisfactory and even dangerous, owing to the risk of sepsis in the moist and, in places, ulcerated skin. The heroic measure of disarticulation a t the hip might be considered, but, as stated, the large vessels were varicose as far as they could be palpated into the pelvis. F. CAVERS Fibroma with Atypical Epithelial Proliferation, H. BIBERSTEIN. Fibrome mit atypischer Epithelwucherung, Arch. f. Derm. u. Syph. 164: 69-81, 1931. The writer describes four cases of fibroma of the skin; these were multiple in some instances, single in others. Great stress is laid upon the epithelial hyperplasia which exists over the surface of some of these tumors. To the ordinary

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pathologist these growths do not seem extraordinarily different from the fibromata which are repeatedly removed by surgeons from various portions of the human anatomy.

Fibrosarcomas of the Skin, W. BRUCK. Zur Frage des Fibrosarkoms der Haut, Arch. f. Dermat. u. Syph. 165: 797-807, 1932. A detailed account of a single case, occurring in a man of twenty-four years. A scleroderma-like nodule in the abdominal skin had existed from birth but had recently grown more rapidly, projecting as a rounded mass. As biopsy showed a sarcoma-like structure, the nodule was excised, the author cutting well into sound tissue around and below. The epidermis was practically unaltered, but the derma showed the histologic appearance of a densely fibrotic type of spindle-cell sarcoma. As so often happens with cutaneous fibrosarcomas, recurrence had taken place when the patient was seen fifteen months later. This was not nearly so hard as the original tumor but again was of spindle cell type and showed more marked tendency to infiltrate the adjacent tissue and grow downwards, especially in the septa of the subcutaneous fat masses. Four good photomicrographs are given. F. CAVERS Large Cavernous Angiofibroma of the Lumbar Region, AUVRAY.Volumineux angio-fibrome caverneux de la region lombaire, Bull. et m6m. SOC.nat de chir. 58: 587-592, 1932. A man had had since infancy a tumor of the lumbar region, projecting to the left of and below the left sacro-iliac synchondrosis, which had grown steadily in size. I n 1899, a t the age of sixteen, he had an accident in which the tumor, a t that time as large as an infant’s head, was contused and ulcerated. It was recognized on biopsy as a fibroangiomatous neoplasm, and an attempt to remove it surgically was abandoned because of the profuse bleeding and presence of dense adhesions. The patient when seen by the author, thirty years later, was in a wretched state, highly anemic and cachectic; the tumor was a large mass, measuring 80 X 70 X 50 cm., and its surface showed deep infected and bleeding ulcers. The author managed to remove the tumor, despite the difficulty in minimizing hemorrhage, but the patient died shortly afterwards. F. CAVERS

Cells with Sudanophile Granules in Neurofibroma of Skin, T. WLASSICS. Sudanophil-granulierte Zellen in Neurofibromen, Arch. f . Derm. u. Syph. 165: 352-356, 1932. The author points out that while neurofibromatosis is essentially in its origin ti disease of the ectodermal system, arising by proliferation of the cells of Schwann’s sheath and of the accompanying glial tissue of the nerve bundle, mesodermal tissue enters secondarily into the composition of the developed tumor-for instance, proliferated blood vessels, fibroblasts, leukocytes, mast cells, clasmatocytes. He is concerned mainly in this concise paper with the origin of the cells which play a part in the degenerative changes undergone by these tumors by phagocytozing the fat of the degenerating myelin sheaths. In a histologic study of five cases he claims to have demonstrated that these phagocytic cells, which contain fine or coarse fat granules staining with Sudan 111, arise from the primary cells of the tumor itself (that is, from the Schwann cells) and are not of extraneous origin. One photomicrograph is given. F. CAVERB

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ABSTRACTS

Histology of Syringocystadenoma Papilliferum, C. CARDENAL.Zur Kenntnis der Histologie des Syringocystadenoma papilliferum, Arch. f. Dermat. u. Syph. 166: 315-318, 1932. The author describes two cases of syringocystadenoma papilliferum, occurring in a man of seventeen and a girl of fifteen. Both cases showed the typical distribution of this tumor (chest and arms). In the first case the nodules showed the usual histological picture: (1) slender solid tracts of columnar epithelium usually two or three cells wide, (2) round or ovoid cysts filled with hyaline material, (3) dense infiltration with lymphocytes and plasma cells. I n the second case, however, the lymphocytes formed clumps in the cutis with definite germinal centers. I n both cases the tumors showed evidence of the typical origin from the duct of a sweat gland, but the histological features of the second case suggest to the author that the lymphatic system of the skin may play a n important part in the formation of these and similar benign tumors, and that the development of the skin lymF. CAVERS phatics deserves detailed study. Tumors of Muscle, HAYWARD.Muskelgeschwtilste, Med. Klin. 27: 1218, 1931. Rheumatic symptoms, particularly when they affect the same muscle constantly, should lead to a suspicion of sarcoma. DiBuse Angioma of the Anterior Muscles of the Forearm, H. L. ROCHER AND UZAC. Angiome diffuse des muscles anterieurs de l’avant-bras, Gaz. hebd. d. sc. m6d. de Bordeaux 52: 380-382, 1931. The authors report a case of angioma of the anterior muscles of the forearm which is of interest because tumors of this type are relatively rare in muscle tissue. The case was also unusual in that an osteoma in the form of several nodules of bony tissue had developed in the angioma, which also showed the presence of smooth muscle fibers. The growth was widely excised under local anesthesia, and subsequent function of the arm and hand was excellent. Le Page has collected from the literature 228 cases of angioma of the striated muscles, of which 61 occurred in the upper and 110 in the lower extremities. In 27 cases the presence of angioliths is recorded; in only one case was an osteoma found. Fibroma of the Rectus Abdominalis, L. MULLER. Fibrome du muscle grand droit, Bull. et m6m. Soc. d. chir. de Paris 23: 577-578, 1931. A woman, twenty-one years of age, was operated upon and a tumor on the left side of the abdomen attached to the rectus muscle was removed. No microscopic diagnosis was made. [Evidently it was a desmoid growth.] Two Cases of Rapidly Growing Connective-tissue Tumors of the Thigh, A. PARCELIER AND A. CHENUT. Deux cas de tumeurs conjonctives de la cuisse, Gaz. hebd. sci. med. de Bordeaux 53: 43-45, 1932. Also in Bordeaux chir. 3: 162-164, 1932. The authors report these two cases together because both were connectivetissue tumors occupying the thigh, and in both cases the tumor had grown slowly a t first and very rapidly a t a later stage. (1) A fifty-three-year-old man said that thirteen years ago a cart had fallen on his right thigh. The wound was contused and ecchymosed, and about a month after the accident a lump some 3 cm. in size was felt, which moved freely under the skin, This steadily grew larger, slowly a t first; then, suddenly assuming rapid growth, it increased to the size of an adult head. The overlying skin was ulcerated. The bone was found normal by roentgenography. Resection of the tumor involved resection of considerable portions of the adjacent muscles. The tumor was diagnosed histologically as a rhabdomyosarcoms.

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The authors do not suggest any genetic relation between trauma and tumor in this case. The tumor had evidently been growing in its site before the leg was injured. (2) A woman aged sixty-one presented a tumor similar both in appearance and location to the one just described. It had appeared about ten years previously and had grown slowly for over nine years and had suddenly enlarged from the size of an orange to about thrice that of an adult head during the past three months. On account of this astonishingly rapid growth the authors suspected malignancy and excised the tumor. It was found histologically to be a lipoma, though in places groups of sarcoma-like cells were seen. The authors consider that amputation would have been a safer procedure than resection in both of these cases. F. CAVERS THE ORAL CAVITY, NOSE AND PARANASAL SINUSES, THROAT, SALIVARY GLANDS, CAROTID BODY

Carcinoma of the Upper Respiratory Tract, THFXLEMANN. Carcinome der oberen Luftwege, Med. Welt 5: 1341-1344 and 1381-1383, 1931. Theilemann discusses the diagnosis and treatment of cancers of the upper respiratory tract, beginning with the skin of the nose and concluding with the larynx. He favors the combined use of radical surgery and radiation when this is possible and believes that the end-results in the treatment of these growths have been improved. BENJAMIN R. SHORE Epitheliomas of the Buccal Cavity, Treatment by Radium and X-ray, C1. REGAUD. Les kpith6liomas de la cavit6 buccale: leur traitement par et le radium et les rayons X, J. de m6d. et chir. prat. 103: 15-28, 1932. Except for relatively rare tumors such as lymphosarcoma, osteogenic sarcoma and such epithelial tumors as arise in salivary glands of the mucosa, or in paradental ddbris, most malignant tumors of the mouth are epidermoid carcinoma. In any case the latter cause only 2 per cent of the general mortality from cancer. Their interest lies rather in the difficulty of treatment, and the progress in that direction in recent years. Until a dozen years ago the only resource was surgery. Measures sufficiently radical for hope of cure often entailed extremely mutilating procedures and lasting cure was infrequent. With the improvement in methods of utilizing the physical agents, the prognosis of buccal cancer has been bettered. Cancer of the mouth occurs ten times as often in the male as in the female. Syphilis, abuse of tobacco, and chronic oral sepsis probably account for this difference. These conditions produce leukoplakia upon which epitheliomas may develop. Glandular metastasis is the rule in epitheliomas of the buccal mucosa. The primary and the secondary deposits require different treatment, the latter being much more difficult to control. Not all palpable nodes are involved by cancer. The palpable nodes accompanying cancer of the lip are actually invaded by cancer in only 60 per cent of cases; on the other hand, palpable nodes associated with cancer of the tongue are definitely cancerous in 86 per cent of cases. Primary cancer of the mucosa of the cheeks, lips, and anterior floor of the mouth usually metastasizes to the submaxillary lymph nodes; cancer of the palate and base of tongue to the upper deep cervical group; that arising on the tip, dorsum or borders of the tongue usually appears next, in the middle carotid nodes. Bilateral adenopathy is common in lesions located near the midline, as in the soft palate, tongue, and floor of the mouth, and is fairly common in lesions limited to one half of the tongue.

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ABSTRACTS

The gravest danger in diagnosis is delay. Precious time should not be wasted on a therapeutic test for syphilis. Instead an immediate biopsy specimen should be taken for histological examination. Regaud’s four hundred and thirty-six cases of intraoral epithelioma were distributed as follows: Location Number Per cent Mucosa of cheek. .................................... 47. . . . . . . . . . . . 11 Hard palate, gums and ascending ramus of mandible. . . . . . 34. . . . . . . . . . . . 8 Soft palate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . . 6 Under surface of tongue and floor of mouth. . . . . . . . . . . . . . 7 7 . . . . . . . . . . . . 18 Dorsum and borders of anterior two-thirds of tongue. . . . . . 174.. . . . . . . . . . . 40 Dorsum and edges of posterior third of tongue. . . . . . . . . . . 7 9 . . . . . . . . . . . . 18 Roentgen therapy as employed in the average hospital produces minimal regression and never accomplishes a cure of epidermoid buccal carcinoma. The dose of x-rays which one must administer to epidermoid carcinoma of the pharynx or buccal cavity is so large that it involves a most laborious technic if one is t o avoid serious damage t o normal structures. The factors required, are 180 to 200 kilovolts, heavy filtration (2 mm. of zinc or copper), and 60 to 80 cm. distance. In addition] an exposure which may total forty-eight hours, must be administered daily in divided doses over a long period. With this technic and dosage many cures of carcinoma of the pharynx may be accomplished. Carcinoma of the tongue is, however, more radioresistant and is rarely cured by x-ray alone. Some excellent palliative effects can be procured in buccal cancers which are too extensive for radium therapy. The employment of wax or hard rubber molds of the lesion bearing many tubes of radium of weak strength is adapted to treatment of lesions of the mucosa of the cheek, floor of the mouth, or hard palate, but is not feasible for a movable organ like the tongue. At best it is simply a part of the complete treatment and is so inconvenient that it can be tolerated for only a few hours daily. For superficial lesions radium mounted in wax moulages 3 cm. thick may be directed through the overlying skin.of the cheek, floor of the mouth, or submaxillary gland. Deeper lesions, as of the soft palate, and adenopathies a t the angle of the jaw or carotid bulb require the radium to be directed from a distance of 6 or 8 cm. over large areas. This latter requires 1 gram or more of radium, and normal structures must be protected by sheets of lead, the weight of which prevents continuous application. There are two methods of interstitial radiation. One consists in the insertion of tiny capillary gold seeds containing from 1 to 2 millicuries of radon. These are left permanently i n situ. Their radioactivity diminishes to half value in about four days. Despite the gold or platinum filtration of these seeds, radionecrosis is a fairly frequent complication especially if the cancer is extensive. The second method consists in radium puncture by needles of platino-iridium with walls 0.5 mm. thick. The needles are of various lengths, with a radio-active length of 15 mm. They contain 1 to 2 mgm. of radium element or its equivalent in emanation. They are inserted about the lesion under local anesthesia and left in place for seven or eight days. Radiotherapy is difficult. It requires the delivery to all parts of the invaded tissue of a dose of radiation sufficient to destroy all neoplastic cells but not enough to destroy the normal tissues. Where the radioresistance of a tumor approaches that of normal tissues the dose sufficient to destroy the tumor may lead to late radionecrosis; if less than this dose be given, a recurrence will develop. The radium reaction which develops is a superficial burn of the mucosa. It is unavoidable and if extensive may interfere with proper nutrition or be the point

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of origin for oral sepsis. Where large amounts of radiation are given over an extended time, the general condition of the patient may be greatly depreciated. Radionecrosis of soft parts or bone is usually the result of a combination of excessive dosage plus infection. It is therefore essential that the mouth be thoroughly cleaned up before the lesion is punctured by radium needles. Regaud’s material consisted largely of inoperable cases and his statistics are rigidly compiled to include, without selection or deduction, all cases which were treated. Patients who died before five years had elapsed since treatment, and all patients untraced, were included with those who died of cancer. Between 1919 and 1925, 436 patients were treated, of whom 341 died of cancer or complications following their treatment. Twenty-three patients were untraced or died of intercurrent disease. There were 72 five-year curea, 16 per cent of the total number. The percentages of five-year cures of lesions of various regions follow: mucosa of cheek, 19 per cent; maxilla, 11 per cent; soft palate, 4 per cent (1 case); under surface of tongue and floor of mouth, 16 per cent; anterior dorsum of tongue, 21 per cent; posterior dorsum of tongue, 8 per cent. Cervical adenopathy gravely affects the prognosis. No treatment is satisfactory. Surgical dissection cures few cases with histologically proved involvement. Effects of radium therapy are difficult to evaluate because the nodes are not proved to be cancerous. Regaud believes that cures occur only in radiosensitive varieties. The employment of both surgery and irradiation affords some cures, but it is difficult to determine the r61e played by each. Nevertheless, the future treatment of cervical adenopathy will probably tend toward the employment of surgery plus radiation by radium and also by x-rays. WILLIAMJ. HOFFMAN

Further Results of Prolonged Rractional Irradiation, with Observations on Simple Fractional Method, R. STEWART-HARRISON, Weitere Resultate bei protrahiert-fraktionierter Rontgenbestrahlung, nebst Bemerkungen uber die einfach-fraktionierte Rontgenbestrahlung, Strahlentherapie 44: 679-686, 1932. The author gives in detail the records of eight cases of carcinoma or sarcoma of the nose and throat region, each of which was treated by the prolonged fractional method. All the patients are alive after one year. No specific rules for dosage can be advanced. In general the intensity of the radiation was about 3 rlmin: the doses varied between 180 and 210 r on the skin per single exposure. Two exposures per day were given on five days of the week, and the treatment was continued until the onset of a mucous membrane reaction. The total doses varied from 3240 to 6370 r on the skin or 5280 r in air. This method is most successful when it is carried on without interruption. Recurrences of cancer of the tonsils are frequent. I n such cases x-rays combined with radium are valuable, using Berven’s method of application (Acta Radiol. Suppl. 11, 1931). Whether simple spaced fractional doses given in a short exposure are as valuable as prolonged fractional doses is still a question. The author cites two cases in which the former method was successful, but is not convinced that it is really as good as the latter. CHARLES PACKARD Surgical Diathermy in Oto-Rhino-Laryngolog, M. KINDERVATER. Uber chirurgische Diathermie in der Hals-, Nasen- u. Ohrenheilkunde, Ztschr. f. Hals- Nasen- u. Ohrenh. 30: 627, 1932. The author has used surgical diathermy in many operations on the mouth, nose, and throat, for lupus, tuberculosis and tumors, both benign and malignant. The use of the electric spark prevents bleeding, and in the case of malignant tumors it lessens the danger of dissemination of tumor cells, as the blood and lymph vessels are sealed by this method. The author has never seen any toxic effect from the necrosis caused by coagulation, 43

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ABSTRACTS

Among the illustrative cases reported are a tumor of the tonsil, hemangioma of the nose, and tumor of the epipharynx. The first two were removed with the cutting current, the third by a combination of the cutting and the coagulating currents.

On the Etiology, Diagnosis and Treatment of Haemangiomata of the Oral Cavity, I. SOBOL. Acta Oto-Laryng. 18: 172-176, 1932. Sobol classifies hemangiomata as of three types. (1) Haemangioma simplex consists of a dense mesh of capillaries between which are elements of connective tissue. This type is usually flat or only slightly raised, and bright red in color. (2) Haemangioma cavernosum resembles in structure corpus cavernosum. It arises from greatly dilated capillaries and the blood stream is separated by intercellular connective-tissue septa covered by endothelium. These growths may occur in the skin, liver, and striated muscle. (3) Racemose hemangioma consists of a ramifying, pulsating new growth composed of trunks and knots of vessels which for the most part are arteries so altered that they look like veins. Between these trunks is a network of capillaries. This type is commonest on the scalp and of infrequent occurrence on trunk and extremities. It may occur in the brain or meninges. Hemangiomas may occur in the mouth, tongue, or pharynx. Sobol reports a case occurring in a female infant one year old. A racemose hemangioma involved most of the anterior two-thirds of the tongue and caused so much enlargement that a part of the dark nodular mass protruded from the mouth. The protruding portion of the tongue was excised and the remaining dilated vessels were injected in nine different areas with 2 C.C. of 90 per cent alcohol over a period of thirty-five days. At the end of this time the tongue was reduced to one-half its original size. WILLIAM J. HOFFMAN

Leukoplakia of the Mouth and Carcinoma of the Lips and Tongue in Smokers, GERHARD HAABE. Zur Kenntnis der Leukoplakia oris und der Lippen- und Zungenkrebse bei Rauchern, Deutsche Monatschr. f. Zahnheilk. 49 : 881-913 and 929-976, 1931. The author discusses a t length the relation of smoking to leukoplakia and in turn the relation of leukoplakia to the development of carcinoma of the lips and tongue. He has assembled and correlated statistics concerning these conditions from many sources, but adds no new material of his own. He concludes that the smoking and chewing of tobacco are among the most important immediate causes of leukoplakia of the mouth and cancer of the lips and tongue in individuals already predisposed towards neoplastic growth. An extensive bibliography is appended. BENJAMIN R. SHORE Carcinoma of the Lip, Radium Treatment, M. T. VAN STUDIFORD, New Orleans M. & S. J. 84:252-259, 1931. Carcinoma of the lip is almost exclusively a disease of males, occurring fifty times as frequently in that sex as it does in the female. It affects the lower lip nineteen times as often as it does the upper lip. Two types occur, papillary and infiltrative. The papillary form is slow to invade the deeper structures, metastasizes late, and responds well to conservative treatment. The infiltrating form ulcerates early, metastasizes swiftly, extends deeply, and has a graver prognosis. Cancer of the lip is most often mistaken for syphilis, with which it frequently is associated. Biopsy should be done as soon as any tumor of the lip is encountered. The author treats early papillary lesions by moderate doses of radiation delivered through a moulded applicator of dental compound bearing radium tubes

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employing 1 mm. of brass filtration. Infiltrative lesions are treated by a similar applicator, but larger doses are required. In some bulkier growths radium element needles are implanted into the tumor. Lymph node involvement is treated by radium packs applied a t 5 to 7 cm. distance for 2000 to 3000 millicurie hours. [The dosage of external radiation recommended by the author for treatment of lymph node areas is too small to have much effect on squamous carcinoma in the WILLIAMJ. HOFFMAN nodes.]

Review of Cases of Squamous-cell Carcinoma of the Lip at the New Haven Hospital from Jan. 1, 1920, to Nov. 1, 1931, F. W. ROBERTS.Yale J. Biol. & Med. 4: 187-198, 1931. Roberts reviews 32 cases of squamous carcinoma of the lip treated a t the New Haven Hospital between 1920 and 1931. All the patients were males; all but one were smokers. The youngest was thirty-eight years old; the oldest eighty-four. The average age waR fifty-eight years. The duration of the lesion before admission to the clinic ranged from one month to five years, the most usual interval being three to six months. In five patients the lesion was accompanied by palpable metastatic nodes in the submental or submaxillary regions. Treatment of the operable cases was by surgery; inoperable cases were treated by radium and x-ray. The usual treatment for early lesions waa a V-shaped excision without dissection of the glands of the neck. Moderately advanced lesions were treated by excision of the primary tumor and plastic repair with block dissection of the nodes of the neck. Advanced inoperable cases were treated by x-rays and radium. Of 32 patients treated, 3 were inoperable and two are untraced. Ten have died, six of these with cancer. Causes of death in the other four were: cardiac failure in 3, and acute cystitis and confluent local pneumonia in one. In the three cases of cardiac failure there waa no evidence of cancer. The fourth patient died a few days after operation. Twelve were treated by radical neck dissection, excision of the growth and plastic repair. Two of these died of cancer, and one from cardiac failure. The author concludes that many of these cases were treated too conservatively and that too many secondary operations had to be carried out later because of recurrences. If the early lesions had been excised with a wide margin, followed by dissection of the cervical nodes, it is certain that the results would have been better. WILLIAMJ. HOFFMAN Plastic Replacement of Upper Lip in a Case of Epitheliomatous Ulcer Resulting from X-ray Treatment of Sycosis Barbae, A. J. HUTTON. Glasgow M. J. 36: 225-230, 1932. Hutton’s patient, aged forty-two, came to him with an intractable ulceration of the upper lip as the result of repeated x-radiation in the treatment of sycosis barbae. The loss of substance extended from the right angle of the mouth to within a quarter of an inch of the left angle, and upward to the root of the columella and the left nasofacial fold. The first surgical step was the removal of the whole upper lip, base of the columella, and a portion of the left ala and nasolabial fold. A tube pedicle flap was raised from in front of the right ear to just beyond the vertex (carrying with it the posterior branch of the superficial temporal artery). The edges of the proximal two-thirds were stitched together to form a tube. The distal end was detached, and its under surface covered with Thiersch grafts. This flap was later swung into place and sutured to the freshened edges of the cheek to form a new upper lip. A

1000

ABSTRAUTS

new vermilion border was constructed from a strip of mucosa derived from freslrening the edges of the cheek wound. An excellent final result was obtained. WILLIAMJ. HOFFMAN

Cancer of the Tongue, R. K. KESSEL. Med. Inst. Voronesch Rept. 1: 22-31,1932. On the basis of 10 personal cases and a review of the literature, the author attempts to set up a criterion for the treatment of cancer of the tongue, arriving at the conclusion that surgical treatment for the primary lesion and neck metastases is preferable to all other therapy. He states, however, t h a t postoperative x-ray MAURICELENZ and radium treatment may also be useful. Cancer of the Tongue with Cranial Metastasis, RAYMOND PHILIP. Cancer de la langue A propagation cranienne, Rev. de laryng. 53: 65f5-657, 1932. A man aged sixty-six complained of pain in the posterior pharynx not related to swallowing. Examination of the pharynx, base of the tongue, and neighboring regions revealed a slight diffuse redness but no other evidence of abnormality. Not until ten months later was a tuknor present, at the base of the tongue and in the submaxillary region. The pain in the pharynx had increased and now radiated upward along the ear. During this interval the patient had experienced violent headaches limited to the left half of the cranium, and his general health had failed. Radiographs of the base of the skull showed loss of normal density over an area 5 cm. in diameter. Biopsy revealed a highly malignant undifferentiated carcinoma. [The history of early pain in the tongue and pharynx a t a time when the primary tumor was so small as t o escape discovery by a specialist, the subsequent development of motor and sensory paralysis of the nerves supplying that area, the upward extension of the disease into the cranium, and the histologic picture of undifferentiation, mitoses, and absence of connective tissue, are typical of the life history, location, and histologic appearance of transitional-cell carcinoma.] WILLIAMJ. HOFFMAN Lipoma of the Tongue, A. COLOMBO.Lipoma della lingua, Tumori 6: 233-261, 1932. A man aged eighty-one had a small, soft submucous tumor of the tip of the tongue, which proved on removal to be a pure lipoma. Colombo tabulates 42 similar cases which he collected from the literature. Photographs and a bibliography are included. C. D. HAAQENSEN

A Case of Unusual Sublingual Dermoid, MORRISJOSEPH.Am. J. Surg. 16: 509, 1932. This is a report of a large tumor of the oral cavity in a n eleven-year-old child. The tumor was first observed beneath the tongue, in infancy. It enlarged steadily until it filled the oral cavity, prevented protrusion of the tongue, and rendered speech and deglutition difficult. It was removed surgically under local anesthesia and proved to be a dermoid cyst, weighing 97gm. and measuring 6.5 x 6 x 5.5 cm. WILLIAMJ. HOFFMAN

Carcinoma of the Floor of the Mouth. Radium Therapy. Three-year Cure, V. PALUMBO. Carcinoma del pavimento orale. Radiumterapia. Guarigione da 3 anni (con presentaaione del malato e dei preparati istologici), Sperimentale 86: xlvi-xlix, 1932. A man aged fifty-three had a histologically proved carcinoma involving " almost the entire right half of the floor of the mouth." He was treated by the

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insertion of radium-containing needles into the tumor, and the external application of radium in a molded applicator. He was well three years later. C. D. HAAGENSEN

Malignant Mixed Tumors with Cystic Degeneration in the Sublingual Glands, H. ESCHWEILER. Fall einer zystisch veranderten malignen Mischgeschwulst der Sublingualdriise, Ztschr. f. Laryng., Rhin. 22: 36-39, 1931. Report of a case in which there were swelling and pain on the floor of the mouth, to the left of the median line. At operation a partially cystic, partially solid tumor was found involving the sublingual gland. The tumor could not be entirely removed as i t involved the tissues of the floor of the mouth and base of the tongue. The cystic portion was easily removed. Histologically it showed adenocarcinoma and cystic degeneration of the glandular spaces. The solid part of the tumor showed spindle-cell sarcoma, but collections of epithelial cells were found in the sarcomatous tissue. Only 4 other cases of mixed tumors of the sublingual glands were found in literature, and none of these showed a similar structure.

Tumor-forming Diseases of the Jaws, EDELTRAUD ANGERER-KUX.Beitrag zur Frage tumorbildender Erkrankungen der Kieferknochen, Vierteljalir. f. Zahnheilk. 47: 341-347, 1931. The author presents t h e histories of two patients with intraoral epulides, and discusses the relation of these lesions to true tumors. I n both cases reported paradental infection preceded the development of the growths and the author concludes that they should be considered as giant-cell granulomas. The article is illustrated with photographs of the tumors and pliotomicrographs. BENJAMIN R. SHORE Treatment of Adamantinomas, RICHARD F. C. KEGEL. Zur Klinik und Behandlung der Adamantinome, Vierteljahr. f. Zahnheilk. 47: 505-513, 1931. Kegel reviews the results obtained in the treatment of 35 adamantinomas at the Johns Hopkins Hospital. Twenty-nine of these were situated on the mandible, and 6 on the maxillae. The youngest patient was seven, the oldest fifty-three, the greatest incidence being between eleven and thirty-five years of age. I n 11 cases extensive resections of the jaw bearing the tumor were done, while in 24 cases more conservative local excisions were performed. Recurrences were noted in seventy-nine per cent of the latter group. Eleven patients have remained well for five years, 5 less than five years, and 10 have not been followed. Three patients died of sepsis, 3 more died immediately after operation, and 3 were discharged with incompletely eradicated growths. The article is illustrated with photographs, roentgenograms, and a photomicrograph. This series of cases is reported also in Archives of Surgery 25: 498-528, 1932. BENJAMIN R. SHORE Unusual Bone Cavities in the Mandible: A Report of Three Cases of Traumatic Bone Cysts, T. BLUM. J. Am. Dental Assn. 19: 281-301, 1932. Contrary to the general idea that cysts of the jaws arise as a sequel to infection or embryological abnormality of the dental system, Blum concludes, as the result of his experiences and studies, t h a t trauma may be a cause of cysts in this region. He reports three cases of cyst of the mandible occurring in boys whose ages ranged from fourteen to seventeen years. I n each case there was a definite history of antecedent trauma to the mandible occurring respectively eight, nine, and two years previously. Radiographs disclosed the presence of a mandibular cyst in each case. The cysts were well circumscribed, but the distinct bony line usually noted in radicular or follicular cysts was lacking. On the other hand, wherever

ABSTRAOTS

the teeth were apparently involved in this bony cavity the exposed roots were covered by a distinct peridental lamella, apparently typical of these traumatic cysts. Blum operated on all three patients, obtained biopsy specimens, and made a careful inspection of the interior of the cysts. Their contents were fluid and there was no evidence of epithelial ddbris, cyst lining, or supernumerary teeth. He discusses the etiology of these cysts and concludes that they are formed as the result of trauma which produces interosseous hemorrhage without causing fracture. The presence of this hemorrhage causes a transudate which further increases the interosseous pressure and thus leads to absorption of the surrounding bone as a result of the stimulus given to production of increased numbers of osteoclasts. These cysts occur only in young people. I n older people the same degree of trauma would probably cause a fracture, which by communicating with the surrounding soft parts would promote rapid absorption of hemorrhage or transudate and prevent abnormal increase in pressure such as is a requisite to the formation of a bone cyst. WILLIAMJ. HOFFMAN

Rare Tumors of the Jaw, H. GROSS.Seltenere Kiefertumoren, Vierteljahr. f. Zahnheilk. 48: 370-377, 1932. Gross describes 6 unusual tumors of the jaw. The first was an epithelial tumor arising back of the last molar tooth on the lower jaw, and proved to be a mucous gland adenoma. There were 2 sarcomas, one on the lower and one on the upper jaw. The first was an osteosarcoma, containing some osteoid tissue. The second was a myxo-osteoplastic sarcoma, with a cellular reticular tissue between islands and strands of bone tissue. Two of the tumors originated in the dentigerous portion of the jaw, and contained some of the characteristic tissues forming the teeth. The first of these tumors was a cementoma with fibrous connective-tissue elements, and was therefore designated as a fibro-cementoma; it contained no epithelial elements. The second tumor of this type was an odontoma made up of a " conglomeration of the various tissues characteristically found in the teeth in a calcified cement or connective tissue, All these tumors were primary in the jaw. A sixth specimen is described which represents a metastasis of a malignant hypernephroma of the kidney, and was histologically a hypernephroma. Metastases of hypernephroma in the bones and especially in the bones of the skull are not unusual, but involvement of the jaw is rarely reported. Schmincke Tumor of the Upper Jaw, C. BANDELOW.Ein Fall von Schminckeschem Oberkiefertumor, Mitt. a. d. Grenzgeb. d. Med. u. Chir. 42: 448-4GGJ 1931. Reports a case of a Schmincke tumor of the upper jaw, and reviews the literature of the subject. A total of 23 cases, including the author's own, are summarized and tabulated; the first 5 cases were described by Schmincke in his original contribution (Beitr. z. path. Anat. u. z. allg. Path. 68: 161, 1921). The tumor is a malignant lympho-epithelial growth, consisting of an epithelial syncytial reticulum, the interstices of which are infiltrated with lymphocytes. In the 23 cases reviewed, the site of origin of the tumor was the tonsil in 11 cases; the nasopharynx in 6 cases; the thymus, the hypopharynx, the larynx, and the hard palate, in one case each. I n 2 cases the point of origin was not determined; from this it is evident that these tumors originated chiefly in the lympho-epithelial tissues, although they may appear a t any site where branchiogenic epithelium is present. The youngest patient was fourteen years of age; the oldest, seventy-one; but most were of middle age. These tumors are particularly radiosensitive and 18 of the 23 cases reported were treated by radiotherapy alone, either radium or the roentgen rays. Nine of the 23 patients died, from metastasis in 8 cases and

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from hemorrhage in one. The diagnosis can be made only by histological examination. The author’s own patient was a woman fifty-six years of age; the tumor originated in the hard palate; the diagnosis was made by biopsy; the tumor disappeared under treatment with roentgen rays, but there was a recurrence, which yielded to another series of roentgen-ray treatments. The patient’s condition has since been good, with no recurrence a year after treatment.

Thyrogenous Tumor of the Lower Jaw, R. F. C. KEQEL. Uber eine thyreogene Geschwulst des Unterkiefers, Vierteljahr. f. Zahnheilk. 48: 207-210, 1932. Kegel reports a case in which a tumor on the right side of the lower jaw had slowly increased in size and was occasionally painful. The first roentgen examination showed a multilocular growth in the right side of the maxilla, which in some areas had broken through the bone; a later examination showed an almost complete destruction ?f the bone. The right half of the maxilla was resected. Histologic examination showed thyroid tissue with adenomatous changes. The growth resembled a metastasis of an adenoma of the thyroid, yet there had been no clinical evidence of any thyroid lesion. Autopsy was not done. The lower jaw is an unusual site for metastasis of a thyroid tumor, only 2 cases having been reported. That the tumor may have originated in displaced thyroid tissue in the bone does not appear to be possible in the author’s opinion. He regards it rather as a solitary metastasis of a benign adenoma of the thyroid. Formation of Cysts in the Tooth Pulp, OTTOSCHNEIDER.Beitrag zur Cystenbildung in der Zahnpulpa, Deutsche Monatschr. f. Zahnheilk. 49: 1191-1196, 1931. Schneider describes the cystic degeneration observed in the pulp of the roots of a second molar tooth. The article is illustrated with roentgenograms and photomicrographs. BENJAMIN R. SHORE Case of Dentigerous Cyst, J. F. LLORENS. Un caso de quiste dentifero, Cronica med. 36: 226-233, 1932. The author reports a carefully investigated case of dental cyst of the common retention type, occurring in a seven-year-old girl. Three months before consulting him the girl’s mother had noticed a painless swelling of the left cheek halfway between the naris and the outer angle of the eye. On combined palpation through the mouth and from outside a hard little lump waR felt, corresponding in position with a dense tooth-like shadow seen in a roentgenogram, namely, a t the junction of the floor of the left orbit and the lateral wall of the maxillary sinus. The author incised the mucosa of the cheek, evacuated the cyst cavity, and extracted the unerupted tooth which had caused the development of the cyst. He discusses the differential diagnosis between sarcoma and various types of dentigerous tumors. There are eight illustrations, including two good roentgenograms. F. CAVERS Dental Cyst of the Maxilla, L. COURTY AND A. DEFRENNE.Sur un cas de kyste dentaire du maxillaire infdrieur, J. d. sc. m6d. de Lille 49: 505, 1931. A man of twenty-nine had a t the age of fourteen received a blow from a brick followed by the appearance of a large abscess of the gum on the lower right side of the mandible. He had thereafter suffered from repeated small abscesses of the gums until a larger abscess than usual forced him to consult a dentist, who removed the two lower right molars and curetted the cavities. Three weeks later, another abscess developed a t the operative site. After this was opened and drained, a fistula developed, through the orifice of which a hard, whitish point protruded,

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ABSTRACTS

resembling a tooth. This tumor was bony hard, measured about 2 cm. in diameter, and was not tender to pressure. Radiographs revealed a loss of substance of the anterior part of the right half of the mandible and the carious roots of the canine and premolar teeth. Under anesthesia the roof of the suppurating cyst was removed, and a cavity was found filled with putrid epithelial debris. The etiology and diagnosis of dental cysts are discussed. The origin of the epithelial debris lining such cysts is ascribed, as in this case, to long-standing suppuration. WILLIAMJ. HOFFMAN

A Complex Composite Odontome, G. B. PRITCHARD AND H. H. KENYHOLE. Proc. Roy. SOC.Med. 25: 1461-1466, 1932. A young man of eighteen years had had a small, hard lump in the upper right premolar region for years. A year and a half previously it had begun to enlarge. Radiographs were reported as a ‘‘ composite odontome.” Following operative removal histologic study corroborated this diagnosis. WILLIAM J. HOFFMAN ’

Malignant Tumors of the Maxillary Sinus, FAVIEN.Lea tumeurs maligne du sinus maxillaire, Ann. d. oto-laryng. No. 5: 599-600, May, 1932. Cancer of the maxillary sinus and ethmoid cells accounts for only 2.7 per cent of the total cancer mortality. Sixty-six per cent of sarcomas of the superior maxilla are of round-cell type; 18 per cent spindle-cell. The remaining 16 per cent are divided among fibrosarcoma, myxosarcoma, lymphosarcoma, myelosarcoma, chondrosarcoma, and osteosarcoma. The epithelial tumors are of three types: epidermoid, basal-cell, and adenocarcinoma. The nasal and orbital walls are the most frequent sites of origin. The length of life after the commencement of symptoms is about eighteen months; the average length of life after onset is about three years. The course of a sarcoma or carcinoma of the maxillary sinus in a young person is rapid and featured by extraordinary malignancy. Metastases are, however, rarer than for other localizations of tumors. Diagnosis of sarcoma of the maxillary sinus is uncertain without a biopsy. Radiographs may differentiate between a malignant tumor and granulations surrounding a foreign body. Symptoms vary according to the extent of the disease and the location of the growth. The general symptoms are those of any malignant tumor. When the tumor has extended beyond the limits of the antrum, local complications swiftly develop. Permanent cures are rare by any method of treatment and most of these have been by radical surgery. Electrocoagulation is not yet fully developed. Roentgen therapy cannot be used if there is retention of pus in the antrum, and no definite cures by this means alone are reported. WILLIAMJ. HOFFMAN Pathological Anatomy and Clinical Findings in Hard Papilloma of the Nose, F. MOSSBOECK.Beitrag zur pathologischen Anatomie und Klinik des harten Papilloms der Nase, Arch. f. Ohren- Nasen- u. Kehlkopfheilk. 132: 254-260, 1932. The author states that the so-called hard papilloma (papilloma durum) of the nose is of rare occurrence. He finds only 70 casee reported in literature and reports one case of his own. These tumors are of slow growth, and the chief symptom is progressively increasing nasal obstruction. The diagnosis can be made only by biopsy of sections from various parts of the tumor, in order to differentiate it definitely from carcinoma. Hard papillomata occur at all ages, but chiefly in the fourth and fifth decades of life, and are found more frequently in males than in females.

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The author’s patient was a man seventy years of age, who had had almost complete obstruction of the right nostril for the past ten years. Examination showed the right nostril filled with the tumor. It was radically removed and the patient made a good recovery. Histologically the tumor showed two types of epitheliumcolumnar epithelium with ciliated borders and squamous epithelium in layers. The stroma was loose, edematous connective tissue. Three histological types of papilloma durum of the nose have been described: that composed of columnar epithelium; that of mixed columnar and squamou,s epithelium; and that of squamous epithelium alone. The mixed type, t o which the author’s case belongs, is the most unusual. Careful examination of many sections in the author’s case showed no evidence of carcinoma, but cases have been reported in which carcinomatous changes have occurred. These tumors also tend to recur after removal, so that they cannot be regarded as altogether benign. Roentgen-ray treatment after operation is probably desirable.

Fibro-epithelioma of the Nose and Its Relation to Papillary Carcinoma, H. REUYS. Uber Fibroepitheliome der Nase und ihre Beziehung zu den papillaren Carcinomen, Ztschr. f. Hals- Nasen- u. Ohrenh. 30: 421-432, 1932. Reuys reports a study of 12 cases of papilloma of the nose. Seven were histologically benign fibro-epitheliomata, in 3 the epithelial tissue was of columnar type; in 3 of the squamous type; and in one of a mixed type. In 2 cases there was a tendency to malignancy, as shown by the presence of atypical immature epithelial cells and mitoses; there was, however, no marked infiltration of the connective tissue. These tumors the authors regard as “ border-line ” growths, In the other 3 cases, both benign growths of the fibro-epitheliomatous type and definitely malignant growths of the type of papillary carcinoma were present. These represent either a transition of the benign growth into the malignant growth or the simultaneous occurrence of the two types. Fibro-epitheliomata neither produce metastases nor cause cachexia; but they may invade the nasal sinuses. Unless these tumors are removed early, the authors use postoperative roentgenray therapy. Even if definitely malignant tissue is present, they find that the prognosis is good with adequate removal and postoperative radiation. Cancer of the Nose: Report of Case Treated with Radium, R. L. ZAEGEL. Wisconsin M. J. 31: 256-257, 1932. Zaegel reports a case of extensive carcinoma of the skin of the nose successfully treated by radium. The photograph reveals a huge, fungating, papillary squamous carcinoma arising from the left side of the nose and overlapping the remainder of the organ. I n addition a small cancer was present on the lower lip. A total of 3970 milligram hours of radium radiation was delivered to the tumor from within the nostril and from the external surface of both growths during a period of five days. The destruction of the tumor left a small perforation of the left ala nasi. There was no evidence of disease three months later. WILLIAMJ. HOFFMAN Highly Malignant Tumors of the Pharynx and Base of the Tongue, G . B. NEW, A. c. BRODERS AND JOHN H. CHILDREY.Surg. Gynec. & Obst. 54: 164-174, 1932. The most common highly malignant tumors of the nasopharynx, pharynx, and tongue are the lymphosarcomata and epitheliomata graded 3 or 4. The latter have often been described as lympho-epitheliomata or transitional-cell carcinomata, and are a t times miscalled branchiogenic carcinomata or endotheliomata. Squamous-cell carcinoma grade 3 and 4 is about seven times as common as lymphosarcoma. The latter is the most common type of sarcoma of the pharynx.

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Lymphosarcoma and epithelioma grade 4 are more often primary in the nasopharynx. Epithelioma grade 3 is seen more often in the tonsil, tongue, and hypopharynx. Nine excellent photomicrographs illustrate the histology. The authors’ series of cases numbers 624, in all of which biopsy was performed. Eighty-four per cent of these occurred in males. The average age of patients with epithelioma was fifty-two years, with lymphosarcoma forty-five years. A few lesions of each type occurred among patients less than twenty years old. One fourth of the patients noticed enlarged cervical lymph nodes as the first sign of the disease. On examination a t the clinic, 70 per cent had cervical metastases. Thirty-one per cent of the lesions of the nasopharynx were complicated by cranial nerve palsy. Thirty-three per cent of lesions of the hypopharynx were complicated by paralysis of the vocal cords. Symptoms and signs varied considerably in lesions of the nasopharynx. The number of patients treated was 182, or 29 per cent of the total of 624. Four hundred and sixty-seven patients (75 per cent) had been treated elsewhere. Of these, 246 (40 per cent of the entire series) had been operated on. A great variety of surgical and non-surgical treatment had been employed, in many cases without the proper diagnosis having been made. Patients were treated a t the clinic by irradiation, combined in selected cases with surgical procedures, diathermy, or cautery. Lymphosarcoma was treated almost entirely with irradiation. Ninety per cent of the patients were traced. Seventy-one (40 per cent) of those treated were alive after an average of 43.1 months; 19 (11 per cent) lived fifty-nine months; 86 (49 per cent) lived twenty months. Sixteen per cent of all patients treated lived three years or more. In treated patients the average duration of life after examination was 34.5 months; in untreated patients 6.8 months. A higher percentage of patients with epithelioma grade 4 are alive than of those with lymphosarcoma, but the duration of life after examination is longer in cases of lymphosarcoma. Palliative treatment had little, if any, effect in prolonging life. The life expectancy from onset of symptoms in all patients treated was 42.7 months; in untreated patients it was 17.9 months. Of those who died, 96 per cent died of malignant disease, the local lesion causing the death of 84.5 per cent. A good bibliography is appended. WM. J. HOFFMAN

Primary Malignant Melanomas of the Nasopharynx, H. MAUERHOFER. Zur Kasuistik des primaren malignen Melanoms im Nasen-Rachen, Ztschr. f . Laryng., Rhin., 22: 16-27, 1931. Malignant melanomas, the author notes, arise most frequently in tissues where pigment cells are normally or pathologically present. A case is reported in which a malignant melanoma was primary in the nasopharynx. The chief symptoms were deafness and nasal catarrh; the discharge was often bloody. A dark colored tumor was visible in both choanae on rhinoscopic examination; biopsy showed a melanosarcoma. The tumor showed no regression under radium treatment; the patient grew worse and symptoms of cerebral involvement developed before death. In the left hemisphere of the brain was a cystic growth in which hemorrhage had occurred, which was probably the immediate cause of death. There was a very small metastasis in the gyrus cinguli on the right side. Only the retropharyngeal lateral lymph nodes showed metastases. All showed the histology of melanoma. The clinical and histologic finding8 indicated that the brain metastases had resulted from the tumor invading the venous system. In the literature only one other case of primary malignant melanoma of the nasopharynx was found ,although melanotic pigment undoubtedly occurs in the mucosa of this region.

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Plasmacytoma of the Nasopharynx, J. W. S. BLACKLOCK A N D C. MACARTNEY. J. Path. & Bacteriol. 35: 69-75, 1932. The literature on plasma-cell tumors, exclusive of the types arising in the bone marrow, is reviewed, and a case is reported. The patient, a man aged sixty-four years, complained of hoarseness and difficulty in clearing his throat. Examination of the larynx disclosed two reddish polypi about the size of an acorn or smaller, on the right side of the larynx near the ventricular band. Five similar growths the size of small beans were present in the nasopharynx. These were excised four times but always recurred. There was never any cervical adenopathy. Histologic examination showed the nodules to be composed very largely of plasma cells. Four good photomicrographs illustrate the morphology. WM.J. HOFFMAN Roentgen Diagnosis of Malignant Tumors of the Nasal Sinuses, E. G. MAYER. Uber die rontgenologische Diagnose der malignen Tumoren der Nasennebenhohlen, Monatsschr. f. Ohrenh. 66: 303-309, 1932. From his own experience in the roentgen-ray examination of the nasal sinuses, Mayer has found that a malignant tumor causes a marked and complete loss of the normal transparency in the involved sinus or sinuses, in an early stage of the growth. The extent of this shadow does not necessarily indicate the extent of the tumor, as loss of transparency may be produced by mucous membrane changes or an empyema in neighboring sinuses not actually involved by the tumor. A partial shadow in a sinus indicates that the tumor has not involved this sinus. The type of bone destruction is often not characteristic. There are, however, certain findings of diagnostic significance. A clearly defined area of destruction in the bony wall of the sinus may be caused either by an inflammatory process or a malignant tumor, but more frequently by the latter. Projections of the bone or periosteum a t the border of the defect indicate an idammatory process. A blurring of the outlines of a sinus may occur either with inflammatory conditions or with a malignant tumor, but if this is accompanied by an osteoporosis of the bony wall, it indicates a tumor as a rule. Small defects fairly well defined but not with absolutely clear outlines in the region of the frontal sinus are characteristic of carcinoma. It should be remembered that defects in the bony walls of the nasal sinuses are not always demonstrable in the roentgenogram. Adenoma of the Nasal and Their Accessory Sinuses, Ake Grevillius. De l’ad6nome des fosses nasales et de leurs cavit6s accessoires, Acta Oto-Laryng. 18: 177-186, 1932. The rarest benign tumor of the soft parts of the nasal fossae are adenomae, of which Grevillus found only a score in the literature. These tumors arise in the superior and posterior part of the nasal fossae. Growth is usually slow, but they may reach such size as t o destroy the bony walls of the nasal fossa by pressure and extend into the accessory sinuses. These tumors are usually smooth, or moderately granular, yellowish or pinkish gray, and are covered by one or more layers of cylindrical epithelium which, with a submucosa, forms a capsule. The adenoma proper consists of glandular tubules and alveoli, often dilated to form cystic spaces of large size lined with cubical epithelium. The usual symptom is nasal obstruction; discharge or epistaxis may occur. Unless completely removed, these tumors tend to recur. Grevillius reports two cases. The first patient, a woman forty-six years old, complained of a left-sided nasal discharge and frequent severe nasal hemorrhages. Examination revealed a tumor occupying the left nasal cavity. Biopsy showed no evidence of malignancy. A course of roentgen therapy was given to control the bleeding. This caused moderate reduction in the size of the tumor and diminution

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in the amount and frequency of the bleeding. Six months later this was repeated but without effect, and the tumor extended so that it filled both nasal cavities. Radium was applied to an accessible portion of the tumor and the treated portion disappeared. Two months later the tumor had not only filled the nasal cavities but had broken through the medial wall and filled the left maxillary sinus. Under local anesthesia the tumor was exposed through a Caldwell-Luc incision and was found to have invaded not only the cavities mentioned but also the ethmoid and sphenoid cells. The removal of as much of the tumor as possible left a cavity the size of an orange. Hemorrhage was severe. Four radium tubes were inserted into a portion of this tissue still remaining in the region of the sphenoid. Histologic study revealed a benign adenoma. The second case is essentially similar and was treated by local removal of the tumor. Following its removal a recurrence developed and extended into the neighboring sinuses by local expansive growth, so that a radical surgical removal was required. Histological study revealed a picture similar to that in the first case, diagnosed as benign adenoma. WILLIAMJ. HOFFMAN

Neurogenous Retropharyngeal Tumors, I. DAWYDOW. Zur Klinik der neurogeneii retropharyngealen Geschwiilste, Ztschr. f. Hals- Nasen- u. Ohrenh. 30: 538548, 1932. A case of retropharyngeal tumor is reported which caused pain, and difficulty in swallowing. The tumor was not adherent t o neighboring structures and was apparently benign. Following its removal a Horner syndrome (paralysis of the cervical sympathetic) developed, indicating that the tumor was closely related to the upper sympathetic ganglion or its branches. Histologic examination of the tumor showed a structure characteristic of nerve fibers with satellite cells, representing nerve elements of the sympathetic nervous system. The author states that symptoms due to pressure against the cervical sympathetic have been noted by various authors. But it is probable that these so-called pressure symptoms are due to actual involvement of the cervical sympathetic in the tumor. If these symptoms are marked prior to operation, the fact. that the tumor is a neurofibroma may be suspected. In his own case, there was nothing to suggest involvement of the sympathetic, the Horner syndrome developing only after operation. As a rule, the neurogenous retropharyngeal tumors are benign, and early operation is indicated, in spite of possible paralysis of the cervical sympathetic resulting, as this is not of serious import as far as the comfort or the life of the patient is concerned. Carcinoma of the Hypopharynx and Esophagus; Trotter Operation and Esser Plastic Procedure, H. MARSCHIK.Carcinom des Hypopharynx und 6sophagus, Trottersche Operation mit Esserscher Plastik, Monatsschr. f. Ohrenh. 66: 637-640, 1932. Carcinoma of the hypopharynx and recessus pharyngeus presents one of tllc most serious problems of the laryngologist; the radical operation is technically difficult and dangerous t o life, and the prognosis for ultimate cure very bad. The English surgeon, Trotter, has devised an operation for this type of growth in which the pharynx is opened from the aide. The author reports a case of carcinoma of the posterior wall of the hypopharynx, operated upon by the Trotter method. It was found that the tumor extended downward to involve the orifice of the esophagus, necessitating an almost complete transverse reaection of the hypopharynx and upper portion of the esophagus. An artificial hypopharynx was formed by the Esser method, which gave a very satisfactory result.

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Nasal Tumor of Sarcomatous Structure, D. DI VEaTEA. Contributo alla conoscenza dei tumori nasali a struttura sarcomatosa, Valsalva 8: 409-425, 1932. A rapidly growing, easily bleeding, soft tumor blocked the left nasal cavity of a man aged forty. A similar but much smaller mass was seen in the right nasal cavity. Both were excised, and diagnosed histologically as large round-cell sarcoma. There had been no recurrence after one year. Eleven photomicrographs and a bibliography are included. C. D. HAAGENSEN Case of Nasopharyngeal Fibroma, M. BERGER. Un cas de fibrome nasopharyngien, Rev. de laryng-oto-rhin. 53 : 234-236, 1932. Berger describes a case of nasopharyngeal fibrous polyps occurring in a sixteenyear-old boy. The symptoms which had lasted about a year had included intermittent epistaxis and left nasal obstruction. The hemorrhages at last became so severe that the boy was brought to the hospital. Examination revealed a marked facial asymmetry. The left cheek bulged outward and forward, the left eye protruded moderately, the nose was directed toward the left, while its septum was deviated to the right. The cause of this asymmetry was a pinkish, non-tender, nodular, firm tumor mass completely filling the vault of the nasopharynx. A clinical diagnosis of nasopharyngeal fibroma was confirmed by biopsy. Under general anesthesia administered through the intercricothyroid membrane by means of a cannula, the tumor was exposed through a left transmaxillonasal approach and easily dissected free. Hemorrhage was severe and required tamponade. The postoperative course was normal. Microscopic study revealed a structure similar to benign fibroma with intermediate areas suggesting early malignant change. [It is simpler to treat these growths with a moderate amount of radiation. WILLIAMJ. HOFFMAN They do well.] Andoma of the Nose, PLEWEA.Angiom der Nase, Ztschr. f. Hals-, Nasen- u. Ohrenheilk. 28: 560-564, 1931. The surgical removal of an angioma of the mucous membrane of the nose in a man forty-six years of age is described. A photograph of the tumor and a magnified cross-section are included. BENJAMIN R. SHORE Case of Angiomyoma of the Nasal Passage, CARL0. OLDFELDT.Ein Fall von angiomyomatosem Tumor der Nasenhohle, Ztschr. f. Hals-, Nasen- u. Ohrenheilk. 30: 145-150, 1931. Oldfeldt reports the removal of a vascular tumor from the nasal passage of a man forty-one years of age. Histologic examination showed it to be composed of large numbers of blood vessels with tremendously thickened and hypertrophied walls. In many places the lumina were almost completely occluded. This great increase in the muscular coats of the vessels led to the diagnosis of angiomyoma. The article is illustrated with excellent photomicrographs. BENJAMINR. SHORE Case of Epistaxis Caused by Hemangioma of the Left Inferior Turbinate, I. HERLINGER.Ein Fall von Epistaxis verursacht durch Haemangiom der linken unteren Muschel, Monatsschr. f. Ohrenh. 66: 240-241, 1932. Herlinger reports a case in which uncontrollable bleeding from the left nostril was found to be due to a hemangioma of the left inferior turbinate. After cauterization of this growth with the Paquelin cautery, the bleeding ceased. This case was complicated by the development of mastoiditis and maxillary sinusitis due to the Streptococcus mucosU8, and apparently resulting from the use of Bellocq’s

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ABSTRACTS

tampons in both nostrilu in an attempt to stop the bleeding. After operation on the mastoid and the sinus, the patient made a good recovery. Osteitis Deformans (Paget’s Disease) of the Nasal Sinuses, W. THALMANN. Ostitis deformans Paget der Nebenhohlen, Monatsschr. f. Ohrenh. 66: 371-373, 1932. Thalmann reports a case of generalized Paget’s disease in a woman sixty-three years of age, in which there were marked changes characteristic of the disease in the bony walls of the nasal sinuses. In certain areas these were much thickened, The patient’s daughter had had Paget’s disease, and her son showed symptoms of von Recklinghausen’s disease (neurofibromatosis). Leukemic Infiltration of the Nasal Mucous Membrane, E. RUTTIN. Leukamische Infiltration der Nasenschleimhaut, Monatsschr. f. Ohrenh. 66: 473-474, 1932. A patient with lymphatic leukemia had mastoiditis and was successfully operated upon. The mastoiditis was not apparently of leukemic origin, but a subsequent nasal obstruction was found t o be due to lymphatic infiltration (small lymphocytes) of the nasal mucous membrane. Anatomical-Pathological Observations in a Case of Craniopharyngeal Tumor, C. BORRI. Osservazioni anatomo-patologiche sopra un caso di tumore craniofaringeo, Valsalva 8: 440-449, 1932. At autopsy of a woman aged forty-five who died as the result of a tumor in the rhinopharynx, the petrous portion of the temporal bone, including the middle and inner ear, was found to be invaded by tumor tissue. The tumor had invaded the cranium through the carotid foramen and the foramen rotundum. The sphenoid was full of tumor. There were metastases in the cervical and mediastinal nodes aa well as in the lungs. The histologic diagnosis was ‘ I large spindle-cell sarcoma. ” Five poor photomicrographs are included. C. D. HAAGENSEN Case of Cancer of the Mesopharynx. Electrocoagulation. GUNNAR HOLMQREN. Un cas de cancer du m6sopharynx. Electrocoagulation, Acts Oto-Laryng. 17: 481-482, 1932. Holmgren presented a patient whose lesion, a carcinoma of the mesopharynx, had been treated by electrocoagulation. At the time he discuused the case the operative area had not yet healed and it was too soon. to draw conclusions or formulate a prognosis. WILLIAMJ. HOFFMAN Epithelioma of the Soft Palate Cured with Diathermy and Roentgen Rays, K. KOFLER. Epitheliom des weichen Gaumens mit Diathermie und Rontgen geheilt, Monatsschr. f. Ohrenh. 66: 631-632, 1932. Kofler reports a case of an epithelioma on the left half of the soft palate in a patient sixty-eight years of age. The growth was successfully destroyed by diathermy in several treatments, and the site of the tumor irradiated by Coutard’s method. The glands, which had been palpable, receded completely, and the soft palate healed, with scar formation. In the discussion of this case, the use of Coutard’s method of roentgen-ray therapy was reported in other cases of tonsillar and pharyngeal tumors with good results.

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Endoteliomi del Endothelioma and Mixed Tumor of the Palate, E. PELLEGRINI. palato e tumori misti, Valsalva 8: 454-462, 1932. A man of thirty-six had a large, hard tumor of the posterior and middle thirds of the palate. The mucosa over it appeared normal. A biopsy was reported as ‘‘ endothelioma.” Several small doses of radium inserted in the form of needles had little effect on the tumor. Diathermy coagulation was then done. The further progress of the case is not reported. Two photomicrographs and a short bibliography are included. [The best treatment for these mixed tumors of the palate, which are not “ endotheliomas,” is complete excision, usually a relatively simple procedure.] C. D. HAAQENSEN

Papilloma of the Palate. Mucous Membrane Squamous-cell Epithelioma of the Tonsil. Papillary Cystadenoma of the Nares, H. REUYB. Pspillom des Gaumens- Schleimhautplattenepithelcarcinom der Tonsille-Cystadenoma papillare des Nasenvorhofes, Ztschr. f. Hals-, Nasen- u. Ohrenheilk. 30: 167173, 1931. Three unrelated cases are reported by Reuys with little comment. The first patient was a girl four years of age with a diffuse papilloma of the hard and soft palate. The second was a woman fifty-six years of age with a tumor about the size of a plum on the left tonsil. Histologic examination of the excised growth showed a squamous-cell epithelioma with many mitoses. No follow-up report is given on this case. The third patient was a woman forty-seven years of age with a papillary cystadenoma near the external orifice of the right nostril. The article is illustrated with excellent photographs of the intraoral lesions and photomicrographs. BENJAMINR. SHORE Melanosarcoma of the Left Tonsil; Seven Years Previously Melanosarcoma of the Melanosarkom Right Inferior Turbinate and the Right Antrum, C. WIETHE. der linken Tonsille. Vor 7 Jahren Melanosarkom der rechten unteren Nasenmuschel und der rechten Kieferhohle, Monatsschr. f. Ohrenh. 66: 113-114, 1932. Reports a case in which the patient had been operated upon seven and a half years previously for the removal of a melanosarcoma of the right inferior turbinate invading the antrum. Postoperative radium treatment was given and the patient was entirely free from symptoms for seven years. Then she noticed difficulty in swallowing and a swelling on the left side of the throat. A tumor was found involving the left tonsil and a node on the left side was enlarged. The node was excised and showed melanosarcoma. There was no sign of recurrence a t the site of the intranasal tumor previously removed. Whether the melanosarcoma of the tonsil is an entirely independent tumor or represents a recurrence of the first tumor after seven years, is difficult to determine. Clinical Findings in a Case of Tumor of the Fauces in Which Diagnosis was Dmcult, A. BUCCELLI. Rilievi clinici sopra un tumore dell’istmo delle fauci di difficile diagnosi, Valsalva 8: 426-432, 1932. Buccelli’s patient was a woman of seventy who had a large ulcerated tumor of the anterior pillar of the fauces, but no adenopathy. A biopsy showed lymphoepithelioma. Nevertheless, operative removal was done. A follow-up is not included. C. D. HAAGENSEN

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ABSTRACTS

Cancer of the Larynx, L. VANDEN WILDENBERQ.Cancer du larynx, Scalpel 85: 850, 1932. I n a discussion of cancer of the larynx Van den Wildenberg emphasizes the importance of an early diagnosis without delaying until the classical symptom of hoarseness has been reinforced by the evidence of immobility of the vocal cord. The first suspicion of malignancy should be followed immediately by a biopsy and histologic study. On the basis of his own experience, the author protests against the universal application of radiation to all cases, since, if a failure results, surgery is impossible. He advises that all operable cases be treated by one of three classical surgical procedures : laryngofissure, hemilaryngectomy, or total laryngectomy. When there is a question between two procedures, it is safer t o select the more extensive one. Irradiation in the treatment of operable intrinsic carcinoma of the larynx is only an adjuvant. It is a recourse to which one is driven when the disease is too advanced for surgery, when the patient refuses operation, or when, after an attempt a t cure by total laryngectomy, a recurrence has developed. WILLIAMJ. HOFFMAN Intrinsic Cancer of the Larynx, ST.-CLAIRTHOMBON. Le cancer intrindque du larynx, Rev. de laryng. 53: 689-694, 1932. It is many years since Thomson dispelled an erroneous belief which had been generally accepted concerning the site of election of intrinsic carcinoma of the larynx. This lesion usually begins, as he pointed out, on the anterior half of the vocal cord. The interarytenoid area is so rarely involved that he has never seen such a case. He reports the results of a study of 70 cases of intrinsic carcinoma of the larynx. These patients were aU operated upon and the tumor exposed, so that a careful determination of its localization could be made. The anterior third was involved in 63 cases; the middle third in 67 case8, the posterior third in 44 cases. The anterior third was involved alone in only 3 cases; the middle third alone in 4 cases; involvement of the posterior third alone was never seen. The author concludes that intrinsic carcinoma of the larynx arises in the vocal cord in most cases. It rarely ever begins a t the posterior commissure, ventricular band, or ventricle of Morgagni. The central portion or the anterior half of the vocal cord is the point of origin. I n an elderly person any tumor of the anterior half of the cord should be suspected of malignancy. Since such a tumor does not a t first involve the extremities of the cords, it does not interfere with their mobility. Under these conditions the treatment of choice is laryngofissure. By this procedure Thomson has achieved 76 per cent of three-year cures without evidence of any recurrence. WILLIAMJ. HOFFMAN Treatment of Cancer of the Larynx, J. M. ALONSO AND E. REQULES. Traitement du cancer du larynx, Acta oto-laryng. 17: 6-18, 1932. In this study the authors review the various operative procedures and physical agencies employed in the treatment of cancer of the larynx. The surgical procedures are classified as follows: 1, Total laryngectomy, in one or two stages, 2. Hemilaryngectomy. 3. Partial laryngectomy after thyrotomy. 4. Intervention through the natural channels. The physical means of treatment are radium, x-rays, and electrocoagulation. After reviewing the various operative procedures, the authors discuss the indications for surgery. When conditions permit, they recommend that the operation be conservative. The advantages of conservative treatment are the

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preservation of nasal respiration and, to some extent, of the voice. When total laryngectomy is indicated, operation in two or more stages is advised. Local anesthesia is advised in all cases. Total laryngectomy is done in two stages. At the first operation a tracheal ring is excised. The larynx is removed a t the second stage. Patients who have been operated upon are kept in a semirecumbent position. Nutrition is maintained through a nasal tube. Partial laryngectomy is carried out in one stage. Low tracheotomy is done and a tracheal tube is inserted. The trachea above the laryngeal tube is packed with gauze to prevent' the passage of blood and secretions into the lowe: trachea. Median thyrotomy is then performed, provided the commissure is not invaded, and the lesion is widely excised. The wound is packed with iodoform gauze which is removed four days after operation. The tracheal tube is left in place until the laryngeal cavity is free of sloughing tissue and secretions. Radiotherapy is reserved as a palliative measure for inoperable cases. Cures by radiotherapy have been known, but the percentage is low as compared with surgery. When the growth is extensive or when lymph node involvement is suspected, radiotherapy is employed. Electrocoagulation is recommended in cases in which there is fear that diseased tissue may have been incised. In the five years including and following 1926 the authors observed 95 cases with one operative death. The known late results in these cases were as follows. One patient is alive after four years but now has a carcinoma of the cardia; one patient is alive three years and eight months; one patient is alive three years, a recurrence a t the tracheal orifice having been cured by radium; one patient is alive three years but has beginning lymph node metastases; one patient is alive seventeen months; the fate of three patients is unknown; three have died of intercurrent infection without recurrence; eight from local or lymph node recurrence; one patient is still living but has recurrence a t the tracheal orifice. Seven partial laryngectomies were done during the same period, with one operative death. One of the seven patients has lived a little more than two years after operation; one has lived twenty-two months (with epiglottectomy) ; one has lived eighteen months (electrocoagulation of the posterior part of the oozing surface); one has lived ten months and a half (tumor of the anterior commissure); one has lived eight months (tumor of the anterior third, vocal cord and commissure). All of these five patients are free from recurrence. One patient who refused total laryngectomy has a recurrence. W. F. MACFEE

Total Laryngectomy for Laryngeal Carcinoma; Numerous Plastic Operations to Cover the Large Defect, E. WESSELY. Totalexstirpation wegen Larynxcarcinom. Mehrfache plastische Operationen 5ur Deckung des grossen Defektes, Monatsschr. f. Ohrenh. 66: 634-635, 1932. Wessely reports a case in which a total laryngectomy was done for an extensive laryngeal carcinoma. In spite of three plastic operations, the flaps were necrotic and the defect in the pharynx increased in size until it extended from the hyoid bone to the stroma of the trachea. Another series of plastic operations was done, with the aim of maintaining the circulation in the skin-flaps employed. For covering the upper part of the pharynx, flaps from the floor of the mouth and the side of the neck were employed. In the second stage of operation, on the lower part of the defect, flaps from the upper chest were used. In a third operation a pedunculated flap was formed with its base on the left side of the neck to close the stroma of the trachea.

1014

ABSTRACTS

Radiography of Cysts of the Larynx of Branchial Origin, TERRACOL, LAMARQUE AND H. SAGOLS. La radiographie des kystes du larynx d’origine branchiale, Arch. Soc. d. sci. m6d. et biol. Montpellier 13: 205-212, 1932. Also in Arch. d’6lec. m6d. 40: 30-34, 1932. The authors report the following case of epidermoid carcinoma developing in a branchial cyst in a white male, thirty-three years of age. The patient entered the clinic complaining of persistent hoarseness, interference with respiration, and a tumor on the lateral aspect of the larynx a t the level of the thyroid cartilage. Hoarseness had commenced five years previously, a t first intermittent, then progressive and persistent regardless of weather. Two months previously a small lump had appeared in the neck, which had slowly enlarged to the size of a walnut. Examination of the larynx disclosed a glistening, smooth, bright red tumor mass obscuring the opening of the larynx and hiding the vocal cords and glottis. The mass extended behind the epiglottis and appeared to be fixed to the internal wall of the larynx in front and on the right side, corresponding to the external tumor already described. The tumor was exposed surgically by the cervical approach. Beneath the subhyoid muscles a cystic mass was found containing creamy material similar to that usually found in dermoid cysts. This mass was adherent to the right thyroid ala, which was partly resected with the tumor. Apparently independent of this mass was another cystic tumor arising by a pedicle from the thyro-hyoid membrane. Two separate cystic masses were thus removed, the intra-laryngeal tumor filled with liquid and the extra-laryngeal tumor, apparently solid. Histologic examination of the cystic tumor revealed squamous carcinoma arising in the cyst wall. Study of the solid tumor revealed central necrosis. The lining of this cystic mass presented a n ulcerated area from which arose a squamous carcinoma which had extended into the resected cartilage of the larynx. Seven weeks after operation the area was treated by radiotherapy, a wax collar bearing seven radium tubes of 10 mg. each being worn for fifty-six hours. In presenting this case before their audience, the authors displayed radiographs of the larynx taken by soft tissue technic and revealing the presence of the intralaryngeal cyst and pathologic changes in the thyroid cartilages. It is regrettable that the radiographs were not reproduced in the paper. WILLIAMJ. HOFFMAN Carcinoma of the Larynx with Secondary Laryngocele, E. ERTL. Larynxcarcinom mit sekundarer Laryngocele, Monatsschr. f. Ohrenh. 66: 115-116, 1932. The author reports a case of carcinoma of the larynx that caused pain, hoarseness, and finally dyspnea on exertion; biopsy showed squamous-cell carcinoma. As the tumor was confined to the right side of the larynx, this half was resected. The specimen showed that the tumor occupied the site of the cricothyroid membrane and narrowed the entire ventricle. The laryngocele, which was filled with air, projected from the upper border of the thyroid cartilage; on the lower border of the tumor was the entrance to the ventriculus Morgagni, which was narrowed, but through which a probe could be passed into the laryngocele. The formation of the laryngocele is to be attributed to the pressure of air which entered during a coughing attack, but did not escape owing to the pressure of the tumor a t the entrance of the ventricle. In the literature 7 cases of laryngocele secondary to laryngeal carcinoma were found. Carcinoma Originating at the Aditus Laryngis, K. KOFLER. Carsinom, vom Aditus ad Laryngem ausgebend, entfernt, Monatsschr. f. Ohrenh. 66: 482-483, 1932. Kolfer describes a tumor in a man fifty-two years of age, originating a t the aditus laryngis, where the left aryepiglottic fold meets the border of the epiglottis

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and the pharyngo-epiglottic fold. There was a short pedicle, and the tumor was freely movable; it was easily removed surgically. There was an enlarged hard cervical gland on the left side, the removal of which was impossible, as it was adherent to the skin. It was treated by radium needle implantation followed by deep roentgen treatment; ten weeks later there was a hard diffuse infiltration of the neck a t the site of the gland, but no sign of local recurrence on the larynx.

Atypical Carcinoma Arising in the False Vocal Cord, M. HAJEK. Atypische Form eines vom Taschenbande ausgebenden Carcinoms, Monatsschr. f. Ohrenh. 66: 634, 1932. From a woman seventy-three years of age a tumor which appeared to be an edematous fibroma was removed from the false vocal cord on the right side. Histologic examination showed a n epithelioma with infiltration of the deeper tissues. No treatment was attempted. Large Hemangioma of the Larynx, H. ALTRICHTER.Grosses Hamangiorn deu Larynx, Ztschr. f. Hals- Nasen- u. Ohrenh. 30: 657-658, 1932. Approximately 50 cases of hemangioma of the larynx are reported in the literature, but these are for the most part small angiomatous nodules, only 2 or 3 case8 of larger tumors of this type having been described. The author’s patient was a woman sixty-six years of age who had had repeated attacks of coughing for two years, which were becoming more severe. Laryngological examination showed a bluish tumor with uneven surface arising from the left aryepiglottic fold, projecting over the opening of the larynx, and covering about a third of the vocal cord. Otherwise the larynx was normal. As the tumor was not removed its nature was never determined and the report, therefore, has no scientific value. An Undiiferentiated Rhabdomyoma of the Larynx, I. DAWYDOW.Zur Frage der unausgereiften Rhabdomyome des Kehlkopfes, Ztschr. f. Hals- Nasen- u. Ohrenheilk. 30: 221-227, 1931. The tumor described by Dawydow was removed from the larynx of a thirtyyear-old patient. It was firm, nodular, light in color, and about the sire of a pea. Histologic study showed the growth to be composed of elongated, plump cells with large nuclei supported on a delicate framework of connective tissue. Cross striations could not be demonstrated. The diagnosis of ‘ I rhabdomyoma sarcomatodes et carcinoma superficiale incipiens ’I was made. Upon the basis of this diagnosis laryngectomy was proposed but was refused. The patient has been observed over a period of one year, and there is no evidence of recurrence of the tumor. One photomicrograph is included. BBINJAMIN R. SHORE Disappearance of Complete Congenital Aphonia after Removal of Papillomasof the Larynx, E. BRUCH. Wann und wei schwindet kongenitale vollstandige Stimmlosigkeit nach Entfernung von Kehlkopfpapillomen?, Ztschr. f. Laryng., Rhin. 23: 152-153, 1932. From a child nine years old, who had never spoken above a whisper, multiple papillomas of the larynx were removed. I n the twelfth week after operation the patient was able to speak aloud, and the tone and modulation of the voice gradually improved.

1016

ABSTRACTS

Primary Carcinoma of the Right Cervical Region of Branchiogenic Origin, with

Glandular Metastases to the Left Cervical Region. Cured by Radium, V. PALUMBO. Carcinoma primitivo della regione cervicale destra di origine branchiogena con metastasi ghiandolari alla regione cervical sinistra curato col radium, Sperimentale 86: Ixv-lxvii, 1932. This is a brief report of a case of metastatic carcinoma in the neck in which no primary lesion was found. The radiation “ cure ” reported was of but five weeks’ duration. C. D. HAAGENSEN Case of Carcinosarcoma of the Left Side of the Neck, H. HECKER. Ein Fall von Karzino-Sarkom der linken Halsseite, Deutsche Ztschr. f. Chir. 237: 177-179, 1932. A fifty-year-old man was admitted to the hospital with a large, ulcerated and infected tumor in the left submaxillary region. He had been perfectly well until four months previously, when a tumor of the lower lip was removed surgically. A large portion of the neck tumor was removed by the electrocoagulation method, but the patient died of empyema and sepsis. Histologic examination of the tumor showed typical areas of squamous-cell epithelioma and other circumscribed areas in which connective-tissue proliferation led to the diagnosis of sarcoma. Metastases t o other areas of the body could not be demonstrated a t autopsy. Two photomicrographs show the diverse histologic characteristics. BENJAMIN R. SHORE Mixed Tumor of the Throat, R. BUHR. Mischtumor des Rachens, Ztschr. f. Laryng., Rhin. 23: 75-78, 1932. The so-called mixed tumors of the throat and salivary glands are usually regarded as epithelial tumors. I n the case reported the tumor arose in the left tonsil; biopsy showed a growth made up partly of hyaline cartilage, partly of strands and tubules of epithelial cells-therefore, a mixed tumor. It was removed, and the site treated with radium. The wound healed well and there was no recurrence in six months. Mixed Tumor of Pharyngeal Prolongation of Parotid, H. GODARD AND C. PALIOS. Tumeur mixte du prolongement pharyngien de la parotide, Ann. d’anat. path. 8: 767-768, 1931. This is a report of a mixed tumor in the pharyngeal prolongation of the parotid gland in a young woman of twenty-five years, verified by histological examination of the specimen following its operative removal. WILLIAMJ. HOFFMAN Familial and Bilateral Tumours of the Carotid Body, W. H. CHASE. J. Path. & Bact. 36: 1-12, 1933. Out of 134 cases of carotid body tumor collected from the literature by Bevan and McCarthy (Surg., Gynec. & Obst. 49: 764, 1929), only 3 cases of bilaterality were found. The author reports what seems to be the first instance in which the occurrence of these tumors in two members of a family has been histologically proved. In one of his cases the growths were bilateral. The patients were sisters, one twenty-eight and the other twenty-nine years of age. In the first the right tumor was the t4ae of a hen’s egg, and the left, which appeared six months later, as large as a walnut, Their removal was very difficult and involved much ligation of vessels and clearing of adhesions; the patient died without recovering from the anesthetic. I n the older sister the tumor had appeared a t the age of twenty-two years, and before the patient’s admission to hospital had grown to walnut size; it was easily dissected out and good recovery

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ensued. All three tumors were of the encapsulated benign type. The first two were preserved in formalin, and the reagents used failed t o detect the presence of adrenalin and chromaffin material. The third tumor, studied fresh, gave positive reactions for both these substances. The presence of neurofibrils was demonstrated by the Gross-Bielschowsky method, sections showing typical fine nerve fibers extending towards the parenchyma cells from the fibrous tissue stroma and in places forming terminal knobs or umbelliform clusters on large well differentiated tumor cells. Large myelinated nerves were demonstrated by the Pal-Weigert technic, but sections prepared by Cajal fixation and staining showed no evidence of ganglion cells or of neuroglial fibrils. Six good photomicrographs are given. F. CAVERS

Tumor Derived from an Aberrant Rest of the Carotid Body, Which Simulated Clinically an Infra-mastoid Dermoid Cyst, S. TRAINA.Tumore derivato da germi aberrati del glomo carotico e simulante clinicamente una cisti dermoide sottomastoidea, Valsalva 8: 450-454, 1932. A man of twenty-five had a small round tumor in the neck just below the apex of the mastoid. On removal it proved to have the histologic structure of the carotid body. There had been no recurrence one year later. Two good photomicrographs and a short bibliography are included. C. D. HAAGENSEN THE EYE Epithelioma of the Cornea, H. VILLARD, C. DEJEANAND J. TEMPLE.Epithblioma spinocellulaire mbtatypique de la cornbe, Arch. SOC. d. sci. m6d. et biol. de Montpellier 13: 455-458, 1932. The authors consider that the rarity of primary corneal epithelioma is attributable to the dense texture of the squamous corneal epithelium, which presents considerable resistance to the development of malignant tumors. A man of sixty-nine years showed a small mass in the cornea of the right eye, first noticed about five months previously as a red spot. This had later been replaced by a (‘skin ” which gradually enlarged. Lamp examination showed that the tumor did not extend deeply into the cornea but was connected by a thin tail with the limbus. The tumor was excised and its bed electrocoagulated, with good recovery. Histologically the tumor was of squamous prickle-cell type with numerous mitoses and marked dyskeratosis but only slight keratinization. The authors think that the tumor arose from the limbus. At any rate it here was continuous at its base with the limbus, whence it received its blood vessels, although the main mass had grown inward in the outer portion of the corneal epithelium. No illustrations are given. F. CAVERS

Primary Carcinoma of the Cornea, F.

VON PAPOLCZY. Beitrag zur hiologie der primaren Hornhautkarzinome, Arch. f. Augenh. 105: 537-541, 1932. In reporting a case of primary squamous-cell carcinoma of the cornea, the author points out that diagnosis can be made only after careful examination has excluded the possibility that the growth has invaded the cornea from outside, a much more frequent condition. That is, there must be normal corneal tissue all round the tumor, in the region between the latter and the conjunctival limbus. I n the author’s experience primary corneal cancer is rather rare. He suggests that nevi, as well as corneal ulceration due to various causes, play a considerable part in the etiology of corneal cancers. F. CAVERS

1018

ABSTRAOTS

Plasmoma of the Cornea, C. DIJEAN AND H. HARANT. “P1asmome” de la cornbe, Arch. SOC.d. sci. mBd. de Montpellier 13: 386-391, 1932. A case of plasmoma of the cornea is recorded, a type of tumor that is very rare, only 2 other cases having been previously reported. The tumor, which was situated in the upper part of the sclerocorneal limbus of the right eye, was removed, but recurred within a few months and the eye was enucleated. Histologic examination showed the tumor to consist almost entirely of typical plasma cells. Plasmomata occur in other ocular tissues, and are usually associated with trachoma. In this case there was no trachoma; but there was evidence of syphilis in the history and the authors conclude that the process was probably syphilitic. Papilloma of the Cornea, GINESTOUS. Papillome de la cornbe, Gas. hebd. sci. m6d. de Bordeaux 53: 102-103, 1932. A sixty-year-old man noticed a streak of blood on the outer part of the cornea of his left eye. After about three months, during which this area had been growing larger and becoming more painful, he came for examination. On this part of the sclerocorneal limbus was a tumor the ske of a large pea. It was readily removed proved to be a benign papilloma which had apparently arisen in the conjunctiva and thence invaded the cornea. F. CAVERS Metastatic Adenocarcinoma of the Choroid, Probably of Intestinal Origin, D. MICHAIL. AdBno-cancer mBtastatique choroidien d’origine probablement intestinale, Ann. d’ocul. 169: 119-136, 1932. According to the author, who gives a fair list of references to the literature, Hamburger was the first, in 1871, to report a case of metastatic carcinoma in the choroid. In 1923 Usher (Brit. J. Ophth. 7:10, 1923) collected 110 cases. As the author cites only three cases published in the English language, it may be assumed that his total of 129 cases is an underestimate. In the case described a man of sixty-three complained of pain and lacrimation in the left eye, with progressive dimming of sight. A tumor was seen covering almost the entire retina, and on enucleation it was found to involve nearly the whole choroid. The tumor masses showed the structure of intestinal mucosa. The patient, who had felt no symptoms of intestinal trouble, left the hospital after good recovery from the eye operation. Apparently no attempt was made to discover the presumably latent bowel tumor. The author gives six good illustrations. F. CAVERB Metastatic Carcinoma of the Choroid. A Report of Two Cases Where the Primary Neoplasm Was in the Lungs, R. F. MOOREAND H. B. STALLARD.Brit. J. Ophth. 16:532-536, 1932. (1) A woman of thirty had had a cold a month previously, followed by bleeding ’ from the back of the nose, and had for the past two weeks seen black spots and streaks in the right eye. On examination nothing was found t o account for the bleeding; there was congestion of the anterior ciliary vessels on the temporal side; visual acuity was greatly reduced, and the whole upper part of the visual field was missing. With the ophthalmoscope a large mass was visible in the choroid, and was believed to be a metastatic tumor. Three weeks after admission, the sight having become worse and the eye painful, enucleation was performed. The tumor was diagnosed as papillary adenocarcinoma. Clinical and roentgenographic examination then revealed a large intrathoracic tumor; death occurred five months after the eye operation and necropsy was not allowed. (2) In a man of forty-one attending hospital on account of pain in the chest, roentgenography indicated an intrathoracic tumor. After two months of roentgen therapy the patient noticed that his right vision was misty in the morning and soon

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became worse until he could not count fingers. As the eyeball became painful enucleation was done. The patient was advised on leaving hospital to attend for deep roentgen therapy, but did not return and has not been traced. The choroidal tumor consisted of columns and nests of carcinoma cells and had deeply infiltrated the sclera. The authors state that since 1925 only two patients with metastatic carcinoma of the uveal tract have been seen a t Moorfields Eye Hospital, London, out of a total attendance of 27G,OOO. Of those cases which they found in the available literature the site of the primary tumor was in the breast in 65 per cent, F. CAVERS and in the lung in 10 per cent. DiflPculties and Errors in the Diagnosis of Sarcoma of the Choroid, P. A. JAENBCH. Schwierigkeiten und Irrttimer bei der Diagnose des Aderhautsarkoms, Klin. Monatsbl. f. Augenheilk. 88: 622-643, 1932. Jaensch reports 5 cases of sarcoma of the choroid, in which the symptoms were those of tenonitis-exophthalmos, chemosis, and interference with movements of the eye, which were painful. The marked loss of vision in these cases was not inconsistent with a suppurative inflammation of Tenon’s space. I n none was a diagnosis of sarcoma of the choroid made prior to enucleation of the eye, although in 3 the presence of a tumor was suspected. I n none of the cases was a sclerectasia due to the tumor demonstrated. The author reports one other case in which the eye was enucleated on the diagnosis of sarcoma of the choroid, but the tumor proved to be an angioma. Case of Primary Carcinoma of the Ciliary Body, BRUNO FLEISCHER AND REINHOLD WISSMANN.Ein Fall von primarem Karzinom des Ziliakorpers, Arch. f. Augenheilk. 105: 169-186, 1931. The authors describe in detail the clinical course of a patient thirty-five years of age with a primary malignant tumor of the ciliary body of the right eye. A gradual increase in size of the pigmented tumor was observed over a period of three years, and these findings were carefully recorded. Pathologic examination of the enucleated eye showed a deeply pigmented tumor, apparently arising in the ciliary body, and measuring 9 by 4.5 by 6 mm. Microscopic sections showed the tumor to be composed of large, polygonal, deeply pigmented cells resembling epithelium. The diagnosis was carcinoma of the ciliary body. The article is well illustrated BENJAMIN R. SHORE with photographs and photomicrographs. Intra-Retrobulbar Neurinoma Arising from a Posterior Ciliary Nerve, F. VON PAPOLCZY.Uber ein aus einem hinteren Ciliarnerven entspringendes intraretrobulbares Neurinom, Arch. f. Ophth. 128: 325-335, 1932. The author reports a case in a man forty-three years of age whose left eye-ball had been shrunken since birth; it had recently showed some inflammation and was painful; a hard tumor was palpable through the lower lid. The eye was enucleated and an encapsulated retrobulbar tumor that had also invaded the posterior layers of the sclera was easily removed with the bulb. Histologically the tumor was of neural origin. The tumor filled the eye-ball, taking the place of the vitreous, and causing atrophy of the other bulbsr structures. Only one posterior ciliary nerve was involved. The history indicates a congenital origin. Epibulbar Tumor with Intraorbital Prolongation, GENETAND MONIER-KUHN. Tumeur Bpibulbaire avec prolongement intraorbitaire, Lyon mBd. 150: 128130, 1932. Single case report of a tumor considered histologically to be a ‘‘ spinocellular epithelioma.’ EDWINM. DEERY

1020

ABSTRACTS

Small-cell Glioma of the Retina in a Man Aged Sixty-seven Years, SEMPE,D f JBAN AND HARANT.Gliome de la retine B petites cellules chez un sexag6naire, Arch. SOC.d. sci. m6d. et biol. de Montpellier 13: 554-558, 1932. The patient sought advice because of rapidly progressive failure of vision of the left eye, with inflammation and pain radiating towards the orbit and forehead. The conjunctiva was reddened and bloodshot, and in the infero-external region were three rounded masses which seemed to threaten perforation of the eyeball. The appearance suggested malignancy, and enucleation was at once performed. Examination showed that the tumor had arisen in the retina, had extensively invaded the choroid, and had split through the layers of the sclerotic coat. As the perivascular neuroglia seemed to have undergone no proliferation, the authors think the neoplasm arose in the fibers of Mtiller. It consisted of a stroma rich in fibers, in which there were embedded dense masses of small round cells; the fibers gave the characteristic staining reactions of neuroglia. The authors think the tumor agrees most closely with the small-celled astrocytomas, whereas the retinoblastomas found in early life are neuro-epitheliomas or neurospongiomas. No illustrations are given. F. CAVERS Case of Retinal Glioma Treated by the Insertion of Radium Needles in the Orbit, V. MCDOWALL AND E. 0. MARKS. Brit. J. Ophth. 16: 686-689, 1932. A male baby of six months was referred to the authors with the diagnosis of bilateral retinoblastoma. The left eye showed intense glaucoma, and no intraocular view was possible. It was removed and showed retinoblastoma filling the entire vitreous chamber but not infiltrating the optic nerve. Ophthalmoscopic examination of the right eye under anesthesia showed a globular white mass, traversed by vessels, situated in the upper temporal quadrant, just missing the macular area and well away from the optic disc. The latter fact made unlikely an early extension of the tumor outside of the globe, hence immediate radium treatment was decided upon. Three 0.5 mg. needles with filtration of 0.5 mm. platinum were inserted through small incisions in the upper lid over the area nearest the base of the tumor and spaced 1cm. apart. The needles were removed after six days; total dosage 216 mg. hours. Two months later the tumor had become, and has remained a t time of reporting (after nearly a year), an irregular patchy white area with vessels running across it. The authors now applied radium for two days through a Columbia paste mould 2 cm. thick to the upper part of the orbit and right temporal region, using four needles, each of 4 mg., 2 cm. active length, filtration 0.5 mm. platinum; total dosage 960 hours. They hope to effect a complete cure. F. CAVERS ,

Glioma in the Track of a Persistent Hyaloid Artery, R. SCHEERER.Ein Fall von Gliom im Bereich einer Arteria hyaloidea persistens, Klin. Monatsbl. f. Augenh. 88: 289-302, 1932. A mother noticed that the left eye of her two-year-old son was larger and of darker color than the right eye. Ophthalmoscopy showed clear patches and hemorrhages in the posterior chamber, and the eye was enucleated. Histologic examination revealed a persistent hyaloid artery and typical gliomatous deposits (abundant rosettes) in its neighborhood and in the retina, rupture of the retina, inflammatory changes in iris and ciliary body, hemorrhages in the vitreous body and retina, etc. The gliomatous deposits about the hyaloid artery had evidently arisen from the glial mantle of this vessel, and the presence of pigmented epithelial glands in the retina is regarded by the author as supporting the view that retinoblastoma arises from dislocated or undifferentiated germinal rests. There are four good illustrations. F. CAVERS

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Glioma of the Optic Nerve, B. GLUCK. Brit. J, Ophth. 16: 406-415, 1932. A female child (age not stated) had had her left eye enucleated seven years previously after injury by a snowball. Since the operation she had had fits, and for three months before readmission to hospital had been unable t o swallow solid food. The lids of the operated eye were completely adherent, the skin passing across the front of the orbit in an unbroken sheet. This was incised transversely, exposing a thick fibrous membrane and below this a thin transparent layer. By aspiration 10 C.C. of clear deep yellow fluid was drawn, which clotted spontaneously. A few days later the cyst had refilled; 35 C.C. of similar fluid was withdrawn and 10 C.C. of lipiodol injected. The roentgenograms showed lipiodol above the roof of the orbit and behind its apex, in addition to masses in the orbital cavity. Soon afterwards vomiting, headache, and drowsiness set in, and a few days later death occurred. At necropsy the orbit was found almost filled by a tumor mass which extended into the left frontal lobe, the entire orbital roof being absent. With the microtechnic available the author could not classify this optic nerve tumor further than as a glioma, though a section taken from the stump of the optic nerve itself (three good photomicrographs are given) shows abundant typical astrocytes. A F. CAVERR useful bibliography is appended.

Primary Endothelioma of the Conjunctiva, K: STOJALOWSKI AND J. STABINSKA. Zur Frage nach dem primiiren Endotheliom der Augenbindehaut, Virchows Arch. f. path. Anat. 286: 70-73, 1932. The authors find, from the available literature, that angiomas and endotheliomas are rare tumors in the conjunctiva. The hemangiomas have been reported as sometimes undergoing malignant change. Endotheliomatous tumors are rarer than angiomas. A case is described occurring in a man of twenty years who for about six months had had a sensation of increasing tension in the left eyeball. This presented a conjunctival tumor, the surface of which was covered by numerous small papillae, giving it the appearance of a small raspberry. Histologic examination showed in some places flat and in others cylindric epithelioid cells; the stroma consisted of connective-tissue fibers forming a fine network, in the meshes of which were masses of cells clearly derived from the endothelium of the numerous capillaries. There were no signs of malignancy histologically. One F. CAVERS good photomicrograph is given.

Ptimary Sarcoma of the Conjunctival Cul de Sac, A. RIFFAT. Sarcome primitif du cul-de-sac conjonctival r6cidive au limbe scl6ro-corn6en1Ann. d’ocul. 169: 308-3 13, 1932. The author states that while conjunctival sarcoma occurs with some frequency in the limbic and bulbar regions, it rarely arises in the cul de sac lying between these; he found only two previously reported cases. His own patient, a woman of sixty, complained that for about three months she had felt a pricking sensation behind the right lower lid, as if from sand. A tumor had grown rather rapidly outward and upward. On removal by resection of the conjunctiva of the cul de sac into sound tissue, the tumor proved to be a sarcoma, mainly spindle-cell but with patches of round cells. A year later the eyeball had to be removed for recurrence. F. CAVERS

Mixed Tumor of the Lacrimal Gland, J. F. GIPNER. Trans. Am. Ophth. SOC.39: 392-395, 1931. A mixed tumor of the lacrimal gland was present for twenty-three years. The tumor shelled out easily, having a definite capsule. No cartilage or bone could be found, though extensive dense hyalinization of the stroma was present.

1022

ABSTRAOTS

Cavernous Angioma of Lacrimal Gland, A. PATRY.Angiome caverneux de la glande lacrymale, Ann. d’ocul. 169: 458-464, 1932. Although angiomas of the orbit are not so rare as the author estimates from the available literature, his report of an sngioma of the lacrimal gland is of interest. His patient was a girl of five years. [Two similar cases were reported recently by Scarpadane (Saggi oftal. 5: 497, 1932) occurring in children of four and of nine months.] Patry’s case is interesting because the tumor showed in different parts F. CAVERS lymphangiomatous and hemangiomatous structures. Papilloma of the Lacrymal Sac, R. B. HIRD. Brit. J. Ophth. 16: 416-417, 1932. Brief report on three cases of simple ocular papillomas, one each occurring in the caruncle, palpebral conjunctiva, and lacrimal sac. The first was removed on account of chronic mucopurulent discharge; the others on account of bleeding. F. CAVERS Adenoma of the Lacrimal Gland, H. VILLARD,C. DEJEAN AND J. TEMPLE. Adhome de la glande lacrymale, Arch. Soc. d. sci. mOd. et biol. de Montpcllier 13: 328-330, 1932. A woman of fifty-two years showed a rounded subcutaneous tumor just below tlie tail of the right eyebrow, extending upward and outward but not adherent to the bone of the orbital wall. Roentgenography of the orbit showed only a slight shadow corresponding to the tumor; examination of the nose, nasopharynx, and sinuses was negative. The tumor was easily removed and proved to be a pure adenoma of the lacrimal gland with a thin fibrous capsule. No illustrations. F. CAVERS Radiotherapy of Epithelioma of the Eyelids, F. ARCELIN. Traitement radiothbrapique des Bpith6liomas des paupihres, Lyon m6d. 149: 289-292, 1932. The author has used the roentgen rays in the treatment of epitheliomas of the eyelids for a number of years. The required dose is given in a single treatment without filtration; the rest of the eyelid and the eyeball are protected with lead shields. The results have been excellent; the scar is slight, the palpebral fissure is not altered, and the esthetic results are good. The author has never observed any ill effect on the eye, even if it was not always possible to protect the eyeball completely. In a case reported, with a large epithelioma of the lower lid, a small remnant of tumor tissue persisted two weeks later and another treatment was given, resulting in complete disappearance of the growth without appreciable scarring. Mixed Tumor of the Eyelid, HELENEPUSCARIU.Mischgescliwulst des Oberlides, Klin. Monatsbl. f. Augenheilk. 89: 493-499, 1932. The author reports a case of tumor of the upper lid having the structure characteristic of growths developing in salivary or lacrimal glands. It consisted of pseudoglandular tissue, with cavities containing amorphous secretion products as well as cyst-like cavities. Between the pseudoglandular structures were cellular elements suggestive of cancer cells. Carcinomatous tissue was also present in the coarse fibrous stroma. Zones of hyaline cartilage were present and one area showed the structure of fibrosarcoma. Primary Sarcoma of the Eyelid, C. G A B R I ~ L I D ~Sarcome S. primitif apigmentb de la paupidre, Ann. d’ocul. 169: 593-604, 1932. A man of fifty complained of a hard mass in the left lower lid, which he had first noticed about ten days before and which had grown rapidly in size. The

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mass was painless and there was no disturbance of function. The author at first thought the lesion might be syphilitic tarsitis, but there was no evidence of syphilis and the Wassermann reaction was negative. Twenty days later the tumor had grown t o walnut size and was ulcerated. The biopsy diagnosis was round-cell sarcoma rich in young cells with many mitoses. As the patient refused operation, roentgen ray treatment was given; total dosage of 7200 T, in four sittings of ten minutes each. After the first sitting the tumor became smaller, after the second the ulceration disappeared, after the fourth the tumor seemed to be entirely resorbed, and a month later cure appeared to be complete. About five months later the patient was readmitted with severe pain and palpable nodules in the liver region. He died in a few days; necropsy was not permitted. F. CAVERS

Metastatic Carcinoma of the Orbit, D. MICHAIL. Brit. J. Ophth. 16: 537-545, 1932. The author reports this case partly because of the rarity of the condition (only 20 cases were found in the available literature), partly because his case apparently differs in some respects from others already reported. The patient, a woman of thirty-two, had two years previously noticed a hard lump the size of a walnut in her right breast. After nearly a year, when the tumor had grown considerably, involving nearly the whole breast and invading the axillary, supraclavicular and lateral cervical nodes, the breast was removed with the axillary nodes [nothing is said about the other invaded nodes]. A year later a hard lump was present nearly buried in the thyroid gland. Roentgenography showed a ragged shadow, as large as an apple, above the right half of the diaphragm, and complete opacity of the right maxillary and ethmoidal sinuses; rhinoscopy showed narrowing of the right nasal fossa. Palpation of the lower margin of the right eyeball revealed a hard ellipsoid tumor, 2 X 1 om., adherent to the orbital floor, free from the eyeball. This tumor was extirpated by transpalpebral inferior orbitotomy, and a fortnight later the patient left hospital with her eye in an approximately normal position. The tumor was a highly cellular carcinoma with its stroma reduced to a minimum and with extensive cancerous lymphangitis. In available previous reports stress ha8 been laid on the scirrhous character of carcinomatous metastases to the orbit, especially when the primary tumor arose in the breast. The author associates the encephaloid character of the orbital metastasis in this case with the rapid growth and spread of the tumor. The paper is illustrated by two photographs and two photomicrographs. F. CAVERS Methods of Extirpation of Orbital and Periorbital Cysts, A. T E R ~ O NSur . l’ablation des kystes de la queue du sourcil et de certains kystes orbitaires, Ann. d’OCU1. 169: 297-300, 1932. The author describes his careful methods of dealing with small cysts of the‘ orbit, eyebrow, etc., claiming that these minor operations should be done thoroughly and neatly so as to obtain good cosmetic results. He gives illustrations of three instruments he has devised in order to get satisfactory apposition of stitched edges. F. C A V E R ~ Surgical Removal of Malignant Tumors of the Orbit and Nasal Accessory Sinuses, J. ALPIN. Zur Chirurgie der bosartigen Geschwiilste der Orbita und der Nasennebenhohlen, Ztschr. f. Hals-, Nasen- u. Ohrenheilk. 30: 174-181, 1931. Alpin describes the technic of the radical excision of neoplasms involving the orbit and nasal accessory sinuses, modeled after that first described by Golowin (Exenteratio orbito-sinualis, Wyestnik Ophthalmologii (russ.) 27 : 5, 1910). The eye, together with the surrounding involved tissues, is removed and the defect is

1024

ABSTRACTS

closed by rectangular flaps from the forehead and cheek. Two case histories are given to illustrate this procedure. The article is illustrated with drawings and a BENJAMIN R. SHORE photograph of a patient after operation. THE EAR

Metastastatic Carcinoma of the Internal Auditory Canal, RUTTIN. Karzinommetastase in dem inneren Gehorgang beiderseits, Monatsschr. f , Ohrenh. 66:369-371, 1932. One year after operation for gastric carcinoma the patient became deaf first in the right ear, then in the left ear, and developed vertigo and spontaneous nystagmu8 of central origin. At autopsy carcinomatous nodules were found in the region of the porus acusticus internus on both sides, involving the seventh and eighth nerves on the left side, and adherent to the dura on the right side. Nevo-carcinoma of the Concha of the Ear, B. SIMONETTA. Naevo-carcinome du pavillon auriculaire, Rev. de laryng. 53: 749-758, 1932. The author found five reported cases of melanoma in the ear, and adds to them the following case. A woman, sixty-two years old, for the past thirty-five years had a slightly pigmented nodule on the concha of the left ear. Three years previous to her present examination this had commenced to grow slowly, and now was a rounded mass, about the size of a nut, slightly nodular, rather hard, brownish-red in color, and ulcerated. Biopsy revealed nevo-carcinoma. The lesion was treated by insertion of needles of radium on two occasions, for a total dosage of 3,984milligram hours, which resulted in complete destruction of the tumor and a portion of the surrounding healthy tissue. At the date of the report sufficient time had not elapsed for complete healing or for evaluation of the effectiveness of the treatment. No glandular metastasis had been detected. WILLIAMJ. HOFFMAN Aural Carcinoma during Wound Healing after Radical Operation, E. ERTL. Ohrkarzinom wahrend des Wundverlaufes nach Radikaloperation, Folia otolaryng. 21: 206, 1931. A case is reported in which two months after radical operation on a chronically discharging ear, with no postoperative complications and clean healing, the patient returned with a gaping retroauricular wound from which hard neoplastic masses covered with bleeding ulcerated crusts protruded. X-ray showed extension of the growth internally. Examination revealed it to be squamous epithelioma. Surgery and postoperative radiation were followed by,temporary quiescence and .then reactivation of growth, but the patient could not be traced further. Fibro-Hemangioma of the Petrous Bone and Middle Ear in Three Sisters, C. GOEKOOP. Fibro-Hemangiom des Felsenbeines und des Mittelohres bei drei Schwestern, Acta oto-laryngol. 18:153-162, 1932. Also in Nederl. tijdschr. v. geneeak. 76:2679-2681, 1932. Three sisters were found to have benign tumor of the petrous bone. The first symptom in each case was tinnitus. The tumors were of slow growth and the symptoms of long duration. Two of the tumors were aural polyps, the third, hemangiofibrorna.

THE EAR

1025

Further Studies of the Chemical Diagnosis and Treatment of Middle-Ear Cholesteatoma, A. RETJO. Weitere Beitrage zur chemischen Diagnose und Therapie des Mittelohr-Cholesteatoms, Acta oto-laryngol. 17: 304-310, 1932. The author has previously reported his studies on the cholesterin content of the pus in middle-ear disease in relation to cholesteatoma (Acta oto-laryng. 15: 379, 1931. Abst in Am. J. Cancer 16: abst. p. 95, 1932), and now reports further studies in which cholesterin determinations were made on the blood as well as the ear discharge. Of 28 cases of middle-ear disease, there were 13 in which the cholesterin reaction in the pus was positive and in which the blood cholesterin was definitely above normal in all but 3 cases. In all of these cases a cholesteatoma was found, but in 2 of the 3 cases in which there was no increase in the blood cholesterin the cholesteatoma was not extensive and had not caused bone destruction; while in the third case the patient was tuberculous, which accounted for the lowered blood cholesterin. In 3 cases the pus gave only a weakly positive cholesterin reaction, but the blood showed definitely increased cholesterin; a t operation no cholesteatoma was found, but granulation processes and caries in the bone, indicating that bone destruction, whether caused by cholesteatoma or not, may cause an increase in blood cholesterin. In the remaining 11 cases, the cholesterin reaction in the pus was negative and the blood cholesterin normal; in these cases no cholesteatoma was found and no extensive bone destruction. The author concludes from these studies that in cases of cholesteatoma in which the blood shows no definite increase of cholesterin, there is no extensive bone destruction, and conservative treatment is justified. For such conservative treatment he uses irrigations with 10 C.C. of carbon tetrachloride under pressure, once or twice a week. Deeply Retracted Membrana Flaccida and Cholesteatoma, W. LANGE. Tief eingesogene Membrana flaccida und Cholesteatom, Ztschr. f. Hals-, Nasen- u. Ohrenh. 30: 575-582, 1932. The author has previously stated that cholesteatoma may develop on a deeply retracted Shrapnell’s membrane (membrana flaccida). His recent studies on a larger series of specimens have supported this conclusion. He has found that in the presence of an acute inflammatory process in the ear, the epidermis of the external auditory canal invades the thickened connective tissue of the membrans flaccida, and if the inflammation persists, a cholesteatoma develops in the mucous membrane and below the epithelium. If the inflammation subsides, with resulting deep retraction of the mambrane, a cholesteatoma develops in the same way when a recurrent inflammation occurs in the tympanic cavity or the auditory canal. If the retraction is deep and narrow, the desquamated epithelium cannot escape and a cyst-like growth develops, which also leads to thg production of a cholesteatoma. This may result a t an early stage in a rarefying osteitis of the ossicles. Auditory Canal Exostosis and Cholesteatoma, KRAFT. Gehorgansextose und Cholesteatom, Ztschr. f. Laryng., Rhin. 23: 79-80, 1932. In the case reported a bony exostosis almost entirely blocked the auditory. canal. It was associated with middle ear suppuration, and a fistula had formed behind the ear, resulting from abscess of the soft tissues of the wall of the canal. Attacks of vertigo indicated the possibility of intracranial complications. At operation a cholesteatoma was found, which had destroyed the posterior wall of the auditory canal, necessitating a radical operation. The author notes that the association of a chronic middle ear suppuration with an exostosis of the auditory canal is not rare, but that the further complication of cholesteatoma formation is unusual.

1026

ABSTRAUTS

Anophtbalmos Congenitus; Cholesteatoma with Acute Exacerbation, E. GRABSCHEID. Anophthalmus congenitus, akut exazierbiertes Cholesteatom, Monatsschr. f. Ohrenh. 66: 347-348, 1932. Grabscheid reports a case with congenital anophthalmos and chronic suppurative otitis media, with recent development of severe headache on the left side. The left auditory canal was deformed and almost completely obliterated. A t operation a cholesteatoma was found and removed by the radical procedure. T H E THYROID GLAND Treatment of Cancer of Thyroid Gland by a “ Cytotoxic ” Serum, E. COULAUD. Traitement du cancer thyroIdien par un skrum cyto-toxique, Ann. d’oto-laryn. No. 7: 784-794, July, 1932. The author adds seven cases to the number of those he has already reported as having been treated by him for cancer of the thyroid gland, making a total of 30 cases to date. His method of treatment is based on an experiment which he reported in 1924 (Compt. rend. soc. de biol. 91: 920). He says there that he extracted a sheep’s thyroid in physiological saline, and then injected 5 C.C. of the extract subcutaneously into the sheep. On bleeding the sheep two days later and repeatedly injecting the serum subcutaneously into a rabbit, the latter animal’s thyroid showed on biopsy various histological changes of a degenerative type (no illustrations given). I n recent years the author has been injecting emulsions of human thyroid into sheep and using the sheep’s serum for subcutaneous injection into patients with thyroid cancer, on the assumption that this serum contains what he describes as an “ antithyroid principle ” and therefore ought to inhibit growth of human thyroid cancer. He claims that in several cases malignant thyroid tumors have been cured within a few months, while in most of the other cases life has been prolonged. [It seems very unlikely that more than a small number of these have been actually malignant tumors; the photomicrographs given in this paper are of poor quality and do not support the author’s claims.] F. CAVERS THE BREAST Prognostic Classification of Breast Cancers, R. LEROUX AND M. PERROT.Classification pronostique des cancers du sein, Bull. de 1’Assoc. frang. p. l’ktude du cancer 21 : 37-73, 1932. By means of histologic studies two general types of breast cancer may be recognized, the one with favorable prognosis, the other with unfavorable. In type one, the favorable form, the cancer tissue tends to proliferate within the ducts, to grow in dendritic processes or to have a colloid or scirrhous structure. Mitotic activity is slight and mucous secretion is demonstrable within the cells. The ,stroma is dense, collagenous or hyalinized and arranged about, the groups of carcinoma cells. There is a tendency to fibroblastic metaplasia of the adipose tissue before the invading neoplasm and a lymphoid infiltration is found a t the periphery. In the second type, the unfavorable form, the growth is infiltrating, with an absence of cohesion between the cells, which, therefore, tend to occur singly; mitoses are abundant, and there is no secretion of mucus. The stroma is loose, and free invasion of the adipose tissue and dermis occurs. Lymphatic emboli are found, and invasion of the vascular wall by the cancer tissue occurs. The close correspondence between the histologic form and the clinical outcome of the disease is demonstrated by tabulation of 37 case8 treated prior to 1927 and

THE BREAST

1027

by fourteen extensive descriptions of cases treated since that time. Excellent photomicrographs illustrate the lesions. The cases included are those in which radical amputation followed by x-ray was the method of treatment. [A second article in the series of studies of which this is the first has already appeared in abstract in the Am. J. Cancer (16: abst. p. 1374, 1932). Others HOWARD C. TAYLOR, JR. follow.]

Clinical-AnatomicalStudy of Cancers of the Breast. Prognostic Value of Different Clinical Factors, R. LEROUXAND M. PERROT.Etude anatomo-clinique des cancers du sein. Valeur pronostique respective de diffbrents facteurs cliniques, Bull. de 1’Assoc. frang. p. 1’6tude du cancer 21 : 309-317, 1932. Various clinical factors have been studied in relation to 50 cases of breast cancer. With regard to the age of the patient, it was found that of the women below fifty, 26.3 per cent were living; of those between fifty and sixty-five, 47.7 per cent, and of those over sixty-five, 31.3 per cent. These results confirm the general view of the relatively high malignancy of breast cancer in young women. Of 34 patients now dead, 14 showed involvement of the axillary nodes; of 17 living patients, only 5 showed node involvement. According to the Steinthal grouping of cases the following results were obtained. In the 18 patients in stage I, 9 have remained well; all of these cases belonged histologically to the favorable type. Of the twenty patients in stage 11, 5 have remained well; 2 of these cases belonged histologically to the unfavorable type, thus contradicting the usual parallelism between histology and prognosis. Of the 9 patients in stage 111, 2 are living and 7 dead, the division exactly corresponding with the histologic classification. The cases studied were those treated by radical mastectomy followed by x-radiation. HOWARD C. TAYLOR, JR. Clinical-AnatomicalStudy of Cancers of the Breast. Prognostic Value of Different Histologic Tests, R. LEROUXAND M. PERROT.Etude anatomo-clinique des cancers du sein. Valeur pronostique respective des different8 tests histologiques, Bull, de 1’Assoc. franp. p. 1’6tude du cancer 21: 318-322, 1932. In this paper Leroux and Perrot analyze in relation to prognosis the individual histologic characteristics upon whose combination they had classified 88 cases of breast cancer as either favorable or unfavorable. The following special characteristics are noted. (1) The special cellular morphology showed that each of five types was divided in about equal proportions between living and dead patients. (2) Division into eleven different types according to architectural pattern, showed that the cancers with isolated cells, the tubular, scirrhous, and so-called polyadenomatous forms are especially malignant. (3) Of the 18 patients with nuclear monstrosities 16 are dead. (4) Active mitosis as an isolated guide was less reliable, for of 27 patients in whom such activity was present, 9 are living. (5) Mucous cellular secretion was a most favorable sign, for of the 28 patients in whom this was present, 15 have remained well., (6) Classification of the types of reaction evoked by the invasion of the adipose tissue showed that with a definite fibroblastic reaction 23 patients of 33 have survived; with no reaction only 4 of 32 are living, and with an irregular reaction 3 of 9 are living. (7) The character of the connective-tissue and vascular stroma was found to have a tremendous bearing on prognosis, for when it was loose, necrotic, or irregular, death almost invariably occurred, but when it was moderately or very dense or colloid in character the prognosis proved to be very good. (8) Leukocytic infiltration is of value only when definite lymphoid collections are found in contact with the epithelial masses.

1028

ABSTRACTS

(9) The affinity of the stroma for the mucicarmine stain also showed an important prognostic value, for of cases where mucicarminophilia was present, 24 survived and 14 died, whereas among cases in which it was absent there were 12 survivals and 38 deaths. (10) Lymphatic emboli were found in 18 patients, of whom 15 have died. (11) Blood vessel emboli were found in 11 patients, of whom ten have died. (12) The mode of invasion of the lymph nodes, whether with or without a reaction of the connective-tissue framework of the node was found also to have an important bearing on prognosis. In conclusion emphasis is placed upon the necessity of combining all factors to attain a complete prognostic test. [This plan of combining numerous histologic characteristics, relating not only to the parenchyma of the tumor but to the stroma as well, in order to determine prognosis, is very similar to the so-called malignogram of Hueper. Leroux and Perrot have reported a very consistent success in predicting the outcome of breast cancer cases by means of the microscope, but their cases are relatively few in number and their results will require considerable confirmation before being accepted by the many workers who after enthusiastic attempts have arrived a t somewhat disappointing conclusions in regard t o the practical value of grading JR. cancer, especially perhaps breast cancer.] HOWARD C. TAYLOR, Transillumination of the Breast, A. RAVINA. La transillumination du sein, Presse m6d. 40: 294, 1932. In a review of Cutler’s contributions, the author states that diffuse hyperplasia of the breast occurring about the menstrual periods will give a temporary diffuse opacity, that cancers are much less opaque than hematoma, and that lactating breasts and galactoceles give marked opacities. Several illustrations are included. NELSON B. SACKETT Modem Operation for Cancer of the Breast, J. N. JACKBON. J. Missouri M. A. 28: 513-516, 1931. Jackson states that 80 per cent of tumors in women’s breasts are cancer. He emphasizes the importance of surgical removal of all breast tumors and of careful diagnosis, and advocates a flap operation for radical mastectomy, in which the skin edges are widely undermined, thus permitting ease in closure. The main objection to the skin graft is the poor cosmetic result. [The figures given by Jackson for the frequency of cancer are much higher than those in large cities and would indicate the need of cancer education in Missouri.] W. S. MACCOMB Surgery and the Healing Process in Irradiated Areas, with Special Reference to G . das Operieren und die WundMammary Carcinoma, 0. J ~ N G L I NUber heilung im rontgenvorbestrahlten Gebiet, mit besonderer Beriicksichtigung des Mamma-Carcinoma, Arch. f. klin. Chir. 173:445, 1932. This is essentially the same material as that published in Strahlentherapie 44 : 125-130, 1932 (Abst. in Am. J. Cancer 17: 518, 1933). Anatomical-clinical Contribution to the Study of Benign Tumors of the Female Contributo anatomoclinico all0 Breast, U. STOPPATOAND F. PESCATORI. studio dei tumori benigni della mammella femminile, Sperimentale 86 : IxxiiIxxviii, 1932. The authors describe a type of fibro-adenoma of the breast which occurs in the subareolar region and which often causes retraction of the nipple. The patients are usually between seventeen and twenty-five years of age.

INTRATHORACIC TUMORS

1029

Pescatori believes that this type of tumor is a malformation resulting from failure of the acini and ducts to join. He designates the tumor as “juvenile galactofibroadenoma.” C . D. HAAQENSEN

Giant Cell Reaction of the Stroma in a Carcinoma of the Breast, R. LEROUX. RBaction giganto cellulaire du stroma dans un BpithBlioma mammaire, Bull. de 1’Assoc. franp. p. 1’6tude du cancer 20: 692-697, 1931. In a case of otherwise typical glandular carcinoma of the breast Leroux describes two unusual histologic findings, namely a diffuse infiltration of red cells throughout the tumor and the presence of numerous giant cells of all shapes and sizes. On account of the special relation of the giant cells to masses of cancer tissue and the evidences of disintegration going on in each type of cell when in contact with the other, Leroux advances the opinion that a mutually antagonistic reaction is demonstrated. The giant cell reaction was in his opinion evoked not by the infiltrating red cells but was definitely directed against the abnormal cancer tissue. [As such pictures are not uncommon, especially in keratinizing epitheliomata after heavy radiation, the action may be only phagocytosis of dead cells, not a destruction of living neoplastic structures.] Four photomicrographs HOWARD C. TAYLOR, JR. illustrating the lesions are published. INTRATHORACIC TUMORS

Primary Intrathoracic Growths, MARJORIEGILLESP~E.Glasgow M. J. 117: 296-313 and 118: 26-38, 1932. This paper is based on a series of 61 cases from the post-mortem records of the Victoria Infirmary from 1899 to 1928. I n the decade 1919-1928,38 intrathoracic tumors were seen, representing 2.91 per cent of all post-mortem examinations for the period. A more or less steady increase was observed during this period, 25 cases having occurred in the latter half as compared with 13 in the first half. Contrary to most reported series, the present one shows only a slight preponderance of males-33 males to 28 females, while the greater part of the increase during 1912 to 1928 was due to a markedly increased incidence in women. The majority of the patients were over forty; only 3 were under twenty, and in all of these the growth “ would appear to have been genuine lymphosarcoma.” From the microscopic specimens it would appear that the oldest sarcoma patient was thirty-nine, while the age range for carcinoma was twenty-six to seventy-two years. The histories did not seem to reveal any marked occupational incidence, though in some of the cases in men the occupation was such as to suggest chronic respiratory tract irritation. The average time elapsing between the first symptoms and death was a little over six months, with extremes of three weeks and five years. Clinically the author distinguishes four groups of cases. The first group, in which the effects of pressure-dyspnea, pain, cough, and edema-are the most marked features, included 28 patients or 46 per cent. In the second group pneurnonic and bronchitic symptoms predominated. This group included 25 cases or 41 per cent. In a third group the primary lesion was to some extent marked by signs of cerebral metastases. Five of the 61 patients (8 per cent) made up this group. In the remaining cases, numbering 3 (5 per cent), there were no signs suggestive of respiratory disease and the condition was discovered only post mortem. The author discusses the more important symptoms in some detail-cough, sputum, changes in the voice, cachexia, and pain. The so-called ‘‘ prune-juice sputum,” generally supposed to be characteristic, was not recorded in any of the author’s cases. 44

1030

ABSTRACTS

As t o the tumor site, four groups are recognized, as follows: (1) that in which the tumor is peribronchial, with a large mass in the mediastinum, 32 cases; cases with the main tumor a t the root of the lung, 15 in number; cases with the tumor tumor arising in and confined to the lung tissue, 12; and cases in which the tumor has overrun the entire lung and mediastinum, constituting a solid mass pressing upon the other lung and causing partial collapse, 2. I n only 12 cases were there no metastases. Metastasis occurred most frequently in the suprarenals followed in order by the liver, mesenteric nodes, pancreas, brain, kidneys, ovaries, and bones. The spleen was found t o be involved in but two instances and muscle in but one. Of the 39 cases available for histologic classification, 5 were found to be sarcomatous and 32 carcinomatous in nature. The sarcomas include 4 spindlecelled sarcomas, one of which was metastatic from a tumor of the thigh, and one mixed-cell sarcoma. I n the group of carcinomas, 4 were found to be squamouscell in character, 9 were columnar-cell bronchial tumors, 3 were alveolar carcinomas. Sixteen cases belonged to the small-celled peribronchial type of growth formerly considered sarcomas but more recently classified by Barnard and others (J. Path. & Bact. 29: 241, 1926) as carcinoma. The author made a special study of these cases, and believes that Barnard's theory is correct, basing her decision in part on examination of the metastatic nodules, which frequently revealed marked polymorphism. One of the two remaining cases was found a t post-mortem examination to be an enlarged thymus occurring in conjunction with lymphatic leukemia; the other was found microscopically t o be mediastinal Hodgkin's disease. In summarizing her observations, the author states that no striking causative factor was found in this series. Previous respiratory disease was noted in about 50 per cent of cases; in no case were active tuberculous lesions found. Two patients gave a history of trauma and in 2 anthracosis was present in the lungs. In many of the cases proliferation of the basal cells was found quite apart from the tumor growth and the resemblance between these cells and those of a smallcell carcinoma noted. In none of the cases was a diagnosis of 'lymphosarcoma made. Case reports are given, but no illustrations. A short bibliography is appended.

Tumors of the Trachea, H. BARTH. Zur Kasuistik der Trachealtumoren, Ztschr. f. Hals-, Nasen- u. Ohrenh. 30: 583-589, 1932. I n 1924, 3 cases of tracheal tumor were reported and one has recently been again under observation. The tumor of this patient was first removed in November 1932. There were no symptoms for several years; then the tumor recurred, and the patient came to the clinic in March 1931 complaining of increasing dyspnea for the past six months. The tumor was again removed. A year later a small recurrence was noted, which has not been removed, as it causes but slight symptoms. Pathologic examination of the original tumor and of the recurrent growth removed in 1931 showed a mixed tumor containing both endothelial and epithelial elements, similar to mixed tumors of the parotid. The recurrent growth in some areas showed the typical structure of a basal-cell epithelioma, with some of the cells having characteristics of squamous cells; in other areas the structure was that of a cylindroma of endothelial origin. The tumor evidently arose from the tracheal glands. The original neoplasm and the recurrences were of slow growth and showed no infiltrative tendency. Observations on Intrathoracic New Growths and the Value of Bronchoscopy in Diagnosis and Treatment, M. DAVIDSON.Brit. M. J. 2: 617-621, 1932. The author stresses the evidence as to the increasing frequency of lung cancer afforded by necropsy statistics from various large European hospitals, and deals

INTRATHORACIO TUMORS

1031

briefly but clearly with various aspects such as site, histology, symptomatology, roentgenographic study, bronchography with lipiodol filling, bronchoscopy, etc. " It is now generally admitted that the great majority of lung cancers originate in the bronchial mucous membrane, and in sufficiently early cases it is possible to introduce, by means of the bronchoscope, a small tube containing radon seeds. The remarkable case reported by Chevalier Jackson in 1917, and the removal by Orton of a pedunculated bronchial carcinoma, are two classical examples which, together with numerous other attempts that have been attended with a certain measure of success, should encourage the belief among the more determined investigators that the bronchoscope as a medium of treatment is still awaiting further trial." F. CAVERS

...

Increase of Primary Lung Cancer in Gijttingen, E. SIMMROSS. uber die Zunahme des Lungen-Bronchialkrebs im Gottinger Sektionsgut, Virchows Arch. f. path. Anat. 285: 183-196, 1932. The author has analyzed the necropsy reports a t the Gottingen Pathological Institute and gives much information in tabular form as to age a t death, site of primary tumor, distribution of metastases, etc., in cancer of the lungs. There has been on the whole a gradual increase in the proportion of deaths from pulmonary cancer to those from cancer in other organs, but the ascending curve has been interrupted by a fall in number in two of the years under survey. The Gottingen figures, therefore, do not show the continuous rise reported from the majority of pathological institutes. The total numbers dealt with, however, are rather small. [This last remark applies, of course, to a considerable number of statistical reports on the rising frequency of lung cancer.] F. CAVERS Primary Carcinoma of the Lung, H. M. MOSES. Internat. Clinics, pp. 34-35, Sept. 1932. In a previous report (Am. J. M. Sc., 170: 102, 1925) the histories and pathological findings of eight cases of primary carcinoma of the lung were reported. This article includes briefly the findings on five more patients with the same diagnosis. W. S. MACCOMB Cerebral Form of Pulmonary Cancer, H. ROQER,Y. POURSINES AND J. ALLIEZ. Forme c6r6brale du cancer pulmonaire, Gaz. d. h6p. 105: 1077-1082, 1932. The authors cite a case of cancer of the lungs which caused no local symptoms and was found only a t autopsy. The symptoms were those of brain tumor-rightsided hemiplegia preceded by jacksonian convulsions, severe headache, vomiting, and torpor. The unusual feature was that until near the time of death there was no increase in the cerebrospinal fluid pressure, and no choked disc. At autopsy six cancer nodules were found in the brain, three in the left hemisphere, two in the right hemisphere, and one in the rolandic convolution on the left side. Only the latter had caused any localizing symptoms (the jacksonian epilepsy and hemiplegia). An infiltrating tumor was found in the apex of the right lung. On histologic examination the pulmonary cancer and the brain tumors were found to be of the same type, small spindle-shaped cells predominating. The authors report 2 other cases of metastatic brain tumor in which there was neither increase in the cerebrospinal fluid pressure nor choked disc. [Choked disc accompanies about half the metastatic tumors of the brain.] In one case there were multiple cerebral sarcomas metastatic from a tumor of the breast; in the other case brain metastases from a pleuro-pulmonary tumor, causing hemiplegia, jacksonian convulsions and severe headache. In this latter case the patient did not complain of any respiratory symptoms, but the history showed that she had previously had pain in the right scapular region and an intermittent cough. The

1032

ABSTRACTS

diagnosis of pulmonary cancer was made by the roentgen findings and pleural puncture (showing cancer cells). The authors note that such cases, where there are few or no symptoms referable to the primary tumor in the lungs, but symptoms of brain tumor caused by the cerebral metastases, may be designated as a cerebral form of pulmonary cancer.

Disseminated Carcinomatosis of the Lungs in a Tuberculous Patient Operated A N D F. upon Eight Years Previously for Gastric Carcinoma, COSTEDOAT CODVELLE.Granulie cancbreuse des poumons chez un tuberculeux opbr6 huit ans auparavant d’un cancer gastrique, Bull. et mbm. SOC.m6d. d. 118~. de Paris 48: 1159-1164, 1932. A man had had partial gastric resection a t the age of thirty-four for a tumor diagnosed histologically as “ metatypic epithelioma,” had made a good recovery, and had remained well for five years. He then (1929) began to spit blood, but though he had been losing flesh before and after the hemoptysis began, he did not return to the hospital for another two years. The sputum contained tubercle bacilli, but repeated roentgenograms of the chest were negative. The patient was given sanatorium treatment, but died a few months after admission. During this period the tubercle infection appeared to have died out, the temperature having become normal and the sputum tests remaining persistently negative. At necropsy no definite metastases were found, but dotted throughout the lungs were fine granules consisting of cells giving typical gastric cell staining with mucicarmine. The stomach wall was crowded with similar cells (linitis plastica), F. CAVERS as were the lymphatics of the liver and pancreas.

.

Bronchial Carcinoma, R. JAKSCH-WARTENHORST. Zur Klinik des Bronchialcarcinoms, Deutsches Arch. f. klin. Med. 173: 436-439, 1932. A hitherto robust young schoolmaster [age not stated] became feverish and suffered rheumatism-like pains, which soon became worse. Within two months there appeared signs of compression myelitis, ‘‘ tumours were palpated in the spine,’, and bronchial carcinoma cells were found in the sputum. Death occurred two months later. At necropsy there were found intracranial metastases, which had been suspected during life because of “ choked disc, ocular muscle paralyses, etc.” [The clinical information given is scanty, the foregoing being an almost literal translation of all that the author says about his case. Nothing is said about the actual site and the gross and microscopic features of the vertebral and intracranial metastases, the greater part of the article being devoted to a summary of the literature on lung cancer in the Schneeberg miners, which has no obvious bearing on the present case.] The author distinguishes two clinical types of bronchial carcinoma-that with short history, dominated by early, rapid, and extensive metastasis, as in the case described, and that with a long history (up to three or four years), in which metastasis occurs late if a t all. F. CAVERS Osteoplastic Carcinosis of the Lung Secondary to Gastric Cancer, W. LAUBMANN. Beitrag zur osteoplastischem Carcinose, Virchows Arch. f. path. Anat. 285: 169-182, 1932. A sixty-five-year-old man was operated upon for gastric tumor but died of peritonitis a few hours later. The tumor was found to be of mixed or anaplastic type, showing patches of sarcoma-like appearance scattered irregularly in a typical adenocarcinomatous ground mass. I n the upper right lung were several hard nodules consisting partly of adenocarcinoma but with a large amount of connective tissue passing into masses and cords of cartilage and bone. The author thinks the chondroid and osteoid tissue had arisen by metaplasia from connective tissue.

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[It is not stated whether the chest had been examined roentgenographically before F. CAVERS the stomach was resected.] Clinical Diagnosis of Mediastinal Tumors, RADONICIC.Diagnostic clinique des tumeurs mbdiastinales, Arch. m6d.-chir. de l’appareil respirat. 7: 281-295, 1932. The author gives a general account of the clinical signs and symptoms of “ mediastinal ” tumors, based on 65 cases examined by him during a period of just over ten years (1910-1920) in the medical clinic of Zagreb, Hungary. [The account is vague and incomplete. Even the author’s statements as to the number of cases are difficult to understand. Apparently the total of 65 refers to intrathoracic tumorous lesions in a wide sense, including 34 cases of bronchopulmonary cancer, 13 of aortic aneurysm, and one of retrosternal goiter, the remainder being mostly cases of mediastinal syphilis and some undefined lesions. The author says he appreciates the value of roentgenography in the diagnosis of these tumors, but has deliberately avoided using this and other modern methods, for the strange reason that they make diagnosis a mechanical affair rather than a fine art. He has confined himself to the century-old routine of inspection, palpation, auscultation, percussion, etc. A paper of little value, and without illustrations.] F. CAVERS DiiTerential Diagnosis of Mediastinal Sarcoma and Pulmonary Tuberculosis, H. ALEXANDER.Zur Differentialdiagnose von Sarkom des Mediastinums und Lungentuberkulose, Roentenpraxis (Hft. 10) 4: 428-432, 1932. A woman of twenty-six was admitted to a Swiss sanatorium on account of an infiltration of the left lower lobe of the lung, the size of a walnut, the clinical and roentgen findings pointing to tuberculosis. During four months she lost weight; then there suddenly set in high fever with formation of serous exudate in the left pleural cavity. Within a month the patient’s condition grew rapidly worse until exitus with signs of polyseritis. The last roentgenogram showed dense shading of the whole left lung with marked retraction of the mediastinum to the right. A t necropsy the lower half of the left lung was found to consist of friable tumor-like tissue, diagnosed histologically as lymphosarcoma. After again examining the roentgenograms in serial order, the author concluded that the neoplasm had arisen in the lower mediastinum behind the heart shadow and had thence infiltrated the lower lobes of the lung; the isolated infiltration in the left lower lobe, which was the chief reason for the patient being treated as a consumptive, was a metastasis from F. CAVERS this primary mediastinal tumor.

Primary Carcinoma of the Pericardium, 0. SATKEAND G. SALZER.Uber ein primares Carcinom des Herzbeutels, Virchows Arch. f. path. Anat. 284: 632639, 1932. A man of fifty-six was admitted to hospital in an advanced stage of cardiac failure and died two days later. His illness had begun three years previously with slight fever and increasing dyspnea. Pericarditis was suspected, and as the Wassermann reaction was positive, neosalvarsan and other antiluetic remedies were given, but the reaction remained positive. On admission the patient was deeply cyanosed and showed widespread edema. At necropsy the pericardial sac was found to be obliterated. The parietal endocardium was about 1.5 cm. thick and showed groups of small masses; others occurred in the wall of the left ventricle and interventricular septum. This diffuse carcinoma of the pericardium had also extended to the adjacent surface of the left pleura, and there was an isolated metastasis in the sac of a right inguinal hernia. The author criticizes as academic terminologists those writers who give the name endothelioma or celothelioma to these carcinoma-like tumors which arise in the serosa of the celom and its derivative cavities. F. CAVERS

1034

ABSTRACTS

Myxomatous Structures on the Heart Valves of the Newborn, I. ABRAHAMER. Myxomatose Bildungen an den Herzklappen beim Neugeborenen, Zentralbl. f. Gynak. 55: 2344-2348, 1931. Post-mortem findings are described in the case of a female child dying immediately after delivery. The pregnancy and labor had been normal save that the mother was known to have suffered from endocarditis for some years. There were found on the anterior tricuspid valve and on the pulmonary valve of the newborn child small growths that could not be rubbed off. On histologic section the involved valves were found to be covered by a delicate endothelium under which lay a mucoid tissue containing numerous cells with fine prolongations. The small polypoid growths showed two layers, a central one of dense tissue and a peripheral one of fewer cells. In spite of the suggestion of a relation of this process to the maternal endocarditis, Abrahamer is inclined to regard these myxomatous structures as independent congenital malformations. [These nodules are not uncommon on the cardiac valves in very young infants, and are usually regarded as evidence of infection.] HOWARD C . TAYLOR, JR. THE DIGESTIVE TRACT The Clinical Importance of Porphyrines in the Pathology of the Digestive Tract, I. BOAS. Beitrage zur Koprohamatologie. 111. Mitteilung. Die klinische Bedeutung der Porphyrine fur die Verdauungspathologie, Klin. Wchnschr. 11: 1496-1498, 1932. Boas calls attention to his previous articles (Klin. Wchnschr. 10: 2311, 1931, and 11: 1051, 1932), and to the fact noted in them that in the study of the pigment contents of the feces it is important to remember that while the protoporphyrines may be hematogenous, they may still be found after the exclusion of blood pigment. The deuteroporphyrines, however, are due to the presence of blood in the feces. The deuteroporphyrines may be present when the peroxidase reaction is negative for blood. Such a phenomenon may be due either to the fact that the amount of blood is extremely small, or that the main amount of blood has already been passed in the feces, and only traces remain. In suspected carcinoma of the gastrointestinal tract it is important to test for deuteroporphyrines when the peroxidase reaction is negative. This will rarely be necessary, for not more than 8 per cent of cases of carcinoma of the stomach, and almost no cases of carcinoma of the colon, are seen in which the peroxidase reaction is constantly negative. In cases of esophageal and cardial carcinoma the number of negative peroxidase reactions is somewhat greater, varying between 15 and 20 per cent, according to Boas. It must not be assumed that the presence of deuteroporphyrine in the stools has any specific diagnostic value for carcinoma, On the contrary, this derivative of hemoglobin is quite constantly found in the stools in cases of ulcer of the stomach and duodenum, and postoperative jejunal ulcers. The peroxidase test often fails in these cases. [Those who are interested in the reaction for deuteroporphyrine will find full details on page 1052 of Klinische Wochenschrift, vol. 11, 1932. The procedure is complicated and requires skill in the handling of a spectroscope.] Functional Disorders of the Esophagus and the Development of Malignant Esophageal Tumors, F. WOHLWILL.Funktionelle Storungen der Speiserohrenentleerung und Entstehung basartiger Oesophagusgeschwiilste, Med. Welt. 6: 800-802: 1932. Two patients, each with dysphagia for five years, showed signs of malignant tumor, and growths were found a t autopsy. With such a long duration of s y m p

T E E DIGESTIVE TRACT

1035

toms it is evident that the malignant tumor was not the primary lesion. The roentgen findings during this period also indicated only a functional disturbance. I n each case the tumor was situated above the cardia, in the dilated portion of the esophagus. In one case the tumor was a carcinoma, in the other a mixed tumor, with both carcinomatous and sarcomatous elements. Statistics indicate that patients with stenosis of the cardia and secondary dilatation are more apt to develop esophageal carcinoma than persons without esophageal stasis. An unusually high percentage of carcinosarcomata is found in these cases. These findings indicate that the stasis causes an irritation both chemical and mechanical, which tends to produce malignant changes in the esophageal wall.

New Clinical Symptom in Partial Paralysis of Deglutition, with Special Relation to Carcinoma of the Esophagus,G. CLATJS. uber ein neues klinisches Symptom bei partieller Schlucklahmung mit besonderer Beriicksichtigung des Speiserohrenkrebses, Ztschr. f. Hals-, Nasen- u. Ohrenheilk. 32: 1-7, 1932. Others have observed the presence of frothy sputum in the sinus piriformis in cases of diverticulum of the hypopharynx and esophagus. In 9 out of 10 cases of carcinoma of the esophagus the author found frothy sputum in both piriform sinuses and in both valleculae epiglotticae. I n 3 of these cases the carcinoma was in the upper third of the esophagus, in 3 in the middle third, and in 4 cases in the lower third. In 6 of the 9 cases in which frothy sputum was found in the pharyngeal pouches the carcinoma was extensive causing marked stenosis. Diagnostic Value of the History of a Recent Onset in Cancer of the Stomach, M. DELORTAND J. BLANC-CHAMPA~NAC, Le valeur diagnostique du “ debut recent ” dans le cancer de I’estomac, Bull. et m6m. SOC. m6d. de Paris no. 17: 645-647, Dec. 11, 1931. Of 150 patients with histologically verified gastric cancer, 117 presented histories of ‘ I stomach trouble,” varying in duration from a few months to several years. Thirty-one of these patients had experienced symptoms longer than two years. I n patients with histories of dyspepsia extending over four to five or more years, there may occur certain new and different symptoms which suggest cancer. Of 110 patients with peptic ulcer, verified by operation, 83 presented clinical histories of five, ten, and fifteen years’ duration. These histories were characterized by the usual alternations of acute gastric distress and periods of well-being. These data are presented t o illustrate the relatively short history of gastric cancer and the long history of chronic peptic ulcer. Erroneous diagnoses are frequently made. For example, cancer of the stomach occurring in young patients in good general health is seldom diagnosed. Gastric cancer may exist in the presence of gastric hyperacidity. The diagnosis of cancer may be incorrectly made in old patients in poor general health, who are suffering from chronic peptic ulcer. Gastric cancer may be present in certain cases, when ‘ the radiographic evidence points to chronic ulcer. GEORGET. PACK ’

Late Results Obtained by Gastrectomy for Cancer of the Stomach (125 Observations), HENRIHARTMANN. RBsultats Bloignes de la gastrectomie dans le cancer de I’estomac (125 observations), Bull. Acad. de mBd., Paris 107: 95-98, 1932. In this article, Professor Hartmann has reviewed his results in 125 patients who survived gastrectomy for carcinoma. At the time of the report 24 patients had survived without recurrences; one for three months, one for seven months, six for one year, two for three years, one for four years, one for five years, four for six years, and one each for seven, eight, ten, twelve, eighteen, twenty, twenty-six and twenty-seven years. Nine patients died of intercurrent disease without evidence of recurrent carcinoma. Eighty patients died of recurrences; 31 in the course of

ABSTRACTS

the first year, 35 in the second year, 8 in the third year, and 6 in the fourth year. There was no knowledge of the cause of death in 13 patients, although some may have died of late recurrence, as Hartmann has observed it seven, eight, and nine years after operation. Thirty-nine patients (31 per cent) survived three years without evidence of carcinoma, Le., three-year cures, but 6 of these patients ultimately died of recurrent gastric cancer. Recurrence in the stomach itself is unusual; only one of Hartmann’s patients developed carcinoma in the stomach after gastrectomy had been performed. The usual sites of recurrent gastric carcinoma are the perigastric, prevertebral, and prepancreatic lymph nodes, the liver, the peritoneum, and occasionally the vertebral column (two cases). The author stresses the secondary development of other tumors in patients who have had partial gastrectomy for cancer. Two carcinomas of the colon were considered to have developed by grafting of detached cancer cells of the ulcerated stomach into the colon, causing death nine months and two years respectively after gastrectomy. GEORGE T. PACK Linitis Plastica: A Study of Ten Cases, C. P. HOWARD.Quart. J. Med. 2 (n. s.): 59-78, 1933. The author defines linitis plastica as (‘clinically a skiagraphic and, in the post-mortem, a gross contraction of the stomach, caused most frequently by a fibrosing cancer, occasionally by syphilis, and possibly in rare cases by a simple inflammatory process. The fibrosis involves chiefly the submucosa and to a less extent the other layers, sometimes extending to the connective tissue in the region bordering on the stomach.” He gives, in chronological order, no fewer than fortytwo names that have been hestowed on this lesion by different writers, and describes 10 cases from the Montreal General Hospital material. In 8 of these cases a histologic diagnosis of sclerosing carcinoma was made a t laparotomy (biopsy) or a t autopsy; in the ninth case the condition was inoperable, and in the tenth operation was declined, but in both of these the clinical features were those of sclerosing carcinoma. The author concludes, from a study of cases reported in the available literature and from his own experience, that the majority of cases of linitis plastica belong to the sclerosing type of gastric carcinoma. It is hardly possible to deny absolutely the existence of a benign form of linitis, the so-called gastric fibromatosis, but it seems probable that many of the cases so diagnosed have not been submitted to a careful enough histologic examination to exclude a malignant process. The author also suggests that, while syphilis may be an exciting factor in a certain number of cases, in most cases of so-called syphilitic leather-bottle stomach the infection has been secondary. The clinical picture of probably every case, whatever the etiology, is that of a rather chronic form of carcinoma. I n doubtful cases exploratory laparotomy should be carricd out, and where possible some radical form of surgical procedure’undertaken. The author gives six illustrations and an extensive bibliography. F. CAVERS Gastric Cancer Perforating into the Free Peritoneal Cavity, A. PUECH A N D J. J. VIDAL. Cancer gastrique perforb en peritoine libre, Arch. SOC.d. sci. mbd. et biol. de Montpellier 13: 22-23, 1932. Gastric cancers seldom perforate. The perforation of malignant gastric ulcers is usually preceded by the formation of protective adhesions rendering the prognosis less serious. The perforation may occur into a neighboring organ; the most frequent is the establishment of a gastrocolic fistula. Jafsson has discussed this subject at length (Les perforations du cancer de l’estomac, Paris ThBse, 1911).

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The author’s patient was a fifty-year-old man who complained of dyspepsia of ten years’ duration. The variability in symptoms, the transient character of the pain, and the long history of his complaint led to a diagnosis of chronic gastritis, The patient later entered the hospital with an acute peritoneal syndrome, a distended, hard abdomen, fast, weak pulse and hippocratic facies. Operation was refused. Necropsy showed a perforated prepyloric cancer, the peritoneal cavity being free of all adhesions. GEORGET. PACK

Case of Carcinoma of the Stomach Occurring in a Patient with Atrophic Gastritis W h o Had Recovered from Addison’s Anaemia, N. S. PLUMMER AND C, K. SIMPSON.Guy’s Hosp. Rept. 81: 407-417, 1931. A sixty-three-year-old man dated the onset of his illness in 1922. In 1926 he entered Guy’s Hospital, a t which time examination showed hemoglobin 25 per cent and erythrocytes one million per cu. mm. of blood. The color index was 1.25. There was complete absence of hydrochloric acid in the gastric contents. The diagnosis was pernicious (Addison’s) anemia, and treatment consisted in three blood transfusions and the administration of liver and arsenic. Five weeks later the hemoglobin was 85 per cent and the erythrocyte count four million two hundred thousand, with a normal color index. On readmission, in 1931, the red blood count was normal, but the achlorhydria persisted and there was occult blood in the stools. The patient had recently discovered large, firm cervical lymph nodes. Radiographic study showed gastric retention and a prepyloric filling defect. The diagnosis was carcinoma of the stomach metastatic to cervical nodes, secondary to chronic gastritis, and occurring in a patient who had recovered from pernicious anemia. The patient refused operation. The cervical lymph nodes later suppurated and were found to be tuberculous. A partial gastrectomy was done but the patient died after evisceration occurred during a state of maniacal excitement. The microscopic report was “ ulcerating, infiltrating adenocarcinoma developing on the basis of chronic atrophic gastritis.” The achlorhydria was caused by the atrophic gastritis rather than by the gastric cancer, since it had been discovered five and one half years before the radiographs. GEORGET. PACK Sarcoma of the Stomach, E. V. ASKEY,E. M. HALLAND K. S. DAVIS. Western J. Surg. 39: 839-847, 1931. Only 335 cases of sarcoma of the stomach were reported prior to 1930. These cases comprise one per cent of all gastric tumors. Males are predominantly affected (70 per cent). The average age of the patients (forty-one years) ie considerably less than for carcinoma of the stomach. There is no significant etiological relationship to gastric ulcer. Benign gastric polyps seldom undergo sarcomatous changes. Sarcomas of the stomach are classified histogenetically as: (a) fibrosarcomas and spindle-cell sarcomas of connective-tissue origin; ( b ) myosarcomas of smooth muscle origin (5 to 7 per cent of all gastric sarcomas) ; (c) lymphosarcomas originating in the lymphoid follicles of the submucosa; ( d ) endotheliomas of vascular origin. A regional classification is sometimes employed: (a) exogastric sarcomas, usually large pedunculated tumors; ( b ) endogastric sarcomas, chiefly sessile, with intact mucosal covering and later ulceration and hemorrhage; (c) intramural sarcomas, frequently myosarcomas or infiltrating lymphosarcomas. Gastric sarcomas are seldom diagnosed as such preoperatively. They are usually situated in the epigastrium or under the left costal margin and are larger and more easily palpable than the average carcinoma of the stomach. Their mobility is an important characteristic, and they seldom cause pain. Sarcoma rarely obstructs the cardia or pylorus sufficiently to induce vomiting, hence there

1038

ABSTRAOTS

is seldom a necessity for gastro-enterostomy or gastrostomy. Cumston has classified these tumors into three groups, according to their symptomatology : (a) the latent form, ( b ) a n abdominal tumor with gastric signs simulating ulcer or carcinoma, and (c) an abdominal tumor without gastric symptoms (Am. ,J. 8iirg. 3: 111, 1927). The authors present a case report of lymphosarcoma of the.stomach diagnosed preoperatively as Banti’s splenomegaly with anemia. Resection of the stomach is the treatment of choice if the tumor is operable. Radiation therapy is said to be dangerous because of the possibility of necrosis and hemorrhage. GEORGET. PACK

Report of a Case of Sarcoma of the Stomach, C. L. GILSTRAP. Western J. Surg. 39: 848-852, 1931. A fif ty-four-year-old woman complained of asthenia, dyspnea, insomnia, hematemesis, nausea of seven years duration, and melenn intermittently for three years. A movable tumor the size of a grapefruit was palpated in the epigastrium. Because her hemoglobin was only 21 per cent, two blood transfusions were given. The patient recovered from a subtotal gastrectomy. The bulky tumor situated on the lesser curvature was diagnosed as a leiomyosarcoma. GEORGET. PACK Fibroma of the Stomach, C. PAN^. Sui fibromi dello stomaco, Tumori 6: 216-232, 1932. The patient was a man aged sixty-five, with a history of vomiting, anorexia, and loss of weight. Roentgenograms substantiated a diagnosis of carcinoma of the stomach, but when autopsy was done a single large pedunculated fibroma arising from the lesser curvaturz was found. P a d tabulates reports of 28 similar cases which he collected, Good photographs of the tumor and a bibliography are included. C. D. HAAGENSEN Leiomyoma of the Stomach, Report of a Case, 0.H. FULCHER.Proc. Staff Meet. Mayo Clin. 6: 547-549, 1931. A man of forty-four complained of epigastric distress, loss of weight, and weakness. Examination revealed a firm, movable mass in the epigastric region, about 8 cm. in diameter. The concentration of hemoglobin was 13.3 gm. to 100 C.C. of blood. The leukocyte count was 5,300 per cu. mm. of blood. There was blood in the stools. Examination of the gastric contents showed a concentration of total acids of 38 and of free hydrochloric acid 24. Roentgen examination gave evidence of a large, hard polypoid tumor of the middle third of the stomach. This proved to be a leiomyoma 6 cm. in diameter with a hemorrhagic ulceration 2 cm. x 1.5 ctn. x 5 mm. on the surface. Following resection of about a third of the stomach and a posterior Polya type of anastomosis, the patient made an uneventful recovery. While the symptoms in this case, especially the secondary anemia, and the roentgen picture suggested a benign growth, the fact that the tumor could be palpated led to the preoperative diagnosis of malignancy. A Myoma of the Stomach and a Myosarcoma of the Cecum, F. NEUGENBAUER. Uber ein Myom des Magens und ein Myosarkom des Zokums, Bruns. Beitr. Z. klin. Chir. 156: 476-479, 1932. The first patient reported by Neugenbauer was a man fifty-six years of age with a large tumor situated in the peritoneum between the stomach and the transverse colon. This mass, together with a portion of the wall of the stomach and 13 cm. of the transverse colon, was removed, and the patient made a satisfactory recovery. The tumor weighed 3 ) kg. and measured 60 cm. at its greatest circumference. Histologic examination showed it to be a leiomyoma derived from the longitudinal musculature of the stomach.

T H E DlGESTIVM TRACT

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The second patient was a woman forty-eight years of age with a small, movable, tender tumor in the region of the cecum. Roentgenograms of the colon showed no gross abnormalities. At operation a nodular, yellowish-white, pedunculated tumor about the size of a walnut was found in the wall of the cecum. Histologic examination showed i t to be a myosarcoma. The tumor and adjacent intestine were resected, and the patient has remained well for one year. This article is illustrated with photographs of the gross specimens, but photomicrographs and detailed descriptions of the morphology of the tumors have been omitted. BENJAMIN R. SHORE

Case of Multiple Lipomas of the Small Intestine, A. ESSER. Ein Fall multipler Dunndarmlipome, Centralbl. f. allg. Path. u. path. Anat. 55: 6-9, 1932. Report of a case in which eight small lipoinas were found in the lower part of the jejunum at autopsy. They were submucous, raising the mucosa up slightly and had caused no symptoms during life. Myxofibroma Invading the Small Intestine, F. AMAN-JEAN A N D M. PERROT. Myxo-fibrome envahissant de l’intestin grele, Ann. d’anat. path. 8: 1260-1264, 1931.

A sixty-one-year-old woman had intestinal obstruction of eight days’ duration. For eight to ten months previously, she had presented the typical syndrome of Konig, phases of partial intestinal obstruction occurring with increased frequency and accompanied by marked meteorism and pre-umbilical pain. At operation a tumor the size of a walnut was found to have invaded the intestine a t the junction of jejunum and ileum, causing a small intussusception. The tumor invaded all layers of the intestine and projected as a polypoid mass into the jejunal lumen. On histological examination, the structure resembled an edematous fibroma, with many stellate cells, probably myxoblasts. This neoplasm was classified as benign, although its invasive properties were well established. GEORGET. PACK

Case of Intussusception Due to a Solitary Polyp of the Small Intestine, A. JONA. Un caso di invaginazione da polipo solitario del tenue, Tumori 6: 262-268, 1932. Jona’s patient was a seventeen-year-old girl who over a period of two months had had several attacks of sharp abdominal pain and vomiting. I n the lower abdomen a tumor was felt. It increased in size over a period of a few days, the symptoms of intestinal obstruction meanwhile becoming more acute. Operation showed an intussusception of the ileum caused by a small polyp a t the apex of the intussusceptum. Intestinal resection was successfully done. The polyp was not examined microscopically. C. D. HAAGENSEN Roentgen-Ray Picture of Cancer of the Colon, 0. DYES. Systematisches zum Rontgenbild des Dickdarmkarzinoms, Fortschr. a. d. geb. d. Rontgenstrahlen 46: 287-295, 1932.

I n order to study the various roentgen pictures that may be found in carcinoma of the colon, the author has made roentgenograms of the intestines before operation and also of the resected portion of the colon bearing the tumor after operation. The appearance of the intestinal mucous membrane and of the tumor vary somewhat in the living patient and in the postoperative specimen. The author has found that the ordinary method of filling the colon with the opaque medium does not give clear pictures of the turnor or of the intestinal niucosa, and lie uses instead two other methods: filling the colon with a smaller amount of opaque medium combined with air; and using a smaller amount of the opaque medium sufficient to coat the mucous membrane without air inflation. The study of the postoperative

1040

ABSTRACTS

specimens by this method aids in the interpretation of the findings in the living patient. In one of the cases studied the tumor projected into the lumen of the intestine and was coated with a layer of the contrast medium; the roentgen picture made previous to the operation showed much the same appearance as that of the posfoperative specimen with a small amount of opaque medium without air; the surface of the tumor appeared to be more uneven in the former, in accordance with the findings on section. In the second case examination before operation showed only a stenosis, while the roentgenograms of the postoperative specimen showed the tumor more definitely.

Primary Lymphosarcoma of the Rectum, J. CARLSuTi?oN. Canad. M. A. J. 26: 71-73, 1932. The pathology department of the Montreal General Hospital accumulated fifty-eight surgical specimens of rectal carcinoma but only one lymphosarcoma during the past decade. Lymphosarcoma may be polypoid, but its firm texture and smooth surface distinguish it from the irregular, soft, and cystic adenomatous polyps. It tends to become voluminous and obstruct the rectal lumen. Its position in the rectum is lower than that of most carcinomas. Pain, ulceration, and bleeding are of late onset, since lymphosarcoma does not invade the rectal mucosa as early as carcinoma. An illustrative case report of primary lyniphosarcoma of the rectum is presented. A fifty-five-year-old man had complained for five weeks of rectal bleeding, constant desire to defecate, and dull pain in the sacrococcygeal region aggravated by defecation. A large nodular mass, covered by intact, freely movable mucosa, could be felt within an inch of the anus. The treatment decided upon was colostomy, perineal resection of the rectum, and interstitial radium therapy. The final diagnosis was primary lymphosarcoma of the rectum, GEORGE T. P A C K

THE LIVER Syndrome of Acute Metastatic Carcinoma of the Liver, R. HUGWENIN, P. I’’ OULON AND C . ROSENRATJCH. Syndrome metastatique aigu du foie, Ann. d’anat. path. 8: 1166-1172, 1931. The authors describe a syndrome said to be characteristic of acute metastatic carcinoma of the liver. This syndrome usually appears five to eight days following operation and it is assumed that the manipulations during the operation release showers of cancer emboli which lodge in the liver. The clinical features simulate an infectious hepatitis, but an important differential sign is the absence of leukocytosis. The liver is enlarged and tender; violent abdominal pain occurs accompanied by a high fever. This condition is followed shortly by the hemorrhagic phase of the syndrome, characterized by prolongation of the bleeding and coagulation times, purpura, and hemorrhages into various viscera. An illustrative casc T.P A C K report is presented. GEORGE Blood-forming Liver Adenomas in Man, A. SSOLOWJEW.Uber Blutbildung in Leberadenomen beim Menschen, Beitr. z. path. Anat. u. z. allg. Path. 88: 337-348, 1932. Two liver adenomas found a t autopsy are described. The first, which occurred in a six-year-old child, was a small nodule made up of cords of large liver cells. Within its capillaries were groups of immature blood cells in various stages of development.

THE PANCREAS

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The second tumor was found in a ten-months-old child, and involved a large part of the left lobe of the liver. It was made up of cords of liver cells, and of masses of polymorphous undifferentiated epithelial cells. Areas of hyaline and osteoid tissue were seen. This tumor also contained capillaries filled with immature blood cells. Five photomicrographs and a bibliography are included. C. D. HAAGENSEN Polycystic Liver Simulating a Cancer of the Stomach, ROUHIERAND PALMER. Foie polykystique ayant sirnu16 un cancer de l’estomac, Bull. et m6m. SOC.nat. de chir. 57: 1452-1457, 1931. The authors’ patient had a large epigastric tumor resembling a bulky carcinoma of the stomach. There was some dysphagia and constant vomiting, yet the patient retained an excellent appetite and digested perfectly all food he was able to swallow. At operation the obstruction a t the cardia was found to be due to extrinsic pressure by a polycystic liver. A biopsy from the liver was reported as biliary cystadenoma associated with subacute cirrhosis. The patient also had a left polycystic kidney. The coexistence of polycystic kidney and polycystic liver GEORGET. PACK has long been recognized as not infrequent.

THE PANCREAS Cancer of the Pancreas, E. BENHAMOU AND J. MONTPELLIER. Cancer du pancreas, Arch. d. mal. d. l’app. digest. 22: 21-29, 1932. Carcinomas of the pancreas are seldom palpable. They are situated deep in the epigastrium and rarely surpass the dimensions of a closed fist. The authors present the case of a thirty-two-year-old man in good general health, who complained only of dyspepsia of the hypersthenic type. A large tumor resembling a splenomegaly appeared in the left hypochondrium. It was associated later with an irregular and intermittent fever, chills, and profuse perspiration. The relative fixity of the tumor, its tendency to invade the epigastrium, and tympany over the spleen led to the diagnosis of either carcinoma of the stomach or pancreatic cyst, although the possibility of malignancy was not strongly considered because of the patient’s age. X-ray examination showed a typical filling defect caused by extrinsic pressure on the duodenum; the x-ray diagnosis of pancreatic tumor was confirmed a t operation. The neoplasm was classified as an atypical anaplastic undifferentiated carcinoma. The authors have adopted the classification suggested by Oberling and Guerin (Cancer du pancrths, Paris, G. Doin et Cie, 1931) for carcinomas of the pancreas: (a) exocrine carcinomas, (b) endocrine carcinomas, T. PACK GEORGE and (c) atypical carcinomas. Cancer of Pancreas with Metastasis in Ovaries, T. HIRAI AND J. NAKAGAWA. Jap. J. Obst. & Gynec. 14: 467-469, 1931. This is a clinical report of a carcinoma of the pancreas with metastases to the ovaries. The patient, a woman forty-eight years of age, gave a history of jaundice, abdominal discomfort, and gradual enlargement of the abdomen of one year’s duration. Only after operation and microscopic examination of the mass in the pancreatic region was this identified as the primary growth. A photomicrograph accompanies the publication. W. S. MACCOMB Fat Necrosis due to Carcinomatous Metastasis in the Pancreas, E. MATHIASAND H. BOCK. Auslosung einer Fettgewebsnekrose durch Metastasierung eines Karzinoms in das Pankreas, Centralbl. f . allg. Path. u. path. Anat. 55: 177-180, 1932. A case of a woman forty-one years of age in which a clinical diagnosis of mediastinal carcinoma with gland and liver metasta.ses was made is reported. The

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patient died suddenly and a t autopsy the primary tumor was found to be a bronchial carcinoma, which in some areas showed a structure suggesting sarcoma. There were numerous areas of fat necrosis in the abdomen, especially in the region of the pancreas and the great omentum. There were carcinomatous metastases in the pancreas, which had caused hemorrhages and necrosis. The authors note that metastasis to the pancreas is not rare in bronchial carcinoma.

Unusual Lipomatosis of the Pancreas, 0. MICHAELIS. Ungewohnliche Lipomatosc des Pankreas, Centralbl. f. allg. Path. u. path. Anat. 55: 131-133, 1932. Michaelis reports a case with the characteristic symptoms and renal pathology of lipoid nephrosis, in which the pancreas was entirely replaced by nodular, light yellow tumor tissue, considered from its gross appearance to be a liposarcorna. Histologic examination, however, showed that the mass consisted almost entirely of fatty tissue, with no evidence of a malignant tumor.

Anatomic Findings in Spontaneous Hypoglycemia Produced by Multiple Pancreatic Island Adenomas, AUGUSTT E R B R ~ ~ QAnatomische EN. Befunde bei spontaner Hypoglykiimie infolge multipler Pankreasinseladenome, Beitr. z. path. Anat. u. z. allg. Path. 88: 37-59, 1931. Terbriiggen’s patient was a woman aged thirty who died in coma with hypoglycemia. Autopsy showed multiple, encapsulated, yellow nodules in t h e midportion and tail of the pancreas. Histologically these nodules proved to be adenomas which showed island hyperplasia. The liver contained no glycogen, and the organs were poor in fat. Seven photomicrographs and an extensive bibliography arc included. C. D. HAAGENSEN Cystadenoma of the Pancreas, C. HARMS. t h e r ein Zystadenom des Pankrcas, Centralbl. f. allg. Path. u. path. Anat. 55: 53-56, 1932. I n a woman seventy-three years old a pre-operative diagnosis of gastric carcinoma was made; but a t operation a tumor a t the head of the pancreas was found pressing the stomach downward. Histologically this tumor was found to be a benign cystadenoma. The smaller cysts were lined with a single layer of cubical epithelium; in the larger cysts this epithelial lining was flattened so that it had the appearance of endothelium. The connective-tissue stroma showed calcification in the center and contained smooth muscle fibers not related to the blood vessels. There are 53 examples of cystadenoma of the pancreas in the literature. Most of these cases have occurred in women of advanced age. I n only 6 out of 31 cases in which the exact site of the tumor is reported, was i t found in the head of the pancreas. RETROPERITONEAL TUMORS, CYSTS AND TUMORS 011” TIIE MESENTERY

Retroperitoneal Ganglioneuroma, C. JACKSON A N D W. W. BABCOCK.Surg. Clin. North America 11: 1233-1238, 1931. A case report is presented of a retroperitoneal ganglioneuroma occurring in a fourteen-year-old boy, who had had an insidious enlargement of the abdomen for fourteen months. These tumors originate in sympathetic ganglia of the neck, thorax, and abdomen, probably as the result of ectopia of embryonal cells. The majority of these neoplasms are benign and do harm by their mass and pressure on vital structures.

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The gross pathologic picture of this tumor is of pale, yellowish tissue in which fine trabeculae divide the cut surface into larger lobules. On microscopic examination, bundles of myelinated and non-medullated nerve fibers are seen to be supported by a connective-tissue stroma of spindle and stellate cells, collagen fibrils, and a n interstitial mucoid matrix. The ganglion cells, both unipolar and bipolar, are of the sympathetic type. GEORGE T. PACK

Rare Mesenteric Cyst, H. F. HARBITZ. Eine seltene, aber typische Mesenteridcyste, Acta chir. Scandinav. 70: 28-38, 1932. A boy five years of age was operated upon because of symptoms of intestinal obstruction. A cystic mass was found surrounding the small intestine and compressing it. On examination the excised mass was found to consist of cysts arising from the mesentery. Two separate groups were found, the contents differing, one being a milky chyle, the other a gelatinous serum. There was no communication with the intestines. The outer layer of the cyst wall was composed of serosa, underneath which was a layer of muscle tissue arising from the musculature of the intestinal wall; the rest of the cyst wall consisted of loose connective tissue with a lining of endothelial cells. These cysts occur in children or young persons, as a rule. Radical operation with resection of the intestinal segment involved is the treatment of choice. Obstruction of Inferior Vena Cava and Recurring Mesenteric Lipoma: Report of a Case, C. W. MAYO. Proc. Staff Meet. Mayo Clin. 6 : 649-651, 1931. A man of fifty years complained of ten years’ intermittent indigestion. Two years before admission he suffered a fracture of the right femur. After removal of the cast the leg was swollen and painful and as the swelling subsided large tortuous veins appeared over the legs, abdomen, and lower part of the thorax. The patient observed that the blood ran upward in these veins. Examination showed a markedly distended abdomen with tortuous veins and a large apparently peducc ulated tumor, which appeared to fluctuate and transmit impulses on percussion. A diagnosis was made of cystic abdominal tumor arising probably from the pancreas and obstruction of the inferior vena cava. At operation a pedunculated lipoma arising from the stem of the mesentery was removed along with two or three smaller tumors of similar nature. It proved to be a fibrolipomyxoma with early degeneration. About two years and a half later the patient was again seen complaining of digestive disturbance and enlargement of the abdomen, and a large fibrolipomyxoma (14 lb.), also arising from the stem of the mesentery, was removed. I n the discussion of this case it was stated that there was no direct evidence of any relationship between the tumor and the obstruction of the vena cava. T H E SPLEEN

Sarcoma of the Spleen, LOUISFRANK.Am. J. M. Sc. 183: 77-81, 1932. Primary sarcomas of the spleen are rare. Frank presents two case reports of splenic lymphosarcoma. I n one patient the disease resembled pernicious anemia, with a high color index, leukopenia, and an increase in the icteric index of the blood. Lymphosarcoma is the most common histologic variety of sarcoma of the spleen. The characteristic symptoms are splenomegaly, pain in the left hypochondriiim, left shoulder and back, indigestion, flatulence, constipation, secondary anemia, and occasionally jaundice and anasarca. The diagnosis is made on the basis of the rapidity of growth and by exclusion of the other causes of splenic enlargement. Frank asserts that splenectomy is the only curative treatment, but at the same time he realizes t h a t lyniphosarcoma of the spleen is usually only part of a generalized disease. GEORGE T. PACK

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T H E FEMALE GENITAL TRACT

New Instrument for Determining the Focus in Gynecological Deep Therapy, FRITZ STAHLER. Ein neues Zielinstrument zur Erleichterung des Einstellens bei gynakologischen Tiefenbestrahlungen, Strahlentherapie 44: 475-480, 1932. When irradiating a patient through several portals it is necessary that all of the beams be focussed exactly on the chosen site. If that is considered as the center of a sphere then the beams must pass along the radii. The instrument here described is designed to locate the center of such a sphere and to indicate exactly its various radii. It consists of an upright standard on which is a sliding lug whose height can be adjusted. To this lug is attached by its lower end an arm which can be rotated through a vertical angle. The arm in its various positions represents the radii. A second horizontal arm, also movably attached to the standard, can be adjusted so that its distal end touches the surface of the patient directly above the point to be irradiated. If that point is 5 cm. below the surface, the axis of the first arm is fixed 5 cm. below the second. The x-ray tubes are arranged so that their central beams will coincide with the direction of the radial arm. CHARLES PACKARD Delimitation of the Matrix and Carcinoma Zones in the Region of the Cervix and Vagina, HANS HINSELMANN.Uber die Abgrenzung des Matrix- und des Karzinomgebietes im Bereicii der Portio und Scheide, Munchen. med. Wchnschr. 78: 1094-1097, 1931. Hinselmann asks a t what point one is to draw the line marking the lower lirnit of carcinomatous growth in the cervix and vagina and in answer emphasizes that the limit will depend very largely upon the method of investigation, whether by the eye, the colposcope, or the microscope. Below the carcinoma stage one must recognize the matrix from which the cancer arises, and in such recognition the colposcope is of great aid. Such a suspicious soil must be excised, for upon microscopic examination it may be found that very early cancer is already present. The morphology of the matrix, and especially that of leukoplakia, has been exhaustively studied by Hinselmann, who has developed a detailed classification upon which he has written elsewhere. See, for example, an admirable paper in Veit-Stoeckel, Handbuch der Gynakologie, vol. VI, Pt. 1, page 854; also Klin. Wchnschr. 9: 1507, 1930. [Hinselmann’s studies have received such wide publicity that an attempt a t critical evaluation appears in order. His teaching may be said to have developed into a threefold doctrine, pertaining to the etiology, diagnosis, and social control of cervical cancer. The histologic changes in the cervix which constitute leukoplakia consist essentially in a hyperplasia of the basal layer of cells, a more pronounced development of the epidermal papillae, and a subepithelial round-cell infiltration. In certain cases of this condition cellular changes are found which, were any tendency to invasion present, would justify a diagnosis of cancer. Four cases with untreated leukoplakia were observed over a period of years by v. FranquB, and all four were later found to have developed cancer. On account of the morphology, the clinical history of v. FranquB’s cases and the alleged malignant tendency of leukoplakia elsewhere in the body, Hinselmann maintains that cervical leukoplakia is an irreversible process leading to cancer, and may justifiably be termed precancerous. The second part of Hinselmann’s doctrine teaches that these potentially dangerous lesions can be recognized clinically with any ease and frequency only by means of the special illumination and magnification offered by the colposcope, which is only a specially constructed low-power binocular microscope provided with a powerful illuminating system. Although the lesion has been regarded as

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rare, leukoplakia can be demonstrated by means of this instrument in about one per cent of all patients examined. The obvious conclusion is reached that cervical cancer can perhaps be largely prevented by use of the colposcope and amputation of the portio vaginalis in all cases in which leukoplakia is discovered. An enthusiastic disciple has recently written: ‘I A colposcopic examination must come to be a part of every periodic health examination, of every examination for life insurance, and should be as familiar and routine as an urinalysis and a blood examination.” (Ries, Am. J. Obst. & Gynec. 23: 399, 1932). Hinselmann’s histologic studies are of considerable interest and their clinical significance may eventually prove to be of importance. At present several long gaps remain in the proof that the incidence of cervical cancer can be materially lowered by discovery and elimination of leukoplakia. As Martzloff has pointed out in a recent article (Am. J. Obst. & Gynec. 24: 57, 1932. Abet. in Am. J. Cancer 17: 849, 1933), the presence of carcinoma-like tissue on the surface of the cervix is not final evidence that ultimate invasion will occur, nor are the cited cases of the later development of cancer in patients in whom leukoplakia had been observed, necessarily to be regarded as examples of the origin of cancer directly on the site of the leukoplakia. In particular is there no evidence that all or even a small proportion of the minute areas of leukoplakia detectable only by the colposcope will become carcinomatous. Finally, it is not known whether the cases of cancer arising on a basis of leukoplakia form an important or only a minor but interesting part of the total cases of cervical carcinoma. Both the new doctrine and the new instrument are being brought before the medical world by enthusiastic advocates. The large amount of work already published on the subject appears a t first excessive and is doubtless to be attributed to the sincere belief of its authors in the importance of their mission. It will justify itself if present claims are substantiated. A particular need a t present, if the new method of diagnosis is to be widely applied and not limited to a few special clinics, seems to be a less expensive instrument.] HOWARD C . TAYLOR, JR.

Present Status of the Treatment of Carcinoma of the Uterus, G. G. WARD. Minnesota Med. 14: 943-952, 1931. A plea is made for establishing efficient cancer clinics in general hospitals, closely connected with a radiotherapeutic institute. The general practitioner is urged to aid in reducing the 80 per cent of patients now applying for treatment of uterine cancer in the advanced stage. In Ward’s opinion the Wertheim hysterectomy in the best hands will give as good results as radium in the early cases of cancer of the cervix, but at the cost of a high operative mortality and morbidity and loss of time; in the inoperable cases radiotherapy has no rival, giving 12 per cent cures and much palliative benefit. The results of leading clinics are compared with those at the Woman’s Hospital, New York, where in the period 1919-1924, 259 cases were seen and 251 treated with 361 applications of radium. The mortality was 4 or 1.1 per 100 applications. Of the 170 cases treated by standard technic, 35 were of Classes I and I1 (Schmitz) and gave 20 (57.1 per cent) five-year cures. In Classes I11 and IV, comprising 79.4 per cent of the 170 cases, there were 24 (17.7 per cent) five-year cures. The total curability was, therefore, 44 cases or 25.9 per cent. Follow-up records were complete in 96.4 per cent of the 251 treated cases. The standard technic consists of preliminary supportive treatments, transfusions where the red blood cells are less than 3,500,000 or the hemoglobin 50 per cent or less, spinal anesthesia, 2400 to 4200 mg. hrs. of radium, permanganate douches, monthly follow-up examinations, and re-radiation with small doses (300 to 1200 mg. hrs.) by tubes or platinum needles whenever evidence of beginning

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recurrence or vaginal metastasis is found. Of late, pelvic x-ray therapy has been added. Adenocarcinoma of the body of the uterus occurs in 10 per cent of all cases of uterine carcinoma, is operable in about 80 per cent, and has a five-year cure rate of about 60 per cent. The author believes that radium therapy combined with panhysterectomy is the ideal method of handling these cases. I n his conclusions he calls for prophylactic treatment of cervical injuries and disease and the comNELSON B. SACKETT pulsory registration of all cancer cases.

Modern Treatment of Cancer of the Cervix Uteri, H. S. CROSSEN.J. Missouri M. A. 29: 105-109, 1932. The author favors Adler’s method of radical vaginal hysterectomy with immediate implantation of radium through the vaginal operative wound, deep into the metastatic area of each side. Under local anesthesia, and with the aid of a deep paravaginal (Schuchardt) incision, the uterus, adnexa, and parametrium are excised and the peritoneum is closed. The ureter is then exposed and retracted medially while a rubber tube containing 50 mg. of radium with the usual metal screen is placed in direct contact with the tissues of the lateral pelvic wall. Gauze packing separates the tube from the ureter. The same method is used on the opposite side; a third tube is placed in the region of the uterosacral ligaments wherever involvement is suspected, and the whole is fixed by gauze packing. A retention catheter is used during the treatment, which lasts six to ten hours. Deep roentgen therapy follows after ten days and is repeated twice a t intervals of six months. I n certain cases additional radium treatments are given in the rectum and vagina about eight weeks after operation. The technical difficulties, bleeding, and shock are slight; and the author believes the method is valuable in well selected cases. [Why the title of this paper should read “ modern ” is not clear. The modern ” attitude is not to cut through tissues which may be invaded nor to rely upon obviously insufficient radiation.] NELSON13. SACKETT ((

Absolute Cures of Cancer of Cervix Uteri by Early Operation, J. L. FAURE. La guerison definitive du cancer du col uterin par I’operation precoce, Presae mCd. 40:585-586, 1932. That radical cure of cervical cancer by early operation is possible in nine out of ten cases must be shouted from the housetops in order t o convince the skeptical public and profession of this hopeful outlook with early treatment and of the superiority of surgery over radium in early cases. Of 185 cases seen during 1924, 1925, and 1926,28 were early, being 15 per cent of the total and 22 per cent of the 127 operated cases; one operative death gives a 3.57 per cent primary mortality; of 26 traced cases, 25 are cured (96.15 per cent). Although 8 of the follow-ups extended for only two t o four and one-half years, the author includes these cases since-contrary to the experience after radium-recurrences after eighteen months are rare. These excellent results are not surprising in view of the author’s earlier report (Bull. e t m6rn. SOC. de chir., Paris 46: 502, 1920) of 18 early cases with one death, 2 recurrences, and 15 or 83.3 per cent permanent cures. The conlbined series give 4.34 per cent operative mortality and 90.9 per cent curability. The most likely explanation is that in the first two or three months the pelvic lymph nodes are not invaded. While surgery had said its last word and radium has not, still the latter is not likely to better the above results. The Wertheim technic can be mastered by surgeons accustomed to pelvic work, if they will study it. The author pleads for the cancer organizations to issue posters emphasizing these excellent results. NELSONRSACKETT

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Radiotherapy of Cancer of the Uterus, J. I. RUSSINAND I. N. SLOBODSKOI. Med. Inst. Voronesch Rept. 1: 13-21, 1932. A report of 88 cases of uterine cancer followed up one year or less after intrauterine radium treatment. The author calls attention t o the fact that lesions limited t o the cervix and inner parts of the parametria do best, while treatment in postoperative recurrences usually fails. The type of treatment given is 6,000 mg. hrs. divided into six intra-uterine applications, one every six days. MAURICE LENZ Pyometra after Radium Treatment of Cancer of the Cervix, GUILHEM A N D GOUZY. Les pyometries apres traitement du cancer du col de I’ut6rus par le radium, Presse m6d. 40: 242-245, 1932. Following 751 radium treatments 8 cases of pyometra occurred (1.06 per cent). The predisposing causes are persistence of secreting corporeal glands with destruction of cervical glands, cicatricial contraction and stenosis of the cervix (due to radiation or to local recurrence of the neoplasm) with atony and overdistension of the corpus due to tissue destruction and infection, and suppuration due to persistence or lighting up of bacterial infection. Broad ligament thickening and cellulitis, peritoneal adhesions, and adnexal disease are found in connection with the uterine infection, which is always fetid from the presence of anaerobes. The onset may be from three weeks to several months after radium treatment. The closed type is distinguished from the open by absence of discharge, exaggerated signs of toxic absorption, infrequent occurrence or absence of colicky attacks, and the sound test. Local complications are spontaneous rupture of the uterus, phlebitis, adnexal disease, and pelvic abscess, while general symptoms result from toxemia, pyemia, or septicemia. These factors influence prognosis, which is more grave in the closed pyometra. The combination of colic, fever, fetid discharge, and growing uterine tumor, will differentiate the condition from uterine or parametrial recurrence, fibroids, and pelvic inflammatory conditions. Prophylaxis includes preoperative vaginal douches and vaccines, good radium technic, and occasional cervical dilation in the months following treatment. If this fails, prompt hysterectomy may be a safeguard. A well established case may be drained and irrigated with peroxide, extreme care being necessary in dilating the cervix. Hysterectomy or irradiation of the cavity may be necessary later. NELSON B. SACKETT Cancer of the Cervix in Nulliparous Women, Report of Three Cases, L. E. PHANEUF. New England J. Med. 206: 840-843, 1932. The author reports three cases of carcinoma of the cervix seen in a period of five months, and pleads for routine examination of nulliparous women. The ages of his patients were twenty-five, twenty-eight, and thirty-four years. All were treated with radium and were under observation a t the time of the report. NELSONB. SACRETIT Frequency of Errors of Diagnosis in Uterine Fibromata; Means of Avoiding These Errors; Reflections on the Therapy of Fibroids, J. DUCUING.Frbquence des erreurs dans le diagnostic des fibromes ut6rins; moyens d’6viter ces erreurs; reflexions sur la therapeutique des fibromes, Bull. et m6m. SOC.de radiol. m6d. de France 19: 525-531, 1931. In 2.50 hysterectomies for “ fibroma ” the diagnosis was “ doubtful ” in 20 cases. Only 6 of these proved to be fibroids, an error of 70 per cent. I n the other cases the diagnosis was “ certain,” yet in 70 cases, or 30 per cent, i t proved incorrect. In 30 of these the error lay in the failure to detect coexistent pathology. The

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other 40 cases which were diagnosed erroneously included 27 ovarian cysts, 4 cases of tuba1 disease, 3 solid ovarian tumors, 3 cancers of the corpus uteri, and 3 cases of encysted hematocele. The author emphasizes the importance of evacuation of the rectum and bladder, gentle palpation in supine and Trendelenberg positions, rectal examination, exclusion of pregnancy and uterine cancer, the AschheimZondek test, and direct or lipiodol radiography. In doubtful cases laparotomy is preferable to x-ray therapy, a8 it is also where epithelioma is suspected, where adnexal disease coexists, in subniucous, subserous, very large, calcified, multiple, or pedunculated tumors, and in young women. All other cases-about 70 per cent of the total-are irradiated, avoiding the 6 NELSONB. SACKETT per cent surgical mortality.

Spontaneous Expulsion of a Uterine Fibroid, K. W. BRUMBACK.Kentucky M. J. 29: 592-593, 1931. A forty-one-year-old woman had a severe metrorrhagia, and after excruciating cramps expelled a leathery mass as large as a grape-fruit. The cut section was NELSONB. SACKETT typical of fibroid. Pregnancy and Fibromyoma, Report of Case Complicated by Rectal Obstruction, S. R. MEAKER. New England J. Med. 205: 679, 1931. A nulliparous, married, forty-two-year-old patient, with amenorrhea for three months, complained of severe constipation with blood-streaked ribbon-stools. Behind the pregnant uterus was a hard fibroid 9 cm. in diameter, incarcerated in the hollow of the sacrum. It was removed and the patient was delivered at term NELSONB. SACKETT by cesarean section. Saccular Dilatation of the Lower Segment of the Fibroid Uterus in Pregnancy, G. MULLER. Dilatation sacciforme du segment inferieure de l ’ u t h s fibromateux gravidique, GynBc. e t obst. 24: 730-735, 1931. Two cases are described in which fibroids complicating pregnancy resulted in a distention of the lower uterine segment. The first patient was brought to the hospital a t seven months on account of bleeding and severe abdominal pain. Vaginal examination disclosed a large mass in the cul de sac and the cervix pushed forward under the symphysis. Following a partial reposition of the uterus and a packing of the cervix, a spontaneous delivery was accomplished. A few months after delivery myomectomy was performed and a myoma 9 by 12 cm. enucleated from the fundus. In the second case pregnancy was normal until labor began. Upon examination numerous nodules were felt in the uterus, the anterior vaginal fornix was filled by a hard mass, the posterior was very deep, and the cervix undilated and high up near the concavity of the sacrum. The patient was delivered by Cesarean section and hysterectomy practised on account of a fibroid the size of an adult head springing from the fundus of the uterus. Muller points out that the first tumor probably caused trouble through adhesions which displaced and restricted the uterus, while in the second the tumor was responsible at the time of labor for disturbing the normal axis of descent of the fetus. HOWARD C. TAYLOR, JR. Two Cases of Primary Sarcomata in the Pelvic Connective Tissue, N. STROMBERG. Acta Obst. e t Gynec. Scandinav. 12: 85-90, 1932. A woman of fifty, who had one child, complained of heaviness in the pelvis, cystitis, a yellow mucoid discharge sometimes blood-tinged, and hemorrhages from the anus since the menopause a year earlier. The uterus was of normal size, partly prolapsed, and displaced to the left and downwards by a firm, elastic,

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lobular tumor the size of a child’s head, fixed in the pelvis and extending half way to the umbilicus. It was found to be hard but fragile, dull yellow, and bled easily. It was loosely attached t o the rectum only. The tumor issued from the posterior leaf of the right broad ligament. Histologically it was a spindle-cell fibrosarcoma. No node metastases were observed. The patient was well six months after operation. A second patient, a woman aged thirty-seven, had a hard tumor growing rapidly in the lower left quadrant. When divested of its covering of adherent thick omentum, the tumor was found to spring from the right uterovesical fossa a t the site of the round ligament; there was one metastasis as large as an egg, in the mesoappendix, but all other organs were normal except for a few miliary peritoneal metastases over the right kidney. The soft marrow-Like bloody tumor tissue presented varying cellular structure. Embryonal connective tissue elements with anastomosing fibrils, fibroblasts, areas in which the nuclei were arranged in palisade-like bands as in a neurinoma, numerous mitoses, and absence of collagen were indicative of sarcoma, although a malignant myoma is not excluded. The tumor of the mesoappendix showed the same structure. Six months later the patient was well but had palpable recurrences. Neoplastic growths in the pelvic connective tissue are of four types: (1) fibromata, lipomata and sarcomata developing primarily in the connective tissue; (2) tumors originating in embryonal remnants of organs, as the parovarium, Gartner’s duct, remnants of the embryonal kidney, and aberrant adrenal substance; (3) tumors growing into the broad ligament from the surrounding tissues, such as myomata and ovarian tumors, both solid and cystic; (4) metastatic tumors which either by continuity or along the lymph passages spread from the uterus, rectum, bladder, or ovaries into the ligament. The author found only 10 cases with an unmistakable diagnosis of primary sarcoma of the pelvic connective tissue in the literature from 1905 to date. Some of these he reviews. Roentgen Therapy of Ovarian Carcinoma, H. WINTZ. Die Rontgentherapie dcs Ovarialkarzinoms, Strahlentherapie 44 : 201-226, 1932. In the treatment of ovarian carcinoma an operation is always necessary because diagnosis is uncertain. Statistics show that the primary mortality after operation is 15 per cent. When the carcinoma is obviously operable, about 25 per cent of the cases are cured. For all cases the proportion of cures is about 10 per cent. Wintz believes that postoperative irradiation is followed by better results. About two-thirds of the abdomen must be irradiated. Because of the large area, the single doses must be small-not over 110-115 per cent of an erythema dose-for larger ones will cause serious injury, especially to the blood. The technic of exposure is given in detail. Wintz uses two or more large portals, through each of which 45 per cent of an erythema dose is given. A second exposure is given six to eight weeks later. In some instances a third may be given. Not all ovarian carcinomas need necessarily be irradiated, but when one has broken through its cyst and when even a very few metastases are present, radiotherapy is essential. Wintz reports that 40 per cent of his inoperable patients are living after three years, CHARLES PACKARD and 23 per cent after five years. Ovarian Epithelioma Mistaken for a Uterine Fibroma, Treated by Roentgen Therapy with Subsequent Rapid Growth of the Tumor, VIANNAY. Epithblioma de l’ovaire pris pour un fibrome ut6rin et trait6 par la roentgenthbrapie; accroissement rapide de la tumeur b la suite de l’irradiation, Loire mCd. 45: 525, 1931. Having declined operation for a supposed fibromyoma, a woman of forty-four was treated with x-rays. Five months later the tumor had doubled in size and

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ABSTRACTS

there was a metastatic node in the left infraclavicular fossa. Palliative panhysterectoniy was done and the patient lived nine months. The polycystic tumor of the left ovary consisted of solid masses, papillary vegetations, and pseudoglandular collections of epithelial cells with great variability and numerous mitoses. This case emphasizes the dangers of radiotherapy where there is any doubt as to diagnosis. NELSONB. SACKETT

Struma Ovarii, with a Note on the Iodine Content, E. 6. J. KINGA N D J. H. NORRIS. J. Coll. Surg. Australasia 3: 373-384, 1931. A concise review of thyroid tumors of the ovary and a bibliography accoinpany the report of three cases occurring in a series of 500 ovarian tumors. The first patient, aged forty-five, complained of nausea, epigastric pain, and irregular profuse periods. She was operated upon for a cystic tumor of the right ovary. This proved to be a 15 cm. unilocular cyst containing clear fluid, and having thin walls with a mass 5 X 2.5 cm. projecting into the cavity on one side. The thyroid tissue contained 11.1 mg. of iodine per 100 gms. The second patient, aged thirty-six, was two and one-half months pregnant, complained of lower abdominal pain for four months, and was operated upon for a tumor of the right ovary. The latter contained a single tooth and some ovarian cortex with the corpus luteum of pregnancy, but was otherwise entirely formed of thyroid tissue, containing 12.8 mg. of iodine per 100 gm. of dried gland. The third patient, aged forty-three, had symptoms attributable to a pedunculated tumor of the left ovary reaching to the level of the umbilicus. The derrnoid elements of this cyst were overshadowed by the bulk of thyroid tissue, again with typical acini containing colloid. NELSONB. SACKETT Vaginal Cyst as an Obstacle to Delivery in Face Presentation, WALTERSPITXER. Scheidencyste als Gehurtshindernis bei Gesichtslage, Zentralbl. f. Gyniik. 55: 2348-2350, 1931. A thirty-year-old primipara, after a labor of thirty-six hours, was found on examination to have a cyst in the vagina springing from the right lateral wall and preventing both the rotation and descent of the child’s head, which lay in a mentolateral face presentation. Following a puncture of the cyst, rotation and delivery were accomplished. This is believed t o be only the second case reported of dystocia due t o a vaginal cyst, which on account of its anatomic structure and its position was probably derived from embryonal rests of Giirtner’s duct. HOWARD C. TAYLOR, JR.

THE GENITO-URINARY SYSTEM

Tumors of the Kidney, B. 1,. CRAWFORD.Pennsylvania M. J. 35: 629-630, 1932. A general discussion of tumors of the kidney with brief reference to a singlc case seen by the author. R. S. FERGUSON Three Cases of Cancer of the Kidney with Early Diagnosis by Pyelography, L. DAX. Trois cas de cancers du rein diagnostiqu6s prbcocement par la py6lographie, J. de m6d. de Bordeaux 109: 416-419, 1932. The author describes three cases of cancer of the kidney in males from fortyfive to fifty-four years of age in which the diagnosis was definitely made by means of pyelography. R. S. FERCUSON

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Grawitz Tumors of the Kidneys, LUDWIG PUHR. Uber die Grawitzschen Gewachse der Niere, Virchows Arch. f. path. Anat. 285: 291-317, 1932. The writer believes t h a t the well-known Grawitz tumors are derived from the reticulo-endothelial structures, that the character of the tumor cells shows a common origin, and t h a t therefore the names ‘‘ hypernephroma ” and “ hypernephroid tumors” should be abandoned. Inasmuch as the accurate title of reticulo-endothelioma lipomatoides renis is somewhat cumbersome, he prefers to fall back on the old name of Grawitz tumor. The paper is illustrated by eight excellent photomicrographs, and a bibliography of moderate size is appended. Sarcoma of the Kidney, G. MARION. Un cas de sarcome vrai du rein, J. d’urol. 33: 470-473, 1932. A woman twenty-six years of age complained of pain in the left kidney region associated with chills and fever. The kidney was palpably enlarged. The urine contained pus and colon bacilli but there was no hematuria. A diagnosis of liydronephrosis was made and nephrectomy undertaken. The kidney measured 10 X 15 cm. On section a tumor was found in the central pazenchymal portion of the liydroneplirotic organ. A histological diagnosis of fusiform sarcoma was made. R. S. FERGUSON Discussion on the Treatment of Inoperable Carcinoma of the Bladder, R. 0. WARD ET AL. Proc. Roy. SOC. Med. 24: 1549-1560 (Sect. Urol. 55-66), 1931. Ward states that the inoperability of bladder carcinoma is t o be determined by cystoscopic examination, with manual examination of the pelvic contents. Fixity of the growth, wide extension, or secondary deposits in lymph nodes and other tissues, may contribute to the decision against operation. I n general, Ward is in favor of radical surgery in operable cases. Forty-three cases of inoperable bladder carcinoma were treated between the years 1927 and 1930. Of 15 patients treated by radium applied through t h e open bladder, 12 are believed to be dead. Three have been benefited t o some extent. Glass seeds of radon encased in a platinum filter are used. The average strength of each seed varies from 1.3 t o 1.7 millicuries. Ten t o 12 seeds were usually inserted, but exceptionally as many as 20 were used at one time. The,procedure described was used in 8 cases of ulcerative and infiltrating carcinomata, all beyond any possibility of excision. Five of these patients are dead; none is cured; three are benefited. Nine cases of papillary carcinoma were also treated by the same technic. Five are without evidence of disease. The others have been benefited little. Ward summarizes his remarks by stating that radium in late cases of bladder carcinoma has no curative value. [The cure of extensive inoperable infiltrating carcinoma of the bladder is scarcely to be expected with doses of 12 to 20 millicuries of radon.] The various methods of relieving pain due to inoperable carcinoma of the bladder are discussed briefly. Division of the presacral nerve and cordotoniy have not been used in a sufficient number of cases, nor for a sufficient length of time, to judge of their value. R. S. FERGUSON Surgical Technic in Tumors of the Bladder, RENE LE FUR. Technique des operations concernant les tumeurs de la vessie, Rev. tech. chir. (Paris chir.) 23: 43-60, 1931. Le Fur advocates the use of electrocoagulation for small and relatively benign epithelial tumors of the bladder and treats large papillomas and the carcinomas with radium. His usual technic for the application of radium is to open the

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ABSTRACTS

bladder and insert needles containing 10 to 12 mg. of radium at intervals of 1 to 2 cm. throughout the tumor base. This procedure usually requires from five to ten needles. They are left in situ from two to three days. At the time of the present report 8 patients are apparently cured from two to eleven years after the application of radium by the technic described. The author believes that radium therapy and fulguration give better results with less mortality than radical surgery R. s. FERGUBON and are, therefore, to be preferred.

Malignant Bladder Tumor of Allantoid Origin, M. VEAUDEAU.Tumeur vhsicale maligne d'origine allantoidienne, Echo m6d. du nord. 36: 306-309, 1932. An unusual tumor is described involving the bladder vault in a woman sixtythree years of age. The patient has survived seven years after operation without evidence of recurrence. Microscopic examination showed the tumor to be composed of tubular cylindrical intestinal epithelium. The author briefly reviews seventeen cases from the literature. R. S. FERGUSON Spindle-Celled Sarcoma of the Bladder with a Report of One Case, F. K. GARVEY AND T. R. BARRY. Southern M. J. 25: 864-865, 1932. A spindle-cell sarcoma of the bladder originating in a girl thirteen years of age is described. The patient had complained of urinary difficulty for one month prior to examination. Cys'toscopy revealed a large jelly-like tumor apparently attached to the bladder base a t the trigone, infiltrating the urethra and lateral walls of the bladder. A biopsy showed the tumor to be a small spindle-cell sarcoma. The patient died seven months after operation, of extensive local recurrence, but no distant metastases were found. The authors were able to find less than 100 cases of sarcoma of the bladder in the literature. R. S. FERGUWN Treatment of Vesical Papillomata of Medium or Large Size, J. B. MACALPINE. Lancet 2: 1403-1404, 1931. Macalpine describes a technic for the treatment of vesical papillomata in cases that are unsuitable for cystoscopic fulguration and not sufficiently extensive to warrant partial cystectomy. The bladder is opened in the usual manner but extreme care is taken to protect the wound edges and the growth itself is not handled for fear of disseminating tumor cells. A disc-shaped indifferent electrode is placed a t the base of the growth. The active electrode is then applied to the superficial parts of the growth until it is judged that the entire tumor has been thoroughly fulgurated. The endotherm current is then applied with a wire loop taking off successive slices of the papilloma until nothing but the stump remains. The latter is now destroyed by fulguration, again using the indifferent electrode. The procedure described is best suited for large pedunculated growths. It is also used prior to partial cystectomy as a prophylactic measure against wound implantation. R. S. FERCUSON Case of Amyloidosis at the Bladder Neck Resembling a Tumor, R. CHWALLA. Urol. & Cutan. Rev. 36: 381-384, 1932. The author finds 35 reported examples of amyloid disease of the urinary organs. Instances have been reported involving the seminal vesicles, urinary bladder, and urethra. An amyloid tumor involving the bladder neck and urethra in a man fifty-seven years of age is described. The patient had previously been treated for a papillary tumor of the internal urethral orifice over a period of two years. He then complained of difficulty in urination and hematuria, and cystoscopic examina-

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tion revealed a solid tumor of uneven surface involving the trigone and bladder neck. The bladder was opened and the tumor excised. A microscopic diagnosis of local amyloid tumor of the urethra and bladder was made. R. S. FERGTJSON Carcinoma of the Prostate: A Clinical and Pathological Study, J. A. C. COLSTON AND L. G. LEWIS. Southern M. J. 25: 696-703, 1932. The authors review the 1040 cases of carcinoma of the prostate seen a t the Brady Urological Institute. The cases are divided as follows: (1) cases suitable for radical operation; (2) cases too extensive for radical operation but without urinary symptoms; (3) cases too extensive for radical operation with urinary symptoms of varying degree. Of the 1040 cases only 36 were found to be suitable for radical operation. Operation in these 36 cases resulted in 4 deaths, a mortality of 11.1 per cent. The average duration of life of the 32 patients surviving radical operation was five years. In 58 of the 1040 cases a diagnosis of benign hypertrophy had been made and operation was undertaken for that condition, the true nature of the process being discovered in the laboratory. Benign adenoma was found to be associated with R. S. FERGIJSON carcinoma in 50 per cent of the total series. Cancer of the Prostate, Early Diagnosis, Radium Treatment, H. FRUCHAUD. A propos du cancer de la prostate, Diagnostic pr6coce. Traitement par le radium, Gar. m6d. d. France pp. 305-309, May 1, 1932. The author briefly discusses the difficulties of diagnosis and the indications for surgical and radiological treatment in cancer of the prostate. Fruchaud states that only one method of treatment is effective, namely the use of radium needles inserted in the tumor after perineal exposure, combined with hypogastric and perineal irradiation. A single case treated by this method is cited. The diagnosis was proved by biopsy, and the patient is reported in good condiR. S. FERGUSON tion four and one-half years after operation. Osteoplastic Metastases in Prostatic Carcinoma, PAUL CAVE. Brit. J. Radiol. 5: 745-760, 1932. Also in Royal Berkshire Hospital Reports, 1932. The author reports a case of extensive metastases from a carcinoma of the prostate, in the spine, pelvis, ribs, and inner third of both clavicles, with a patch in the glenoid cavity of the left scapula. No deposits were found in the lungs. Microscopic sections showed the tumor to be an adenocarcinoma. The bodies of the vertebrae were extraordinarily dense and contained practically no marrow. Chemical examination showed a 44 per cent increase in the amount of mineral matter in comparison with normal bone, a 44 per cent increase in the amount of calcium carbonate, and a 30 per cent decrease in the organic matter and water. The different theories for this osteoplasia and the routes of metastatic distribution are summarized, and the evidence given which the author thinks shows that the spread of the neoplasm is through the lymphatics rather than the blood vessels. The paper is illustrated with several excellent radiograms, and a full bibliography is appended. Large Calculus of the Rectal Ampulla in a Case of Cancer of the Prostate with Recto-prostatic Fistula, PERRIN AND F. ROLLAND.Volumineux calculs de l’ampoule rectale dans un cas du cancer de la prostate, avec fistulisation prostatorectale, Lyon m6d. 150: 124, 1932. The patient described by the authors had been subjected to perineal prostatectomy three years before the present complaint. The histologic diagnosis a t the time of the prostatectomy was adenoma with early cancerous degeneration. After

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ABSTRACTS

operation two tubes of radium of 50 mg. each were placed in the prostatic urethra and left forty-eight hours. Two and one-half years later the patient complained of increasing dysuria and of urine issuing from the rectum. The rectum was dilated under anesthesia and two large calculi the size of hen’s eggs were removed from a recto-prostatic fistula. R. S. FERGUSON

Case of Leiomyoma of the Prostate, P. DEUTICKE.Ein Fall von Prostataleiomyom, Deutsche Ztschr. f. Chir. 236: 475-480, 1932. The author discusses benign tumors of the prostate as recently reported in the literature. A case occurring in a man sixty-five years of age is added. I n some of the reported examples the tumor simulated hypertrophy of the prostate. In others, as in the author’s, the tumor probably originated from the posterior capsule of the prostate, causing no dysfunction of the bladder but resulting in symptoms of pelvic pressure, obstinate constipation, and pain. There were no urinary symptoms in the author’s case, but the patient suffered from obstipation which simulated ileus. These symptoms were found to be due to a large tumor originating from the posterior region of the prostate and compressing the rectum. The tumor was removed by perineal section and proved to be a solid leiomyoma of the prostate. R. S. F E R ~ U S O N Personal Methods of Roentgen Therapy in Forty-four Cases of Adenoma of the Prostate, A. A. ZACCARIA. 44 cas d’adQnome de la prostate trait& par la roentgenthhrapie description de ma technique personnelle, J. radiol. e t d’B16ctrol. 15: 693-696, 1931. A technic for the treatment of adenoma of the prostate by irradiation is given. The author first determines the position of the prostate and its depth, using a lead marker in the rectum and projecting its image on films by the usual method of foreign body localization. The skin is then divided into four portals 10 X 15 cm. each. The angle of the tube is directed a t the two anterior portals in such a manner that the central rays converge at the prostate. The third portal is the perineum, and the fourth is the sacral field. This technic requires the use of 220 kv., 2 ma., at a target-skin distance of 32 cm., through a filter of 0.5 mm. zinc and 4 mm. aluminum. Five to six weeks after this cycle of treatment has been completed, it is repeated if necessary. The author treated 44 cases using the technic described. In some cases spontaneous urination occurred fifteen to twenty days after the first treatment, but in more severe cases was delayed as long as three months. The author further states that he has seen a large prostate the size of an orange return to normal size. [There is nothing in the paper to show the condition of each case prior to treatment, the amount of residual urine before and after treatment, nor any other factors which would enable one to judge the result on sound evidence.] R. S. FERGUSON Tumors of the Testes. A Brief Review, W. F. MCCROCKLIN. Internat. J. M. & 8urg. 4s: 224-226, 1932. A textbook discussion of tumors of the testis. R. S. FERGUSON Teratoma of the Testicle, L. STROMINGER AND M. J. BLUM. TQratome d u testicule, Bull. SOC.frang. d’urol. No. 5: pp. 188-194, May 9, 1932. Also in J. d’urol. 33: 563-569, 1932. A polycystic teratoma of the left testis in a boy of five and a half years was removed a t operation. Three weeks before admission the mother had observed a tumor in the left scrotum which was very painful. The skin over the mass was reddened. The left testis was adherent to the skin, hard, irregular, round and tender.

THE QENITO-URINARY SYSTEM

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On section the testis, which was the size of a pigeon’s egg, showed a central grayish zone, finely granular, surrounded by dense, white, fibrous tissue, with numerous cystic cavities throughout. One of the cysts contained fine hairs 3 to 4 cm. long. A diagnosis of polycystic teratoma was made. Chevassu, who presented the case, has encountered but 10 such instances in a series of 288 testicular tumors. R. S. FERGUSON

Primarp Carcinoma of the Epididymis Simultaneously Occurring with Seminoma, M. SATO. Ein Fall von primaren Nebenhodenkarzinom, bei welchem gleichzeitig das Seminom sich vorfand, Gann 26: 341-352, 1932. The patient was a farmer thirty-six years old, who had a tumor which had existed in the left testis for four years. In spite of radical extirpation of the diseased testis, the patient died three months later. No autopsy was performed. The tumor measured 7.0 X 7.5 X 5.0 cm. The tumor mass consisted of two parts. The upper part showed an adenomatous structure which was associated with a rich connective-tissue stroma. The main tumor mass was composed of cylindrical epithelial cells having elongated or ovoid chromatin-rich nuclei. The protoplasm was granular or vacuolated. Mitotic figures were abundant. The lower part of the testicular tumor, which was separated from the upper part by a broad connective-tissue wall, showed the picture of the so-called largecell malignant testicular tumor-the seminoma. The author could not find any direct connection between these two tumors. However, from the histological findings, he believes that the adenocarcinoma developed, independently of the seminoma, from the epithelium of the vasa efferentia. K. SUCIURA Multilocular Cysts of the Epididymis, BINET. Kystes multiloculaires de 1’6pididyme, Rev, m6d. de l’est 60:370-371, 1932. A man of fifty years had had bilateral scrota1 swellings for about ten years, and requested operation on account of their increasing size. The swellings were mamillated, distinguishing them from hydrocele. On each side the author incised the anterior surface of the scrotum and exteriorized the tumor. Each tumor consisted of several cysts, giving the external mamillated appearance. On neither side could a trace of epididymis be found. The author distinguishes three types of cysts of the epididymis: (1) multilocular cysts, usually small, developed at the expense of the epididymis itself and containing spermatozoa; (2) cysts arising from wolffian remains and analogous with the wolffian cysts of the broad ligament in women; (3) cysts arising in the peritoneovaginal canal, in reality cysts of the spermatic cord which have insinuated themselves between the testis and epididymis, often obliterating the tubules of the latter, usually unilocular and containing fluid like that of a hydrocele. The author thinks his case falls into the third category, though it was unusual in F. CAVERS being multilocular. He gives no illustrations.

Squamous Cell Carcinoma of Glans Penis, R. S. WIDMEYER.West Virginia M. J. 28: 267, 1932. A report of a squamous-cell carcinoma of the penis of five years’ duration in a man of sixty years. It was treated by partial amputation of the penis. R. S. FERGUSON

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ABSTRACTS

Phlebectases and Hemangiomas of the External Male Genitals, E. PAWLOWSKI. Uber Phlebektasien und Hamangiome der ausseren mannlichen Geschlechtsorgane, Dermat. Wchnschr. 95: 1821-1826, 1932. In a forty-five-year-old man extensive venous sinuses involved the entire pars anterior of the urethra, the glans penis, and lower surface of scrota1 skin. Clinical findings and the literature indicate that in this localization besides the venous dilatations hemangiomatous changes also occur. Every hemangioma of the urethral mucosa should be closely watched. In selected cases cauterization may be employed, in more extensive cases operation. Bleeding and urinary retention are indications for surgery. THE ADRENAL GLANDS

Extensive Pyelonephritis ; Primary Bilateral Carcinoma of the Adrenal Glands ; Clinical Study, W. S. PUGH. Internat. Clin. 2: 151-157, June 1932. Pugh presents a brief case report with autopsy findings, dealing with a male negro of fifty-seven years who succumbed to bilateral carcinoma of the adrenal R. S. FERGUBON glands with general metastases. Cortical Adrenal Tumour, C. HUNTER, J. C. MCMILLAN,W. BOYDAND A. T. CAMERON.Canadian M. A. J. 25: 180-193, 1931. The authors report an instance of cortical tumor of the adrenal with virilism in a woman thirty years of age. The thyroid had been removed for goiter seven years previous to the development of obesity with virilism in October 1929. One month later the menses ceased. Five months thereafter the hair on the face and extremities began to grow rapidly and its distribution on the abdomen and pubes assumed the masculine type. The skin was coarse and dry. The breasts were normal. A tumor the size of the fetal head was present in the right upper abdomen. A diagnosis of tumor of the adrenal cortex was made. Roentgen studies revealed displacement of the right kidney downwards, with distortion of the renal pelvis and elevation of the right side of the diaphragm. There was marked decalcification of all the vertebral bodies. Sections of the tumor removed a t operation were typical of carcinoma of the adrenal cortex. R. S. FERGUSON Case of Bilateral Cysts of the Adrenals, P. LEVISON. Un cas de kystes bilatkraux des surrhales, Ann. de mkd. 31: 548-555, 1932. Of cysts of the adrenal, there are four varieties exclusive of echinococcus cysts: the true glandular cysts, cystic adenomas, cystic lymphangiomas, and pseudocysts. The case described by the author is the first reported in which the diagnQsis was made by means of x-ray examination. A woman, forty years of age, complained of lumbar pain. Roentgen examination showed a large, rounded, calcified shadow a t the level of the eleventh and twelfth ribs on the left side. A similar but smaller shadow was seen on the right side. Lateral views revealed the retroperitoneal position of the calcified cysts. The larger cyst, on the left side, was removed at operation. On section it proved to be a benign cortical adrenal tumor, cystic and partially calcified. After operation a goiter previously observed decreased markedly in size. R. s. FERGUSON THE NERVOUS SYSTEM

Intracranial Tumors, D. G. DICKERSON.Northwest Med. 31: 58-65] 1932. The diagnosis of intracranial tumor depends primarily upon a carefully taken chronologic story. The localizing diagnosis is made on the history and the neuro-

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logic findings, supplemented in certain cases by ventricular air insufflations. A working knowledge of tumor classification and of gross as well as microscopic pathology are fundamental for good surgery. Surgical management depends upon accurate localization and special technical devices, supplemented by local anesthesia and unstinted transfusions. EDWINM. DEERY

Incidence and Types of Intracranial Tumors in the Necropsies of the Pathological Institute of Heidelberg, V. RUDERSHAUSEN. Uber Haufigkeit und Art der Hirngeschwulste an Hand des Sektionsmaterials des pathologischen Instituts Heidelberg, Virchows Arch. f. path. Anat. 285: 318-331, 1932. A short review of the statistics of some 546 cases of brain tumors: 444 primary brain tumors, of which 232 were gliomas, and 102 metastatic tumors. The figures cover the years 1854 to 1931. EDWINM. DEERY Pathology of Intracranial Tumors, T. B. DAVIE. Liverpool Med.-Chir. J. (pt. 1) 40:26-44, 1932. The numerous types of neoplasms which are met with within the skull may be divided into the following general classes with their percentage incidence: gliomas 41.2; meningiomas 12.5; auditory nerve tumors 9.4; pituitary and hypophyseal duct tumors 21.7; secondary carcinoma 4.7; granulomas 2.7; blood vessel tumors 1.7, together with certain rare tumors such as those of the choroid plexus, cholesteatomas, and dermoids. The author describes each tumor type, illustrating his remarks with gross and micro-photographs of the various tumors. EDWINM. DEERY Diagnosis of Intracranial Tumors, H. COHEN. Liverpool Med.-Chir. J. (pt. 1) 40: 45-56, 1932. General remarks, chiefly concerning the neurologic aspects of diagnosis. EDWINM. DEERY Focal Enlargement of the Temporal Bone as a Sign of Brain Tumor, R. H. THOMPSON. J. A. M. A. 99: 379-381, 1932. Bony thickening or hyperostosis of the skull overlying tumors of meningeal origin is well known. Two cases not due to hyperostosis are reported. Both patients showed a marked prominence of the squamous portion of the temporal bone, both were children, and in each case the prominence was due to actual bulging of the bone. The tumors proved t o be a meningioma and a cystic glioma. EDWINM. DEERY Surgery of Intracranial Tumors, R. E. KELLY. Liverpool Med.-Chir. J. (pt. 1) 40: 57-63, 1932. General remarks upon neurosurgery, with the presentation of a few illustrative cases. EDWINM. DEERY Some Considerationson the Surgical Treatment of Brain Tumors, J. CHAVANNAZ. Quelques considbrations sur le traitement chirurgical des tumeurs de l’enc6phale, J. de mbd. de Bordeaux 109: 383-387, 1932. General remarks reflecting the accepted points of view upon surgical technic and diagnostic methods. EDWINM. DEERY

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Neuro-surgery :Presentation of Seven Patients Cured by Operation, J. DEREUX. Neuro-chirurgie: Prbentation de sept op6r6s gubris, J. d. Sc. m6d. de Idle 50: 297-304, 1932. The cases reported include fibroglioma of the cauda equina, decompression for serous meningitis, prefrontal meningioma, hemangioma of the Rolandic area, cerebellar astrocytoma, prefrontal unipolar spongioblastoma, and a pituitary adenoma. EDWINM. DEERY Tumors Associated with the Nervous System, G, MARINESCO A N D M. GOLDSTEIN. Contribution a 1’6tude des tumeurs associbes du systeme nerveux. Ann. d’anat. path. 9: 457-476, 1932. Two case reports with clinical and histopathologic findings. The first patient proved to have multiple tumors, including meningeal fibroblastoma and gliomas. The second case was one of cystic hemangioblastoma of the cerebellum. The cases are described to illustrate the difficulties sometimes encountered in fitting certain tumors into the more recent classifications in general use. EDWIN M. DEERY Symptomatology of Neoplasms of the Apex of the Pyramid, V. TANTURRI. Beitrag zur Symptomatologie der Neoplasmen der Pyramidenspitze, Monatschr. f. Ohrenh. 66: 798-808, 1932. General remarks upon neurological diagnosis of tumors of the apex of the EDWIN M. DEERY pyramid. Histopathology is not discussed.

Fourth Ventricle Region Tumors with Irregular Form of Oscillation from Caloric Nystagmus, H. FRENZEL. Tumoren im Bereich das 4. Ventrikels niit Regelwidriger Schlagrichtung des calorischen Nystagmus, Klin. Wchnschr. 11: 802805, 1932. Clinical case reports of three patients who proved to have a small-cell sarcoma, EDWIN M. DEERY a gliosarcoma, and an ependymoma respectively.

Blood Supply of the Gliomas, C. A. ELSBERG A N D C. C. HARE. Bull. Neurol. Inst. N. Y. 2: 210-246, 1932. In the gliomas of the brain there is a close connection between the distribution of the blood vessels and the manner in which the tumor invades the brain tissue. The distribution and number of blood vessels within and about a series of gliomas were studied and recorded. I n astrocytomas and medulloblastomas the largest number of vessels were found in the depths of the growth. In glioblastoma multiforme the peripheral areas showed the greatest vascularity. These differences in vascularity may explain the known differences in the invasive tendencies shown EDWIN M. DEERY by tumors of these types. Histologic Prognosis of Gliomas of the Brain, J. DECIIAUME, J. F. MARTINA N D P. WERTHEIMER.Prognostic histologique des gliomes du cerveau, Lyon m6d. 150: 89-94, 1932. The writers offer a simplified classification of the gliomata. Type I is the neuro-epithelioma; Type 11, the neurospongioma [medulloblastoma]; Type 111,undifferentiated-cell glioma [glioblastoma multiforme] ; Type IV, the adult-cell glioma (astrocytoma and oligodendroglioma). A final suggestion is that types one and two can be combined. There is nothing new ventured as to prognostic EDWINM. DEERY aspects.

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Astrocytoma of the Temporal Lobe, J. L ~ P I N EWERTHEIMER, , J. DECHAUME, AND CHRISTY.Astrocytome du lobe temporal, Lyon m6d. 150: BOTJRRAT 125-128, 1932. Single case report of an astrocytoma histologically verified. EDWINM. DEERY Spongioblastoma, H. R. G. POATE.Med. J. Australia 2 : 216-217, 1931. Presentation of a case of spongioblastoma multiforme of the right cerebral hemisphere, histologically verified. EDWINM. DEERY Ganglioneuroma of the Cerebrum, 1,. B. Cox. Med. J. Australia 1: 347-351, 1932. A further case of this uncommon tumor& reported for addition to the literature. The lesion was found in the left frontal lobe. There follows an histologic description of the tumor with photomicrographs. The growth was one differentiating mainly along the line of the neuroblast. EDWINM. DEERY Syndrome of Tumor of the Middle Cerebral Fossa and of the Retroparotid Space with a Malignant Tumor of the Nasopharynx, TERRACOL, BONNAHON AND SAQOLS.Syndrome tumoral de la fosse cbr6brale moyenne et syndrome de l’espace r6tro-parotidien dans und nboplasie maligne du naso-pharynx, Arch. SOC. d. sci. m6d. et biol. Montpellier 13: 178-183, 1932. An elderly patient showed evidence of a nasopharyngeal tumor together with symptoms of increased intracranial pressure. He also had paralyses of several cranial as well as high spinal and sympathetic nerves. [Histopathology not discussed.] EDWINM. DEERY Dermoid Cyst of the Temporal Fossa, J. E. HEARD AND P. D. ABRAMSON.Am. J. Surg. 16: 510-512, 1932. A clinical case report, with operative findings, of an extradural dermoid cyst which had eroded into the middle cerebral fossa through the greater wing of the sphenoid and, penetrating the retrobulbar space, had produced unilateral exophthalmos. The tumor was removed through a frontal osteoplastic craniotomy. A possible explanation for the origin of this tumor is offered by the penetration of the temporal fossa earlier in life by a sharp instrument, which may have implanted a piece of skin into this region. [The histologic description, however, is EDWINM. DEERY that of a true dermoid.] Trigeminal Naevus and Homolateral Pial Angioma, R. W. B. ELLIS. Proc. Roy. SOC.Med. 25: 954-956, 1932. A clinical case report of a nevus of the right forehead in a boy. BecauAe of convulsive attacks, roentgenograms were taken, which showed evidence of two calcified angiomas within the substance of the right cerebral hemisphere. [Unoperated; unverified.] EDWINM. DEERY Brain 55: 122-134, 1932. On Suprasellar Cholesteatomas, H. OLIVECRONA. Two cases of suprasellar cholesteatoma are described. The following variations of the chiasmal syndrome may probably be regarded as typical of suprasellar cholesteatomas: (1) a very slowly progressing primary optic atrophy with bitemporal hemianopsia occurring in a young person; (2) a sella turcica essentially

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ABSTRACTS

normal but with widening of the optic foramina and the sulcus chiasmatis of the sphenoid bone; (3) complete absence of pituitary manifestations. EDWINM. DEERY

Roentgen Therapy of Pituitary Adenomas, A. BECL~GRE. La roentgentherapie des adhomes de l’hypophyse, Medecine 13: 406-410, 1932. The writer mentions four cases of pituitary adenoma and concludes t h a t roentgen therapy is the best form of treatment. Surgery should be resorted t o EDWIN M. DEERY only when there is an increase of symptoms. Sphenoidal Mucocele or Cystic Pituitary Tumor? A. SCHULLER.Sphenoidale Mucocele oder zystischer Hypophysentumor? Monatsschr. f . Ohrenh. 66: 166-172, 1932. While some authorities have claimed that the roentgen-ray findings in sphenoidal mucocele are sufficiently characteristic to establish the diagnosis, the author has found that another condition may give a very similar picture, namely cystic tumor of the pituitary, either intrasellar or subsellar. He reports an illustrative case in a fourteen-year-old boy, who had suffered from headache since early childhood. The pain had become more severe in the last few months, accompanied by attacks of vertigo, vomiting, and a diminution of the sense of smell. Roentgen examination of the head showed a marked widening of the sella turcica, the floor of which was thinned; the corpus sphenoidale showed marked destruction. A diagnosis of intrasellar pituitary tumor, apparently cystic, or sphenoidal mucocele was made. Operation was done by the endonasal route and mucocele of the sphenoid found and removed; the patient was entirely relieved of symptoms. From this case and similar cases, the author comes to the conclusion that a differential diagnosis between cystic tumor of the pituitary and sphenoidal mucocele cannot be made with certainty prior to operation, and that in such cases operation by the endonasal route is indicated. Bilateral Trochlear Paresis as the Only Motor Sign With a Tumor of the Pined, P. A. JAENSCH. Doppelseitige Trochlearisparese als einzige Motilitatsstorung bei Zirbeldrusentumor, Ztschr. f. Augenh. 75: 58-68, 1931. A clinical case report of a “ glioma ” of the pineal gland. Histology is not discussed. EDWINM. DEERY Intramedullary Spinal Cord Tumors, A. EIBELSBERO. Intramedullare Riickenmarkstumoren, Mitt. a. d. Grenzgeb. d. Med. u. Chir. 42: 613-622, 1932. Eiselsberg reports that in his clinic a t Vienna, among 75 spinal cord tumors proved a t operation or autopsy, 14 were intramedullary. All of these cases were operated. One patient with a neurofibroma was entirely relieved of symptoms for eight years and died of tuberculosis; autopsy showed a small neurofibromatous nodule below the site of the primary tumor, probably not a true recurrence. Of 3 patients with cyst, one was cured for eighteen years; one showed signs of recurrence three years after operation; one could not be traced. Of 3 patients with glioma, one died postoperatively, one in two and a half years, and one has lived nine years, maintaining the improvement that resulted from operation. Of 5 patients with sarcoma, 3 died within two months, one four years after operation, and one is living six years after operation and shows some improvement. In this last case a second laminectomy was done, and only a chronic inflammatory process in the spinal cord found; no evidence of recurrence. One patient with fibroepithelioma of the dura mater died in three months from infection.

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Considering that both gliomas and sarcomas are malignant tumors, the late results are not discouraging. The operation should be as radical as possible, for in one case of sarcoma an incomplete operation appeared to hasten recurrence. The author has seen no evidence that postoperative roentgen irradiation is of value. Even with modern methods of diagnosis, a laminectomy may sometimes be necessary in order to establish the diagnosis before the full clinical syndrome of spinal cord tumor has developed. But this is justifiable, as the early removal of spinal cord tumors gives relatively good results.

Localization of Spinal Cord Tumors, N. R. SMITH. J. Oklahoma State M. A. 24: 8, 1931. Three cases are reported to illustrate the essentials in localization of spinal cord tumors. Surgical Treatment of Intraspinal Tumors, DESGOUTTES AND RICARD. A propos du traitement chirurgical des tumeurs intra-rachidiennes, Lyon m6d. 149: 578-582, 1932. A review of the surgical results in a series of 68 laminectomies for spinal tumors. Histopathology is not discussed in any detail. EDWINM. DEERY Recurrence of a Spinal Cord Tumor Previously Relieved by Operation, A. DEVIC AND L. OLIVIER. Recidive d’une tumeur intrarachidienne op6r6e e t temporairement gubrie, Lyon m6d. 149: 772-776, 1932. Recurrence of a fibrous tumor, probably a meningeal fibroblastoma. EDWINM. DEERY Case of Tumor of the Spinal Cord Manifested by Intestinal Symptoms, 0. WEILL. A propos d’un cas de tumeur de la moelle s’6tant manifestbe par les symptbmes intestinaux, Bruxelles m6d. 12: 208-209, 1931. A forty-seven-year-old farmer had suffered for one year with intermittent acute abdominal pain, beginning in the left iliac fossa and radiating to the liver. He was incapacitated for work, walked with difficulty, and could not lie down because of aggravation of the pain. The ascending colon was palpable and tender. Nothing abnormal was found during laparotomy. The tabetic nature of the pain, the impaired gait, and the muscular atrophy suggested a neurological examination. This showed an absence of left patellar, cremasteric, and Achilles reflexes, and positive LasBgue, Kernig and left Babinski signs. Lumbar puncture obtained a xanthochromic fluid, which coagulated spontaneously and contained 2 per cent albumin. A radiograph of the spine with ascending and descending lipiodal injections showed an obstruction in the region of the twelfth dorsal vertebra. At the operation, an extramedullary, intradural tumor of unspecified type was enucleated with difficulty. GEORGET. PACK Neurofibromatosis with Large Tumors, LOUSTE,B. GRIFFITHSAND F. CAILLAU. Maladie de Recklinghausen B tumeurs Bnormes, Bull. Soc. franp. dermat. et syph. 39: 669-672, 1932. The authors have made a histological study of neurofibroma, using various methods of fixing and staining. The material was provided by a man of thirtytwo, who had developed during the past twenty years an enormous number of these tumors and also abundant sebaceous cysts of the scalp. Several of the tumors were removed from time to time because of bleeding and ulceration. The authors found that the Cajal technic showed up the schwannian sheath and the axis cyl45

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inders, which stood out distinctly from the myofibrils around them; while Masson’s trichrome method allowed of sharp distinction between the myofibrils and the neural cells. They think that neurofibromatosis is probably a dysembryoplasia of the nervous elements and smooth muscle cells, but that there seems to be no evidence that the parent cells form part of the embryonal blood vessels. F. CAVERS

Tumor of the Vagus in a Case of von Recklinghausen’s Newofibromatosis, M. SIEBNER. Vagustumor bei Recklinghausenscher Neurofibromatose, Deutsche Ztschr. f. Chir. 237: 63-79, 1932. A tumor of the right vagus nerve was observed in a thirty-four-year-old patient with the typical cutaneous tumors seen in von Recklinghausen’s type of niultiple neurofibromatosis. The tumor of the vagus measured 9.5 X 6 X 5 cm. and weighed 130 gm. Following the removal of the tumor, paralysis of the right vocal cord, hoarseness, and hyperemia of the right half of the face ensued. Detailed neurological studies failed to reveal any evidence of involvement of the other cranial nerves. Histologic examination of the tumor from the neck showed i t t o have a structure similar to that found in the cutaneous nodules. The article is well illustrated with photographs and photomicrographs. BENJAMINR . SHORE Changes in the Ear with Bilateral Acoustic Nerve Tumor in a Case of Neurofibromatosis Multiplex (von Recklinghausen), T. GERMAN. Veranderungen des Gehororgans bei beiderseitigem Akustikustumor in einem Fall von Neurofibromatosis multiplex (Recklinghausen), Monatsschr. f. Ohrenh. 66: 541-556, 1932. Although there are more than 30 cases of central neurofibromatosis reported in the literature, there are very few in which the internal ear has been examined histologically. The author’s patient was a girl, seventeen years of age, under observation for two and a half months before death. She had numerous neurofibromas on the neck and trunk, and cerebral symptoms indicating the presence of intracranial involvement. There was also increasing bilateral deafness, most marked on the right side, and diminution of the vestibular reaction also most marked on the right side. Because of rapidly increasing diminution of vision, a n attempt a t partial removal of the tumor in the cerebellopontile angle was made by a two-stage operation. The patient showed marked improvement after t h e first stage (decompression) but died four days after the second stage operation. At autopsy bilateral tumors of the acoustic nerve were found. On the right side the tumor had caused practically complete destruction of the cochlear and vestibular nerve elements; on the left side the spiral ganglion except for its basal turn was intact, the cells of the stria vascularis were normal, and Corti’s organ was not tts completely destroyed as on the right side. The tumor of the acoustic nerve was a typical neurofibroma, made up of two types of tissue-a fibrillar connective tissue and a glia-like reticular tissue. The tumors of the dura did not show a similar histological picture, but were made up of a coarser connective-tissue network, with cells with round nuclei in the interstices. Such tumors resemble endothelioma and are difficult to classify when occurring in association with neurofibromatosis. A Case of Acusticus Tumor in Which Both Auditory Nerves Were Involved by Separate Growths, A. de KLEJNAND A. A. GRAY. Proc. Roy. SOC.Med. 25: 1273-1286, 1932. A report, with necropsy findings, of a patient who proved to have bilateral acoustic neuromas. “ Numerous tumors were also present in the skin of the back and of the right arm.” Some excellent photographs show the relationship of the tunior to the middle ear. EDWINM. DEERY

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Malignant Neurinoma of the Ulnar Nerve, G. ALBOTAND B. JEHIEL. Sur un cas de gliome p6riphCrique malin du nerf cubital, Bull. de 1’Assoc. franc. p. 1’6tude du cancer 21 : 448-453, 1932. A woman of thirty-one noticed in the year 1919 a small firm swelling on the medial surface of the right arm, which gradually grew larger. In 1926 the tumor was excised from the surface of the ulnar nerve, to which it was attached. After the operation there were paralysis and atrophy of the muscles supplied by the nerve, also pain in the operated region, then recurrence of the tumor. A year later the new tumor was removed by incising and decorticating the nerve sheath; but the same surgeon had to operate again for recurrence in the following year, and found that the tumor was growing down towards the ulna. The author, three years after this, performed a fourth operation, finding below the recurrent tumor two amputation neuromas; he resected the portion of nerve including the tumor and the neuromas. At the time of reporting, nearly a year after this fourth operation there has been no recurrence of tumor or reappearance of pain. Histologically the tumor proved to be a neurinoma, or schwannoma, but with numerous atypical mitoses, often tri- or quadripolar. Two photomicrographs are given. [Several cases of neurinoma showing histologic signs of malignancy, as well as a tendency to local recurrence, which is less rare in these tumors, have been reported.] F. CAVERS T H E BONES AND JOINTS

Bone Tumors from the Roentgenologist’s Aspect, W. J. MARQUIB A N D W. G. MCDEED. Texas State J. Med. 27: 652-654, 1932. Twenty-five cases of bone tumor are discussed. In their radiological study of these cases, the authors have found that it is sometimes difficult to make a definite diagnosis between inflammatory lesions and neoplasms in bone. Neoplasms show a greater tendency to produce new bone; characteristically this is produced in spicules that tend to lie a t right angles to the axis of the involved bone. Benign tumors remain sharply circumscribed, cause expansion of the bone, and little or no periosteal reaction; cyst formation is common. Malignant tumors cause little expansion of bone, but the periosteum is elevated, and as it separates from the bone shows a frayed-out appearance like that of the frayed end of a rope; the more malignant the tumor, the more marked is this change in the periosteum. Malignant tumors show an irregular outline and some areas of bone destruction, but rarely true cyst formation.

Primary Tumors of the Joints, P. RAZEMON AND G. BIZARD. Lea tumeurs primitives des articulations, Rev. de chir. 50: 229-266, 1931. The authors present a summary of 74 cases of primary tumors of the joints collected from literature, including one case of spindle cell sarcoma of the synovial membrane of the knee not previously reported. The 74 cases reviewed include 45 benign and 29 malignant tumors. The benign tumors were lipomas, fibromas, definitely intra-articular angiomas, and benign tumors with giant cells, xanthomatous cells, and yellow pigment. Of the benign tumors, 26 were of the latter group. The malignant tumors were sarcomas-the most frequent type being spindle-cell and round-cell sarcomas-and synovial endotheliomas containing certain cell elements indicating their synovial origin. The knee joint is most frequently involved. Clinically the tumors are of three types: mobile tumors simulating loose bodies in the joint; circumscribed fixed tumors; diffuse tumors simulating tuberculosis. The diagnosis of joint tumors is very difficult; angiomas alone may show characteristic signs that distinguish them from arthritis. These signs are un-

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usually sharp pains on palpation of the tumor and sudden changes in its volume and appearance. Differentiation between benign and malignant tumors can often be made only by histological examination. On this account, the authors have adopted the following provisional rules for the treatment of joint tumors: If the tumor is certainly malignant, amputation should be done. If malignancy not proved, the tumor is to be removed en bloc by simple excision, synovectomy, or resection of joint as indicated. If subsequent histologic examination shows malignancy, amput8tion may be done immediately, but if it is considered preferable to wait until there is evidence of recurrence, deep roentgen ray-treatment is indicated after operation. Of the 29 malignant tumors in the series studied, 17 were followed up after operation. In 8 of these removal was done, of which 4 showed recurrence within a few months and 4 showed no recurrence in four to twenty-four months, the last being the authors’ own case reported in this article. In one partial synovectomy was done with no recurrence in two and a half years. I n 2 cases in which total synovectomy was done, there was one postoperative death (from infection) and one recurrence in a short time. In 3 cases in which resection of the joint was done a t the first operation, there were 2 recurrences and one case without recurrence in six months; in one case in which resection was done for a recurrence, there was a subsequent recurrence. In 3 cases in which amputation was done, there was one death from metastasis, and 2 “ cures ” for nine and twelve months; of 4 cases in which amputation was done for a recurrence, 2 were without recurrence for twentyseven months to four years, and in 2 there was recurrence or metastasis.

Giant-Cell Bone Tumor, CARLETON B. PIERCE.Am. J. Roentgenol. 28: 167-191, 1932. This paper is devoted to a consideration of the morphology of giant-cell tumor of the bone, its response to surgical and radiation therapy, and a report in detail of two apparently malignant cases. The paper is well illustrated by radiograms and photographs of the tissues. Nineteen cases are studied, of which fourteen have microscopic reports. I n general, the opinion of other workers as to the benign quality of the growth is substantiated. The various types of the giant-cell tumor cannot always be differentiated by roentgenographic methods. If surgery is used, it should be followed by a consistent roentgen therapy program; otherwise recurrence may take place. I n the two cases in which malignancy was suspected, the opinion was based in one instance on the microscopic morphology of the tissues, and in the other, on the fact that there were present in the lungs some metastatic particles. The author raises the question whether the lung involvement may be a result of embolus only. The x-ray picture of the lung strongly suggests to the abstractor a metastasizing bone tumor. Nor can there be any question of the malignant nature of the other case described, which is plainly an osteogenic sarcoma, just as was the case reported by Ewing and Stone in the Archives of Surgery (7: 280, 1923). A bibliography of moderate extent is appended. Treatment of Giant-Cell Bone Tumors by Roentgen Irradiation, GEORQEF. PFAHLER AND LEO D. PARRY. Am. J. Roentgenol. 28: 151-166, 1932. This paper surveys 26 cases of giant-cell bone tumor. Two patients have died of intercurrent disease, one had an amputation for an osteomyelitis; another developed a deformity of the jaw from an incision. The authors use fractional doses of x-ray, being careful to avoid damage of the normal tissues. No interference with growth has followed irradiation of the epiphyses. The authors do not believe in biopsy. The radiation given is 200 kv., with 0.5 mm. copper filtration, giving about 25 per cent of a skin erythema at each sitting. Excellent radiographs illustrate the paper. There is no bibliography.

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Case of Giant-cell Sarcoma, A. M. REMIS. Med. Inst. Voronesch Rept. 1: 32-34, 1932. The author reports a giant-cell sarcoma of the lower end of the humerus in a girl of eighteen, which had gradually developed during the course of three years to the size of a man’s head. The involved bone was resected and the defect replaced by a tibia1 transplant six months later. The function of the elbow joint was preserved and motion of that joint was reestablished three months after the graft had been inserted. MAURICELENZ Osteogenic Sarcoma, R. J. WHITE. Texas State J. M. 27: 596-600, 1931. This is a general discussion of osteogenic sarcoma quoting extensively from Kolodny and Coley. Melanotic Sarcoma of the Fibula, P. INGELRANS AND J. MINNE. Sarcome m6lanique du p6ron6, Echo m6d. du Nord 35: 243-246, 1931. The authors report a case of tumor of the fibula in an infant five months old, which had been observed since birth, but had grown rapidly in the last three weeks. The tumor was firm but not hard in consistency; the skin over it was movable. The fibula was resected; the tumor proved to be a round-cell melanotic sarcoma. The child died two weeks later. No autopsy was done, and it was impossible to determine whether the tumor of the fibula was primary or secondary; there was no clinical evidence of any other primary growth. But no other similar case of primary melanotic bone sarcoma in so young an infant has been found in the literature. New Studies on the Reticulosarcomas of the Bone Marrow, Ewing’s Sarcoma, C. OBERLINGAND C. RAILEANU.Nouvelles recherches sur les r6ticulosarcomes de la moelle osseuse (sarcomes d’Ewing), Bull. de 1’Assoc. frang. p. 1’6tude du cancer 21 : 333-347, 1932. I n an earlier paper Oberling (ibid. 17: 259, 1928) dealt with the classification of bone sarcomas and particularly with the sarcoma of Ewing or diffuse endothelioma. The present paper is partially a repetition of the earlier one, omitting the somewhat elaborate classification scheme of bone sarcomas regarded as arising from the reticulo-endothelial tissue. It is based on the examination of twelve additional cases. The authors agree that the tumors described as Ewing’s sarcoma form a group of sharply defined neoplasms and that very little remains to be added to the descriptions given by Ewing, Connor, and Kolodny. Yet they have been struck by the range of variability observed among the component cells of these tumors. According to them the cellular syncytium of the tumor tends to show, starting from undifferentiated cells of embryonal appearance, differentiation into adult reticular elements, endothelial cells, and myeloid tissue elements. The examination of the twelve new cases leads the authors to reaffirm the conclusions arrived a t by Oberling. They point out that some writers have interpreted the radiosensitiveness of these tumors as a sign of relative benignity, which is a serious error, for in many cases the tumors grow and metastasize with extreme rapidity and the outcome is fatal in the majority of cases. In too many cases the patient is seen and roentgen therapy begun when the tumor is no longer localized. It is imperative to resort to biopsy or a t any rate puncture of the medulla in every case in which roentgenography shows a zone of decalcification in a bone which is the seat of pain and in every case of apparent osteitis or arthritis of which the cause cannot be rapidly and correctly determined. The superior treatment results reported by American writers are largely attributed to early diagnosis. On the other hand, while these tumors are certainly much more fre-

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quent than has been hitherto supposed, and their diagnosis is now more frequently made, it is necessary to guard against making a diagnosis of Ewing tumor when the presenting characters do not correspond closely to the descriptions and pictures of it which are readily available. A false diagnosis of Ewing tumor may lead to loss of time in applying radiotherapy to a refractory bone tumor before amputation has finally to be performed. The authors give three plates, two in color, and an extensive bibliography containing references not included in the earlier paper by Oberling. F. CAVERS

Multiple Myeloma (Plasmocytomata)with Blood Picture of Plasma-cell Leukemia, Folia Hematol. Report of Two Cases, G. L. MULLERA N D E. MCNAUGHTON. 46: 17-25, 1031. Plasma cells are found only rarely in the circulating blood even in patients with multiple myeloma involving many parts of the hematopoietic system. A moderate leukocytosis is usually due to secondary infection, but a few cases are known in which a pseudo-leukemic white blood picture was present and the plasma cells numbered from 5 to 70 per cent of the total leukocytes. The two cases here reported showed, the one, from 11,000 to 27,000 leukocytes and 39 to 53 per cent plasma cells; the other, 50,000 to 60,000 white blood cells with 65 per cent plasma cells on one occasion. The authors regard this disease as a systemic one involving all parts of the hematopoietic tissues, with all gradations from multiple tumors confined to the bone marrow to the generalized disease with plasma-cell infiltration of organs and the appearance of plasma cells in the blood stream. The important recent references are given, also drawings and photomicrographs. LEILAC. KNOX Vertebral hgioma, CLAVELINAND GAUTHIER. Un cas d’angiome vertbbral, Rev. de chir., Paris 51: 308-315, 1932. A twenty-one-year-old soldier had about a month before reporting sick noticed first lameness and then loss of sensation in both legs, followed by increasing dysuria. The army surgeon made a tentative diagnosis of spastic paraplegia due to Pott’s disease of the spine and sent the patient to the authors for neurologic examination. They give the results of this in detail. The upper line of lost touch sensation ran transversely across the nipples; lumbar puncture showed increased fluid pressure; roentgenography showed distortion of the fourth and fifth dorsal vertebrae, and descending lipiodol was arrested a t the body of the fourth. Laminectomy was performed on the third to sixth vertebrae, and a large portion of the bodies of the fourth and fifth, which were soft and very vascular, was resected. The patient died an hour after the operation, and necropsy was not permitted. Histologic examination of the removed mass showed the structures of typical hemangioma. The authors give references to the few cases found reported in the available literature since the publication of Bailey and Bucy’s paper, the most important F. CAVERS on these tumors (J. A. M. A. 92: 1748, 1929). Vertebral Angioma, Radiologic Diagnosis, J. A. L I ~ V R E .Angiome vertbbral, I ‘ vertebre poreuse.” Diagnostic radiologique, Bull. et m6m. SOC.m6d. d. hap. de Paris 48: 896-901, 1932. A woman of thirty-six had suffered for about seven years from lumbar pain shooting into the sciatic nerve of each side. Five years after this pain began she had the right breast removed for carcinoma. Roentgenograms showed in the body of the first lumbar vertebra the typical all-round expansion and spongy appearance typical of angioma. The author notes that in most of the cases of vertebral hemangioma described in recent years the growth of the tumor had caused com-

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pression of the spinal cord, but his patient showed no signs of this; on the other hand, severe pain is somewhat rare, and many of these tumors have been accidental necropsy findings. F. CAVERS

Two Cases of Chondroma, C. VIANNAY. Deux cas de chondrome, Loire m6d. 45: 348-353, 1931. Viannay states that no type of tumor shows more variability in its characteristics and course than chondroma. Chondromas may develop slowly, with all the characteristics of benign tumors, or they may be malignant, with distant metastases, or locally malignant with local recurrences, operative removal of which prolongs the life of the patient. Two cases are reported. One of chondroma of the thoracic wall showed histologic characteristics suggesting sarcoma. A wide resection resulted in cure persisting for three years without evidence of recurrence. The second case was a chondroma of the pubis, without histologic evidence of malignancy, which recurred in four years, and was again removed. Histologically this recurrence was of the same type as the primary tumor. Chondroma of Finger of Twenty Years’ Duration, P. CORRETAND PIEHSON. Chondrome d’un doigt datant de plus de vingt ans, Rev. m6d. de l’est 60: 509-510, 1932. A chondroma in the left ring finger of a woman of thirty-eight years, of twenty years’ duration, was divided into two lobes, the larger (of small orange size) corresponding to the second phalanx. The three phalanges were fixed, but the metacarpophalangeal joint was free and the finger was disarticulated here. Histologically the tumor consisted of fully developed hyaline cartilage; most of the cells were in course of necrotic degeneration, and there were wide spaces indicating a tendency to the formation of irregular cysts. The roentgenograms had suggested the possibility of myeloma. No illustrations are given. F. CAVERS Osteochondromatosis of the Joints, R. K I E N B ~ C Kuber . die Osteochondromatose der Gelenke, Rontgenpraxis 3 : 895-899, 1931. One patient, a man sixty-one years old with a history of right knee joint involveinept of sixteen years’ duration, showed roentgenographically the usual form of joint osteomatosis., but in addition there was an exostosis articularis bursata on the posterior aspect of the femur directed proximally. A second patient, a boy of twelve, reported difficulty with the right knee after a fall. X-rays showed a large exostosis articularis bursata of the femur on the medial side of the shaft above the condyle. Two years later the exostosis was larger, had broken off, without callus, and the entire subcrural joint pocket was filled completely with over 100 chondromatous free bodies, ranging in size up to that of a pea. Nervous and Vascular Symptoms (Raynaud’s Syndrome) in Osteochondromatosis of the Elbow, L. GERNEZ. Troubles nerveux et vasculaires (syndrome de Raynaud) par ost6ochondromatose du coude, Rev. d’orthop. 18: 330-334,1931. The patient had pain and limitation of movement of the left elbow for several years before developing circulatory and nervous symptoms resembling those of Raynaud’s disease. The left hand and arm were cold and cyanotic; there was definite hypesthesia in the area supplied by the median, cubital, and radial nerves, especially marked in the field of the radial nerve on the back of the hand. Pulsation of the radial artery was not perceptible. X-ray examination showed numerous calcified loose bodies in the elbow joint, especially on the anterior side of the lower end of the humerus. The patient refused operation. The circulatory

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symptoms in this case were undoubtedly due to pressure of tlic loose bodies on the brachial artery. I n a series of 111 cases of osteochondromatosis collected from the literature, there were 49 in which the elbow was involved, and in none of these were similar circulatory symptoms noted. Le chordoaic sacrococcygien, Rev, Sacrococcygeal Chordoma, P. MOULONQUET. crit. de path. et de th6rap. 2: 217-221, 1931. This paper presents a general discussion of sacrococcygeal chordoma based on recent French literature. Diagnosis can be made only by biopsy. Treatment should be surgical whenever possible, as these tumors are not radiosensitive. The results of operation in the cases reported have not been good, but the author believes they could be improved by careful operative technic, perhaps by the usc of electrosurgery, as the tumor rarely invades blood-vessels or lymphatics or forms distant metastases.

Malignant Chordoma, HERRMANN.Malignes Chordom, Ztschr. f. Laryng., Rhin., Otol. 22: 171-173, 1932. The author describes a tumor which was found a t necropsy, extending from the sphenobasilar synchondrosis to the body of the third cervical vertebra and projecting into the nasopharynx. Although the material was in a poor state of preservation for histological purposes, the author could determine that it was a chordoma and that it probably originated in the epistropheus, the tissue of which it had replaced. [In their recent paper on cervical chordomas Owen, Hershey and Gurdjian (Am. J. Cancer 16:830, 1932) discuss in detail the cases reported in the literature, adding one of their own; among these is included a case previously reported by Herrmann and also arising in the epistropheus-evidently the rarest site of chordoma.] F. CAVERS Atypical Tumor of Bone, BOUTIN. Tumeur osseuse stypique, Bull. et m6m. Soc. radiol. m6d. de France 20: 142-144, 1932. The author reports a peculiar case in which the chief symptom was pain in the right leg and the radiographic examination showed a lesion in the lower part of the shaft of the femur, the appearance of which was that of sarcoma. Biopy, however, showed no evidence of sarcoma, but a syphilitic lesion. Antisyphilitic treatment, however, was without effect and amputation was done. The surgeon declared the lesion to be a sarcoma, but when the specimen was sent to another laboratory, the biopsy diagnosis of a syphilitic osteitis was confirmed. The patient showed w r k e d improvement after operation, and no evidence of recurrence in five months. Schiiller-Christian Disease, E. LESNE,J. A. L I ~ V RAEN D Y. BOQUIEN. Xantliomatose crhio-hypophysaire (maladie de Schtiller-Christian), Bull. e t m6m. SOC.m6d. d. h8p. de Paris 48:610-616, 1932. This somewhat rare and remarkable syndrome has for its signs and symptoms diabetes insipidus, cranial lacunae (bone replaced by xanthomatous tissue), exophthalmos, and general developmental defects. The authors have not been able to find a previous report of this disease in France, but believe that in some reported cases of diffuse xanthomatosis associated with diabetes insipidus closer examination might have revealed cranial lacunae. Their patient, a boy of three and a half years, was admitted to hospital on account of polyuria, which remained constant a t two to four litres daily. He showed exophthalmos, general underdevelopment, and numerous cranial lacunae (good roentgenogram). Biopsy of a lacuna showed the replacement of bone by the characteristic xanthomatous foam

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cells, mostly large and often multinucleate. The ratio of cholesterol to total lipoids in the blood was raised to nearly 1 : 2 (3 mg : 6 mg. per gm.). The authors mention some possible lines of treatment such as administration of pituitary and thyroid extracts, and of insulin, and irradiation of the xanthomatous deposits and of the hypophyseal region, but do not say they have yet tried any of these, [For abstracts of other recent papers on Schuller-Christian disease see Am. J. Cancer 16: abst. pp. 261, 709, 1932.1 F. CAVERS

Bone Cyst and Spontaneous Fracture, J. MINNE,R. LOORIUS A N D L. GERNEZ. Kyste des 0s et fracture spontan6eJ Echo m6d. du Nord 35: 413-414, 1931. Report of a case of fracture of the femur in a boy eight years of age, which resulted from a slight blow on the thigh received during play. Examination on the following day showed that there was a swelling on the upper part of the thigh which was not painful on pressure; active movement was impossible; passive movement, if made with care, caused no pain. The roentgenogram showed a transverse subtrochanteric fracture which passed through a large bone cyst. The radiographic appearance of the cyst was characteristic; the bone was uniformly enlarged and the cortex was thinned. After treatment by extension for six weeks, a strong callus formed and the cavity of the cyst was being filled in with bony trabeculae. Some thinning of the cortex was still evident. The patient was discharged with good function. Where fracture occurs in a bone cyst, the symptoms that distinguish it from fracture of normal bone are the slight pain, absence of ecchymoses, moderate swelling and slight deformity, crepitation, if elicited, resembling that of epiphyseal separation. The fracture always unites rapidly; and the healing of the fracture appears to have a favorable influence on the bone cyst by stimulating new formation of bone that gradually fills the cavity. A Case of von Recklinghausen’s Fibrocystic Disease, HUGUET.Un cas de maladie fibro-kystique d e Recklinghausen, avec prksentation de maladie, Bull. et m6m. SOC.de radiol. m6d. de France, 20: 82-85, 1932. In the case reported the right radius showed typical changes of von Recklinghausen’s disease, with definite cysts, but other bones showed changes suggestive of Paget’s disease. This seems t o support the theory that these two diseases represent different manifestations of the same disturbance of calcium metabolism with cyst formation predominating in one and abnormal deposition of calcium in the other. I n this case, on account of the uncertainty of the situation, the risk of operation on the parathyroids, and the patient’s unwillingness t o submit to surgery, parathyroidectomy was not attempted. Roentgen-ray treatments to the parathyroids were given, and irradiated ergosterol by mouth in large doses. After eight treatments, the calcium content of the blood and urine was found to he practically normal, the blood calcium slightly low. As treatment is not completed, no report is made on the results obtained. Retrosternal Parathyroid Adenoma with Osteitis Fibrosa, M. RENAUD, G. PETITMAIREA N D M. FAYOT.Adknome rktrosternal dans une maladie osseuse de Recklinghausen, Bull. et m6m. SOC.mkd. d. hap. de Paris 48:.1107-1110, 1932. The patient whose case is described by the authors was first seen in 1925. She then had numerous areas of cystic fibrous osteitis. For six years these steadily became larger and more numerous, leading to spontaneous fracture of nearly all the long bones and several ribs, until death occurred with symptoms of mitral stenosis. At necropsy the mitral valve showed so much sclerosis and fusion that the free opening was about the size of a radial artery. The authors made a special study of the endocrine glands. The pituitary seemed to be normal, the adrenals

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and thyroid showed slight hyperplasia. The thyroid gland was covered by several enlarged lymph nodes, removal of which disclosed a tumor 4 X 2.5 cm., lodged in the upper part of the anterior mediastinurn, evidently a parathyroid adenoma [histological account not clear, no illustrations]. The ovaries were small and the uterus hypoplastic. The patient had not menstruated [age not mentioned]. F. CAVERS

Fibrocystic Osteitis of the Lower End of the Tibia, I~ERTRAND.OstBitc fibrokystique de l’cxtremit6 infhrieure du tibia, Toulouse mBd. 32: 669-671, 1931. A boy sixteen years of age had pain and swelling on the internal side of the lower end of the tibia, and slight difficulty in walking. Radiograms showed findings typical of fibrocystic osteitis with a single cyst cavity in the shaft of the tibia. Pathogenesis of Osteodystrophia Fibrosa of the Facial Bones, A. GREnwNsrEm. Beitrag zur Osteodystrophia fibrosa des Gesichtsschadels, insbesondere zur Frage ihrer pathogenetischen Stellung, Arch. f. Ohren- Nasen- u. Kelilkopf. 130: 1-21, 1931. A patient of fourteen years showed thickening and decalcification of the right mandible and maxilla. Microscopic examination revealed osteitis fibrosa. A second patient, a man sixty-two years of age, had a perforation of the nasal septum which was thought to have been caused by trauma sustained one year previously. A biopsy specimen taken from the bony septum showed a histologic picture resembling epulis. Similar cases in the literature are reviewed. The article is illustrated with roentgenograms and photomicrographs. BENJAMIN R. SHORE Localized Form of Paget’s Disease, OUDARD.Forme partielle de la maladie de Paget, Rev. d’orthop. 18: 324-329, 1931. A case of Paget’s disease of the bone involving the tibia only is reported. Case of Paget’s Disease, R. SARASIN. A propos d’un cas de maladie de I’aget, Ann. m6d. 32: 174-182, 1932. The author reports a case of Paget’s disease of the bones in which the diagnosis was obscure. There had been an operation for carcinoma of the rectum and the radiographic appearance of the bones showed a marked resemblance to carcinomatous metastases of bone of the osteoplastic type. The general condition of the patient was good, and radiotherapy of the bone lesions caused no change, whereas in carcinomatous metastases radiotherapy often results in bone regeneration. Finally radiograms of the skull showed the typical changes of Paget’s disease. T H E LYMPHATIC SYSTEM, T H E LEUKEMIAS, HODGKIN’S DISEASE

Hyperplasias and Neoplasms of the Lymph Nodes, J. MONTPELLIIR, A. M A N ~ E A U X and ASSAN. Hyperplasies et nhoplasies des ganglions lymphatiques Gaz. m6d. d. France pp. 667-676, Dec. 1, 1931. Although no original work is included, the author has given an excellent general discussion of the histology, histogenesis, and clinical and radiological characteristics of the lymphomas, leukemias, lymphosarcoma, the leukosarcoma of Sternberg, LEILAC. KNOX and the reticulo-endothelial neoplasms.

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Peculiar Generalized Fluctuating Tumors of the Lymph Nodes of Unknown Etiology in an Eleven-Year-Old Boy, OTTOWIESE. Eigenartige fluktuierende generalisierte Drusentumoren unklarer Aetiologie bei einem 11 jahrigen Jungen, Ztschr. f. Kinderh. 51: 432-434, 1931. Wiese reports the case of Q boy eleven years of age with generalized fluctuating swellings situated in the lymph nodes of the axillae and groins. The differential diagnosis between tuberculosis and malignant lymphogranuloma could not be made even after histologic examination of a biopsy specimen. BENJAMIN R. SHORE Report of a Case of Lymphosarcoma, FREDERICK P. SCRIBNER. New England J. M. 206: 736-737, 1932. The clinical history and autopsy findings are described in a case of lymphosarcoma in a boy eighteen years of age. There was an abrupt onset, a clinical .course of sixteen days with fever and delirium, and signs of pleurisy. Massive tumors involved the mediastinum, lungs, heart, and kidney. Sections showed the tumor to be a lymphoblastoma. There are no illustrations. LEILA C. KNOX A Case of Lymphosarcoma of the Ileum, H. L E F ~ V R ESur . un cas de lymphosarcome de l’ilbon, Bordeaux chir. pp. 417-418, October 1931. A single case report of a tumor of the terminal ileum in a boy seventeen years of age. Eighty centimeters of intestine was resected but the growth recurred rapidly, nearly filling the pelvis, although without intestinal obstruction. Death took place within a year. No bibliography is given nor are there illustrations. LEILAC. KNOX Tumors of the Blood, ROBERTA. KILDUFFE. Hygeia 10: 124, 1932. A brief description is given of the clinical symptoms of patients with myeloid and lymphatic leukemia. Special stress is laid upon the obscurity surrounding the etiology of the disease, and a plea is made for animal experimentation on the ground that birds and certain mammals have the same or a similar disease, and hence such studies may eventually throw light on some method of cure or preLEILAC. KNOX vention of the human disease. X-ray Treatment of Chronic Mastitis and CertainLeukaemias, RUSSELLREYNOLDS. Proc. Roy. SOC. Med. 25: 969-972, 1932. Also in Lancet 1: 454-456, 1932. In the first portion of this paper Reynolds discusses the treatment which he has given to about 150 patients suffering from chronic mastitis in whom the breasts were slightly tender and very slightly swollen, but without cysts. This lesion is often bilateral, and pain radiates to the axilla. Reynolds is accustomed to give half an erythema dose unfiltered, with low voltage, once a week for three doses. Longer doses and higher voltages are given if cysts are present. I n the second portion of the paper, the importance of treating patients with chronic leukemia with minimal doses of low-voltage x-ray is emphasized, even if a high degree of splenomegaly and leukocytosis are present; 80 kv., with 0.5 mm. aluminum filter, up to an erythema are given, so long as any favorable results are LEILAC. KNOX obtained. Only after this is higher voltage resorted to. J. Oriental Med. 16: 5, 1932. Acute Leucaemia, K. KASHIWABARA. Brief mention is made of three cases of acute leukemia, all studied at autopsy, two being myelogenic and one monocytic. In the myelocytic cases no remarkable hyperplasia or hypertrophy of the reticulo-endothelial system was observed, but in the monocytic case this was present to an advanced degree. For this reason the

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author inclines to the belief that monocytic leukemia is a totally independent systemic disease, but that the origin of the monocytes must be made clear for an understanding of its nature. LEILAC. KNOX

Acute Lymphatic Leukemia with Streptococcemia, C. BACALOQLU AND M. ENACHESCO.Leuc6mie lymphatique aigue. Streptococcie. Bull. et m6m. SOC. m6d. d. h8p. Bucarest 13: 99-101, 1931. Also in Sang 6: 233-240, 1932. A report of a single case of acute lymphoid leukemia occurring in a man twenty years of age, with a course of four weeks. The clinical symptoms, as well as the autopsy findings, were characteristic of this disease; but the author concludes, on the basis of a post-mortem blood culture, that the bacterial etiology was established by finding a streptococcus in these cultures. LEILAC. KNOX Observations on the Paper ‘‘ Congenital Leukemia ” of Walter Biingeler, E. STRANSKY.Bemerkungen zur Arbeit ‘‘ Angeborene Leukamie ” von Walter. Btingeler, Frankfurt. Ztschr. f. Path. 43: 173-174, 1932. Stransky wishes to add to Biingeler’s report, published in the same journal (41 : 257, 1931. Abst. in Am. J. Cancer 16: 272, 1932) a case of congenital myeloid leukemia which he observed and published. The child, born a t full term, survived three weeks. Leukemic infiltrations of the skin were present a t birth. Postmortem examination showed enlargement of the spleen and liver, generalized swelljng of lymph nodes, and myeloid infiltration in the kidneys, pancreas, wall of the gastro-intestinal tract, lungs, and skin, as well as punctate and macular hemorrhages in the skin and oral mucosa. Congenital hydrops was excluded by (1) the duration of survival, (2) the lack of edema, and (3) the fact that the extramedullary blood-forming foci were almost exclusively composed of immature white cells. The infiltrations being greenish, this case was classed as one of chloroma. L. F. CRAVER Atypical Leukemias, G. WALLBACH.Die atypischen Leukamien, Ergeb. der ges. Med. 17: 389-453, 1932. This long article, although it presents nothing new, is well worthy of perusal by all interested in leukemia. The author discusses thoroughly, with many references to the literature, all varieties of “ atypical ” leukemia. Variations from the typical are grouped in three divisions: (1) with respect to the white blood count, (2) with respect to the general blood picture; (3) with respect to the systemic lesions. The discussion of atypical features in the white blood count includes chronic and acute aleukemic lymphadenoses and myeloses, and leukopenic leukemias-the “ pseudoleukemias.” Discussion of atypical blood pictures includes leukemia, borderline pernicious anemias, erythroleukemia, and monocytic leukemia. The author questions many of the reported cases of monocytic leukemia. Discussion of atypical systemic lesions includes chloroma, Sternberg’s leukosarcomatosis, bone lesions of leukemia, and an extensive consideration of multiple myeloma, which latter disease the author is inclined to regard as essentially leukemic. L. F. CRAVER Leukemoid Blood Reactions, Differential Diagnosis of Conditions Which May Simulate Leukemias, THOMAS FITZ-HUQH. Pennsylvania M. J. 35: 290-293, 1932. Blood pictures not infrequently closely simulate true leukemia. This is especially true of the monocytic leukemoid counts. These have been observed in patients suffering from a reaction t o neo-arsphenamine therapy for syphilis, preceding aplastic anemia and agranulocytopenia; in rapidly advancing tuber-

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culosis; in recovery from agranulocytic angina; in advanced streptococcus viridans infections, etc. Myeloid and leukemoid counts were found in pregnancy with pyelitis, the total count reaching 65,000, with 8 per cent myelocytes and many normoblasts. The erythroblastic anemia of infancy, Hodgkin’s disease, and trichinosis also occasionally simulate leukemia, the writer having seen a patient with Hodgkin’s disease showing 95,000 white blood cells with 75 per cent eosinophiles. Photomicrographs are given. LEILAC. KNOX

Erythremia or Erythro-leukaemia, F. P. WEBER. Proc. Royal SOC.Med. 25: 964-965, 1932. Weber reports a case of erythremia under observation over two years. The treatment consisted of repeated administration of phenylhydrazin hydrochloride and occasional blood-letting. The white cell counts of 17,800 and 23,600, with myelocytes and metamyelocytes 5 to 7 per cent, suggest, according to Weber, that the case is one in the erythroleukemic chain, but very close to typical erythremia. L. F. CRAVER Practical Notes on Lymphoadenoma, M. DAVIDSON.Post.-Grad. M. J. 7: 3 6 3 7 , 1931. This paper is an excellent general discussion of the clinical picture presented by several patients who were suffering from Hodgkin’s disease, and in whom the practical difficulties of making a diagnosis without a microscopic section are well exemplified. Emphasis is put upon the need of biopsy material and the very limited degree of help which may be expected from blood examinations. The LEILAC. KNOX effects of radiation therapy are well evaluated. Clinical and Therapeutic Considerationsin a Case of Malignant Lymphogranuloma, P. STOENESCU, E. CRACIUNAND L. C A F F ~ ~Consid6rations . cliniques et thbrapeutiques sur un cas de lymphogranulome malin, Bull. et m6m. SOC.med. d. hSp. Bucarest 13: 76, 1931. A man forty-eight years of age with a history of pulmonary tuberculosis had very large supraclavicular and axillary lymph nodes with fever. No biopsy was done, but a diagnosis of lymphogranuloma was made on clinical grounds and radiation therapy applied as described by Chaoul and Lange (Strahlentherapie 15: 620, 1923). This consists in giving 10 per cent of a skin dose (i.e. about 70 T ) using 1 mm. of copper as a filter and a large field. This dose is repeated every few days until 500 r have been administered in six weeks. The series is repeated in three months. The temperature became normal in the course of thirty-three days, and remained so for fifteen months. The authors gave much heavier doses, however, 500 r being given twice a week until a total of 5000 had been given. A second series of exposures was made after two months, and a third after that. The patient was still under observation a t the time of the report. LEILAC. KNOX Hodgkin’s Disease:AnUnusual Case, C. M. FLEMINO. Glasgow M. J. 119: 13-17, 1933. A man of fifty-eight years was admitted to the hospital suffering from jaundice and “ indigestion ” of about three months duration, with nausea and loss of appetite but no pain or vomiting. He had lost about twenty pounds of weight in the three months. The Wassermann reaction was weakly positive. Pancreatic deficiency, shown by analysis of the feces, was almost entirely corrected by administration of pancreatin. After being kept under observation for three months, during which time his condition considerably improved, he resumed work for three ‘years, returning a t the end of that time to report that he had lost strength, was

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ABSTRAUTS

again jaundiced, and had soft swelling of the feet and legs. The edema became worse, considerable ascites developed; the Wassermann reaction was still positive; death occurred two weeks after readmission. At autopsy Hodgkin deposits were found in the mediastinal and hilar lymph nodes and in numerous superficial nodes and the spleen; also, syphilitic aortitis, hepatic cirrhosis, and obstructive jaundice owing to deposits about the bile ducts. The author discusses the possibilities that the Hodgkin’s disease and the syphilis were merely coincident, or were etiologically related, and the question whether both diseases were present when the patient was first seen, or the .Hodgkin’s disease was a later development. F. CAVERS

Lymphogranulomatosiswith Spinal Cord Compression and Paraplegia, J. PAVIOT, DECHAUME, CROIZAT A N D M. LEVRAT. Granulome malin A Bvolution paraplbgique, Lyon mBd. 149: 620-623, 1932. The patient was a woman of twenty-one, whose illness began, four years before death, with loss of weight, night sweats, and general weakness. She then noticed enlargement of glands in the neck, and roentgenography revealed large nodes in the mediastinum. Biopsy of a supraclavicular node showed typical Sternberg cells. After roentgen therapy the enlarged nodes regressed. Suddenly one day the patient was seized by painful cramp in the legs, followed by progressive paraplegia, which became complete within two days. A few days later ascending paralysis caused heart failure. Lipiodol had been injected suboccipitally and revealed arrest a t the fourth dorsal vertebra; as no bone change could be seen, it was assumed that the paraplegia was due to blockage of the cord by an extradural mass of lymphogranulomatous tissue. Autopsy was not permitted. F. CAVERS Aneurysm of the Femoral Artery in Hodgkin’s Disease, ERIK KARLMARK. Aneurysma der Arteria femoralis bei Lymfogranulomatose mit Verblutung, Acta chir. Scandinav. 69: 446-449, 1932. A woman seventy-four years of age was found to have Hodgkin’s disease when the right inguinal and axillary nodes were removed a t operation in 1921. Recurrence took place in the inguinal region in 1925, several roentgen treatments being given subsequently. Ulceration finally occurred and in 1927 death followed due to a massive hemorrhage from the right femoral artery. At autopsy it was shown that the granulation tissue containing characteristic lesions of Hodgkin’s disease had eroded the wall of the artery near the site of a small aneurysmal sac. LEILAC. KNOX Secondary suppuration was also present. Compression of the Cord by an Epidural Metastasis of a Mediastinal LymphoA N D P. VANDERLINDEN.Compression granuloma, P. BERT,R. DE PUYSSELEYR medullaire par une mbtastase Bpidurale d’un lymphogranulome mBdiastinal, Rev. belge d. sci. mBd. 3: 938-947, 1931. Also in Ann. et bull. SOC.roy. de m6d. de Gand. 10: 93-102, 1931. The symptoms in the case reported were those of paraplegia of the lower extremities. All the neurological tests indicated a lesion of the cord a t the level of the 6th or 7th dorsal vertebra. Radiography showed a decalcification of the 5th, 6th, and 7th dorsal vertebrae. Comparison of the spinal fluid from the lumbar region with that from a suboccipital puncture indicated blockage of the canal. The exact site of the compression was determined by suboccipital injection of lipiodol. The above findings, together with a slight scoliosis of the middorsal spine, and a radiographic appearance consistent with that of tuberculosis, led to a diagnosis of Pott’s disease. Autopsy, however, showed lymphogranuloma, believed to have arisen in the

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thymus, involving discretely the lymph nodes of the anterior and posterior mediastinum as well as the intercostal nodes, and extending through the intervertebral foramina to the epidural space. The posterior and lateral surfaces of the dura mater of the cord were infiltrated from the 2nd thoracic to the first lumbar vertebra. The dura itself was not infiltrated, being separable from the tumor. There was a cylindrical constriction of the cord a t the level of the 7th dorsal segment.

L. F. CRAVER Pulmonary Tuberculosis Followed by Lymphogranuloma, P. CONRATH.Tuberculose pulmonaire suivie de lymphogranulomatose, Strasbourg m6d. 91: 669672, 1931. A youth of eighteen years developed pulmonary tuberculosis on the right side in 1926. He was treated by pneumothorax and improved so that he was able to return to work. The tuberculosis seemed to be completely arrested, but three years later the patient was suffering from Hodgkin’s disease of the mediastinum on the right side and of the right supraclavicular nodes. Biopsy confirmed the diagnosis. The patient’s condition rapidly became worse and he died. Apparently an autopsy was not done. The author discusses briefly the question of the relationship between Hodgkin’s disease and tuberculosis, stating that usually tuberculosis appears as an ‘‘ epiphenomenon ” to hasten the fatal termination of a previously existing case of Hodgkin’s disease. Although the case reported might serve as an argument in favor of the tuberculous etiology of lymphogranuloma, the author does not make any such claim, stating that while tuberculosis is often seen as a terminal feature of Hodgkin’s disease, much more frequently patients with tuberculosis do not develop Hodgkin’s disease. L. F. CRAVER Atypical Forms of Malignant Granuloma, M. FAVRE, P. CROIZAT AND A. GUICHARD. Les formes atypiques de la granulomatose maligne, Gaz. d. h6p. 105: 16331634, 1932. This is an abstract of a paper presented a t the 22nd French Medical Congress in Paris in October, 1932. The authors feel that there exists too great a tendency to label as atypical those classical cases of Hodgkin’s disease in which one symptom or another dominates the clinical picture, or larval cases which show a paucity of symptoms. It seems preferable to reserve the term atypical for those cases in which the condition remains localized for a long time or in which a localized process remains without appreciable change throughout the entire period of evolution of the disease. There follows a discussion of certain localized forms, mostly secondary, questionably primary in some instances, including localized tumorlike manifestations, neurological, osseous, splenic, pleural, pulmonary, gastrointestinal, and cutaneous types. It is suggested that certain pulmonary and cutaneous forms may represent the initial lesion. The discussion of atypical histology gives occasion for reference to Sternberg’s dictum that it is best to reject from the category of Hodgkin’s disease all the doubtful forms; otherwise one risks resurrecting the antiquated pseudoleukemia under the pretext of atypical lymphogranuloma. Typical cases have a great scope of variation in their histology, (1) in respect to development (lymphoid forms, cases with reticular hyperplasia, inflammatory lymphadenitis); (2) in the fully developed nodes, which cover the whole range between the neoplastic form and the inflammatory and sclerotic form; (3) in forms associated with tuberculosis or other infections; (4) in forms modified by therapy, especially radiotherapy. In conclusion, the authors insist on strict adherence to anatomical and clinical criteria in order to assure a true autonomy of this disease. L. F, CRAVE^

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STATISTICS

Contribution to Geographical Pathology, A. E. SITSEN. Beitrag rur geographlschen Pathologie, Virchows Arch. f. path. Anat. 285: 506-549, 1932. The material for this study in so far as it concerned tumors was collected in Soerabaja, Java, and compared with material from Innsbruck, taking into consideration such factors as higher mortality, difference in age groups, etc. The author finds that cancerous growths are fewer in Soerabaja than in Innsbruck. Involvement of the digestive tract in Malays is low in incidence. It is tentatively suggested that the vegetarian mode of living may play a r61e. On the other hand, uterine cancer and primary growths of the liver which are closely associated with cirrhosis are frequent. These conclusions are based on autopsy material. Another source of material was a group of @mars from the pathologic-anatomic laboratory of the Niederliindisch-Indischen Arrteschule. From a study of this material it is a conspicuous fact that skin cancer is of greater frequency in Malays than in Europeans. It must be remembered, however, that these figures are drawn from patients presenting themselves for treatment and in no way indicate the actual incidence of cancer, and that in every new clinic the cases coming first for treatment are those with external cancer followed later by those with internal organ involvement. In the Malays cancer of the genital organs, as of the breast, uterus, ovaries, and penis, ranked next in frequency. Sarcoma is relatively very frequent in the Malays as compared to its occurrence in Europeans. An excellent bibliography is appended. Frequency and Types of Cancer among the Annadtes of Tonkin, J. BABLET. Sur la fr6quence et les modalit6s du cancer cher les Annamites du Tonkin, Ann. Inst. Pasteur 48: 594-603, 1932. The writer has studied the frequency and types of cancer among the Annamites and finds some evidence for the belief that cancer occurs earlier in the hot climate of Indo-China than elsewhere, as he has seen a large number of examples of cancer of the stomach, liver, uterus, and ovary in young persons, the average age for cancer of the liver in women, for example, being twenty-seven years, and the average for cancer of the uterus being forty-two. He does not see any other differences in the occurrence of cancer in Tonkin and in the temperate climhtes. The histological study of the tumors shows nothing of special interest, except that the number of sarcomata seems rather in excess. Certain localities, such as the penis, neck, and oral cavity, show an abnormal frequency of carcinoma, while cancer of the digestive tract is rarely observed. Cancer of the skin is somewhat more rare than in Europe [contrary to what has been reported in Java among the Malays (see above)]. The disease is about equally distributed between the two sexes.

Mortality from Cancer in Cairo, DELBET.La mortalit6 par cancer & Kasr-el-Aini, Bull. Acad. de m6d., Paris 108: 1133-1139,1932. Comparaison de la mortalit6 par cancer A Kasr-el-AIni e t dans sept hbpitaux parisiens, Bull. d. I’Assoc. franc. p. 1’6tude du cancer 21: 554-569, 1932. The author communicates some statistics received from the chief native hospital and medical school of Cairo. He compares the total deaths and the deaths from cancer recorded a t Cairo with those recorded a t seven hospitals in Paris. The percentage of cancer deaths to total deaths is one-tenth as great in Egypt as in Paris. [Most people would consider the Egyptian records to be far too scanty to be of any use for comparisons like this, and would expect that even were the incidence of cancer in native races known much more accurately than a t present it would, for obvious common-sense reasons, be lower than among

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civilized races. Even allowing for the fact that in native races relatively few individuals survive to advanced age, careful inquiries are showing that malignant disease is not so rare among such races as was until recently imagined. The author, however, attributes the difference stated to the fact that the soil of Egypt is rich in magnesium, and his pet theory is that soil richness in magnesium and prevalence of malignant disease-excluding sarcoma, however-march in inverse ratio.] F. CAVERB Cancer Mortality and the Magnesium Content of Soil, Drinking Water and Food in Three Departments of Alsace and Lorraine, A. SARTORY, R. SARTORY, J. MEYER AND E. KELLER. La mortalite can cereuse et la teneur en magnesium du sol, des eaux, et des aliments usuels dans les trois departments d'Alsace et de Lorraine, Bull. Acad. d. med., Paris 108: 1097-1098, 1932. The authors question the validity of comparisons between regional cancer mortality and magnesium content of soil. On the basis of their analyses of food and drinking water in small communities where practically the whole food supply is of local origin, they conclude that there is no close parallel between the magnesium content of the soil and the food grown in the soil, and no relation between the magnesium content of food and drinking water and cancer mortality. H. Q. WOODARD Influence of the Geological Nature of the Soil and the Mineral Content of Drinking Water on Human Cancer Incidence, L. BETHOUX AND F. BLANCHET. Influence de la nature geologique du sol et de Ia mineralisatioir des eaux d'alimentation sur la frequence du cancer chez Phomme, Bull. Aoad, d. med., Paris 108: 1094-1096, 1932. The authors have studied the rigures for cancer mortality in two regions in France where the geological formation 15 ancient and well leached and the drinking water low in mineral content, and in two other regions where the rocks are predominantly calcareous and the drinking water has a high mineral content. They conclude that the cancer mortality is higher in the calcareous regions. H. Q. WOODARD Cancer Statistics, M. NAGAYo. Gann 26: 353-361, 1932. In this number, Nagayo gives his report on a statistical study of cancer among Koreans and Chinese. The results are recorded in 13 tables. K. SUGIURA EDUCATION Cancer Control in Germany, H. HOLFELDER. Zur Zentralisation der Geschwulstbekampfung, Med. Welt 5: 1309, 1931. The author maintains that moderate centralization of radiation therapy with the founding of an independent roentgen institute with bed provision and a school for general clinical roentgenography, has proved its value in Frankfort and is to be recommended as the most appropriate solution of the problem of cancer control. Organization of Cancer Control in Baden, K. WEISS. Uber die Badische Organization der Krebsbekiimpfung und ihre Einrichtungen, Strahlentherapie 41: 11-24, 1931. A report on the organization and activities of the various agencies engaged in cancer control in Baden. 46

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ABSTRACTS

Toulouse Regional Anti-Cancer Center, GIBONAND GUILHEM. Le fonctionnement du service de propagande au centre regional anti-cancereux de Toulouse, Prat. m6d. franp. 13: 187-191, 1932. The authors describe the publicity methods used in the Toulouse center under the direction of Professor Ducuing. The medical practitioners of the district have given hearty support to the center and to the methods of propaganda, which include newspaper articles, posters, leaflets, radio talks, conferences, a bureau for keeping contact between the center and the mayors of communes, etc. Statistics are given to show that this propaganda has already proved effective, as judged by the larger number of patients now seeking advice in earlier stages of cancer. F. CAVERB What an Organized Group Can Do Toward Forwarding Clinical Research and Treatment of Cancer, G . R. STEVENSON.Southwestern Med. 16: 374-378, 1932. Stevenson has given a brief review of the history of the treatment of cancer. Since 50 B.C. the method of choice has been surgery. Becase of their gullibility and the fear of this disease, the public are imposed upon by " cancer quacks." According to the American Society for the Control of Cancer, four cases of cancer a year are seen by the average physician. Consequently there can be but few who are qualified to diagnose and treat this disease. Because of the attempt to educate the public, many cases of cancer are being seen earlier by the physician than formerly., ,l?y~,s $he&gpp#i#:becomes more difficult. The need, therefore, is emphasize439 ape>@er&+x? p$hplogist as well as radiologist in a group clinic where malig6at&*t~hf?tkSbnI'y ti% being treated. Such a group clinic, opened thret?Tapftgg, is,dyi.?fibed. : * * &l$&,6j&~fi@fsEst y~aj;.'fj&.&i&& hid been admitted for treatment or +aths (50 per cent), 28 improved (24 per cent), advanced cases, however, and had two years, 318 cases were treated. One hundred and twenty-three were treated by surgery only, and seventy-two received radium or x-ray therapy or a combination of the two, as the major treatment. Of these, 124 are dead (39 per cent), 75 (23 per cent) improved, and 32 (10 per cent) unimproved. Seventy-three per cent of the cases seen in the second and third years were shown t o be malignant by microscopic examination, 17 per cent were non-malignant, and 7 per cent undetermined. Biopsies are taken routinely. The importance of repeated biopsies in face of negative reports when clinically the tumor is malignant is noted. The author believes that too frequently patients are pronounced inoperable when actually the removal of the tumor is anatomically possible. W. S. MACCOMB

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