ABSTRACTS EXPERIMENTAL STUDIES; ANIMAL TUMORS Similarity Between Fasciations in Plants and Tumors in Animals and Their Genetic Basis, D

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ABSTRACTS EXPERIMENTAL STUDIES; ANIMAL TUMORS Similarity between Fasciations in Plants and Tumors in Animals and Their Genetic Basis, D. F. JONES. Science 81: 75-76, 1935. The author compares tumors in animals with fasciations in plants-irregular development of the growing points of the main stem or branches. Both are forms of unregulated growth, though fasciations do not exhibit the malignant features which characterize many animal neoplasms. In some cases fasciated plants are able to reproduce, and all their descendants show the same abnormality. In many others, fasciations occur only in one part of a plant and so sporadically that they seem not to have any basis in inheritance; yet they appear more frequently in some germinal lines than in others. Fasciations can develop only in growing points. In animals, similar growths may occur wherever there are dividing cells, as particularly in glands and in tissues regenerat- ing after an injury. It is possible that unregulated proliferation may be the result of chromosomal unbalance, and significant that tar, aniline dyes, x-rays, and radium, all of which may initiate unregulated growth, will also cauae chromosomal aberrations. If these act indirectly through the manifestation of hemizygous recessive genes or the total loss of genes necessary for normal growth, or directly as a result of chromosome unbalance in particulrtr regions, it is easy to understand why unregulated growths occur sporadically but with higher frequencies in some families than in others. [Dibenzanthracene is not, as the author says, the active principle of coal tar, but an entirely synthetic product.] WM.H. WOOLOM Rae of Roentgen Rays in Experimental Carcinogenesis. ANTOINEBI~CL~ZRE. Le r8le des rayons de Roentgen dans la carcinog6n6se expkrimentale, Schweiz. med. Wchnschr. 15: 679-681, 1934. A comparative study of roentgen cancer in man and the lower animals shows that it develops upon an ulcer frequently in the former and invariably in the latter. In both it is a slow destruction of the activities and life of the cell rather than excitation of its proliferative capacity that terminates in malignancy. This end-result is to be regarded as a more or less accidental complication, for the r81e of the x-ray is restricted to preparation of the soil. The actual cause of cancer remains still unrecognized, but it seems to be some factor quite independent of the cell changes which prepare for and favor its inception. The hypothesis of an external agent seems the moet reasonable, WM. H. WOGLOM

Production of Tumors with Cultures of the Parasite of the Flemer- Jobling Carcinoma, M. M. NEWIADOMSHI.Ueber die Hervorrufung von Geschwiilsten durch Kulturen der Parasiten des Flexner-Joblingstammes, Cancer, Bruxelles 11 : 69-74, 1934. The author has found an animal parasite in all of the 2000 animal tumors which he has examined during the past four yews, whatever their histological structure, and believes that the tumor cell is but one stage in the extraordinarily complicated life cycle of this organism. The parasite, which belongs to the Sporozoa, has been successfully grown in culture (Cancer, Bruxelles 10: 31, 135, 1933. Abst. in Am. J. Cancer 21: 112, 663, 1934). In the present paper Newiadomski describes the production of Flexner-Jobling tumors by inoculation of cultures. The resulting growths contained a large proportion of connective tissue and often underwent early degeneration. Their fibrous nature is referred to a reaction on the part of the host against a virus weakened by the unfavorable conditions attending cultivation in vitro. 837 838 . ABSTRAUTS

In addition, the author has isolated from another transplantable neoplasm (Sinel- nikoff-Kritschewski) a I' cancer toxin " which killed rats a few hours after intravenous injection. It gave a characteristic allergic reaction when introduced into the skin of cancer patients, but none in healthy persons. [The abstractor would be very wary of fibrotic nodules in an animal which, like the rat, responds to local irritation with a vigorous connective-tissue reaction, particularly if they broke down readily.] WM. H. WOGLOM Studies of Cell Potencies and some Relations to Reoplada, STANLFYP. REIMANN.Ann. Int. Med. 8: 504-508, 1934, The author sums up his paper with the following definition. A neoplasm is a mass of cells which arises from and continues to proliferate within an organism a~ a result of and in direct proportion to their degree of internal qualitative differences from the other cells of the organism with respect to the potencies of differentiation and organization particularly. WM. H. WOQLOM Influence of Ovarian and Anterior Pituitary Hormones upon Experimental Tar Cancer, E. MAURIEIOAND E. DEBIA~I.Influenza degli ormoni ovarici e preipofisari sul cancro sperimentale da catrame, Monitore ostet.-ginec. 5: 321-302, 1933. Mice were painted with tar two or three times a week. A control group of 53 animals received only the tarring. Experimental groups of 15 mice each were subjected, in addition, to several procedures, utilizing prolan, folliculin, and corpus luteum extract. The number of animals used is too small to permit of generalizations as to the effects. Ten photomicrographs and a bibliography are included. c. D: HAAQENBEN Internal Secretion of the Ovary and Tumor Growth, I-IV, Y. YANO.Innere Sekretion des Ovariums und Geschwulstwachstum (I-IV), Acta Dermat. 22: 140, 1933; 23: 18-22, 1934. The Honda rat sarcoma, inoculated into adult rats nine days after removal of both ovaries, grew much more vigorously thhn in controls until toward the end of the second week; after this time the difference was not so distinct. [The number of animals in this experiment is not mentioned.] Total castration five or seven days after sarcoma inoculation resulted in stimulation, which became evident two days [eic]after the operation and persisted until the end of the aecond week. At a later period there wa8 no difference between the tumors in castrated and normal animals. There were 10 castrated and 10 control rats in this experiment. The tumor generally receded when inoculated shortly befor8 or during pregnancy. Various preparations of ovarian follicle stimulated groyth, on the whole, whereas those of corpus luteum had some inhibitory action, both in vivo and in vitro. WM. H. WOQLOM Metaplasia of Uterine Epithelium Produced by Chronic Oestrin Administration, H. SELYB,D. L. THOMBON,AND J. B. COLLIP. Nature 135: 65-66, 1935. The synthesis of polycyclic compounds with both estrogenic and carcinogenic properties, the presence of estrin in cancers and in the blood of tumor-bearing male mice, and the correlation between the amount of estrin in the body and the incidence of spontaneous mammary carcinoma in susceptible strains of mice, suggest some connection between epithelial growths and the female sex hormone. Metaplasia from columnar to stratified epithelium has been noted in the seminal vesicles and coagulating glands of mice end rats treated with estrin, but analogous effects in female animals have not yet been reported. It is true that treatment with estrin and corpus luteum hormone has been said to enhance the atypical epithelial proliferation produced by traumatizing the cervix uteri in monkeys; but since this proliferation occurred in 8 region in which squamous epithelium is normally present it oannot be determined whether metaplasia occurred or not. The authors report the production of complete metaplasia of the cylindrical uterine epithelium into stratified squamous epithelium with kerstinization, in 4 out of 8 EXPERIMENTAL STUDIES ; ANIMAL TUMORS 839

castrates [kind of animal not stated], after the daily intraperitoneal administration for ten weeks of 30-607 of oestrone in oil (crystalline folliculin). The mammary glands showed distinct duct proliferation with some formation of alveoli; these changes were as advanced in biopsy specimens removed two weeks after the beginning of treatment as at the end of the experiment. In another series, 0.1-0.3 C.C. of 0.1 per cent oestrone in corn oil was placed in one horn of the uterus of each of 6 adult castrated rats, escape of the oil being prevented by ligation. The animals had been treated previously with moderate doses of oestrone intraperitoneally in order to distend the uterus. They were killed on the fourth day after filling the uterus. The oestrin-treated horn showed signs of commencing metaplasia in 3 cases and complete metaplasia to stratified squamous epithelium in one. [In an editorial summary on page 72 of the same number of Nature it is stated that the authors " now report cancer symptoms in castrated female rats injected with oil- solutions of the sex hormone." This statement is not supported by the context of the article.] WM. H. WOGLOM

Results of Inoculation with a Transplantable Spindle-cell Sarcoma (Honda) of the White Rat, I-IV, Y. YANO. Impfversuche mit einem transplantablen Spindel- zellensatcom (Honda) bei weissen Ratten (I-IV), Acta Dermat. 23 : 15-17, 1934. The Honda rat sarcoma, in the course of 54 generations in 955 rats, took in 74.4 per cent of the animals, failed in 11.6 per cent, and underwent early absorption in 14.0 per cent. Growth was distinctly better in younger rats (up to 59 gm. in weight), and somewhat more vigorous in the fall months, Rats refractory to a first inoculation were often (80 per cent) resistant to a second, while those in which a tumor had regressed were almost always so (98 per cent).

" Superinoculation )) (reinoculation of rats with growing tumors) succeeded only when carried out very soon after inoculation of the first tumor. It exerted no influence upon this growth. Rats in which a second attempt failed were invariably resistant to a third inoculation (180 days after the first). WM. H. WOGLOM

Effect of Malignant Tumours on the Hypophysis, C. S: MCEUEN,H. SELYEAND D. L. THOMBON.Brit. J. Exper. Path. 15: 221-223, 1934. Malignant tumors often lead to definite histologic changes in the pituitary gland. Wyeth (Abst. on p. 848, below) has recently reviewed these findings and discussed the possible importance of the hypophyseal hormones for the growth of malignant tumors. Guyer and Claus (Abst. in Am. J. Cancer 16: abst. p. 1261,1932;21: 391,1934) recorded changes in the anterior pituitary of rats bearing Flexner-Jobling carcinoma, and regarded them as being identical with those observed after castration. The authors have made a histologic study of the pituitary in 40 adult male albino rats bearing Walker tumor 256 (a carcinosarcoma of mammary origin), and noted the appearance, in the anterior lobe, of numerous vacuolated cells identical with those described by Guyer and Claus. They believe, however, that these are not quite identical with castration cells, since the vacuoles in the latter are much more regularly circular and as a rule contain slightly eosinophile colloidal material, and that they more clearly resemble the cells observed in adrenalectomized or thyroidectomized rats and in rats given chronic treatment with thyreotropic extract. In order to ascertain whether these changes in the pituitary are characteristic of malignant tumors, or are due simply to toxic substance liberated from such necrotic material as is usually found in the centers of these tumors, the authors implanted 10 adult male albinos, of the same age as those used in the tumor experiments, with fresh kidneys taken from other albino rats. The implants were made intraperitoneally a intervals of three to ten days during a period of forty-nine days. Four rats were killed on the 18th, 34th and 38th days, the remaining 6 on the 49th day. The anterior pituitary showed the same changes as those found by Guyer and Claus in Flexner-Jobling carcinoma and by the authors in Walker tumor rats. Hence it is concluded that these changes are not necessarily related to malignant growths as such, but are due, at least in part, to decomposition of tissue in the necrotic center of the tumor. There are two photomicrographs. F. CAVERS 840 ABSTRACTS

Specific Chemotherapy for Cancer, H. E. EWERS. Arch. Path. 18: 507-515, 1934. The author has attempted to cure tumors by selective intoxication of their cells with sugar compounds carrying toxic radicals. Rats bearing the Flexner-Jobling carcinoma or sarcoma 39 were treated with lead or arsenic combined with various acids derived from hexose. The results with lead were unsatisfactory on the whole, for while a number of growths of relatively low malignancy (Flexner-Jobling rat carcinoma) disappeared, the more malignant sarcoma 39 was practically uninfluenced. Tetramethylarsonium gluconate, in safe doses, caused the disappearance of a considerable proportion of tumors of low virulence. With more malignant growths, better results were obtained when insulin was administered concomitantly; 21 out of 22 disappeared when thus treated. If chemotherapy is to be successful, early treatment seems to be necessary. WM. H. WOGLOM

Investigation of a Method for Testing the Value of Substances for the Chemotherapy of Carcinoma, B. LUBTIOAND H. WACHTEL. Versuch einer Prufung von Substanaen auf ihre Eignung fUr die Chemotherapie des Carcinoms, Biochem. Ztschr. 271: 346-356, 357-369, 1934. The authors tested the effect of various substances on the viability and growth of carcinoma cells in vifro and in vivo. For in vitro tests they used the method of Freund ’ and Kaminer (Wien. klin. Wchnschr. 46: 1576, 1933. Abst. in Am. J. Cancer 21: 682, 1934). This is based on the finding that normal serum contains a saturated fatty acid allied to succinic acid which will cytolyre carcinoma cells, while serum from carcinoma cases contains an unsaturated fatty acid allied to maleic acid which protects the malignant cells from cytolysis by normal serum. The malignant acids may be produced by the action of intestinal secretions from normal or carcinomatous individuals on fatty nutrient media. Substances were first tested for cytolytic activity against carcinoma cells; if this was found, the experiments were repeated with normal and sarcoma cells to determine the specificity of the cytolysis; if the action was found to be specific for carcinoma, it was further tested against the protective action of carcinoma serum. The activities were also tested by the effect on the percentage of takes and rate of growth of transplantable mouse tumors. It was found that vitamins BI and B2, oxytocin, vasopressin, thyroid extract, male sex hormone, insulin, histamin, coagulen, and hirudin had no effect in vitro or in viuo. Female sex hormone and adrenalin had a non-specific cytolytic activity in vitro but no action in vivo. Anterior hypophyseal extract and vitamin D had some protective action on carcinoma cells in vitro and some stimulating action in viuo. Vita- min C had no effect in vitro and a slightly stimulating effect in uiuo. These results are being tested clinically. H. Q. WOODARD

Heterologoas Transplantation of Malignant Tumors : Its Difiiculties and the Biological Aspects of the Problem. A Critical Study, R. KEROUNTUL.La greffe des tumeurs malignes entre esphces animales distinctes. Ses difficult& et les blbments biologiques du problbme. Etude critique. R. KEROUNTUL.Rev. de path. compar6e. 33: 442, 811, 945, 1075, 1149, 1933. Published also 8s a monograph, Laboratoire du Pro- fesseur Peyron, Institut Pasteur, Paris, 1933. Pp. 104. The subject of heteroplastic grafting has not received the attention which it deserves, despite its great interest, in monographs on cancer research. It ought to be brought up for discussion by geneticists and pathologists at a cancer congress, where histological preparations relative to published cases might be carefully studied and compared. Among recent claims to success, that of Putnocky (Ztschr. f. Krebsforsch. 32: 520, 19301, who transplanted the Ehrlich mouse carcinoma to rats, is the only one which the author believes will withstand critical examination. The following conditions must be fulfilled before heterotransplantation can be Tegarded as successful. A. There must be regular development of a neoplasm biologically and histologically similar to that implanted. EXPERIMENTAL STUDIES ; ANIMAL TUMORS 841

B. Metastasis is important, though perhaps not so indispensable as A, for it is not invariably present after homografting. C. Growth through several generations is an essential requirement. It should be remembered, however, that even simple granulomas can be carried through a few series, particularly in the rat, where most of the successful heterotransplantations have been described. However, these inflammatory nodules seldom survive a third generation, and differ from the original tumor in both structure and evolution. D. The cells of the growth must be descendants of those comprising the original neoplasm, and not derivatives of the host. This fundamental distinction does not hold, however, for the propagable avian tumors, as chicken sarcoma has been transferred to ducks by what appears to be inoculation rather than true grafting. E. There must be integrity of tumor cells and absence of the round-cell infiltration characteristic of granulomas, immune reactions, etc. F. The new tumor should become palpable within three or four weeks. Although absence of the stroma reaction that marks the success of a homograft may explain the failure of the heterograft, recent investigations suggest that a general response is concerned as well, the reticulo-endothelial system appearing to play a predominant, if not an exclusive r61e in resistance. Heterologous transplantation readily succeeds in the hen’s egg up to the eight- eenth day. The results of intracerebral inoculation cannot be accepted without further study; contrary to early opinion, the graft does not retain its original vitality. Treatment with x-rays does not suppress the immune response to a point where heterotransplantation will succeed. Neither the exclusive r61e of the lymphocyte in resistance, nor the existence of antibodies, has been demonstrated. [In the judgment of the abstractor, this monograph is an unusually valuable contribution to the literature of cancer research. See also, on this same subject, the excellent monograph by Andersen, reviewed in Am. J. Cancer 23: 353, 1935.1 WM. H. WOQLOM

A Virus-Induced Mammalian Growth with the Characters of a Tumor (the Shope Rabbit Papilloma). I. The Growth on Implantationwithin Favorable Hosts, PEYTONROUS AND J. W. BEARD. J. Exper. Med. 60: 701-722, 1934. The Shope transmissible rabbit papilloma [see J. Exper. Med. 56: 793, 803, 1932. Abst. in Am. J. Cancer 17: 808,809,1933], hitherto grown only in the skin, can be readily transferred to the inner organs of favorable hosts by grafting; liver, spleen, and voluntary muscle seem to offer the most favorable soil. The tumors thus elicited proliferate actively as a rule, are often distinctly invasive and destructive, particularly in the presence of bacterial infection, tend to recur after excision, and frequently cause death. They have the morphology characterizing epidermoid neoplasms of greater or lesser malignancy and elicit similar changes in the surrounding tissues. These internal growths are due to survival and multiplication of the implanted cells. WM. H. WOQLOM A Virus-Induced Mammalian Growth with the Characters of a Tumor (the Shope Rabbit Papilloma). 11. Experimental Alterations of the Growth on the Skin: Morphological Considerations: The Phenomena of Retrogression, J. W. BEARDAND PEYTONRous. J. Exper. Med. 60: 723-740, 1934. Though the papilloma grows progressively when implanted within the animal, invading and replacing normal tissues and ultimately causing death, on the skin, its natural habitat, it invariably ceases to extend after a time, though its cells continue to proliferate, heaping up its mass. This secondary limitation of growth seems to be due to local conditions, for the injection of Scharlach R into the skin about papillomas produced by virus inoculation causes them to infiltrate the underlying tissues, where they form large masses which frequently invade blood vessels and which possess the histological characteristics of malignancy. Prevention of outward growth, too, by the application to 842 AB6TRACTS

young tumors of a layer of collodion causes them to burrow downward and to enlarge at the expense of the normal tissues. Cessation of extension in the skin is associated with epitheliai differentiation and a dense fibrotic reaction beneath the tumor. Similar changes have often been recorded for various other neoplasms, notably tar cancer in the rabbit. WM,H. WOGLOM A Virus-Induced Mammalian Growth with the Characters of a Tumor (the Shope Rabbit Papilloma). III. Further Characters of the Growth: General Discussion, PEYTON Rous AND J. W. BHARD. J. Exper. Med. 60: 741-700, 1934. The Shope papilloma, endemic in wild rabbits, manifestly falls into the dubious group of infectious warts, condylomas, and papillomas, though it differs in several important respects from those that have hitherto been studied experimentally. Thus, no development of secondary nodules takes place by infection from an existing papilloma; the growth capnot be distinguished morphologically from the tumors; it does not often regress; and, finally, the virus will cause vigorous progressive lesions in animals of an alien genus (domestic rabbits). It looks and acts like a true tumor, and often like a highly malignant one, after implantation into an internal organ. It frequently penetrates blood or lymph vessels and recurs after incomplete removal, but conclusive instances of metastasis have not yet been encountered. The papilloma produces no distinctive cytological changes in the blood or other organs, and itself seems to contain no inclusion bodies such aa are ordinarily associated with the presence of a virus. Though caused by a virus, the established growths appear to enlarge solely by multiplication of their own aells; on transfer to other hosts the fate of the graft seems to be wholly uninfluenced by the presence of a causative virus to which, as such, the host may be susceptible, but is determined instead by those laws which govern the transplantation of tissues in general, including tumors. As in the case of chicken sarcoma, two sorts of resistance can be detected in animals to which the growth is transferred-one directed against the cells of the papilloma and another against the etiological agent. The enhanced malignancy, or the retrogression, exhibited by tar tumors in response to local stimulating or repressing influences have been often invoked to prove that neoplasms are the consequence of intrinsic cell changes. The rabbit papilloma, a growth due to a virus, behaves in precisely the same way. Tar cancers of the rabbit often stop growing, like the papilloma when it is situated in the skin; in both cases a dense layer of new-formed connective tissue is found next the growth, and in both there is evidence that this is responsible for the cessation of proliferation, Like the chicken sarcoma, the Shope papilloma resembles the authentic tumors in its manifestations within the individual host, yet both are due to flltrable agents specific for cells of a certain kind-connective tissues in the case of the former, epithelium in that of the latter. Nevertheless, some of the agents will act upon the cells of a foreign species- duck or pheasant in the case of certain chicken sarcomas, domestic rabbita in that of the Shope papilloma. In both, cell injury is a prerequisite, but once the cells have been involved, their character and activities are responsible for the resulting neoplasm. When the virus of either growth has become associated with the cells It appears to be protected from the influence of neutralizing principles in the body fluids. On the other hand, the papilloma differs significantly from the neoplasms in the conditions governing its natural occurrence. It is an infectious disease, and arises within a few days on the basis of an acute injury, such as a scratch. Tumors, on the contrary, give no sign of an infectious cause and usually appear only after long continued disturbance. The discovery of this epithelial growth raises once more the question whether tumors in general can be ascribed to viruses or other extraneous agencies. The supposition is tenable only if the etiological principle is constantly present in or upon the body, like the colon bacillus or the staphylococcus, and only if it requires very special conditions to become operative. Otherwise, multiple spontaneous growths would be common. Yet these may arise where the local situation is exceptionally propitious, as when a broad , expanse of skin has been damaged by roentgen rays, tar, or other physical or chemical EXPERIMENTAL STUDIES ; ANIMAL TUMORS 843 influences; and where the necessary general conditions are fulfilled, as in certain races or families, the case incidence may be high. Our present knowledge makes it reasonable to assume, as a basis for further work, that the failure to demonstrate hitherto a cause for neoplasms in general may be explained by the hypothesis that the responsible extraneous living entities are widely distributed but become effective only under highly special circumstances. Demonstration of the cause therefore waits upon discovery of the conditions under which it will act. WM. H. WOQLOM

Problem of Intranuclear Inclusions in Virus Diseases, E. V. COWDRY.Arch. Path. 18: 527-542, 1934. In describing intranuclear inclusions it is customary to emphasise: (1) their aci- dophilic staining; (2) the presence of clear halos between them and the nuclear membrane; (3) margination of chromatin on the nuclear membrane. They are found under conditions ranging from severe epidemic diseases (e,g., yellow fever) to mild infections called I‘ inapparent ” because they are associated with no clinical symptoms (e.g., salivary gland disease of guinea-pigs). The relationship between viruses and inclusions is not yet clear. The viruses may not themselves produce the inclusions but merely initiate physicochemical changes that lead to their appearance in some cases and not in others, and it is possible that nuclear inclusions may arise even in the absence of any virus. The author provisionally divides inclusions into two groups-one associated with complete and one with partial degeneration of the nucleus; the two may be but different expressions of the same process. WM. H. WOQLOM

Studies on Mouse Leukemia. XI. Metabolic Effects of Host Constitution, JOSEPH VICTORAND JAMESS. POTTER.J. Exper. Med. 60: 547-558, 1934. Two highly inbred strains of mice were employed to investigate the host’s influence on the metabolism of cells of transmissible lymphatic leukemia. It was found that while their inherent nature did not appear to be modified by the genetic constitution of the host, this did exert some effect upon their metabolism. WM. H. WOQLOM

Experimental Radiologic Studies Concerning Polygraphy in Malignant Lesions of the Stomach, Especially in Relation to the Early Diagnosis of Cancer, c. TAMIYAAND S. NOBARI. RBntgenologisch-experimentelle Studien iiber die Bedeutung der “ Polisographie ” bei pathologischen Vorgangen am Magen, mit besonderer Ruck- sicht auf die Fruhdiagnose des Magenkarzinoms, Fortschr. a. d. geb. Rontgenstrahlen 50 : 284-280, 1934. The stomachs of cats, into the walls of which bits of tumor had been transplanted, were studied radiologically in order to determine at what stage in the development of these growths they could be detected by radiologic means. In all instances R contrast medium was used and three exposures were made on the same film in three different phases of peristaltic activity. As soon as the tumor could be detected, the animals were killed and the stomachs were fixed for study. It was found from these

Tumor Metabolism, S. EDLBACHERAND F. KOLLER. Uber den Stoffwechsel der Tumoren, Ztschr. f. physiol. chem. 227: 99-113, 1934. The arginase and phosphatase content of intact and necrotic Jensen rat sarcoma were studied. Both enzymes were abundant in the intact tissue, where their presence may be considered to be a sign of the high cell activity of rapidly growing tissue. They were also present in necrotic tissue, where their function was probably to split nuclear substances. The arginase in the necrotic tissue was much less fully active than that in intact tissue, 844 ABSTRACTS

owing probably to the absence from necrotic tissue of reducing substances such as glutathione and ascorbic acid, which act as natural activators. H. Q. WOODARD

Tumor Glycolysis aed Carotin, C. FRISCHAND R. WILLHEIM. Tumorglykolyse und Carotin, Biochem. Ztschr. 272: 337-340, 1934. Glycolysis was studied by adding heated tissue extract to guinea-pig muscle extract which had been inactivated by dialysis. In a previous paper (Ibid. pp. 332-336) the authors showed that the glycolytic activity of muscle extract was increased by carotin. In the present paper they report that the glycolytic activity of heated carcinoma and sarcoma extracts was not increased by carotin, nor was the activity of muscle-sarcoma mixtures. They conclude that there is not enough oxidator in muscle tissue to counter- act the glycolysis inhibitor in sarcoma tissue. H. &, WOODARD

Glycolytic Activity of Tumors, M. Novr. Sulla attivith glicolitica dei tumori, Clin. chir. 36: 629-652, 1933. Novi determined the glycolytic activity of series of benign and malignant tumors by making alcohol extracts of the tumors, bringing these extracts into contact with a standard glucose solution, and determining the amount of glucose destroyed. He reports that the glycolytic power of malignant tumor tissue is much higher than that of benign tumor tissue. C. D. HAAQENSEN

Lactic Acid Content of Normal and Malignant Tumor Tissue, R. BIERICHAND A. ROSENBOHM.tfber den Milchsauregehalt von normalen und von Krebsgeweben, Ztschr. f. physiol. Chem. 214: 271-280, 1933. In slices of normal tissues the intake of oxygen by the surviving cells rapidly ceases and there is a transition from aerobic to anaerobic respiration. During this phase normal rat tissue may contain as much lactic acid as Jensen sarcoma. The authors have confirmed in two cases of human sarcoma the findings of Cory and of Warburg that aerobic glycolysis occurs in living tumor tissue. They advise that in experiments on carbohydrate metabolism different portions of a tumor should be used in the determination of lactic acid content, or that fatty, stromal, and necrotic tissue should be carefully removed. For instance, in making such determinations for normal skin, they dry the skin of freshly killed animals for five to ten minutes at 105" C. and remove the adherent subcutaneous tissue. The authors give their results in G series of tables. F. CAVERS

Trephones, P. LEMAY. Les trfiphones, Neoplasmes 13: 228-233,1934. This is a general discussion, containing no new material. WM. H. WOGLOM Tumors of the Guinea-pig. Critical Review, ANTONINMAURY. Les tumeurs chel; le cobaye. Revue critique. Travail des Laboratoires de M. le Rocteur A. Peyron (Institut Pasteur, Paris-Facult6 de MBdecine, Marseille), Versailles, 1931. Pp. 70. Among mammals that are constantly under observation the guinea-pig presents the smallest number of spontaneous new growths. So far there have been recorded only 5 epithelial neoplasms (3 of the breast, 1 of the suprarenal capsule, and 1 of the ovary), 2 spindle-cell sarcomas, 1 liposarcoma, 1 splenoma, and 2 sarcomas of undetermined nature (round-cell sarcoma or lymphosarcoma). The evolution of grafts is much slower than in the mouse or rat (four to seven weeks or more). As for experimentally produced tumors, those of the gallbladder seem to be the easiest to elicit. The method most commonly employed is the deposition of foreign bodies (with or without addition of a carcinogenic agent), but the malignancy of the growths thus incited is open to question, Radium and x-rays, on the contrary, have undoubtedly produced malignant neoplasms (sarcoma of the skull or kidney, carcinoma of the bile ducts). [To the author's list of spontaneous tumors there may be added the following examples: subcutaneous sarcoma in a male (Dickson: Proc. SOC.Exper. Biol. & Med. 13 : 26, 1915); 2 adenocarcinomas in the region of the mammary gland in males (Migunow: Centralbl. f. allg. Path. u. path. Anat. 51: 417, 1931); fibrosarcoma of the foreleg in a EXPERIMENTAL STUDIES ; ANIMAL TUMORS 845

female (Wood: Proc. N. Y. Path. SOC. n.s. 16: 1, 1916); osteogenic sarcoma of the kidney and adenocarcinoma of the breast in the same male (C. C. and J. M. Twort: J. Path. & Bact. 35: 976, 1932); a mammary carcinoma and an adenocarcinoma with cystic kidney in two guinea-pigs of unstated sex (Katase: Verhandl. Jap. path. Gesellsch. 2: 89, 1912).] WM. H. WOGLOM Spontaneous Tumors of the Rabbit. Critical Review, GASTONFARDEAU. Les tumeurs spontanees chez le Lapin. Revue critique. Travail fait B 1’Institut Pasteur de Paris, dans le laboratoire de M. le Docteur A. Peyron, Versailles, 1931. Pp. 104. The author reviews the 73 spontaneous tumors of the rabbit which he has found discussed in the literature. Of these 68 were malignant. The organ most frequently involved was the uterus, where 32 of these neoplasms were found. Epithelial growths were much more common than myomas, of which but two examples were discovered. The other tumors were found in the testis (seminoma), breast (carcinoma), kidney (mixed tumor), adrenal (sarcoma), jaw (sarcoma), stomach (carcinoma, leiomyoma), cecum (papilloma), liver (carcinoma in a syphilitic animal), pancreas (carcinoma), omentum (sarcoma), lungs (carcinoma), spleen (uncertain), skin (carcinoma in a syphilitic animal), nervous system (neuroblastoma, sarcoma), eye (melanotic sarcoma in a syphilitic animal), subcutaneous tissues (sarcoma), hypophysis (adenoma), peritoneum (probable endothelioma), generalized, primary site unknown (sarcoma, lymphosarcoma). No statistical study has been made, and it can be said only that various authors have reported 4 tumors among 150 animals, 2 among 400, and 7 among 660. Thus neoplasms of the rabbit would appear to have been overlooked, rather than uncommon; yet on the other hand one investigator encountered no tumor among 3,500 animals, a rarity that seems excessive. Rabbits with new growths have generally been old; in the case of the uterus the youngest was four and the oldest eight years of age. The rabbit is the only laboratory animal in which a connection between syphilis and malignant disease is suggested, for carcinoma of the liver, carcinoma of the skin, and melanotic sarcoma of the eye have occurred in syphilitic animals. Five sarcomas, a seminoma, and a carcinoma of the skin have been successfully transplanted. It is difficult to assess the influence of heredity, discussed by one writer in the case of uterine carcinoma, for even the mere frequency of new growths is difficult to determine, since rabbits are usually sacrificed during early life. WM. H. WOGLOM Spontaneous Tumors in Birds, LAJA MAKOWER.Les tumeurs spontanees chez les oiseaux, Collection des travaux de pathologie compar6e, 1931. Pp. 86. The author first reviews all the tumors of birds that it has been possible to find in the literature. Seven or eight hundred have been described, of which about 25 were in parrots or parrakeets. The incidence in chickens is from 1.5 per cent to 3 per cent. This rather high figure deserves emphasis because most of the neoplasms have occurred in young birds, less than two years old. The most frequent, and at the same time the most interesting to the student of comparative pathology, is the ovarian carcinoma, which seems to be a result of the congestion and irritation incident to laying. New growths of the gastro-intestinal tract are much less common than in mammals Other affected sites are the testis, skin, and kidney. Hyperplasias of the lymphoid or myeloid tissues, with or without leukemia, are much more frequent than in mammals. The fusiform and polymorphous-cell sarcomas resemble those of mammals. Some of the sarcomas and fibrosarcomas were no doubt unrecognized myomas, a suggestion which may easily be reconciled with the distinctly myotropic character of the etiological agent. Metastasis, exclusively visceral because of the absence of lymph nodes in birds, could be studied to advantage with respect to the relative importance of the blood and lymph streams. In the case of sarcoma there are encountered not only true metastases developing from cell emboli, but other secondary nodules produced in the connective tissues by the circulating virus. The nature of this agent is still unknown, and an attempt to transmit by graft or filtrate the ovarian carcinoma which is of such common occurrence might yield information that would be of distinct value. WM. H. WOGLOM 846 ABSTRACTS Experimentd Study of Spontaneous Tumors in Birds, JACKNICOLAI. L’Btude ex- p6rimentale ,des tumeurs spontan6es chez lea oiseaux, Laboratoire du Professeur Peyron, Institut Pasteur, Paris, 1932. Pp. 92. Most of the transmissible avian tumors have been sarcomas. It may be said, on the whole, that they are easier to propagate than those of the small laboratory mammals, no doubt because the responsible extracellular agent outlives the tumor cells themselves, and epithelial growths such as those of the ovary would perhaps prove to be just as readily transplantable. The similarity between avian and mammalian sarcoma has now been definitely established, and except for the filtrability of the former there is no difference between them. Like most others, the author dismisses the idea that the propagable sarcoma of the fowl is a granuloma or that it is analogous to Hodgkin’s disease. The cells of the avianwwcoma are of two types, fibroblasts and monocytes (macrophages), each of which is regarded by the adherents of two opposing schools as the characteristic malignant element. Filtrability has turned out to be a property not only of the highly malignant sarcomas, but also of those that are less malignant, and even of two fibrosarcomas recently studied. It does not isevitably separate the avian sarcomas from those of mammals, since it may be absent for a time, during which the tumor is propagable only by grafting. The author finds it difficult to accept the view of a few investigators that centrifuged, or even desiccated, extracts still contain more or less intact and viable cells. He discusses the conflicting views on the nature of the etiological agent, whether chemical substance or living virus, but, like others, is unable to reach a decision. WM.H. WOGLOM

GENERAL CLINICAL AND LABORATORY OBSERVATIONS Carcinogenic Action of Sunlight, M. LARABI. L’Action cancbrigbne de la lumibre solaire, Rev. de path. compar6e 32: 757, 853, 1932. Published also 8fil a monograph, Laboratoire du professeur Peyron, Institut Pasteur, Paris, 1932. Pp. 87. The carcinogenic activity of sunlight is now well established, for it has been amply shown that precancerous lesions and cancer are much more frequent on exposed portions of the body. This is particularly true for the faoe, where 90 per cent of all tumors of the skin occur, yet where those areas protected by coiffure, hood, or beard are exempt. Persons of light complexion, and particularly reddish blondes, are especially subject to acute or chronic erythematous lesions, precancerous keratosis, and cancer. This is clearly shown: (1) in the temperate zone by the unequal distribution of senile or solar keratosis between city and country and between indoor and outdoor occupations; (2) in Australia by the rarity or even the absence of such lesions in dark-skinned immigrants (Italians) and their great frequency in the blonde Anglo-Saxons; (3) in various tropical countries by the almost complete exemption of colored races in contrast with the predisposition of the white race. The cancer which arises from long-standing keratosis is virtually always of the squamous-cell rather than of the basal-cell type. The responsibility of the ultra-violet portion of the spectrum, suggested but un- demonstrable by clinical observation, has been, according to the author, definitely proved by experiments on rats and mice. The necessity of prolonged exposure to massive doses explains the infrequency of ultra-violet cancer in man; it should be the concern of the actino-therapeutist, however, to consider the situation carefully from a prophylactic standpoint . Xeroderma pigmentosum is a more or less pure type of solar cancer whose evolution proceeds without the intervention of any secondary factor such, in particular, as age, Unna’s disease (carcinoma of the skin in sailors) is undoubtedly a result of exposure to the sun. It is not confined to sailors, however, and might perhaps be more properly regarded as a late xeroderma, The cutaneous lesions of pellagra may terminate in cancer. Though only three instances have so far been reported, they are of great pathogenic importance because GENERAL CLINICAL AND LABORATORY OBSERVATIONS 847 here neoplasia suddenly develops upon a background of pellagrous dermatitis in the absence of any accessory factor. This may be an argument for the etiological importance of cutaneous photosensitivity in pellagra. All .the various preceding lesions are no doubt due to the absence of some protecting mechanism from the skin. This deficiency is more often congenital than acquired, and is sccornpanied by various humoral modifications. Porphyrinuria, common in certain solar dermatoses, is rather rare in xeroderma. A.,constantly increasing comprehension of photosensitization by endogenous and exogenous agents suggests the existence of some mechanism common even to diseases so widely different as pellagra and xeroderma. WM. H. WOGLOM

Cancer and Syphilis, G. ETIENNE,P. L. DROUET,AND J. WATRIN. Syphilis et cancer. A propos de deux observations, Bull. SOC.frang. de dermat. et syph. 41 : 7-10, 1934. Cancer and Syphilis, A. TOURAINE.La syphilis dans les observations de cancer publikes aux SocietBs frangaises de Dermatologie, Ibid. 41 : 503-508, 1934. These two papers are abstracted together because their authors hold the view that syphilis is the moat frequent direct determining cause of cancer in the skin and in other sites which they regard as belonging to the province of the dermatologist-mouth, tongue, breast, anus, penis, vulva, and vagina. They believe that cancer may arise in such sites, even in the absence of definite luetic lesions such as leukoplakia, ulcers, and gummata, in a person with either acquired or congenital syphilis. In the paper by Etienne et al. two cases are reported. (1) A man of sixty, who had contracted syphilis forty years previously, attended hospital on account of gastric trouble, and on examination an ulcerated patch was found on the back. The Kahn resction was positive, and vigorous specific treatment was given, but without result. Biopsy showed basal-cell carcinoma (not squamous-cell as in most cancers arising on luetic lesions of the skin); the patch was curetted, x-ray treatment was given, and complete healing resulted. (2) In a woman of fifty-one who had been operated upon a year previously for breast cancer, the authors found recurrent nodules in the operation scar, clinical signs of aortitis, and a positive Kahn reaction. They suggest that the breast cancer had arisen on a luetic infection, and that the untreated lues had caused the local recurrence I Touraine refers to previous papers in which he claims to have established that at least two-thirds of superficial cancers, including those of the uterine cervix, are of luetic origin. He has read, in the journal in which his paper appears, reports of 180 cases of cancer of the skin, anogenital region, breast and mouth. Deducting reports in which there was no mention of proved or probable lues, there remain 116 cases in which (1) the serologic reactions were positive, or (2) there was evidence of hereditary syphilis either in the patient or the near relatives. In only 13 of these cases had specific treatme’nt been given, and in most of these the treatment had been inadequate. Of the 116 cases, 45 fell in group 1 and 20 in group 2, giving 56 per cent of cancers of the sites mentioned as occurring in syphilitic subjects, within the author’s definition. [The author mentions a third series, termed suspected syphilis,” raising his percentage to 75, but fails to define this series, making no statement of the characters on which he bases suspicion of syphilis.] From these data it is concluded that the majority of cancers in these sites could be prevented by early diagnosis of lues and thorough antiluetic treatment. F. CAVERS

Is Cancer Transmissible from Mother to Fetus?, G. LECLERC.La transmission du cancer de la mere au foetus existe-t-elle? GynBc. et obst. 29: 40-44, 1934. The author refers to a case of apparent direct transplacental transmission of melanosarcoma from mother to child, reported by Weber, Schwarz and Hellenschmied (Brit. M. J. 1: 537,1930). He himself reports the case of a woman of nineteen who during her first pregnancy was found to have a round-cell sarcoma of the maxillary antrum. Re- section was followed by radium treatment, but metastases appeared in various organs, including the vagina and uterus. Cesarean section was done in the eighth month, but the child lived only for a few minutes. Necropsy showed no signs of a tumor in the 848 ABSTRAUTS

child’s body, although the fetus had been in contact with ulcerating infected metastases in the uterus. The placenta, also, was free from cancerous tissue. F. CAVERS Origin of Sacral Dermoids, H. MEYER-RURGDORFF.uber die Entstehung der Kreuz- beindermoide, Arch. f. klin. Chir. 180: 406-409, 1934. Dermoid cysts developing over the sacrum are due to invagination of the epithelium, especially around hair papillae, and from a pathological standpoint may be considered as small diverticulae of the skin. Inflammation, retention of secretions, and friction are predisposing factors. The article is without illustration. BENJAMINR. SHORE Rhabdomyoma, E. SANTI. Contributo all0 studio del rabdomioma, -4nn. ital. di chir. 12: 745-759, 1933. The author describes a tumor in the perianal region of a five-months-old boy, undoubtedly congenital and recurring twice. Histologic study led him to consider even the connective-tissue elements to be derived from muscle tissue by a process of de- differentiation, and to classify this malignant growth as a rhabdomyosarcoma. A photograph shows the tumor attached to the mucocutaneous junction of the anus; and two subcutaneous nodules one to the right of the anus and the other on the perineal raph6. The child is well at ten months, after wide excision and irradiation. Photomicrographs illustrate the various types of cells : striated muscle fibers; fusiform cells with atypical narrow nuclei and faint striations; and polygonal or racket- shaped cells with eosinophilic cytoplasm full of mitochondria and with large, central, deeply-staining nuclei. The author agrees with Masson and earlier workers that the latter myoblastic elements are the precursors of the striated cells, and also gives the evidence in favor of a similar origin for the histiocytes found in the stroma. NELSONB. SACKETT

Subcutaneous Bilateral Sarcoid of the Gluteal Region, A. KOERNER,D. H. KLING,AND D. SASHIN. Arch. Surg. 29: 59-63, 1934. A Jewish woman aged fifty complained of four hard, painless lumps over the buttocks of four weeks’ duration. Examination showed them to be freely movable, measuring about 1 to 2 inches in diameter. The skin was apparently not involved or attached to the lesions. Biopsy of one nodule demonstrated the presence of single and conglomerate tubercles, although with special stains no tubercle bacilli could be seen. A diagnosis of sarcoid was made, and the patient put upon sodium cacodylate therapy. After eighteen of these injections the tumors had entirely disappeared. There are three illustrations. THEODORES. RAIFORD Two Cases of Angeio-flbro-sarcoma Operated on by Diathermy Eight Years and a Half and Four Years Ago Respectively, E. BROUGHTONBARNES. Proc. Roy. Soc. Med. 26: 907, 1933. Brief reports of two cases as described in the title in youths of nineteen and seventeen years. Histological Findings of the Hypophysis in Cancer, GEORGEA. WYETH. Endocrinology 18: 59-70, 1934. The hypophysis was found to be distinctly heavier than normal in both men and women of all ages (thirty to ninety) with carcinoma of various organs. Thus, for example, the average weight for cancerous males between fifty-one and sixty was 0.800 gm., whereas the normal average for this sex and age is 0.596 gm., and equally large differences appeared in females. A review of hypophyseal weights for the 80 patients examined showed that in a considerable number where the autopsy revealed general cachexia the hypophysis not only did not participate in the atrophy but actually increased in weight. Augmentation is referred to the anterior lobe, and particularly to its eosinophile cells, though the functional significance of their proliferation is not evident; no acro- megaloid changes could be detected. DIAGNOSIS AND TREATMENT 849

[For a study of the hypophysis in animals bearing transplanted tumors, see McEuen ef al: Brit. J. Exper. Path. 15: 221, 1934. Abst. on p. 839, above.] WM. H. WOGLOM

Chemical Structure of Nucleic Acid from Malignant Tumors, K. STERNAND R. WILL- REIM. Zur Frage der chemischen Zusammensetzung der Nucleinsauren maligner Tumoren, Biochem. Ztschr. 272 : 180-188, 1934. Nucleic acid was prepared from five human malignant tumors and analyzed. . Its nitrogen content was found to be lower than the usual value and the PIN ratio was altered. The authors consider that this indicates that the structure of the nuclei of malignant cells is different from that of normal cells. H. Q. WOODARD

DIAGNOSIS AND TREATMENT

Biopsy, S. W. BUDD. Internat. J. Med. & Surg. 47: 490-491, 1934. The author sets forth the general principles of biopsy. In capable hands and with certain restrictions this offers the earliest, best, and most accurate method of diagnosis of malignant disease, though clinical observation should not always be subordinated to it. In institutions where the services of an expert pathologist are available at the time of operation, frozen section is a most valuable aid to the surgeon. Where such expert opinion is not available, it is safer, even if it entails a delay of several days, to wait for a reliable opinion before proceding with removal of the growth.

Aspiration Biopsy, H. E. MARTINAND E. B. ELm. Surg. Gynec. & Obst. 59: 578-589, 1934. A positive diagnosis of cancer has been made by aspiration biopsy in 1405 cases of cancer seen at the Memorial Hospital in New York. The technic of obtaining material and of preparing the specimens for study is described in detail. The article is illustrated with several drawings and photomicrographs. BENJAMINR. SHORE

Correlative Value of Clinical and Pathological Findings in Roentgen Diagnosis, K. IKEDA.Minnesota Med. 17: 1-4, 1934. A discussion, illustrated by suitable case reports, of the mistakes which may occur from incomplete or inadequate x-ray examination, examination of an uncooperative or critically ill patient, failure to make proper x-ray examination before radical surgical procedures, failure to examine the primary focus of disease, failure to examine patients suffering from recurrent attacks of the same symptoms over a period of years, and failure to obtain corroboration of a diagnosis by biopsy. GRAY TWOMBLY

Clinical Experiences with the Early Diagnosis of Cancer by the Method of Links, H. WEBERAND F. SCH~LE.Klinische Erfahrungen tiber die Links’sche Friihdiag- nose des Carcinoms, Chirurg 6: 633-641, 765-770, 1934. In the first of these papers the authors report 100 cases in which Links performed his test for the early diagnosis of cancer (see Med. Klin. 30: 165, 1934. Abst. in Am. J. Cancer 21: 684, 1934. Also Abst. 23: 612, 1935). He received some clinical data but did not examine the patients. In a series of 41 patients with known carcinomas, the results were positive in 100 per cent; in the 42 control cases, the results of Links’ tests were correct in 88.1 per cent; and in 11 unproved cases the results were thought to be correct in 7. The tests were negative in the 4 remaining cases of sarcoma and were positive in one patient each with a neuroma and myeloma. The authors conclude from the study of this small number of cases that all true carcinomas give a positive reaction but that all positive reactions may not necessarily be due to cancer. The authors also report a second series of 100 cases in which Links performed his test. In the group of 60 patients with known carcinomas, the results were positive in 96.7 per cent; in the 31 controlled cases, the results were correct in 93.2 per cent. Negative results were obtained in 3 cases of sarcoma, one case of melanosarcoma, and 850 ABSTRACTS one case of lipomatosis. Positive results were obtained in one case each of lymphosarcoma, polyposis of the rectum, and papilloma of the urinary bladder, and an intermediate reaction was obtained in one case of polyp of the stommh. Combining the two series of 100 cases each, a correct diagnosis was made in 98 per cent of 104 proved cases of carcinoma and a negative result was obtained in 93 per. cent of 71 patients supposedly free from cancer. BENJAMINR. SHORE

Precipitation of Serum Proteins by Sodium Chromate as an Aid in the Diagnosis of Cancer, G. J. VAN DEN BOVENKAMPAND W. H. KISJES. Uitvlokking van serum- eiwitten door natriumchromaat als hulpmiddel bij de kankerdiagnose, Nederl. tijdschr. v. Geneesk. 77: 2319-2327, 1933. The writers Rtudied the precipitation of serum proteins under the influence of various salt-acid combinations, of which a mixture of sodium chromate and propionic acid proved.most suitable for their purpose, Sera from healthy persons and from patients with pulmonary tuberculosis, tuberculous peritonitis, pneumonia, nephritis, and various typee of cancer were studied. The results obtained in 72 different cases are tabulated. The authors conclude that the serum of cancer patients lacks partially or wholly a factor which exerts an inhibiting influence on the precipitation of proteins under the influence of the substances employed. From the amount of precipitated protein in heated and unheated serum in certain concentrations the existence or non-existence of cancer is determined. JORANNESP. M. VOGELAAR

Serum Diagnosis of Cancer, G. J. VAN DEN BOVENKAMPAND W. H. KISJEI. Serum- diagnose des Krebses, Klin. Wchnschr. 13: 810, 1934. Differences observed when a mixture of sodium chromate and propionic acid was added to heated serum from cancer patients or persons free of malignant disease suggested a variation in the binding power of the proteins for electrolytes. A detailed description of the test appeared in Nederl. Tijdschr, Geneesk. 77: 2319, 1933 (Abst. above). WM. H. WOGLOM Diagnostic Dmculty in Acute Carcinosis with a Febrile Course, P. MARIN. Difficolth diagnostiche in carcinosi acute a decorso febbrile, Minerva med. 2: 18-26, 1933. Marin points out the difficulty of diagnosing some cases of generalired carcinoma metastases in which the only signs are a remittent fever, general malaise, and pleural or peritoneal effusion. C. D. HAAQENSEN Some General Considerations on the Difaculties in Prognosis and Therapy of Malignant Tumors, L. W. VAN DER Burta. Eenige algemeene beschouwingen over de moeilijk- heden in prognose en therapie der kwaadaardige gezwellen, Geneesk. tijdschr. v. NederLIndie 73 : 1661-2668, 1933, In attempting to analyze the factors involved in so-called radio-resistance of malignant tumors, the author discusses the significance of the tumor bed, the general and local resistance of the patient’s body, the rapidity of growth, the simultaneous development of tumors in various places, the formation of metastases, the differentiation of the tumor cells, secondary infection, and general intoxication. The sire of a tumor plays an important r61e not only because the chance of metastasis is greater in the larger tumors, but also because a greater quantity of toxic substance will enter circulation during the resorption of the tumor under the influence of treatment. It is therefore advisable to decrease the size of large tumors by surgical methods-if possible, electrocoagulation-before applying radiation. A few references are given. JOHANNBSP. M. VOOELAAR Principles Governing the Present Day Radiation Therapy of Cancer, 8. R, JOHNSTON. Nova Scotia M. Bull. 13: 238-242, 1934. After considering some of the physical properties of radium and radon and discussing suitable methods of filtration, the author describes the biological effects of radiation under three headings, caustic action, selective lethal action on rapidly growing cells, and growth restraint. He mentions, as factors decreasing radiosensitivity, individual DIAGNOSIS AND TREATMENT 85 1 decreased resistance to cancer, old age, anemia, cachexia, syphilis, tuberculosis, diabetes. Local conditions decreasing radiosensitivity are sepsis, edema, extension to bone, poor blood supply, previous surgery, and previous irradiation. GRAYH. TWOMBLY Present Status of Radiation in the Treatment of Cancer, MAX CUTLER. Internat. J. Med. & Surg. 47: 157-161, 1934. A review of the possibilities of radiation therapy in cancer in various sites. As originally presented, the paper was illustrated by lantern slides, but these are not reproduced.

Radiation Treatment of Cancer, W. DIETERICH. Erfahrungen in der Behandlung des . Krebses mit Strahlen, Radiol. Rundschau 3: 2-10, 1934. This is a general article concerning the radiation treatment of malignant tumors. No new material is added. BENJAMINR. SHORE X-ray Therapy of Surgical Diseases, 0. KINGREEN.Die Rontgentherapie chirurgischer Erkrankungen, Therap. d. Gegenw. 74: 350-358, 1983. The author has used radiotherapy in various acute infections as well as in neoplasms. Of the latter, carcinomas do not, theoretically, react to radiation as well as to surgery, hence operation is recommended whenever possible. If the disease is beyond the removable stage, palliation may be secured by radiation. Sarcomas are the most radiosensitive of the malignant tumors, and of these the lymphosarcomas respond most readily, Good results are not infrequently obtained in certain of the bone sarcomas. There are no illustrations and no statistics are included. THEODORES. RAIFORD X-ray Therapy of Malignant Tumors, G. M. TICE. J. Kansas M. SOC.35: 241-245, 1934. A general discourse on recent developments in radiotherapy for malignant neoplasms. Treatment has become more successful with more precise methods of determining dosage and the ability of the radiologist and pathologist to determine the sensitivity of lesions from biopsy specimens. The methods of treatment advocated by Pfahler and Coutard are reviewed briefly. A short bibliography is included. There are no illustrations. THEODORES. RAIFORD Activities of the League of Nations in Connection with Cancer and Its Treatment by Radiotherapy, G. S. BUCHANAN.Arbeiten des Volkerbundes fiber den Krebs und seine Strahlenbehandlung, Schweiz. med. Wchnschr. 64 : 677-678, 1934. This article mentions a few problems selected for study by the Health Committee of the League of Nations. It is concluded that race does not influence the occurrence of cancer; that susceptibility to mammary carcinoma does not decline after the age of fifty-five but increases progressively up to seventy; that the " natural duration l1 of mammary cancer is somewhat more than three years and of uterine cancer twenty-one months; that carcinoma of the cervix depends not upon the number of births but upon lacerations resulting from the first one; and that radiotherapy should be internationally standardized. [This material may be found also in the Lancet 1: 935, 1934.1 WM. H. WOGLOM The Inoperable Cancer Patient, STANFORDCADE. Internat. J. Med. & Surg. 47: 91-92, 1934. The author suggests briefly the palliative possibilities of irradiation, lead selenide, and general medical measures in inoperable cancer.

A Plea for Discrimination in Accepting the Cancer Patient for Treatment, DONALD GUTHRIE. Internat. J. Med. & Surg. 47: 371, 1934. The author suggests that palliative surgery and radiation in late incurable cases of cancer, especially when it is not understood by the patient or his family that the case 852 ABSTRACTB is beyond permanent help, tend to discredit treatment and to fix in the minds of the laity the idea that all cancer is hopeless. Organotherapy and Cancer, J. MAISIN. Internat. J. Med. & Surg. 47: 161, 1934. A brief statement to the effectthat substances inhibiting the development of experimental cancer have been found in small amounts in the brain, bone marrow, and thymus. No experiments are reported. Therapeutic Value of Cobra Venom, TAQUET.Le venin de cobra et son usage thera- peutique, Bull. et. m6m. 8oc. de m6d. de Paris 138: 404-410, 1934. The author presented 9 patients treated by cobra venom with encouraging results. Sarcomas were refractory to this therapy, as were certain very advanced neoplasms and those which threatened life by their location (esophagus, rectum, brain, mediastinum). WK H. WoaLoM A Method of Preventing Cancer, RUDOLFROOSEN. Ein Weg zur Krebsverhiitung, Schweia. med. Wchnschr. IS: 856-858, 1934. In endeavoring to prevent cancer it is of great importance that chronic inflammatory lesions be abolished. Isamine blue is a valuable agent for the purpose, WM. H. WOQLOM THE SKIN

Precancerous Lesions of the Skin, 0. SCH~RCH.Die Priicancerosen der Haut, Zentralbl. f. Haut- u. Geschleohtskr. 47: 1-20, 1934. The author has arranged the precancerous lesions of the skin, according to the frequency with which they show malignant changes, into four groups: (1) basal-cell tumors and lesions of Paget’s and Bowen’s diseases, which may possibly be classed as malignant from the start; (2) senile hyperkeratoses, melanotic tumors, lesions produced by certain chemicals such as tar and arsenic, roentgen keratoses, warts of xeroderma pigmentosum, and certain forms of leukoplakia; (3) ulcers of lupus vulgaris, scars from burns, ordinary leukoplakia, pigmented nevi, atrophic senile skin, and skin damaged by x-rays; (4) lesions of psoriasis and lupus erythematosis, angiomas, atheromas, and crural ulcers. Only rarely do benign tumors of the skin become malignant, but the malignant degeneration of superficial neurofibromas, especiatly after trauma, should be remembered, The article is without illustrations. BENJAMINR. SHORE Intractable Carcinomas of the Skin and Their Treatment, A. HINTZB. Hartniickige Hautkarzinome und ihre Heilung, Strahlentherapie 51 : 237-270, 1934. Hintae reports 71 cases of intractable skin cancers seen by him from 1912 to 1928; 38 of these were primarily operated on and 33 primarily irradiated. Forty-six of the patients had been operated on and 17 had received irradiation therapy elsewhere. Two types of recurrences were seen in these cases: (1) those which took place at the border of the old growth and (2) those which arose at some distance and were probably dependent upon some chronic and precancerous change in the skin. Basal- cell tumors were observed just as often as those of the squamous type. Adenocarci- noma was rarer but showed an unusual resistance to all forms of treatment. Tumors localized on the forehead and temporal regions were extremely difficult to cure completely, usually due, however, to their tendency towards multiplicity and more rarely to recurrences in the border of a previous growth. It is concluded from this study that failure to obtain a cure of skin cancers, except those due to multiple growths, is dependent upon insufficient treatment of the primary lesion. The ,duration of life for patients in this series from the time of the first treatment was up to forty years in some cases. The article is illustrated with photographs of patients before and after treatment. BENJAMINR. SHORE THE SKIN

Epithelial Tumors of the Skin, R. L. SUTTON. J. Missouri M. A. 31: 28-31, 1934. Sutton names and describes the microscopic appearance of all the primary epithelial tumors of the skin. In treating these he gives a preliminary dose of radium and then excises the tumor with the actual cautery or by endothermy. No statistics are given. GRAYTWOMBLY

Cancer of the Skin, R. L. KELLY. Kentucky M. J. 32: 155-158, 1934. A general discussion of basal and squamous carcinoma of the skin, containing nothing new. GRAYH. TWOMBLY Epithelioma in a Girl Aged Fifteen, M. SCOPQSI.Particolare decorso clinic0 di neoplasia epiteliale in una giovinetta quindicenne, Dermosifilografo 8: 117-128, 1933. Scopesi’s patient was a girl aged fifteen in whom there developed, over a period of eight months, a large, soft, fleshy tumor projecting from the skin of the left pre-auricular region. It was removed with the diathermy knife and proved to be a basal-cell epithelioma. A radium pack was applied to the base. At the time the author wrote his description of the case, two years after treatment, there had already been three recurrences, each treated with more radium. Photographs of the lesion, as well as three photomicrographs of the sections, are included. C. D. HAAQENSEN Basal-cell Carcinoma of Face, Simulating Scleroderma, F. WORINGER.Epithblioma baso-cellulaire de la joue d’aspect sclbrodermique, Bull. Soc. franp. de dermat. et syph. 41: 617-618, 1934. A woman of thirty-five had a tumor of the face, first noticed four years previously, and treated without effect by x-rays. It was now a very hard nodule of yellowish color, clinically resembling scleroderma, and had undergone ulceration. On excision it proved to be a basal-cell carcinoma containing much sclerotic connective tissue; the normal blood vessels of the dermis were replaced by large bIood sinuses. It was pro- posed to give postoperative radium treatment. F. CAVERS

Observations of Cutaneous Tumors. 11. Secondary Epitheliomas, G. MANGANOTTI. Osservazioni sui blastomi cutanei. 11. Sugli epiteliomi secondari, Dermosifilografo 8: 333-374, 1933. By secondary epitheliomas, Manganotti means those which have developed on the basis of pre-existing non-neoplastic skin lesions. He presents brief summaries of 13 such cases. Four were squamous-cell epitheliomas developing in long-standing lupus vulgaris. In three cases epithelioma occurred in lupus erythematosus, two of the tumors being squamous and the third basal-cell. In a patient who had had rhino- scleroma for fourteen years, squamous-cell epithelioma developed. This was also the histological type in another case where epithelioma of the nose developed twenty-two years after destruction of the organ by leishmaniasis. In three patients squamous carcinoma developed in old burn scars on the thigh, buttock, and hand, respectively. The final case was that of a man whose hands were crippled by gout. A basal-cell epithelioma developed in the skin over one of the tophi. Clinical photographs of all these lesions, as well as a bibliography, are presented. Unfortunately the author does not include the details and the results of treatment. C. D. HAAQENSEN

Sweat Gland Epithelioma, H. GOUGEROT,ALBEAUX-FERNET, AND A. DREYFUS. Epi- thblioma sudorifhre, Bull. SOC.franp. de dermat. et de syph. 41 : 294-295, 1934. A tumor on the right shin of a woman of forty-three had been noticed for about three months and had reached the size of a hazelnut. It was excised and was found to be a carcinoma arising from the sweat glands, but not yet invading the upper layers of the epidermis, while it was separated from the subcutaneous tissue by inflammatory reaction tissue consisting mainly of lymphocytes. F. CAVERS 864 ABIJTMCTB Biagaosis of MelaaoinaB and the Recognition of Melanin Plgment, Y. KITAGAWA. Bur Kemtnis des Melanoms, nebst Bemerkungen itber den Melaninfarbstoff, Mitt. it. allg, Path, u. path. Anat. 8: 221-230, 1934. The author reports three case6 of melanoma. The first patient a sixty-three-year- old woman, had a melanoma of the lower lip which had involved the submaxillary nodes. It was removed with the nodes and was found histologically to be of the spindle-cell type. The patient has remained symptom-free for five years since operation. The second patient, a fifty-five-year-old woman, had a lesion involving the fourth and fifth toes on the right foot. The femoral nodes were enlarged and hard on that side. The tumor was excised together with the fourth and fifth metatarsals, and a radical dissection of the right femoral and inguinal glands was carried out. The tumor was histologically a melanoma of alveolar type. The patient has remained well for four years, in spite of the proved femoral metastases. The third patient, a fifty-three-year-old man, had a pigmented nevus of the right temporo-vccipital region. Similar lesions had recently appeared in the retromandibular region, on the abdominal wall, and on the back. In addition there was melanuria. The three secondary nodules were removed surgically, but the primary lesion in the temporal region was untouched. Postoperative x-ray treatments were administered to the primary lesion and the metastatic sites. The disease progressed rapidly, however, and death occurred three weeks later from general cachexia. The tumors were histologically melanomas of an alveolar type with increased connective-tissue stroma. At autopsy'metastases of a similar nature were found in almost every organ of the body. The use of the various dye reactions in the diagnosis of melanomas and melanuria is briefly discussed. There are no illustrations, but a bibliography is appended. THEODORE5. RAIFORD

Treatment of Pigmented Moles, H. F. ANDERSONAND C:A. SIMPSON. M. Ann. District of Columbia 3: 159-162, 1934. Also in Am. J. Roentgenol. 33: 54-58, 1935. After a general discussion of the histology of moles and melanomata, the authors describe three methods of treatment. These are complete surgical excision with a wide margin, cauterhing doses of unfiltered low-voltage roentgen rays, and thorough electrodesiccation combined with curettage. They feel that the last method is the most satisfactory in both types of lesion if properly done. GRAYH. TWOMBLY

Post-traumatic Nevocarcinoma of the Thigh, GOU~EROTAND BURNIER. Naevo- carcinome de la jambe post-traumatique (aprds blessure d'accident du travail), Bull. SOC.franp. de dermat. et syph. 41: 286-287, 1934. A man of fifty had been struck four years ago by an automobile, causing a contused wound on the left thigh. The wound healed in about a month, but eight months later there appeared in the scar a rounded purple swelling which grew to the size of a hazelnut and was very hard. The tumor was excised and was diagnosed as a basal-cell cancer, with pigmented cells in the deeper layers and in the dermis. In commenting on this case, P. Ravaut said he had seen one very similar, also diagnosed as nevocarcinoma. The patient had not noticed a nevus before the injury, and there had been conaiderable difficulty in persuading the insurance company that a nevocarcinoma could have been caused by trauma. He himself doubted whether the term nevocancer could be strictly applied to any malignant tumor not arising on a preexisting nevus. F. CAVERS

Generalized Sarcomatods of the Skin, WATRIN AND ROSENTAL. Sarcomatose g6n6ralis6e, Bull. Sac, frang. de dermat. et syph. 41: 23-25, 1934. A woman of forty-seven hsd noticed a swelling in the right groin about six weeks prior to hospital admission. Further swellings then appeared, some in the axillae and others scattered over the trunk. These were subcutaneous tumors, varying in size from a haaelnut to an orange. Biopsy of a tumor showed thinning of the epidermis and the presence in the dermis of closely packed, small, round cells in a fibrous stroma. The diagnosis made wm round-cell sarcoma, but a blood count showed 12,000 leuko- THE SKIN 855

cytes, with 54 per cent lymphocytes; a second count made a week later showed 32,000 leukocytes, with 89.5 per cent lymphocytes. The patient’s condition became rapidly worse, and she died six weeks after admission. [The authors make no mention of the probable diagnosis of lymphatic leukemia in their brief account of the case, though they state that the liver and spleen were much enlarged.] There is one illustration. F. CAVERS Multiple Eruptive Cutaneous Myomas with Clinical and Histological Features Not Previously Described, G. SANNICANDRO.Miomi cutanei multipli eruttivi con particolarita cliniche ed istologiche sinora non descritte, Dermosifilografo 8: 569- 570; 618-626, 1933. In a man of sixty, successive crops of small raised intracutaneous nodules appeared on both lower legs, the overlying skin being normal in color. They disappeared spontaneously leaving pigmented areas. Excised, they proved to be encapsulated myomas. A photograph of the lesions and two unsatisfactory photomicrographs are included. C. D. HAAQENSEN Generalized Eruptive Xanthoma of the Skin, J. NICOLAS,A. DUMAS,C. PI~TOURAUD AND P. DUGOIS.Un cas de xanthome bruptif, Rull. SOC.fran9. d. dermat. et. syph. 41 : 367-369, 1934. A man of seventy-one was admitted to hospital with chronic nephritis and a generalized skin eruption. There was a history of intermittent diabetes during the past twenty years, but no sugar was found in the urine or the blood. The skin lesions, which had been first noticed about eighteen months previously, varied up to the size of a pea, and in color from dirty white to red and (mostly) yellow, and all were very hard. Histologically they showed typical xanthomatous structure. There were no enlarged lymph nodes. The blood cholesterol was only 1.8 mg. per 1000 C.C. F. CAVERS Large Congenital Facial Lymphangioma Cured by Radium Therapy, AUVRAY.Gukri- son d’un Bnorme lymphangiome de la face par la radiumthbrapie, Bull. et mbm. SOC.nat. de chir. 60: 611-615, 1934. A soft tumor was observed involving the right half of the face and neck of a newborn child. It was decided to defer radium therapy for two years, when the use of a flat applicator (dosage not stated) was followed by an intense local reaction and high fever but had no effect on the tumor, except that the skin over it broke and lymph escaped. Further radium treatment was given six years later, eight needles being implanted, with total dosage of 23.5 m.c.d. in six days, after which the tumor disappeared; at the time of reporting, ten years after the needle treatment, there had been no recurrence. There are three illustrations. F. CAVERS

Subungual Glomus Tumor, ALVAREZCASCOS. Un nuevo caso de tumor subungueal, Arch. de med., cir. y especialid. 37: 634-635, 1934. In a woman of forty-one who attended hospital on account of syphilitic myocarditis and arterial hypertension, there was noticed a round tumor under the nail of the left middle finger. The patient had injured the nail about four years previously. The tumor was removed and diagnosed as a glomus, but no histologic account is given and there are no illustrations. F. CAVERS Review of Recent Literature on Skin Tumors, H. FuHe. Gutartige und biisartige Tumoren nebst Ntivi, Dermat. Ztschr. 69: 325-358, 1934. This is an extremely useful classified collection of abstracts of available publications on skin tumors for the years 1932 and 1933. F. CAVERS 856 ABSTRACTG

THE EYE Malignant Tumors of the Visual Apparatus, M. MARIN AMAT. Tumores malignos del aparato de la visibn, Siglo med. 90: 425-435, 1932. This is a general review of tumors of the eye and orbit with notes on pathology, diagnosis and treatment of each group. There are no illustrations. C. D. HAAGENSEN

Three Cases of Leukosarcoma of the Uveal Tract, G. DE VINCENTIIS. Tre casi di leuco- sarcoma del tratto uveale, Boll. d’ocul. 12: 22-41, 1933. Three cases are described: (1) sarcoma of the choroid in a woman aged forty-two, treated by enucleation with no recurrence after two years; (2) sarcoma of the choroid in a five-year-old child, in which the course of the disease after enucleation was not known; (3) sarcoma of the anterior uveal tract in a woman aged seventy. Enucleation was followed in nine months by liver metastases and death. Seven unsatisfactory photomicrographs and a bibliography are presented. C. D. HAAQENSEN

Report of a Case of Metastatic Glandular Carcinoma of the Ciliary Body and Iris, CLARENCEKING. J. Med. 15: 211-212, 1934. A woman of twenty-six was seen a year after a partial mastectomy of the left breast for scirrhous carcinoma had been performed. She complained of redness and pain in the left eye. Examination showed a tumor invading about one quarter of the iris and extending well into the anterior chamber, On enucleation the tumor was found to be a metastasis from the adenocarcinoma of the breast. The patient died three months later from central nervous system metastases. GRAYH. TWOMBLY

Pigmented Tumor of the Uveal Tract, Having a Peritheliomatous Structure, G. Bos- SALINO. Su di un caso di blastoma pigmentato primitivo del tratto uveale a carat- tere periteliomatoso, Boll. d’ocul. 12: 129-148, 1933. Bossalino’s patient was a woman aged twenty-nine with a pigmented tumor of the right eye. Exenteration was done and the growth proved to be a perithelioma-like sarcoma arising from the anterior uveal tract. The further history of the case is not stated. Photographs of the gross specimen and six photomicrographs are included. C. D. HAAGENSEN

Melanotic Ganglioneuroma of the Choroid in an Infant, L. BERQERAND J. VAILLAN- COURT. Ganglioneurome melanique (ganglio-neuro-naevus) de la choroide, Bull Assoc. franp. p. 1’6tude du cancer 23: 275-302, 1934. A boy of fourteen months was born with the left eye buphthalmic and much larger than the right. It was enucleated on suspicion of choroidal sarcoma. At the time of reporting, twenty months after operation, there was no sign of recurrence. When the globe was sectioned, the choroid showed a lens-like thickening about the equator, owing to neoplastic tissue. The latter is described in very great detail. Roughly, it consisted of cellular masses and of fasciculated and retiform elements, among which were scattered pigmented cells. The authors interpret the tumor as being essentially of neuroblastic origin. The elements arranged in bundles are interpreted as being schwan- nomatous and containing much of the pigment present in the tumor; the rounded or

pear-shaped cells as ganglion cells; and some of the cell masses as tactile corpuscles intermediate between the‘ + Wagner-Meiusner and the Golgi-Mazzoni types. The authors have made a fairly thorough search of the international literature on tumors of the choroid, and have found several reports of cases apparently similar if not identical with theirs, though diagnosed as neurofibromas or plexiform neuromas, which they believe would have been recognired as ganglioneuromas had modern methods of staining been used. They promise a further paper in which the nature of these tumors will be more fully discussed. There are four black and white and seven beautifully colored illustrations; also an extensive bibliography. F. CAVERS THE EYE

Sarcoma of the Choroid and Glaucoma, M. DE-PETRI. Sarcoma della coroide e glaucoma, Boll. d’ocul. 12: 770-787, 1933. This is a description of a case of melanotic sarcoma of the choroid in which glaucoma suddenly developed a few days before enucleation was done. The author attributes the glaucoma to rapid obstruction, by the neoplasm, of some of the channels of reflex circulation in the posterior chamber. Two photographs of the gross specimen and five unsatisfactory photomicrographs are included. The end-result is not stated. C. D. HAAGENSEN

Basal-cell Epithelioma of the Bulbar Conjunctiva, F. ORZALESI.Epitelioma baso- cellulare primitivo della congiuntiva bulbare, Boll. d’ocul. 12 : 1098-1107, 1933. ;he author describes, and includes illustrations of, a basal-cell epithelioma of the bulbar conjunctiva which he removed with a Paquelin cautery. The end-result is not recorded. C. D. HAAGENSEN

Sarcoma of Orbit, Possibly Metastatic from Malignant Spinal Meningioma, J. C. NAVARROAND J. M~NACO.Sarcoma meningeo con methtasis mbltiples, Prensa m6d. argent. 20: 1685-1690, 1933. The patient was a boy of two and a half years, who for about twenty days had suffered from abdominal pain, lost appetite, become irritable, and lost use of the lower limbs. The neck was retracted and rigid, and the lower extremities showed flaccid paralysis. There was right exophthalmos, and small subcutaneous tumors were present in the right thigh and sacral region. Instead of investigating the spinal condition first, the authors enucleated the right globe and found soft red tumor tissue filling the orbit. This tissue and the skin tumors were diagnosed histologically as sarcoma. Lipiodol filling showed obstruction at the first lumbar segment. The child died two months after admission, and necropsy was not permitted. The authors’ diagnosis, therefore, cannot be accepted as established. There are five illustrations. F. CAVERS

Epibulbar Endothelioma Recurring in the Orbit, L. LUGLI. Endotelioma epibulbare recidivato con manifestazioni orbitarie, Boll. d’ ocul. 12 : 269-280, 1933.

Lugli recounts his inability to control an (I endothelioma ” which first manifested itself as a small tumor on the bulbar conjunctiva. Local removal was followed by recurrence. After two years exenteration of the orbit was done. A year later there was extensive recurrence in the periorbital tissue. Photographs of the gross and micro- scopical specimens are included. C. D. HAAGENSEN

Observations Concerning a Neurinoma of the Orbit, M. FOCOSI.Osservazioni su di un neurinoma dell’ orbita, Boll. d’ocul. 12: 1063-1074, 1933. This is a description of a neurinoma removed from the orbit of a woman aged forty- two. It was necessary to do an exenteration, which showed the tumor encircling but not involving the optic nerve. The author suggests that the growth arose from one of the small nerves in the dural sheath of the optic nerve. A photograph of the tumor and four good photomicrographs are presented, but the further history of the patient is, unfortunately, not stated. C. D. HAAGENSEN

Tumors of the Eyelids, M. VELE. Sui tumori delle palpebre, Boll. d’ ocul. 12: 788-831, 1933. Brief descriptions of ten eyelid tumors are given, including an adenoma, a carcinoma, a squamous-cell epithelioma, a fibromyxoma, a fibro-angiomyxoma, four fibrosarcomas, and a lymphangio-endothelioma. Although 22 photomicrographs are included, the treatment is not stated in enough detail or the follow-up given in such a manner as to make this paper of much value. C. D. HAAGENSEN 858 ABSTRACTS

A Palpebral Sarcoma with a Lympho-endothelial Structure, Which Recurred Repeatedly, A. DE Low. Sarcoma palpebrale primitivo a struttura linfo-endoteliale pih volte recidivato, Boll. d’ocul. 12 : 313-324, 1933. This is a description of a tumor of the lower eyelid, of a man aged thirty- four, classified histologically as a ‘‘ lympho-endothelial sarcoma,” which recurred three times after local excision. The final outcome of the case is not stated. A clinical photograph and six photomicrographs are presented. C. D. HAAQENSEN

THE EAR Etiologic Factors in the Formation of Cholesteatoma, K. M. DAY. Aqn. Otol,, Rhin. & Laryng. 43: 837-850, 1934. Cholesteatomas are formed from the desquamated epithelium of the epidermis which has grown into the tympanic cavity from the external auditory canal, However, these growths will occur only if there is an inadequate outlet for the drainage of the exfoliated material. One of the primary and major additional factors is the presence of moisture. Whether this is due to suppuration, or whether it is a transudate, an exudate, or even water, the effeot is the same, The surface epithelium of the body does not tolerate moisture well and the continued contact of moisture causes irritation and desquamation. The formation of cholesteatomas is considered to be primarily due to the constant presence of fluid bathing the epithelium. [It should be remembered that certain pathologists consider that the cholesteatomata are derived from congenitally displaced epithelial remnants. Others divide the neoplasm into two groups, calling the type discussed in this abstract false cholesteatoma.” See, for example, Marx in Henke and Lubarsch: Handbuch der spea. path. Anat. u. Histol, 12: 510-519, 1928.1 During the past nine years, 60 patients with cholesteatomas have been seen by the author. Conservative treatment was advocated only in those cases in which there were no signs or symptoms suggestive of involvement of the labyrinth or meninges. A radical mastoidectomy was performed in 14 cases; all of these patients now have clean, dry cavities. It is believed that the early recognition with proper treatment of chronic otitic suppurations with cholesteatomas should obviate the need of radical surgery and prevent the serious oomplications which so commonly occur. BP~NJAMINR. SHOR~ THE BREAST Mammary Bleeding, Y. KON. Xur Anatomie und Klinik der ‘(blutenden Mamma,” Mitt. 8. allg. Path, u. path. Anat. 8: 231-246, 1934. Kon reports three cases of bleeding from the female breast in which widely different causal factors were responsible. The first patient, a forty-three-year-old woman, had noticed a thin, sanguineous secretion from the left breast for ten days. A small chest- nut-sized mass was palpable deep in the mammary tissue. This mass was surgically excised and found to be a papilloma of the lactation ducts. The patient has remained free from symptoms for four years. The second patient was a thirty-eight-year-old woman, who had been aware of a thin, bloody, intermittent discharge from the left nipple for over three years. A lump the sise of an egg was felt in the upper outer quadrant. This was removed and histological examination showed a hemorrhagic epithelial cyst. The patient was well and symptom-free three years after operation. The third patient, a woman of forty, had felt a swelling in the right breast for eight years, since the birth of her last child. For one month she had noticed some bleeding from the nipple. On examination a diffuse mass, 6 11 10 om., was felt in the upper half of the right breast. It was removed by operetion and found to be a polymorphous-cell sarcoma. Enlarged axillary glands were also removed but showed no evidence of metastases. There has been no return of symptoms in three years. It is pointed out that bleeding is not in itself a pathological entity but a clinical manifestation of some underlying lesion. Neither does the appearance of a sanguineous THE BREAST 859

isecretion necessarily indicate a malignant process. In the first two cases, although a careful search was made, no evidence of malignant change could be detected. There are two illustrations and a comprehensive bibliography. THEODORES. RAIFORD

Cancer of the Breast, E. P. BUCHANAN.Internat. J. Med. & Surg. 47: 152-156, 1934. The author’s discussion is based upon his experience in 147 operations for mammary cancer and 150 for benign breast lesions. He concludes that operation to-day, as two and a quarter centuries ago, offers the only hope of cure in breast cancer. Of the 147 cases of carcinoma, 9.5 per cent were diagnosed as benign preoperatively, and of the 150 benign cases, 10.6 per cent were believed to be malignant. The preoperative diagnosis was thus incorrect in approximately 10 per cent of the cases, indicating conclusively that no one is justified in pronouncing a breast tumor benign until it is proved so by operation Recent follow-up results were unavailable in many of the author’s cases and no attempt is made to estimate the number of three- and five-year cures.

Gelatinous Carcinoma of the Breast, B. J. LEE, H. HAUSERAND G. T. PACK,Surg., Gynec. & Obst. 59: 841-857, 1934. Although cancer of the breast is basically a disease entity, it is really not one but many diseases. The diffuse duct carcinoma, the bulky adenocarcinoma, the intra- cystic or intraductal papillary carcinoma, the acute inflammatory carcinoma, the sweat gland carcinoma, and Paget’s cancer are all varieties of mammary cancer, yet they differ greatly in their clinical and pathologic characteristics. A rare subvariety is the gelatinous carcinoma which has been observed in 30 of 1922 breast cancers studied histologically. Purely gelatinous carcinomas, recognized grossly as such, are a great rarity, although gelatinous degeneration of parts of any of the varieties of breast cancer nay not be so infrequent. Gelatinous carcinoma of the breast may be subdivided into two distinct groups based on physical signs, clinical course, and gross and microscopic pathologic anatomy. I. Primary gelatinous carcinomas are those in which the gelatinous element presumably arises with the onset of malignancy in a preexisting papillary cystadenoma. This type occurs usually in patients of advanced age. It is of extremely slow growth and may exist many years before it is suspected to be carcinomatous. The absence of skin adherence and nipple retraction, the encapsulation of the tumor, and the infrequency of metastasis confirm the relative benignity of this variety of mammary cancer. The tumor has the gross appearance of a gelatinous or mucous cyst and under the microscope the epithelial elements are few and scattered. These encapsulated gelatinous carcinomata have sometimes been cured by local excision, although this treatment is not recommended as a routine procedure. 11. Ordinary carcinomas of the breast with secondary gelatinous degeneration are more commonly seen. The gelatinous character of the tumor may or may not be grossly discernible and on histologic study of the tumor it may be seen to involve only a portion of the growth. In these tumors in which gelatinous degeneration is an in- cidental occurrence the full degree of malignancy may be maintained. In certain of the growths studied other parts were anaplastic and highly malignant. GelatinouEi carcinomata of this group have no distinguishing clinical or pathological characteristics. They occur in patients of all ages; the rate of growth, degree of malignancy, tendency to metastasize, and physical signs produced are the same as for ordinary mammary cancers of the same histological classification. The gelatinous degeneration originates either in the connective tissue or in epithelial elements of the tumor, or both. In many cases the origin cannot be determined. Metastases to the axillary lymph nodes were observed clinically in 10 patients, and their presence was verified histologically in 7 cases. Three patients had pulmonary metastases and 2 showed definite evidence of metastases to bone. Five-year cures were obtained in 57 per cent of these 30 cases as compared to 41 per cent in a control group of 217 cases of ordinary mammary cancer treated by similar methods. The article is illustrated with photographs and photomicrographs, BENJAMINEl. SHORE. 860 ABSTRACTS

Value of Breast Radiography, I. H. LOCKWOOD.Radiology 23: 202-207, 1934. To obtain roentgenograms of the breast which are of value in diagnosis it is important that the rays strike the breast in an exact transverse position to prevent super- imposition of the radiographic image. Lockwood advises a 36-inch distance, with a Potter-Bucky diaphragm, kilovoltage from 55 to 70, 100 ma. and an exposure of 0.3 to 1 second. Four zones are to be distinguished in the normal breast; the cutaneous, the adipose, the glandular and the retroglGdular. Two distinct histologic patterns are recognized in the glandular aone: (1) mazoplasia, indicating the desquamation of epithelial cells in the terminal ducts and their acini, accompanied by hyperplasia of the pericanalicular and periacinar connective tissue, and (2) cystiphorous desquamative epithelial hyperplasia, which begins as a desquamative epithelial hyperplasia and ends with the formation of cysts. The former is recognized roentgenographically by a frond-like appearance of the parenchyma with the converging striations forming an indistinct band beneath the nipple and a varying amount of non-opaque stroma beneath the mass of the gland and the derma. In the latter condition the fibro-glandular striations are marked, the parenchyma appears to fill all the available space to the derma, and there is a broad, dense band beneath the nipple. Pathological processes appear in the roentgenogram as alterations in density or changes in contour and outline of the different zones of the breast. Cysts are associated with the second of the above named histological patterns and appear as clear, relatively smooth meas in the parenchyma of the gland. When containing fluid, the cysts appear less dense than solid tumors. Solid benign tumors appear as circumscribed opaque areas, either single or multiple. The periphery may be dense but there is no evidence of invasion into the surrounding tissues. There may be distortion but no interruption of the striations. Papillomata present no characteristic x-ray findings other than those of cystiphorous desquamative epithelial hyperplasia. This in the presence of bleeding from the nipple, however, is presumptive evidence of a papilloma in the absence of a palpable tumor. Fibrosis presents numerous faint masses of scar tissue without abnormalities of the anatomic zones. Carcinomas show irregular areas of opacity with interruptions of the striations. The periphery may be feathery or more compact than the mass itself due to the compression of the surrounding tissues. Metastases to axillary nodes appear as smooth, dense opaque areas and are to be distinguished from inflammatory nodes, which are faint and irregular. The roentgenographic findings should always be augmented by clinical evidence of malignancy before the diagnosis is made. Three illustrative cases are cited, and there are four illustrations in which the x-ray and histologic findings are compared. There is also a short bibliography. THP~ODORES. RAIFORD Radiotherapy in Adenocarcinoma of the Breast, J. BORAK. Die Aussichten der Strah- lentherapie bei den Adenokarzinomen der Mamma, Htrahlentherapie 49: 263-290, 1934. This paper is based upon a small series of 17 adenocarcinomas of the breast observed between the years 1928 and 1932, which received radiotherapy. Ten of the patients died from extension of the malignant growth from three to thirty months after treatment. Seven are still living from eight months to four and one-half years after treatment. In regard to the immediate effects of radiation, of 8 lesions confined to the breast tissue, distinct regression was perceptible in 7, while the eighth was unchanged. In 6 cases where the lymph nodes were irradiated regression was noted in 5, while the tumor disappeared in the sixth. Six of the tumors were surgically removed after operation and 4 of these were studied histologically. Three of these demonstrated evidence of re- gressive changes, while in the fourth no reaction to radiation could be detected. In order to evaluate the effects of radiotherapy upon the duration of life, the author has compared the life span after the first recognition of the tumor in his treated cases with untreated cases as illustrated by the work of de Quervain (Statistik uber den Brustkrebs in der Schweiz 1911-1915, Berlin und Bern, 1930). The latter author found the average duration of life to be 32.8 months without treatment. The duration of life in the present series averages forty-one months, a conservative figure, since some THE BREAST 86 1

of the patients are still living. It is therefore computed that irradiation has added nine months to the life span. The author does not, however, make any claims for complete healing of the disease. While irradiation may cause temporary regression of the tumor with amelioration of symptoms and an increase of the life span, doses which are small enough to prevent connective-tissue necrosis will not produce complete disappearance of the lesion. The literature is reviewed briefly. There are five illustrations and four cases are briefly reported. THEODORES. RAIFORD

Combined Radium and X-ray Treatment of Mammary Carcinoma, F. MELCHARTAND W. SCHLOSS. Uber die kombinierte Radium-Rontgenbehandlung des Mammakar- dnoms, Wien. med. Wchnschr. 83 : 930-932, 1933. A short discussion of the relative merits of radium and x-ray in the treatment of mammary cancer. Nothing new is contributed. There are no illustrations. THEODORES. RAIFORD Electro-surgery and Radium in Carcinoma of the Breast, ALBERTF. HARDT. Internat. J. Med. & Surg. 47: 199-201, 1934. The author outlines the technic for the radical breast operation by electrosurgery with the implantation of radium by a method described by Moore in 1929 (see Texas J. Med. 25: 453, 1929; also Am. J. Surg. 15: 248, 1932). He believes that with this technic there has been a decided improvement in five-year cures, but no statistics are presented. He would limit preoperative irradiation to a small group of inoperable cases in which there is a possibility that it may render the condition operable. Post- operative irradiation by an experienced operator is unquestionably valuable. Results of Radiation and Combined Treatment in Primary Inoperable Breast Cancers and in Inoperable Recurrences, A. HINTZE.Erfolge der Bestrahlung und der kombinierten Behandlung beim primiir inoperablen Mammacarcinom und beim inoperablen Residiv, Arch. f. klin. Chir. 180: 43-64, 1934. Abstracted histories of 26 patients with breast cancers who had roentgen-ray therapy are presented. Six of these patients had inoperable tumors and received no other treatment except irradiation; 3 had irradiation treatments for supposedly inoperable growths and were later operated on; 12 were treated for recurrences after operation; and in 5 instances irradiation was given to distant metastases. These cases have been used to show the beneficial results which may be obtained in certain cases. The five- year survivals obtained in an unstated number of cases of breast cancer are as follows: of the patients with inoperable tumors treated by irradiation alone, 6 per cent are alive after five years; of those treated by operation and operation and irradiation for recurrences, 32.2 per cent are alive; and of those treated by operation and given prophylactic irradiation, 54.9 per cent are alive after five years. BENJAMINR. SHORE Saturation Irradiation by Deep X-ray Treatment for Cancer of the Breast, W. J. YOUNQ. Kentucky M. J. 32: 149-151, 1934. Young favors postoperative irradiation by the saturation technic in cancer of the breast. GRAYH. TWOMBLY Treatment of Chest Wall Secondaries in Breast Carcinoma, G. E. RICHARDS.Radiol- ogy 23 : 280-284, 1934. In the treatment of recurrent breast carcinoma of the chest wall the major difficulties encountered are the delivery of an evenly distributed dose of x-rays to the curved wall of the thorax which will be effective and the application of a relatively heavy dosage without affecting the sensitive intrathoracic structures. To overcome this difficulty, the author has devised a new form of radium jacket, which consists of a piece of felt one half inch thick, cut and fitted to the affected half of the thorax. Upon this are fastened approximately 100 radium needles so spaced as to give an even distribution of emanation. Using 60 mm. needles containing 3 mg. of radium it has been found that 802 ABSTRACTB

from ninety to one-hundred hours are required to give the necessary dosage. The reaction which follows is fairly severe and consists of a first or second degree erythema with vesication, which may require hospitaliration. A cream of castor oil and rinc oxide in equal parts has been found most effective in counteracting the effects. The results obtained have not been particularly satisfactory in advanced cases where distant metastases were evident at the time of treatment. In those cases without widespread metastases, however, the method has been of great value and has produced a definite improvement of the local condition, with prolongation of life. The method has also been applied to advanced cases of primary malignancy as an immediate postoperative measure, but the results have not been ascertained as yet. Two disadvantages of the method are mentioned. In several cases a marked constitutional reaction characterized by a rise in temperature and moderate shock have necessitated hospitaliration, Again, if the treatment fails to control the disease, it produces a fairly marked devitaliza- tion of tissue which makes subsequent treatment almost impossible. There are eight illustrations showing the jacket and some of the reactions produced. THEODORES. RAIBORD Large Skin Recurrences Fifteen Years after Excision of a Papillary Cystadenoma of the Breast, 8. HINDSE-NIIOLSEN.Monstrgses cancrbses Hautrecidiv 16 Jahre nach Exzision eines papilliferen Cystadenoma mammae, Zentralbl. f. Chir. 61 : 1863- 1864, 1934. A sixty-year-old woman died with extensive, raised, nodular tumor masses over the right breast and in the scar resulting from a mastectomy performed fifteen years previously for a cystadenoma of the left breast. Histologic study of these secondary tumors showed them to be adenocarcinomas. Whether they represented recurrences from malignant portions of the cystadenoma in the left breast or whether they were metastases from a histologically unstudied mass which developed in the right breast three years before death is unknown. One photograph of the patient is included. BPNJAMINR. SHORE Breast Cancer during Pregnancy, P~RY.Cancer du sein et grosseme, Bull. SOC.d’obst. et de gyn6c. 23: 232-223, 1934. A woman of thirty-one was found by her neighbors in a semicomatose condition and was brought to the hospital, where she was found to be in about the sixth month of pregnancy. There was a hard tumor in the left breast, and hard enlarged left axillary nodes were present. Death occurred on the third day after admission, and necropsy revealed a nodule in the liver. The breast tumor was an adenocarcinoma, and the liver nodules had the same structure; no other metastases were found. Although nothing was known of the previous history, the author believes that the pregnancy had caused increased malignancy, expressed by the rate of metastatic spread rather than by increase in sire of the primary tumor, which was only the sire of 8 harelnut [obviously an entirely unwarranted assumption, as extensive metaRtases of breast cancer are occasionally seen with very small, often wholly unsuspected tumors in the mamma]. F. CAVDRS Mixed Mesenchymal Tumor (Osteochondromyxosarcoma)of the Breast, V. BANIOT J. M. BOLAROSAND R. SUTTPR. Sarcoma osteogenico de la mama, Bol, Liga contra el c&ncer 8: 321-328, 1933. This unusual tumor occurred in a woman of fifty-seven, who had two years previously noticed a swelling of the upper half of the left breast. This was a hard nodulated mass, free from the skin and the greater pectoral muscle; the nipple was not retracted and there was no palpable axillary adenopathy. Radical operation was done, and the patient was in good health at the time of reporting, five months after operation. Histologically the greater part of the tumor consisted of spindle cells with large deeply staining nucleus and vacuolar cytoplasm, showing in places sclerotic , hyaline and myxomatous modifications of the fibroblasts. In other parts of the tumor there were trabeculae of newly formed bone, with deposition of calcium salts; around these trabecu- TUMORS OF THE NECK, INCLUDING THE SALIVARY GLANDS 863 lae were osteoblastic giant cells, containing large numbers of nuclei. There was also rudimentary cartilage, and the stroma was highly vascular, but no epithelial cells were found anywhere in the tumor. Several similar tumors have been reported, unknown to the authors, who wisely refrain from the pathogenic guesses to be found in these previous reports. There are four illustrations. F. CAVERS Calcium Deposition in the Lactating and Excretory Ducts of Both Breasts, R. FINSTER- BUSCH AND F. GROSS. Kalkablagerungen in den Milch- und Ausfuhrungsgangen beider Brustdrusen, Rhtgenpraxis 6: 172-174, 1934. A carcinoma of the left breast in a sixty-two-year-old woman was accompanied by diffuse deposition of calcium phosphate in the ductal system. Its presence was demonstrated roentgenographically. The fact that the calcification was found in both breasts led the authors to believe that it was in no way connected with the malignant growth. There are two illustrations. THEODORES. RAIFORD

Melanoma of the Male Breast, URBANMAW. Internet. Clin. 44: 163-172, 1934. A man of fifty-one years had a tumor of the left breast which had developed following injury to a mole a year before. There were palpable nodes in the left axilla. Radium was applied (500 mg. hours), and a week later the mass was excised by cautery. The pathological report was melanotic carcinoma. The patient failed to return for observation and was not seen again until fifteen months later. He then reported that several months after his discharge a number of small nodules had appeared in the region of the excised tumor. These had now begun to ulcerate, involved a large part of the breast, and extended into the axillary region, where metastases were evident. Death occurred within two months, from cachexia. Metastases were widespread. Sections of the original breast lesion and the metastatic growths showed struc- tural characteristics of both carcinoma and sarcoma, but the final diagnosis was melanosarcoma. Maes emphasizes the potential danger of pigmented moles and points out that in malignancy of the male breast, with its scanty areolar tissue, early infiltration of the pectoral muscles to which the breast is firmly attached is characteristic. Removal of these muscles is therefore imperative if the spread of the disease is to be checked.

TUMORS OF THE NECK, INCLUDING THE SALIVARY GLANDS Congenital Solid Tumors of the Neck Diagnosed as Branchiomas, P. TRUFFERT. Trois observations de branchiomes (tumeurs congenitales solides du cou), Bull. et m6m. SOC.nat. de chir. 60: 602-611, 1934. Remarks on Branchiomas, M. CHEVASSU.A propos des branchiomes, Ibid. 60: 666-667, 1934. Truffert’s three patients were women of fifty-five, sixty-four and thirty-five. In the first a tumor, the size of an orange, was removed from the supraclavicular fossa; the pathologist reported that it consisted of small, round or polyhedral cells with a vascular stroma, suggesting a carotid tumor. Two years later a smaller tumor was removed from the retrocarotid tissue higher up, which the same pathologist reported as an aberrant thyroid adenoma. The second patient had a tumor, noticed five months previously. It was removed from below the upper third of the right sternomastoid, and some months later the patient died from intercurrent pneumonia. The pathologiat diagnosed pure fibroma. In the third case there was a tumor occupying the supraclavicular fossa. It was enucleated, and diagnosed by the pathologist as a fibromyoma. Despite the pathologist’s reports, the author holds that all these tumors were branchiomas, evidently because they all arose below the anterior border of the sternomastoid muscle. In discussing Truffert’s paper Veau said he thought it about time to abandon the old practice of applying the term branchioma to any cervical tumor, other than a malignant metastasis, found anywhere near the site of an embryonal branchial arch. It was absurd to apply this term to aberrant nodules of thyroid or thymus tissue, tumors arising 864 ABSTRACTS from the sympathetic, etc. While not denying the existence of tumors derived from undifferentiated rests of the branchial arches and clefts, he considered that the term branchioma was,more often than not loosely and erroneously used. Chevassu considered that not one of Truffert’s cases was a true branchioma, but that Veau had taken an excessively skeptical attitude. Anatomists have proved that epithelial rests of branchial origin exist in the neck in adults, and if these can give rise to fistulas and cysts it is reasonable to suppose that they can produce solid tumors as well. F. CAVERS Branchial Tumors, True and Otherwise, L. A. BOSSI,JR. Los tumores de origen branquial de conformidad con la patogenia en uso, Semana m6d. 1 : 827-831, 1934. The author calls attention to the fact that the term branchial tumor has by many writers been loosely and unjustifiably applied to many cervical neoplasms, though embryologic investigations have shown that it is impossible to trace in the adult the sites occupied by the three posterior fetal branchial arches. It is absurd to apply this term to any tumor of the neck which is neither an enlarged lymph node nor an aberrant bit of thyroid tissue, thus making a hit-or-miss diagnosis of tumors that most frequently have nothing to do with the branchial apparatus of the early fetus. The arches are developed from mesodermal tissue, and the clefts are obliterated by bridging growth of this tisaue from the opposing arches. The arches are covered externally and internally, but not on their opposed surfaces, by the epidermis and the stomodeal epithelium respectively. Ectodermal cells may persist in either the outer or inner portions of the clefts after these have undergone obliteration, and a true branchial tumor would almost certainly be congenital and consist of both mesenchymal and epithelial tissue of immature, undifferentiated type. At any rate, the author concludes, a diagnosis of branchial tumor should never be made except by a pathologist familiar with the embryology of the pharynx and the neighboring regions. F. CAVERS

Branchiogenic Carcinoma, FREDERICICCHRISTOPHER. Internat. J. Med. & Surg. 47: 368-369, 1934. A woman of fifty-eight had a painless fusiform mass in the right side of the neck, which had been present for about two and a half months. It was about the size of a walnut, and was situated at the level of the bifurcation of the common carotid artery, somewhat behind and medial to the sternocleidomastoid muscle. At operation a hard tumor was found densely attached to the muscle and the surrounding structures. It was not intimately attached to either the external or internal carotid or to the bifurcation of the common carotid. Removal by careful dissection was followed by uneventful recovery, The encapsulated tumor mass consisted of two fixed nodules of firm, grayish yellow tissue. Solid masses of atypical epithelial cells of squamous type partly replaced the lymphoid and reticular tissue of small lymph nodes and extended through their capsules into the surrounding fibrous tissue. There were a few poorly formed epithelial pearls. The pathologic diagnosis was metastatic squamous-cell carcinoma of the lymph nodes and areolar tissue. Intensive study of the nasopharynx failed, however, to reveal a primary tumor, and the author concludes that he was dealing with a so-called branchiogenic carcinoma. There are no illustrations. Cystic Hygroma of the Neck: Report of a Case and Review of the Literature, A. M. VAUQHN.Am. J. Dis. Children 48: 140-168, 1934. Vaughn describes the successful surgical removal of a cervical hygroma the size of a baby’s head from a seven-weeks-old infant. The tumor was multiloculbted and the cavities were filled with a chocolate-colored fluid. Histologic study showed the cysts to be lined with flat endothelial cells. Sixty-four cases of cystic hygromas reported in the literature since 1913 are reviewed in tabular form. The article is illustrated with photographs and photomicrographs. BENJAMINR. SHORE TUMORS OF THE NECK, INCLUDING THE SALIVARY GLANDS 865

A Papillary Cyst of the Neck, M. FOSSEL.Uber ein Kystoma papilliferum am Halse, Centralbl. f. allg. Path. u. path. Anat. 60:51-55, 1934. A thirty-eight-year-old patient presented a cystic swelling overlying the trachea, the size of a man’s fist. To the right and above it at the edge of the sternomastoid muscle could be felt another smaller swelling, which was nodular in consistency. At operation the cyst proved to be multilocular, filled with yellowish fluid, and not attached to the thyroid gland. The second swelling represented a nodular goiter of the right lobe of the thyroid. The cyst was removed and a partial thyroidectomy performed. His- tologically the goiter was of the simple colloid type. The cyst contained numerous papillary outgrowths which also contained colloid material. It was thought to represent a developmental anomaly, arising either from ectopic thyroid tissue or from the ultimo- branchial body. The origin and nature of the cyst are discussed at length. There are no illustrations, but a full bibliography is appended. THEODORES. RAIFORD

Tumors of the Neck, J. E. ELSE. West. J. Surg. 41: 685-694, 1933. A compilation of tumors which may occur in the cervical region, and a brief discussion of them.

Tumors of the Salivary Glands, J. D. MARTINAND D. C. ELKIN. Arch. Surg. 28: 727-741 , 1934. Reviewing a group of 24 tumors of the salivary glands, the authors find that while occasional growths of mesothelial origin are encountered, the vast majority are of the so-called mixed type, While opinions regarding the origin of these tumors are still at variance, their derivatiop from epithelial cells is now commonly accepted. Pathologi- cally they may be grouped into two classes, those in which mesoblastic tissue pre- ‘ dominates and those in which cellularity is marked. Malignancy apparently varies directly with the cellularity of the growth. Optimum therapy consists of irradiation and early surgical removal of the tumor. The prognosis, judging from the results in the present series, is poor. Not only do the lesions tend to recur, but the reappearing growths become increasingly more malignant and difficult to eradicate. Brief reports of the authors’ 24 cases are included, and there are 11 illustrations. THEODORES. RAIFORD

Curability of Benign and Malignant Tumors of the Parotid Gland, A. HINTZE. Gutartige und bosartige Parotisgeschwiilste und ihre Heilungsmoglichkeiten, Arch. f. klin. Chir. 180: 606-636, 1934..

From 1912 to 1933 the author observed 110 patients with parotid gland tumors; 86 of these growths were malignant, and 24 were benign. Five-year survivals were obtained in 15 of 32 patients after surgical removal of histologically proved malignant tumors; 13 of these are still living but only 7, or 22 per cent, are free of the disease. Of the 6 patients treated entirely by irradiation, 2 are living and 1 is symptom-free after five years. The author concludes from the study of these cases that malignant tumors of the parotid gland and those in which there is a strong suspicion of malignancy should be treated at first by irradiation. If at the end of six weeks there has been a 50 per cent reduction in the size of the tumor, radiation treatment should be continued. If satisfactory diminution in size of the growth is not secured with the first course of irradiation, total surgical excision of the tumor should be done. In all cases prophylactic postoperative irradiation and irradiation of recurrences should be given. Although good results are to be expected from the complete surgical removal of benign mixed tumors and cylindromas of the parotid gland, Hintze believes that satisfactory results may be obtained from the irradiation of these growths if this is undertaken when the tumors are still small. Numerous tables and charts are included in the article. There are no illustrations. BENJAMINR. SHORE 866 ABSTRACTS

Carcinomas and Mixed Tumors of the Parotid Gland; S4t Cases, E. MARTINEZ.Con- sideraciones sobre el cancer de la par6fidal con seis casos clfnicos, Bol. Liga contra el cancer 8: 289-298, 1933. The author cites the conclusions arrived at by McFarland (Surg. Gynec. & Obst. 57: 104,1933. Abst. in Am. J. Cancer 20: 917,1934),whose valuable paper led him to study six cases treated in his clinic. Three of these were diagnosed as carcinoma, squamous- cell carcinoma and adenocarcinoma, The first patient died one month after operation, and at necropsy metastases were found in various abdominal organs. The remaining two patients are alive and still under radium treatment; in one the tumor was removed, in the other it was inoperable. Two of the three patients with mixed tumor were first operated upon eight and twenty years ago, and both had been recently operated upon for recurrence and given radium treatment a few months before the time of reporting. The third patient had noticed the tumor fourteen years previously; operation was followed by radium treatment, and he was well when seen sixteen months later. There are no illustrations. F. CAVPIRS THE THYROID AND PARATHYROID GLANDS

Treatment of Carcinoma of the Thyroid Gland, J. DPIJ. PEMBERTON.Ann. Surg. 100: 906-923, 1934. From 1910 to 1934, 658 patients with malignant tumors of the thyroid gland were seen at the Mayo Clinic. In 406 of these the diagnosis was made from histologic study of the tumors removed at operation and in 252 the obvious clinical diagnosis of inoperable carcinoma was not proved by biopsy. A study of the ratio of malignant thyroid tumors to operative cases of goiter each year does not show any definite trend except for a moderate increase during the years since 1928. This increased incidence probably is not actual but relative and is to be accounted for by the tendency of patients with benign goiters to defer operation because of the economic depression. Of the 658 patients, 421 were females and 237 males, a ratio of 1.77 to 1. In the same period, however, the sex incidence for patients with nodular goiters was about 5 females to 1 male. The age incidence in this series corresponds to that of carcinoma situated elsewhere, 72 per cent of the patients being within the fifth, sixth, and seventh decades of life; however, two patients were less than ten years of age and 9 others less than twenty, There is a wide variation in the histologic characteristics of tbyroid gland malignant tumors, and there appears to be a definite, although not constant, relationship between the clinical course of the disease and the pathological features of the growth. The following classification has been used in the grouping of primary malignant tumors of the thyroid gland at the Mayo Clinic for many years: (1) papillary adenomas; (2) adenocarcinoma in fetal adenomas (malignant adenomas) ; (3) diffuse adenocarcinomas; (4) epitheliomas; (5) sarcomas. Although vascular invasion by tumor is usually considered a valid criterion for the diagnosis of malignancy in the thyroid gland, many pathologists experienced in this field of study are agreed that the finding of vascular invasion is not necessary for a diagnosis of malignant growth. They rely, instead, on the presence of the usual criteria of malignancy elsewhere in the body, that is, anaplasia or cellular non-diff erentiation. In the 406 cases operated on, an endeavor was made to extirpate the tumor in 321 and biopsy alone was performed in 86. The 321 patients undergoing partial thyroidectomy represent 48.8 per cent of the 658 patients with carcinoma of the thyroid gland seen. Operability depends on the extent of the local invasion of the primary lesion and on the absence of distant metastases. In the absence of distant metastases, the relative fixation of the tumor ie the important feature. Tumors which are completely fixed to all the contiguous structures should not be operated on, for it is obvious that the risk of extirpating the tumor is out of proportion to the amount of benefit that can be hoped for. The appearance of enlarged carcinomatous cervical nodes, months or years following removal of a malignant thyroid tumor, in the absence of a recurrent tumor in the thyroid gland, has not the same prognostic significance as the occurrence of enlarged nodes following operation for malignancy situated elsewhere. Here, it indicates that the THE THYROID AND PARATHYROID GLANDS 86'7

primary lesion was of a papillary adenocarcinomatous type, and, if the involved nodes are confined to the neck, surgical removal offers a reasonable chance of cure. Theoretically the surgical procedure in malignancy of the thyroid gland should consist in the wide removal of the primary growth together with the regional lymphatic structures. However, it has been demonstrated that extirpation of the cervical nodes, unless there are reasons to suspect that they are actually involved, is seldom necessary in order to obtain the greatest benefit. This probably depends upon the fact that carcinoma of the thyroid gland, with the possible exception of the papillary type, seldom spreads by way of the lymph vessels until it has penetrated the capsule of the gland. From Jan. 1, 1907, to July 1,1928,323patients with cancer of the thyroid gland were operated on at the Mayo Clinic. In 56 of these cases the operation was limited to removal of only a specimen of the growth for histologic study and grading. All of these 56 patients subsequently received irradiation treatment. In the remaining 267 cases the operation for removal of the malignant growth consisted of partial or almost complete thyroidectomy with or without removal of the cervical lymph nodes. Eleven of the 323 patients died in the hospital, a primary mortality of 3.4 per cent. Of the remaining 312 patients, 137, or 43.9 per cent, have lived five years or longer, and 64, or 20 per cent, have lived more than ten years. Of the 137 patients who have lived five years or longer, 10 received irradiation alone and in 127 radical removal was done with or without postoperative irradiation. Local recurrences or persistence of the malignancy was present in 42 cases, and its presence or absence was unknown in 23 cases. However, it is known that 72, or 24.35 per cent of all the patients treated, lived without evidence of recurrence of the disease for five years or longer. All of the 72 patients who lived five years or more and are known to be free of recurrences were subjected to thyroidectomy. The preoperative diagnosis of malignancy was made or suspected in 134, or 41 per cent of the cases. Of this group, subtotal thyroidectomy was performed in 84 cases and biopsy only in 50 cases. Because of the prevailing opinion that treatment is of little value in cases of carcinoma of the thyroid gland in which the diagnosis can be made preoperatively, it is interesting to know that 34, or 25.4 per cent of these 134 patients, have lived five years or longer; 25 were among the 84 who underwent partial thyroidectomy and 9 were among the 50 in whom biopsy and irradiation were done. This article is illustrated with photographs, a drawing, and photomicrographs. BENJAMINR. SHORE

Cancer of the Thyroid Gland: Twenty-two Malignancies in 2813 Goiter Operations, A. G. BRENIZER. South. Med. & Surg. 96: 392-394, 1934. A malignant tumor of the thyroid must be diagnosed by histologic evidence of invasion of the blood vessels by tumor. In 2813 patients with thyroid disease operated on by the author there were 1162 nodular goiters; of these, 22 were malignant. Eighteen of these patients are living for from two to twenty-three years after operation. No case of carcinoma developing in an exophthalmic or diffuse toxic goiter has been seen. BENJAMINR. SHORE

Carcinoma of the Thyroid, Early and Unusual Case, F. C. LEE. J. M. A. Georgia 23: 123-126, 1934. Lee reports a case of papillary carcinoma of the thyroid in a girl eight years of age. The condition was clinically mpnifested by irritability, sore throat, nervousness, and enlargement of the thyroid gland of seven months' duretion. Thyroidectomy was followed by radiotherapy. There is no note as t6 the ultimate result. This case is unusual not only in the youth of the patient but in the clinical manifestations of hyperthyroidism which are rare in the presence of thyroid malignancy. Two illustrations are included, and a short bibliography. THEODORE5. RAIFORD Hyperparathyroidism due to Diffuse Hyperplasia of All Parathyroid Glands Rather than Adenoma of One: Clinical Studies on Three Such Cases, F. ALBRIGHT,E. BLOOM- BERG, B. CASTLEMANAND E. D. CHURCHILL.Arch. Int. Med. 54: 315-329, 1934. Although the majority of the cases of hyperparathyroidism thus far reported have been due to functioning adenomas of one or possibly two glands, the authors found, 868 ABSTRACTS among 19 cases observed at the Massachusetts General Hospital, 3 in which a diffuse hyperplasia of all parathyroid tissue could be demonstrated. The histologic structure of these glands, which shows a striking uniformity, differed markedly from that observed in the remaining cases, in the large size of the cells, the clearness of the cytoplasm, and the tendency toward glandular formation. There is, however, a difference in the hyperplasia associated with hyperparathyroidism and the so-called compensatory hyperplasia. The former is analogous to hyperthyroidism, and may therefore be regarded as a true disease entity. While not definitely ascertained, it is thought that multiple parathyroid enlargement is in some way associated with changes in the pituitary gland, and that the stimulating factor may possibly be the one of the anterior lobe described by Hertz and Kranes (Endocrinology, 18: 350, 1934). The status of surgical therapy in these cases is equivocal. Removal of two glands in one instance was found to have no effect upon the serum calcium and phosphorus. Furthermore, even when sufficient tissue is removed to affect the blood chemistry, the condition is prone to recur. The authors' three cases are reported in detail and illustrated by six excellent photographs. The literature is reviewed. Among 101 cases of parathyroidism, 14 were found in which multiple enlargements were seen. Some of these, it is believed, represent diffuse hyperplasia not unlike that mentioned above. Brief abstracts of these cases are included. THEODORRS. RAIFORD

THE ORAL CAVITY AND UPPER RESPIRATORY TRACT Diagnosis and Treatment of Incipient Carcinoma of the Lip, R. QUERO. El chncer incipiente del labio, su diagnbstico y tratamiento, Bol. Liga contra el cancer 8: 210-216, 1933. The author urges the general physician to keep on the lookout for labial lesions which may be actual beginning carcinomas or else form a basis on which carcinoma may later develop. Early cancers, in which the lesion is small and there is no submental adenopathy may be ulcerated, papillary, or leukoplakia-like. The ulcerated forms must be distinguished from chancre, which develops much more rapidly and shows earlier infiltration, while the Treponema can usually be found in the lesion by the expert to whom the patient should at once be referred. Infective cheilitis, usually streptococcal, is a more diffuse lesion with a papery surface and is more likely to be mistaken for an ulcerated leukoplakia than an early ulcerated carcinoma. The papillary type has an indurated base and a horny covering, features that should lead at once to the correct diagnosis. Labial leukoplakias, resulting from chronic irritation, develop slowly and are resistant to irradiation, and should therefore be removed surgically as a prophylaxis against cancer. The other lesions mentioned, including early carcinomas, are best treated with radium, which gives equally good curative and better cosmetic results as compared with surgery and electrocoagulation. F. C-4VERB Carcinoma of the Lip: Results of Roentgen and Radium Treatment, B. P. WIDMANN. Am. J. Roentgenol. 32: 211-217, 1934. The author reports 168 cases of carcinoma of the lip treated with roentgen rays, radium, and electrodesiccation at the Philadelphia General Hospital during the past ten years. One hundred and twenty-five, or 74 per cent, were primary cases without recognizable lymph node involvement at the time of the first examination. However, from the standpoint of surgical operability these were in no sense all early cases. For example, 39 tumors were infiltrating in character and measured in excess of 2 cm. in diameter. The average duration of these lesions before the first treatment was thirty- nine months. Of the 126 patients without node enlargement at the beginning of treatment, 78, or 02 per cent, are symptom-free for from one to ten years; 47 patients are symptom-free for three years or more. These results are based on all cases without respect to sire of the lesions; for those about 1 cm. in diameter the curability rate is thought to be greater than 90 per cent. With prophylactic irradiation of the lymph nodes of the neck, subsequent development of cervical node metastases occurred in 17 THE ORAL CAVITY AND UPPER RESPIRATORY TRACT 869

per cent of 52 cases as compared with 51 per cent of 72 cases in which uncontrollable cervical node metastases developed without prophylactic irradiation. No uniformity of irradiation technic was adhered to in this series. Free and wide electrodesiccation in conjunction with radium or roentgen rays is favored for the small lesions. Larger lesions should be given at least 5 skin erythema doses of irradiation to include a surface surrounding the lesion equal to the sise of the lesion. The effects of different qualities of radium and roentgen rays have been observed to be equally good. Filtrations equivalent to 4 mm. of lead are preferred because rays of shorter wavelength do not seem to produce the degree of atrophy that is theoretically more likely with softer qualities and doses equal to 5 skin erythemas. Histologic study of biopsy specimens w&s available in only 78 of the 168 cases. BENJAMINR. SHORE

Carcinoma of tbe Lip, Report of Cases, L. W. FRANKAND C. D. ENWELD.Kentucky M. J. 32: 366-368, 1934. The authors report the histories of two patients, twenty-five and twenty-one years of age, with carcinoma of the lower lip. The concept of cancer as a disease of middle age must be revised as more and more patients in the second and third decades are being seen. Lip cancer in comparatively young individuals is, as a rule, very malignant and metastasizes early. The prognosis for these tumors in young patients is frequently unfavorable. BEINJAMINR. SHORE

Jaw Cysts, Root Cysts and Root Granulomas, M. KRAus. Uber Kieferzysten, Zahn- wurzelzysten und Wurzelgranulome, Wien. med. Wchnschr. 84: 239-242, 1934. This lecture contains a general summary of the clinical and pathologic features of dental cysts and granulomas but offers nothing new. There are three good photomicrographs. F. CAVDRS

Teratoma of the Mandible, A. GARcfa ORTIZ. Un caso de teratoma del maxilar, Arch. d. med., cir. y esp. 37: 802, 834-835, 1934. In a seten-year-old boy a painless swelling of the left lower jaw had been first noticed about three years previously and had grown larger and harder. X-rays showed numerous teeth scattered through the tumor, which was successfully removed by resection. F. CAVERS Tumors of the Mouth, the Dentist’s Responsibility, E. L. JONES,JR. J. Am. Dent. A. 21 : 1228-1239, 1934. It is not only the duty of dentists to help prevent mouth cancer by the proper fitting of plates and bridge-work, but also it is their responsibility and duty to reoognise and diagnose neoplasms of the buccal cavity. If dentists are not specially trained in the treatment of neoplasms, patients with these conditions should be referred to properly qualified physicians for treatment. Several photomicrographs of buccal cavity tumors are included. BENJAMINR. SHORE Cancer of the Mouth in Women,G. W. TAYLOR.New England J. Med. 210: 1102-1105, 1934. This study is based upon a series of 1128 carcinomas of the buccal mucosa observed at the Pondville Hospital, Massachusetts. Of these, only 114 occurred in females. It was observed, however, that while cancer of the floor of the mouth is relatively less common in women, the upper jaw is the seat of malignant growth more frequently than in men. Syphilis has been found a lese conspicuous etiological factor among women, as has tobacco. The greater use of the latter among men is supposed to account for the increased incidence of cancer of the cheek and lower jaw and its infrequency in the upper jaw. The influence of bad teeth is conspicuous in the etiology of carcinoma among both sexes, although the fact that women tend to correct the condition by extraction and proper fitting dentures no doubt decreases their susceptibility. The tumors found in men are usually of a higher grade of malignancy and tend to metastasize earlier than 870 ABSTRACTS those in women. Syphilis is thought to play a definite rBle in this phenomenon although its influence is not explained in any manner other than an increased virulence of malignant growth in its presence. The prognosis of buccal cancer is better among women than men. There are no illustrations, but the statistical data are set forth in seven tables. THEODORE8. RAIPORD Buccal Leucoplakia; Its Relation to Malignancy, FRANCISP. MCCARTY.Internat. J. Med. & Burg, 47: 89-91, 1934. The author considers leukoplakia a definite forerunner of malignancy in the oral cavity.

Leukoplakia Buccalis and Keratosis Labialis, S. H. STURGISAND C, C. LUND. New England J. Med. 210: 996-1006, 1934. The authors have reviewed 520 cases of leukoplakia and keratosis of the mouth and lips observed at the Huntington Memorial Hospital. Of these, 222 exhibited signs of cancer in addition to the above lesions upon their first admission to the hospital. In the remaining 298 cases malignancy developed in 12 per cent during the period of observation. Subtracting from this figure the incidence of malignancy in a similar group of normal individuals, the authors find ample ,evidence to support the consideration of leukoplakia and keratosis as precancerous lesions. Among the various etiological factors which have received consideration, poor dental hygiene and the use of tobacco are probably the most outstanding. Although syphilis is found in about 30 per cent of patients with leukoplakia of the tongue, it is of less significance when located elsewhere in the buccal cavity. Prognosis is apparently affected less by the location and duration of the lesion than by the size and extent. Treatment consists first of oral hygiene. Removal of all irritating factors is essential. If, after this, the lesion persists, irradiation is indicated. Extensive leukoplakias which do not respond to this treatment should be kept under constant observation and electrosurgical excision should be carried out the moment evidence of malignant change is apparent. The accumulated data are presented in 18 tables. THEODORES. RAIFORD Hyperplasias and Neoplasms of the Mouth in Syphilitic Patients, DECHAUME.Con- siderations sur le pathogenie des tumeurs hyperplasiques, Bull. SOC. franc;. de dermat. et syph. 41: 33-37, 1934. The author reports two cases in support of the view that syphilis, if not given early and thorough treatment, produces hyperplasia of the superficial tissues which undergo change into benign or malignant tumors. Both patients, women of thirty-eight and fifty-four,gave a strongly positive Wassermann reaction. In one there was hypertrophic gingivitis and papillomatosis of the palate, which cleared up under specific treatment. The other had a tumor of the gum which did not clear up and was found on removal to be a fibroma undergoing ossification. F. CAVERS Radiation Therapy in Medical Practice. 111. lntraoral Carcinoma, E. A. POHLE. Wisconsin M. J. 33: 353-355, 1934. The author discusses briefly the accepted methods of combined radium and x-ray therapy in intraoral lesions. The principles of fractional irradiation according to Coutard’s technic are outlined, and a case is cited in which this method was employed for an inoperable carcinoma of the tonsil with complete disappearance and freedom from recurrence for a period of six months. There are no illustrations. THEODORES. RAIBORD Dermoid Cyst of the Floor of the Mouth, Report of a Case, H. P. JOHNSON.Maine M. J. 25: 104-106, 1934. A twenty-five-year-old male had noticed a swelling in the floor of the mouth as long as he could remember. For the past ten years it had slowly increased in size. Three years previously it had been opened, and a draining sinus persisted for several months. Upon the closure of this sinus, the swelling began again and at the time of admission was THE ORAL CAVITY AND UPPER RESPIRATORY TRACT 871

of sufficient size to interfere seriously with eating and speech. Examination revealed a soft, rounded, cystic mass measuring 4 by 5 cm. It was dissected out and found to be a dermoid cyst. There is no note of the ultimate result. The origin, diagnosis, and treatment of such lesions are discussed. Surgical excision is advised, through either the oral or submental approach, depending on the position in relation to the myelohyoid muscle. THEODORES. RAIFORD

Tumors of the Nose and Throat: Summary of Bibliographic Material Available in the Field of Otolaryngology, G. P. NEWAND W. KIRCH. Arch. Otolaryng. 19: 621-637, 1934. From an exhaustive study of the reported cases of tumors of the nose and throat, the authors have assembled certain groups, dividing them according to their occurrence in the nose, pharynx, larynx, trachea, or esophagus. The most common types of new growth in each location are reiterated, but since the information is derived from collected groups of selected cases it is difficult to obtain a true impression of their incidence, No cases personally studied by the authors are included. There is an extensive bibliography. No illustrations are included. THEODORES. RAIFORD Recurrent Basal Cell Carcinoma of the Nasal Septum, Histogenesis of So-called Cylindromas, E. A. BREDLAU. Arch. Otolaryng. 20: 382-389, 1934. A fifty-four-year-old man had a massive, vascular, repeatedly recurring tumor in the left naris. In spite of multiple recurrences, the tumor failed to invade the surrounding structures or to produce metastases after four years. Histologic study of the growth showed it to be composed of nests of slightly anaplastic epithelial cells of the surface epithelium. Because of this morphologic similarity to the basal epithelium layer, such tumors are best classified as basal-cell carcinomas. The term cylindroma is quite inappropriate for this type of growth. It is, however, descriptive of a rare subvariety of basal-cell carcinomas in which hyaline cylinders surround the individual cell nests or .central, well defined hyaline cores are situated within the cell nests. Basal-cell carcinomas of the mucous membrane and skin which do not show this hyaline feature are best classified as solid, cystic, and adenoid basal-cell epitheliomas. Two photomicrographs are included. BENJAMINR. SIXORE Sarcoma of the Nasal Cavity, J. KUILMAN.Sarcoom van de neusholte, Geneesk. Tijdschr. v. Nederl. Indie 73: 1557-1561, 1933. Sarcoma of the nasal cavity is almost as frequent as carcinoma, but the prognosis of the former is much better than for the latter provided early treatment is given. The diagnosis of early cases is often very difficult since the tumors may resemble harmless polyps. The round-cell and spindle-cell sarcomas, as also the lymphosarcomas, have very little tendency toward metastasis. Their prognosis is much better than that of melanosarcomas and mixed tumors containing sarcomatous tissue. Kuilman reports the case of a sixty-five-year-old woman who, eight months before, was operated upon successfully for a sarcoma of the right nasal cavity. The histologic diagnosis was sarcoma macroglobocellulare with many cells of the embryonic type. Several polyps in the posterior half of the right nasal cavity were found. The writer stresses the necessity of biopsy for diagnostic and therapeutic purposes. A sarcomatous tumor can easily be mistaken for a benign polyp, a septum polyp, or a papilloma of the septum. JOHANNESP. M. VOQELAAR

Rhinoplasty, G. A. PAQENSTECHER.Am. J. Surg. 25: 491-493, 1934. The author describes the technic of the plastic repair of nasal deformities resulting from cancerous ulcerations and the destruction associated with the extirpation of these growths. He uses a pedicle flap cut from the forehead which has been previously lined with a full-thickness graft from the thigh. The only variation from the usual technic of these plastic procedures is that the lined portion of the flap is turned so as to form the skin of the nose. Several photographs illustrate the technic of this operation. BENJAMINR. SHORE 872 ABSTRACTS

Plasmocytoma and Rhabdomyoma of the Paranasal Sinuses: Pathologic and Surgical Considerations; Report of Caees, K. G. COOPER.Arch. Otolaryng. 20: 329-339, 1934. The author reports the histories of two patients with plasmocytomas involving the nasal bone, The diagnosis was made in each instance by histologic study of a biopsy specimen. The first patient was treated.by irradiation with radium, and the second by radical operation and postoperative irradiation. The end-result is not given in either case. Plasma-cell tumors of the air passages are more commonly solitary and tend to invade adjacent structures by direct continuity. Lymph nodes are rarely involved, and metastasis is uncommon. Because of their solitary nature these growths are thought to be more amenable to treatment by surgery, radium, or a combination of both. The third case reported by the author is that of a sixty-seven-year-old man with a rhabdomyoma of the paranasal sinuses. This tumor was treated by radical surgery and postoperative irradiation. Histologic study of the growth showed it to be composed of large, round or oval, blunt cells with a clear cytoplasm in which rare but definite cross- striations could be seen. The end-result is not given. This article is illustrated with photographs and photomicrographs. BENJAMINR. SHORE Symptomatology and Histologic Structure of Osteomas of the Nasal Accessory Sinuses, G. KRIEQSMANN.Zur Klinik und Histologie der NasennebenhBhlenosteome, Beitr. z. Anat., Physiol., Path. u. Therap. d. Ohres 31: 143-147, 1934. The author reports the case of a twenty-two-year-old man from whom a benign osteoma of the frontal sinus was surgically removed. The tumor was 4 om. in diameter and was recogniaed only after radiologic examination of the skull. Histologic study showed it to be composed of normal dense bone. The article is illustrated with roentgenograms and photomicrographs. BENJAMINR. SHOR~ Syndrome Caused by Involvement of the Apex of the Petrous Portion of the Temporal Bone by Malignant Tumors of the Nasopharynx, E. GIUFITRIDA.Sulla sindrome dell’apice della piramide temporale da tumori maligni del rinofaringe, Minerva mod. 1 : 793-799, 1933. Gradenigo’s syndrome consists in motor and sensory disturbances of the fifth nerve due to a lesion in the gasserian ganglion, diplopia due to paralysis of the sixth nerve, otalgia and deafness due to involvement of the eighth nerve, and miosis, ptosis, exophthalmos and anhidrosis due to involvement of the sympathetic. Gradedgo’s original description of this syndrome referred to its occurrence as the result of suppura- tive processes originating in the ear and extending to the apex of the petrous bone. It is now known, however, that the same syndrome is perhaps more often caused by the extension of malignant tumors from their primary site in the nasopharynx to the base of the skull, and particularly to the region of the apex of the petrous bone, Giuffrida describes two cases of this sort. In both the outstanding symptoms were intense pain in the affected side of the head and face, deafness in the corresponding ear, diplopia, and Horner’s syndrome. In both patients examination of the nasopharynx revealed the primary tumor. A good bibliography is included. C. D. HAAWNSEN Malignant Tumors and Tuberculosis of the Pharynx, H. WULLSTEIN. Maligner Tumor und Tuberkulose im Rachengebiet, Beitr. 5. Anat., Physiol., Path. u. Therap. d. Ohres 31 : 339-344, 1934. The first case reported by Wullstein is that of a forty-six-year-old man on whom a radical excision of the tumor and a neak dissection was done for at‘ round-cell sarcoma lJ of the tonsil. Two and one-half years later this patient‘returned with thickening in the scar and an enlarged lymph node at the angle of the mandible. Histologic study of this excised node showed typical tubercles. The second patient was a sixty-four-year-old man with tuberculosis of the cervical lymph nodes and a primary carcinoma of the tongue. In both of these cases it is felt that the cervical tuberculosis was of long stand- THE ORAL CAVITY AND UPPER RESPIRATORY TRACT 873 ing but that activation of this process'might have been related in some way to the new growths developing in tissues which drained into tliese glands. The article is without illustration. BENJAMINR. SHORE

Multiple Fibrolipomata of the Hypopharynx and Esophagus, R. KRAMER.Ann. Otol., Rhin. & Laryng. 43: 881-883, 1934. The author reports the case of a fifty-seven-year-old man from whom a sessile fibrolipoma situated on the posterior surface of the right arytenoid cartilage and the right pyriform fossa was surgically removed. Two years later a pedunculated fibrolipoma 4.5 inches long was removed from the posterior surface of the left side of the cricoid cartilage. A third lipoma situated in the upper third of the esophagus has not been disturbed because of absence of symptoms. Thirty-six cases of lipomas of the hypopharynx and esophagus have been reported in the literature. The usual symptoms are those of a lump or pressure in the throat and the extrusion of a mass into the mouth. In two cases marked dysphagia was present. In some cases there has been severe dyspnea and even asphyxia, with death resulting from the impaction of the growth in the larynx, although the patient had had no symptoms before the catastrophe. BENJAMIN R. SHORE Operation for Removal of Carcinoma ,of the Faucial Tonsil and Contiguous Parts, D. MACPHERSON.Ann. Otol., Rhin. & Laryng. 43: 727-730, 1934. The author describes the technic worked out by him for the removal of carcinomas of the faucial tonsil and contiguous parts through the floor of the mouth. The first part of the two-stage operation consists in the ligation of the external carotid artery on the sffected side. About two weeks later the removal of the growth is undertaken. The approach to the operative field is through a longitudinal incision extending from the mandible to the suprasternal notch. The corresponding half of the hyoid bone is un- covered and removed. The digastric attachment to the hyoid is separated and lifted upwards, and the mylohyoid, geniohyoid, stylohyoid, middle constrictor, geniohyoglos- aus, and possibly the hyoidglossus muscles and the mucous membrane are severed later- d view of the lower pole of included. The article is BENJAMINR. SHORE , E. MAIER. Lymphoepitheliale Tumoren, Strahlentherapie

nts of lymphoid tissue late, entire pharynx, base rarely these tumors have tid gland. The growths ation. Metastases to m true carcinomas by their lympho-epitheliomas have the vertebral column. As um is the method of ion of the growths may d form. There are no BENJAMINR. SHORE

ABCOCK. Surg. Clin. North America 14: 301-306, April

Babcock reports on a grdp of laryngeal tumors observed at the Presbyterian Hospital in New York. Nineteen-hses of papillomata were seen. These were either single or multiple and occurred Injarious parts of the larynx. Although removal is not difficult, the tendency to recur SoBetimes necessitates several operative procedures. Fulguration emoval by dlrect*sp indireat approach is the most satisfactory means of treatment. rare and, except for recurrences, prognosis is good. There were 874 ABSTRAUTS also seen a number of small benign tumors, designated polyps for lack of a better name, which resemble the papillomata except for the absence of recurrent tendencies. Four were removed without recurrence. Twenty-seven carcinomas were encountered. Of these, 14 were treated by radiotherapy, with 9 deaths occurring from two months to one year after treatment and 5 apparent cures from six months to two years after treatment. Six cases were treated by Iaryngectomy with 2 operative deaths and 4 patients living from one to five years. Other operative procedures were attempted in three cases, with one death and two apparent cures of short duration. The remaining cases were untreated. The type of treatment is subject to individual variation but can always be selected more intelligently with the aid of a biopsy. The importance of early diagnosis is stressed, and the significance of hoarseness as a premonitory symptom emphasized. THEODORE8. RAIFORD

Cancer of the Larynx, C. G. COAICLEY.J. Florida M. A. 21: 23-25, 1934. This is a general discussion of the diagnosis of cancer of the larynx. BENJAMINR. SHORBI Malignant Disease of the Larynx: Rare Types, PremalignantConditions, and Conditions Simulating Malignancy, J. E. MACKENTY.Arch. Otolaryng. 20: 297-328, 1934. This article consists mainly in case reports of patients, with carcinomas and sarcoma of the larynx, acromegaly of the larynx, chondritis of the thyroid cartilage eventuating in cancer, hyperkeratotic papilloma of low-grade malignancy and tuberculosis of the larynx, scleroma, amyloid tumors, and blastomycosis of the larynx. It is well illustrated with photographs and drawings. BENJAMINR. SHORE Intrinsic Carcinoma of the Larynx, J. H. MCCREADY.Pennsylvania M. J. 37: 824-827, 1934. This is a general discussion concerning the diagnosis and treatment of intrinsic carcinomas of the larynx. There are no illustrations. BENJAMINR. bORE Differential Diagnosis of Tuberculosis, Syphilis and Cancer of the Larynx, C. HIRSCH. M. Record 140: 91-92, 1934. This is a general discussion of the differential diagnosis of tueerdosis, syphilis, and cancer of the larynx. BENJAMINR. SHORE Roentgen Therapy of Epitheliomas of the Pharynx . LENZ,C. G.COAKLEY AND A. P, STOUT. Am. J. Roentgenol. 32: 50 During 1931 and 1932, at the Presbyterian Hoe York, 31 patients with histologically verified epitheliomas of the larynx an ere treated by the Cou- tard method of roentgen therapy modified by using 20 r per minute instead of 5 r as preferred by Coutard. Fourteen of these remained clinically well from nine to twenty-four mopths following cessation reatment, while in 17 the disease was not arrested. Twenty-four of these were considered proper for evaluation of the method of treatment and of the a used for prognosticating its success or failure. Of 12 tumors classified by mic c criteria as radiosensitive, 9 were arrested by treatment; none of the 10 tumors classed as radioresistant were arrested. In 2 cases in which the criteria were conflicting the growth was arrested. This study demonstrates that the factors militating tti$alnst successful treatment Qf laryngeal and pharyngeal carcinomas are: (1) extensive infiltration, esPeclallY If It 1s associated with deep infection; (2) invasion of the lmyngd cartilages. An additional note made one year after the presentation of the above material states that 9 of the 14 patients reported as clinically free from cancB appear to be well twenty- one to thirty-six months after the last treatment. BENJAMINR. SHORE s THE ORAL CAVITY AND UPPER RESPIRATORY TRACT 875

Supraglottic Tumors: Methods of Treatment and Illustrative Cases, F. A. FIGI. Arch. Otolaryng. 20: 361-374, 1934. From 1925 to 1933 inclusive, a total of 539 patients with malignant tumors of the larynx were examined at the Mayo Clinic. Approximately 20 of the tumors developed above the glottis and all but one were in men. Most of the growths originated in the epiglottis and secondarily involved the aryepiglottic folds, a few being primary in the latter situation. Malignant tumors developing in the epiglottis spring more commonly from the posterior aspect near the tip. They are usually fungating rather than infiltrating and often appear as cauliflower-like masses. Although they generally have sessile attachments, they may be pedunculated. There is, as a rule, but little infiltration about the base; this accounts for the fact that treatment is effective in eradicating the lesion in a high percentage of cases even when the growth is apparently advanced. Although supraglottic tumors are almost always squamous-cell epitheliomas of low-grade malignancy and metastasize late, exceptions to this rule are occasionally seen. A number of therapeutic procedures are available for the treatment of malignant tumors of the supraglottic portion of the larynx. These differ both in the method of securing access to the lesion and in the means of its actual removal. The various types of pharyngotomy, with or without preliminary tracheotomy, have been in the past and still remain the most satisfactory means of exposing these growths in the majority of cases. In the past few years a modification of these procedures, consisting of laryngeal suspension and electrocoagulation, has been used at the Mayo Clinic in a selected group of malignant tumors of the epiglottic and of the remainder of the supraglottic portion of the larynx. If the lesion is extensive, preliminary tracheotomy is advisable because of the possibility of sufficient edema developing after operation to produce respiratory obstruction. The risk associated with electrocoagulation of these growths appears to be slight; there has been very little immediate postoperative reaction in cases in which it was used and convalescence has been surprisingly mild and brief. Approximately two and one-half to three weeks are required for separation of the slough after coagulation, and healing takes place promptly afterward. Pulmonary complications have not resulted from aspiration of the slough, and postoperative hemorrhage has not occurred in any of the cases. The functional results have been satisfactory; there has been no impairment of the voice or difficulty in swallowing as might be anticipated following complete removal of the epiglottis together with a portion of the aryepiglottic folds. Although some of the tumors treated in this manner were large fungating carcinomas that filled the entire lower portion of the hypopharynx and completely obscured the view of the larynx, in none of the cases in which the patients were followed has there been any evidence of recurrence to date. The periods since operation range up to three years. Laryngeal suspension and electrocoagulation must be limited to inactive, fungating, or pedunculated lesions of limited extent situated at the supraglottic portion of the larynx. Pharyngotomy still remains the most satisfactory means of dealing with most of the malignant tumors in this situation. Irradiation is a valuable adjunct to surgical treatment, but it should rarely be used alone. Several case histories and drawings are included. BENJAMINR. SHORE Carcinoma of Glosso-epiglottic Groove, with Large Cystic Cervical Metastasis, N. PUENTEDUANY. Casos poco frecuentes. Quiste carcinomatoso del cuello, se- cundario a una lesi6n laringea, Bol. Liga contra el c&ncer 8: 180-189, 1933. A man of fifty-five had about three months previously noticed a small hard swelling behind the left angle of the lower jaw, and as this rapidly increased in siae he had difficulty in swallowing and later in speaking. This cystic swelling was fixed to the skin and the deep tissue. On laryngoscopy there was seen an ulcerated tumor, the siie of a pigeon’s egg, in the left glosso-epiglottic groove, causing displacement of the epiglottis to the right; the vocal cords appeared normal. Biopsy of this tumor showed squamous-cell cancer, and it was treated by insertion of four radon seeds of 1.08 millicurie each. The cervical cyst, which on puncture yielded yellow mucous liquid, was extirpated, and in its wall there were found several nodules of squamous-cell carcinoma. F. CAVERB 876 ABSTRACTS

Laryngeal Cysts in the New-born, L. KLEINBELD.Arch. Otol. 19: 590-693, 1934. 80 rare are laryngeal cysts in the newborn that only 15 cases have been reported in the literature, and of these 7 were discovered at aqtopsy. Clinically manifested by dyspnea, cyanosis, stridor or aphonia, and dysphagia, they are to be differentiated from congenital collapse of the larynx, papilloma of the larynx, reaction to a foreign body, atelectasis, thymic enlargement, and pptent foramen ovale. The prognosis is good if treatment is instituted promptly. This consists of incision of the cyst ptith evacuation of the contents. If the cyst recurs, aspiration with resection of as much of the cyst wall as possible is advocated. If this fails or if a bronchoscopist is not available, the cyst may be removed by thyrotomy if the patient is able to undergo this rather extensive operation, A case is reported in which simple incision relieved all symptoms but was followed by a reaccumulation of the fluid. A few weeks later the author was able to excise a portion of the wall of the cyst, following which there has been no further trouble. Roentgenograms taken before and after treatment are included. THEODORE 8. RAIFORD INTRATHORACIC TUMORS Bronchial Obstruction with Special Reference to Endobronchial Tumors, 0. JACKSON AND C. L. JACKSON.Pennsylvania M. J. 37: 740-742, 1934. Investigations of bronchoscopists have called attention to a type of obstruction caused by physiologic conditions that cease at death. Nothing could be wore striking than the contrast seen through the bronchoscope on examination of the tracheobronchial tree of a patient and of a cadaver respectively. Obstructions seen in the living may be absent in the cadaver, and certain kinds of post-mortem obstructions may not have existed during life. After death a lumen or absence of a lumen is of fixed and rigid character; during life the bronchi not only expand and contract, but they also elongate and shorten. These constant movements caum valvular types of obstruction that are peculiar to the tracheobronchial tree. A complete understanding of this valvular mechanism is essential for the correct interpretation of roentgenograms and physical signs, as well as for the proper treatment of diseases of the lung, The final diagnosis of lesions causing bronchial obstruction rests OD the histologic study of a biopsy specimen. After the diagnosis is made, (a) efficient treatment may be given through the bronchoscope, (a) external operation may be necessary, or (c) medical care and management may fulfill all indications. Two drawings illustrate the article. BENJAMINR. SHORE

Diagnosis of Bronchial Tumors, L. HEM AND J. FALTITSCHEK.Zur Diagnose der Bronchus-Tumoren, 11, Deutsches Arch. f. klin. Med. 176: 510-618, 1934. In an earlier paper (Abst. in Am. 3. Cancer 16: abst. p. 1386, 1932) the authors emphasiged the importance of neurologic investigation in cases of bronchial cancer when the tumor has caused compression of the thoracic vagus or the phrenic nerves. Apart from the frequently observed paralysis of the recurrent laryngeal nerve, the vagus trunk may be involved, with resulting obstipation of the ascending colon, or with disturbances in gastric motility. The latter, expressed by spasm of the pyloric region, is now reported in two cases. In one it was so marked that on roentgenography the antral region appeared as a long neck connecting the pylorus with the body of the stomach. There are two illustrations. F. CAVERS Serial Bronchography in the Early Diagnosis of Bronchial Carcinoma, PEDROL. FARIRAS, Am. J. Roentgenol. 32: 767-762, 1934. A presentation in English of material published also in German, in Fortschr. a. d, Geburts. d. Rhtgenstrsh. 48: 330, 1933 (Abst. in Am. J. Cancer 20: 472, 1934).

Surgical Treatment of Carcinoma of the Bronchi and Lungs, W. F. RIENHOFF,JR. AND E. N. BROYLES. J. A. M. A. 103: 1121-1129,1934. The authors describe the successful surgical removal of the left lung of a three-year- old patient for an intrabronchial fibropapilloma, and the left lung of a twenty-four- INTRATHORACIO TUMORS 877 year-old woman for a primary carcinoma. The first of these patients is alive and well one year and the other eight months after operation. Stages in the surgical technic which are emphasized are (I) the preliminary collapse of the affected lung, (2) the anterolateral approach through the third intercostal space, (3) the isolation and separate ligation of the pulmonary vessels, (4) the primary closure of the bronchus after the cartilaginous wall has been interrupted, and (5) the primary closing of the chest wall without drainage. In discussing these cases Graham raised the question of whether it waa wise to avoid resections of the ribs and thoracoplasty. He is afraid that in many old and middle-aged patients a serious kinking of the large vessels will occur by the deflection of the mediastinum sufficient to fill up the empty space. Possibly future experience will show that, although a thoracoplasty may be desirable, it can be safely postponed until sometime after the removal of the lung. The article is illustrated with several drawings of the operative technic and roentgenograms. BENJAMINR. SHORE Analysis of a Group of Primary New Growths of the Lungs Treated with Deep X-ray Therapy, W. F. MANaEs. Radiology 22: 423-425, 1934. A study of 27 cases of pulmonary neoplasms is presented. The histological diagnosis wa8 adenoma or other benign growth in 5, undifferentiated carcinoma in 5, adenocarcinoma in 2, equamous-cell carcinoma in 14, and carcinoma from a metastatic gland in one. All patients were treated by deep x-ray therapy in doses thought sufficient to deliver effective radiation into the lesion. The five lesions which were considered benign all reacted favorably to treatment, and the patients are now living from three to nine years after treatment. In the malignant group, only one patient is living at the present time, four years after treatment. The others died from two months to two years and three months after treatment, but it is believed that treatment in these cases definitely prolonged life and ameliorated symptoms. Diagnosis should be made by biopsy whenever possible. There are no illustrations. TREODORES. RAIFORD Bronchial Carcinoma with Generalized Metastases; Three Cases, P. A. CA~TILLO. Carcinosis generalizada de origen bronquial, Bol. Liga contra el c&ncer8: 161-179, 193-209,225-254, 1933. It is safe to assert that no three cases of bronchial carcinoma have ever been so completely studied as those reported by the author. In two of them there was clear evidence of extrathoracic metastasis when the patient entered the hospital; the third showed at first only slight intrathoracic spread, and in all three necropsy revealed extraordinarily wide dissemination of metastases. In none of the cases were there metastases to the gastro-intestinal tract, thyroid, pituitary, or the biliary passages. The author made a systematic histologic examination of the primary tumor and every visible metastasis, also of the blood and lymph vessels of practically every part of the body, finding cancer cells in these veseels whether near to or remote from the primary tumor and the metastatic deposits. In the case which was less advanced on admission, he made a close study of the progress of the disease as shown by clinical and radiographic findings. The latter lead him to conclude that bronchial cancer at first spreads slowly by the lymphatic route to the hilar and mediastinal nodes and the pericardium, while distant metastases, which appear later and develop much more rapidly, are due to blood carriage of the cancer cells. The author saw the latter in the vasa vasorum, whence they reached the larger blood vessels. In the latter, as in the lymphatics, there were seen clumps of cancer cells, which were entering the surrounding tissue by direct penetration between the lining cells of the vascular walls. This process of diapedesis was seen in the coronary arteries; in each of the three cases there were cardiac metastases, which were not suspected during life. There are fifty-two illustrations. F. CAVERS Primary Bronchial Carcinoma with Secondary Vertebral Deposits, H. A. F. ROFE. Brit. M. J. 2: 1116-1117,1933. A man of fifty had recently noticed pain in both shoulders and in the back, and during the preceding two weeks weakness and numbness of the lower extremities. He attended 878 ABSTRAOTS hospital because of increasing dysuria. The cerebrospinal fluid showed no increase in pressure or other abnormalities. X-ray studies of the chest had shown only displacement of the heart to the left. The patient became incontinent, and despite precautions cystitis developed, death occurring fifteen days after admission. Necropsy revealed a large carcinoma arising from the outer wall of a branch of the right bronchus. There were metastases in the liver, mediastinal and abdominal lymph nodes, and in the spine at the levels of the fifth and sixth dorsal and first and second lumbar vertebrae. The lung tumor had attained a remarkable size without causing any pulmonary symptoms such as cough, hemoptysis, sputum, pain in the chest, or dyspnea. F. CAVER~ Bronchial Carcinoma with Metastasis to the Heart, C. ACHARD. Tumores del coraz6n, Prensa m6d. argent. 20: 1867-1873, 1933. A man of fifty-seven was admitted to the hospital because of intenee dyspnea, with cough, first noticed only a month previously, though for a longer period there had been loss of weight. No abnormality of any kind could be detected in examination of the heart. The fir& x-ray plate showed a faint shadow in the upper left hemithorax. The dyspnea was relieved by digitalis and theobromin administration, but the sputum still contained pus and blood. A second roentgenogram showed deepening of the left lung shadow. The patient had frequent and severe hemoptysis, and died eleven months after admission. There was in the left upper lobe of the lung a bronchial carcinoma; the only metastasis, apart from invasion of hilar lymph nodes, was a mass in the left auricle. There are no illustrations. F. CAVER~ A Case of Primary Carcinoma of the Lung, I. GHIBELLINI. Su di un caso di carcinoma primitivo del polmone destro, Gazz. d. osp. 55: 547-557, 1934. A man of forty-nine, nine months before entering hospital, had begun to have pain in the right side of the chest, with cough and occasionally blood-stained sputum. He was feverish owing to a recent attack of malaria, but the fever promptly disappeared after quinine treatment. There were clinical signs of left-sided pleurisy, and puncture with- drew blood. X-ray studies showed considerable shading in the right hemithorax; the right half of the diaphragm remained immobile on deep inspiration and moved to the right on deep expiration. The patient died a few days later, and necropsy showed bronchial carcinoma with unsuspected metastasis in the rectum, but in no other organs. F. CAVBRS Cryptic Bronchiogenic Carcinoma of the Lung, E. F. HIRBCH. Med. Clin. North America 17: 1627-1532, May 1934. A white woman fifty-nine years of age complained of sharp pains in the left side of the neck radiating down the left side of the back, for five months. Examination showed several small, hard, supraclavicular and submaxillary lymph nodes on the left side. Roentgenograms of the cervical spine demonstrated destructive changes in the fourth cervicai vertebra which in the course of three months had extended to involve the fifth and sixth vertebrae and possibly the ribs. The patient died fourteen months after the first manifestations of her illness. Autopsy revealed a primary growth in the right lung which on histological examination proved to be a bronchiogenic carcinoma. Metastases were found in the skull, ribs, cervical spine, pleura, parabronchial and axillary lymph nodes. The absence of symptoms from the primary growth is emphasized, pulmonary pathology being unsuspected until after death. Three photomicrographs illustrate the morphology of the tumor. THEODORES. RAIFORD Carcinoma of the Lung and Encapsulated Pleural Exudate which Resembled Pneu- monk Infiltration of the Middle Lobe and Atelectasis, H. REICHELAND F. BIEDER- MA". Vortliuschungen von Mittellappeninfiltration und Lungenatelektase durch einen Lungentumor im Unterlappen und abgesackte Pleuraexsudate, Rdntgenpraxis 6: 295-297, 1934. The authors report the case of a forty-seven-year-old man with a primary lung tumor and encapsulated pleural exudate which had been diagnosed during life as a pneumonic INTRATHORAUIC TUMORS 879 infiltration with early cavitation and atelectasis of the right lung. The article is illustrated with two roentgenograms. BENJAMINR. SHORE Carcinoma of the Lung (Primary?) in a Child of Seven, A. W. SOMMER. Minnesota Med. 17: 415-417, 1934. Sommer reports the case of a seven-year-old girl who died seven weeks after the onset of pulmonary symptoms characterized by a cough, signs of consolidation, and a bloody pleural exudate. Autopsy showed a tumor 4 inches in diameter situated in the upper and middle lobes of the right lung and displacing the trachea and mediastinal vessels. Histologic study showed the growth to be composed of epithelium which in many places tended to form glands. The diagnosis of a primary carcinoma of the lung developing in a congenital cyst was made. This is not offered as a proved case of primary lung cancer, as the post-mortem examination was limited to the thorax. Roentgenograms and photomicrographs are included. BENJAMINR. SEORE

Case of Supposed Metastatic Carcinoma of the Lungs, 0. AQUILARAND J. QUEIREL. Consideraciones sobre un caso de cancer de pulmon, Prensa med. argent. 20: 223-230, 1933. X-ray examination of a man of unstated age, suffering from dyspnea and cough, showed round, oval, and irregular shadows in the lower two-thirds of both lungs. The patient died three weeks after admission, and necropsy was not permitted. The authors believe the case was one of lung metastasis from an undiscovered primary tumor. There are five good x-ray illustrations. F. CAVERS Metastatic Renal Hypernephroma of the Lung with Perforation into Bronchus, J. LAYERAAND F. P. MASCfAS. Sobre un c&so de tumor de pulm6n con perforaci6n en el bronquio izquierdo, Semana m6d. 1 : 1091-1096, 1934. A man of unstated age had undergone nephrectomy two years previously for a renal tumor (no mention of histologic diagnosis), and had during the past few months had increasing cough and hemoptysis. Recently he had coughed up bits of flesh-like material, which proved on examination to have the structure of renal hypernephroma.” On bronchoscopic examination a tumor mass was seen plugging the opening of the left bronchus; part of this was removed and showed the same histologic features. The roentgenogram next made surprised the authors by revealing a tumor mass which had filled the lower left lobe of the lung and had perforated the left bronchus. The later history is not given. F. CAVERS Melanoma of Bronchus :Metastasis Simulating Bronchogenic Neoplasm, L. H. CLERF. Ann. Otol., Rhin. & Laryng. 43: 887-891, 1934. The author reports the case of a thirty-one-year-old woman who was referred to him because of a non-productive cough and shortness of breath. Bronchoscopic examination showed the left main bronchus to be completely occluded by a moderately inflamed granular growth situated about 5 mm. beyond the carina. Histologic study of this growth showed it to be a melanoma. In questioning the patient regarding the presence of pigmented moles it was learned that about one and one-half years previously, an irritated mole on the left arm had been fulgurated and later excised. The wound healed promptly and the incident was forgotten. Histologic study of this excised mole showed it to be identical in structure with the tissue removed from the bronchus. A complete physical examination failed to reveal evidences of metastasis elsewhere in the body. The tumor in the bronchus continued to grow, and only symptomatic relief was obtained by bronchoscopy. The patient died sixteen months after the first bronchoscopic examination. The diagnosis, after autopsy, was metastatic melanoma of the left main bronchus and trachea with extension to the peribronchial lymph nodes and metastatic melanoma in the brain, ovary, lung, and skin. The article is illustrated by roentgenograms, a photograph of the bronchial metastatic tumor, and a photomicrograph. BENJAMINR. SHORE 880 ABSTRAaTS

Adenoma of Bronchial Mucous Glands, B. M. FRIED.Arch. Otolaryng. 20: 375-381, 1934. Fried reports the case of a fifty-seven-year-old man who died of congestive oardiac failure. At autopsy an adenoma of the left lower bronchus and an adenoma of the thyroid gland and polypi of the sigmoid were found. The adenoma of the bronchus was situated in the left main stem at the point of its division into the upper and lower branches. The tumor was round and smooth and its cut surface was uniformly pink. Histologic study showed it to be composed of clustered alveolar structures imitating the bronchial mucous glands. The basal membrane was conspicuous throughout the sections; in places there was an abundance of mucus secreted by the cells. No mitoses were present. The article is illustrated by a photograph and two photomicrographs. BEINJAMINR. SHORE

Fibrosarcoma of the Trachea, L. G. RICHARDSAND H,. F. DIEITRICH. Ann. Otol., Rhin. & Laryng. 43: 892-905, 1934. The authors report the case of a negro infant who was first seen at the age of eight months and in whom death was caused, at the age of fifteen months, by a fibrosarcoma originating in the trachea. Autopsy showed the tumor to have arisen in the tracheal wall and to have largely effaced the architecture of the trachea in this area. Only a few small fragments of mucosa and rare, distorted tracheal glands could be identified. Histologic study showed the growth to be composed of slender, elongated cells with relatively large, oval, vesicular nuclei, scanty cytoplasm, and polar strands of moderately fine fibrillae. The cells were arranged in undulating and interdigitating bands. No metastatic tumors were discovered in any portion of the body. The article is illustrated by photographs of the gross specimen and photomicrographs. BENJAMINR. SHORE Intratracheal Thymoma, A. WADO~Thymoma intratracheale, Centralbl, f. allg. Path. u. path. Anat. 60: 308-312, 1934. A woman of fifty-eight years complained primarily of difficulty in breathing and hemoptysis. X-rays of the chest gave evidence of enlarged mediastinal and bronchial nodes, especially on the right side. Death ensued shortly after tl$s, and autopsy revealed a tumor on the anterior wall of the trachea 3 cm. above the bifurcation. This measured 2.4 x 1 x 1 cm. and was yellowish in color at the lower end and reddish brown at the upper. Histologically it was diagnosed as an ectopic thymoma. The occurrence of intratracheal carcinoma is discussed. There are five illustrations. THEODORE8. RAIFORD Surgical Treatment in Fourteen Cases of Mediastinal or Intrathoracic Perineurial Fibroblastoma, 8. W. HARRINQTON.J. Thoracic Burg. 3: 590-611, 1934. According to Harrington, a large proportion of intrathoracic tumors, especially those in the posterior mediastinum, are derived from the thoracic spinal nerves. Thus among 46 tumors encountered, 11 were neurofibromas, two were cellular fibromas, and one was a fibromyxosarcoma, all having arisen supposedly from the thoracic nerve sheaths. All but one were benign. The clinical recognition of the tumor is difficult and almost all manifestations are due to pressure upon adjacent structures unless the tumor be malignant, when pain is a major symptom. Dyspnea, cough, and dysphagia are not uncommon. Neurological symptoms are infrequent, occurring in this series in only two cases. One patient exhibited a typical Homer’s syndrome due to involvement of the inferior cervical sympathetic ganglion. The long duration of symptoms indicates that the rate of growth is slow, and malignancy is rare. Physical examination is of value only in determining the presence of a tumor, not the type, and this only when it is of sufficient si5e to cause bulging through the chest wall. Percussion and auscultation are of questionable value in determining the presence of a solid growth. Diagnosis is most easily and accurately made by roentgenographic examination and may be facilitated by the induction of artificial pneumothorax. The common sign is that of a circumscribed shadow with sharply outlined borders, in the upper mediastinum. X-ray evidence of pressure erosion of the ribs is a common finding and gl‘owth within the vertebral foramina INTRATHORACIC TUMORS 881 produces thinning of the vertebral pedicles and lamina. To be differentiated are aneurysms of the arch or descending portion of the aorta, sarcoma arising from the vertebrae or ribs, and endothelioma. Lipiodol injection into the bronchi serves to distinguish pulmonary or bronchial new growths. Surgical treatment should be instituted as early as possible in view of the possibilities of malignant change. The operative mortality can be materially lessened by the production of an artificial pneumothorax, and this procedure should be carried out in all cases from three to five days before operation. The method of approach must be governed by the site of the tumor and the structures to which it may be adherent. The operation should be done in one stage if possible and should be completed extrapleurally whenever possible. Resection of portions of ribs may be necessary. Care must be exercised to avoid injury to adjacent structures. Hemostasis is facilitated by ligation of the intercostal vessels before removal of the tumor. Intratracheal anesthesia is helpful in over- coming mediastinal flutter and pulmonary collapse. Reconstruction of the thoracic cage is essential after removal of the new growth. Postoperative care is of utmost importance and maintainance of blood pressure and relief of respiratory difficulties are sometimes life-saving measures. Oxygen tents and blood transfusions are invaluable in this respect. Pleural effusions after operation may necessitate one or more aspirations. In the author’s series, two patients died following operation, one from cardiac failure and one from bronchopneumonia. One patient died two and one-half years after operation from a recurrence. The remaining 11 are living from one year to seven years after operation. Four illustrative cases are reported in detail, accompanied by seven photographs. There is a short bibliography. THEODORBS. RAIFORD

Primary Malignant Pleurisy: A Case Report, PI. VITUGAND J. HIZON. J. Philippine Islands M. A. 14: 128-136, 1934. I The authors were able to find only 83 cases of primary pleural new growths in the literature. Their case they believe to be the first reported from the Philippines. The patient was a woman of forty-seven whose illness began in November 1932 with neuralgic pain in the left shoulder. By February 1933 this had become almost unbearable, especially upon lying down, and the patient began to lose weight and to complain of weakness. On examination in June 1933 a probable diagnosis of pleurisy with effusion was made and this was confirmed by x-ray examination. Thoracentesis was done four times at intervals of several days and the patient was discharged apparently much improved. Three months later she was again seen, complaining of fatigue, co,ugh, a sense of oppression in the chest, and pain in the left side. She was unable to lie flat in bed and was pale and thin. Thoracentesis had been done several times recently, but there were still evidences of fluid in the left pleural cavity, as well as impairment of resonance in the left half of the interscapular area. X-ray examination revealed a shadow at the superior mediastinum toward the left, suggesting a diagnosis of malignant disease. Thoracentesis was again done, yielding 460 C.C. of hemorrhagic fluid. On repetition scanty fluid was obtained and on a third attempt the needle met with a firm, solid resistance. Both the pleural fluid and the sputum were negative for tubercle bacilli. Shortly after this a metastasis appeared in the eighth rib just below the point of the thoracentesis punctures, and hard irregular masses developed in the liver and left subcostal region just below the spleen. The patient was still alive at the time of the report, in the fourteenth month of her illness. Several roentgenograms illustrate this paper, and there is a bibliography.

Costal Sarcoma with Intrathoracic Extension, J. A. P~NGAROAND J. L. SILVESTRE. Sarcoma costal a evolucidn endotorticica; su diagnbtico diferencial con el cBncer del pulmh, Sernana m6d. 1: 608-612, 1934. Five months before entering hospital &,storekeeper of thirty-six said he had lifted a box weighing about twenty pounds and to his surprise felt a sudden painful wrench of the left shoulder. After having his shoulder anqupper arm rubbed, he went on lifting heavier weights, as he had done daily for yem!. Five days later the pain suddenly became worse, and radiated along the upper ribs to t)he sternum, being intensified when 882 ABSTRAUTS

he raised the arm or took a deep breath. He had no cough or hemoptysis. On examination pain was elicited on slight pressure behind the left shoulder, in the axilla, or on the three uppermost left ribs. In the latter region, in the nipple line, there was felt a soft thickening, evidently a tumor involving these ribs and the intercostal spaces. X-rays showed rarefaction of the three ribs and a tumor mass extending thence nearly to the pericardium. The second rib was partly resected, and a soft yellowish tumor mass found, which had invaded the left lung, pushing the pleura inwards. The histologic report given is simply “ sarcoma.” As the authors point out, the slight trauma merely caused an already existing tumor to produce painful symptoms. The patient died a few months later, with increasing cachexia, but without cough, hemoptysis, dyspnea, or other symptoms except pain in the chest, which required the use of analgesics. There was no necropsy. Six x-ray illustrations are given. F. CAVERS Ganglioneuroma of the Chest in Children, Report of a Case with Review of the Litera- ture, J. V. BOHRERAND E. M. LINCOLN. J. Thoracic Burg. 3: 365-373, 1934. During roentgenographic examination of the chest of a five-year-old girl suffering from an acute respiratory infection, a dense, sharply circumscribed shadow was seen occupying the apex of the right lung. Although the infection cleared up rapidly, the physical signs of a mass became more pronounced and vomiting and cough increased in severity. Four months after the child’s first admission the tumor was removed through a posterior paraspinal approach. Four hours later a fatal hemorrhage took place. Pathological examination of the specimen showed a firm, grayish white tumor 8 cm. in diameter. The histologic structure was that of ganglioneuroma. These tumors, first described by Loretz (Virchows Arch. f. path. Anat. 49: 435, 1870), supposedly arise from the sympathetic nervous system. They are quite rare, occurring most frequently in infants. A perusal of the literature yielded only nine cases of similar lesions in the chest, the oldest patient being twelve years of age. While as a rule the condition is benign, symptoms are produced by pressure on adjacent organs and structures, The tumors are firm, pale, encapsulated and nodular, resembling fibroma. There may be one or several. Histologically they are composed of nerve fibers, among which are interspersed ganglion cells singly and in groups. The stroma consists of dense, almost avascular fibrous tissue. While in rare instances ganglion cells have been found in adjacent lymph nodes and regarded ae metastases, these have been explained on the basis of individual primary tumor formation and the lesion is now commonly regarded as benign. The authors’ case is reported in full and illustrated by four photographs The nine cases found in the literature are briefly summarized, and there is a short bibliography THEODORE8. RAIFORD

THE DIGESTIVE TRACT Esophageal Carcinoma Associated with Diverticulum, Esophagotracheal Fistula, and Bilateral Recurrent Nerve Paralysis, H. BIANCULLI.Asociaci6n de afecciones esoftigicas: divertfculo, ctincer, fistula; doble parhlisis recurrencial, Semana m6d. 1: 1401-1403, 1934. A man of fifty-five had for several months had dysphagia, and latterly had noticed a swelling of the right side of the neck, which filled up when he swallowed food and disappeared when he pressed it up with his hand. A month before attending the author’s clinic he lost his voice. X-r ce of a diverticulum and showed, just below this, a fie ue material entered the glottis and the bronchi, and also a constr ds for 15 cm. There was a dense mediastinal shadow. patient died two months after admission. Necropsy gs. It is stated that the tumor and the mediastinal inoma, but no histologic description is given, and there are nd illustrations. F. CAVERS THE DIGESTIVE TRACT 883

Diagnosis and Treatment of Pedunculated Tumors of the Esophagus, C. TAMIYAAND S. NOSAKI. Diagnose und Therapie gestielter C)sophagustumoren, Fortschr. a. d. Geb. d. Rdntgenstrahlen 49: 481-498, 1934. The authors have collected from the available literature 12 reported cases of non- carcinomatous tumors of .the esophagus, including 2 carcinosarcomas, 3 fibromas, 3 polyps not diagnosed histologically, one sarcoma, and one mixed tumor. [But benign esophageal tumors are far more frequent than the authors’ estimate suggests.] They report a case of pedunculated fibroma in a woman of fifty-seven, removed endoscopically. The chief feature of the report consists in the beautiful series of roentgenographic and diagrammatic illustrations showing the precise site and dimensions of the tumor. The latter showed in places characters suggestive of sarcomatous change. F. CAVERS

Malignant Lymphoma of the Gastro-Intestinal Tract, A. C. PATTISON.Arch. Surg. 29: 907-922, 1934. Since 1930 six patients with malignant lymphomas localized in the gastro-intestinal tract have been operated on at the University Hospital in Iowa City. Symptomatically the lesions were not characteristic, and in no case was a correct preoperative diagnosis made. Pathologically lymphomas differ from carcinomas in that they arise in the submucosa and infiltrate the submucosa and muscularis. Ulceration is often absent and when it does occur it is due to necrosis from pressure and loss of blood supply rather than to neoplastic invasion. The gastric lesions, when first seen, vary from a small, well localized nodule to a diffuse infiltration of practically the entire wall of the stomach. In the small intestine, the lower part of the ileum is most commonly involved, but lesions have been reported to occur in any portion from the duodenum to the terminal portion of the ileum. The lesions may be diffuse, nodular, sessile, or polypoid. Metastasis to the regional lymph nodes occurs early. Aneurysmal dilatation, due to destruction of the muscular fibers at the site of neoplastic invasion, is frequent. Obstruction, on the other hand, is rare and usually occurs late in the disease from pressure by the enlarged mesenteric lymph nodes. Intussusception is relatively common, the tumor occupying the apex of the invaginated loop. The most common site of occurrence of malignant lymphomas in the large intestine is the cecum, though they may occur in any portion. Abstracted histories of the six cases observed by the author are reported. In two instances the tumors were in the stomach; in three, in the cecum; and in the sixth case the growth was localized in the rectum and was mistaken for a carcinoma. One of the patients with gastric involvement died after resection of the involved portion of the stomach and the other patient is alive and well fifteen months after exploratory operation, the taking of a biopsy, and roentgen irradiation. Of the patients with cecal growths, one died, one is living and well ten months after resection, and the other is living with recurrences two years after resection. The patient with the tumor in the rectum. survived resection but is in poor condition. The article is illustrated with roentgenograms and photomicrographs. BENJAMINR. SHORE

Analysis of 1000 Consecutive Examinations of the Stomach and Duodenum from the Clinical, Roentgenologic, and Surgical Viewpoints, N. M. PERCYAND D. S. BEILIN. Am. J. Roentgenol. 32: 179-188, 1934. In one thousand consecutive radiologic examinations of the stomach and duodenum, 21 gastric ulcers, 171 duodenal ulcers, and 71 cancers of the stomach were found. Of the latter growths, 8.2 per cent occurred in the upper third of the stomach, 12.3 per cent in the middle third, and 78 per cent in the lower third. The entire stomach was involved in 1.3 per cent of the cases. The article is without illustration. BENJAMINR. SHORE Differential Diagnosis of Gastric Ulcer, Duodenal Ulcer, and Cancer of the Stomach as Found in a Study of 337 Hospital Cases, C. S. ROOF. J. Med. 15: 499-512, 1934. In a series of 337 cases studied there were 120 duodenal ulcers, 112 gastric ulcers, and 105 gastric cancers. In the latter group 24.1 per cent of the growths were inoperable; 62.7 per cent were situated at the pylorus; 6.8 per cent were limited to the antrum; and 6.4 per cent involved the transverse colon. Fifty-three patients were treated medically, 884 ABSTRACTB

with a hospital mortality of 30.1 per cent. Fifty-two patients were treated by various surgical methods with a primary mortality of 42.3 per cent. The end-results are not given. BENJAMINR. SHORE

Roentgenographic Features of Gastric Tumors, P. M. SCHLANQERAND M. MAbENCHINI. LOBtumores del est6mag0, Prensa m6d. argent. 20: 805-819, 1933. This is a general account of the x-ray appearances of benign and malignant gastric tumors, but no case histories are given. Forty-two good illustrations occupy the greater part of the article. F. CAVERS Radiologic Diagnosis of Early Cancer of the Stomach, RENE A. GUTMANN. Le diagnostic radiologique du cancer de l’estomac au debut, Arch. d’6lectric. m6d. 41 : 405- 415, 1933. This is a brief article describing the early radiographic signs of carcinoma of tlie stomach, admirably illustrated by 18 diagrams and 14 radiographs. WILLIAMJ. HOFFMAN Treatment of Extensive Malignant Lesions of the Stomach, w. WAbTERs. J. A. M. A. 103: 1345-1349, 1934. During 1933, 126 patients with cancer of the stomach were operated on at the Mayo Clinic. In 62.6 per cent of the caeca the lesion was removed by partial or total gastrectomy. In 37 of these case8 the oarcinoma was very extensive and fluoroscopic and roentgenographic examination seemed to indicate that the lesion was of doubtful operability or was wholly inoperable; yet in 19 of these 37 cases, the lesion was removed successfully. The corollary of this should be that every patient who has a malignant lesion of the stomach and whose condition warrants an abdominal operation should be given the opportunity unless definite evidence of incurability or remote metastasis is present. Surgical removal of the lesion can be accomplished in 10 or 15 per cent of cases in which the lesion on roentgenologic examination appears to be inoperable because of its extent. Large malignant growths of the stomach often will be found to be of a low degree of malignancy, to be sharply demarcated, and to present no node involvement. Removal of such lesions by partial gastrectomy gives a high incidence of permanent cure. The progress that has been made in the treatment and curability of carcinoma of the stomach can be attributed, among other things, to (1) greater recognition of the fact that early symptoms may be significant, (2) increasing efficiency with which the com- petent roentgenologist can identify even the smallest gastric lesions, (3) a working hypothesis that every gastric lesion may be malignant unless proved otherwise, and (4) extension of the field of operability to include extensive carcinomas that heretofore might have been regarded as being on the borderline of operability. Of a group of 82 case8 taken at random in which patients were operated on at the Mayo Clinic in 1933, and in which a preoperative clinical and roentgenologic diagnosis of gastric ulcer was made, 17, or 20 per cent, were found to be carcinomatous, and in 11 of these 17 cases the lesion was inoperable owing to its extensiveness or to metastasis. BBNJAMINR. SHORE Surgical and Radiation Treatment of Gastric Cancer, G. T. PACK.South, M. J. 27: 747-754, 1934. This is a general discussion concerning the surgical and radiologic treatment of cancer of the stomach. Several roentgenograms and photomicrographs of illustrative cases are included. BENJAMINR. SHORE

Linitis Gastrica Type of Gastric Carcinoma, A. V. DI CIO AND A. MAQGI. Linitis g4strica de Brinton, Prensa m6d. argent. 20: 753-767, 1933. A man of sixty-two had for eight months had epigastric pain with nausea and vomiting, and during thi8 time had lost 21 pounds weight. Palpation of the barium-filled stomach before the screen showed great and uniform thickening of the gastric wall, except at the cardia. Since negative blood and cerebrospinal fluid Wassermann reactions ruled THE DIGESTIVE TRACT 885

out syphilis, the authors diagnosed scirrhous carcinoma of linitis type, too extensive for gastrectomy or gastro-enterostomy. They enumerate various forms of palliative treatment (diet, lead, mesothorium, cobra venom, etc.), but do not say which if any of these they employed in this case. There are thirteen illustrations. F. CAVERS Acanthosis Nigricans Associated with Cancer of the Stomach, K. DAMML~~.Uber Akanthosis nigricans bei Magenkarainom, Deutsche med. Wchnschr. 60: 1752-1753, 1934. The author reports the case of a fifty-three-year-old man who showed typical pigmented lesions of acanthosis nigricans several months before symptoms of carcinoma of the stomach became manifest. An association between these two lesions is unusual. Two photographs of the skin lesions are included. BENJAMINR. SHORE Primary Sarcoma of the Stomach, I. J. BALABAN.Zur Frage des primaren Magen- sarkoms, Fortschr. a. d. Geb. d. Rantgenstrahlen 49: 513-518, 1934. In a man of fifty-four complaining of epigastric pain, x-ray examination showed a clean-cut circular filling defect, 5 cm. in diameter, on the boundary between the pyloric rtntrum and the greater curvature. Palpation before the screen showed that the greater part of the tumor was exogastric. The patient’s good general condition suggested fibroma, but the resected tumor proved to be a fibrosarcoma. [No histologic account is given, and, as the patient had lived for a considerable period at the time of the report, the growth was just as likely a fibromyoma or a neurofibroma.) A roentgenogram taken nineteen months later showed the pylorus to be connected with the body of the stomach by a long, narrow neck; evidently insufficient tissue had been removed, leaving the patient with a sort of hourglass stomach. There are six good x-ray illustrations. F. CAVERS

Benign Tumors of the Stomach (Fibroma, Leiomyoma), P. MOURA,J. A. DB BRITOAND C. X. LOPES. Trois cas de tumeurs benignes de l’estomac, J. de chir. 43: 363-373, 1934. The authors consider the figures for the Mayo Clinic; as given by Eustermann and 8enty (Surg., Gynec. & Obst. 34: 5, 1922) to be still the most reliable index to the relative frequency of benign and malignant gastric tumors. These figures showed, for the period 1907 to 1921,27 benign neoplasms out of a total of 2168 tumors. In enumerating the types of benign tumor the authors remark that the true nature of gastric schwannomas is still a matter of doubt, Neither symptoms nor physical signs nor laboratory examination of gastric contents suffice to make a reliable diagnosis between benign and malignant tumors of the stomach, though a long history of gastric trouble favors benignancy, while outspoken malignant signs such as cachexia and metastasis make differential diagnosis unnecessary. Nor do the authors agree that radiographic investigation can always be depended upon in deciding whether the tumor is benign or an early malignant growth. In any case immediate operation should be advised. Three cases are reported in which wide resection was done for a benign tumor. One tumor was an edematous polypoid fibroma, the others were leiomyomas. At the time of operation the symptoms dated back for three to ten years. In one of the myoma cases lactic acid was present in the achlorhydric gastric contents. There are ten illustrations. F. CAVERS Benign Epithelial Tumors of the Stomach, LAMBERTOMORICONI. Tumori epiteliali benigni dello stomaco, Clin. chir. 36: 463-477, 1933. Moriconi’s patient was a woman aged fifty-two who for four years had had a burning sensation and a feeling of fullness in the epigastrium after eating. She became very anemic, and roentgen study showed a lacunar shadow in the antral region and in the duodenal bulb. Operation revealed a large ulcerated adenoma attached by a narrow stalk to the anterior wall of the stomach. The author presents reproductions of roentgenograms and photomicrographs of his own case, and reviews the characteristics of 35 solitary polyps of the stomach of which he has collected reports. C. D. HAAGENSEN 886 ABSTRACTS

Myomas of the Stomach and Intestines, E. C. VAN RIJSSEL. Myome in Magen und Darm, Mitt. a. d. Grenzgeb. d. Med. U. Chir. 43: 633-649, 1934. Symptoms of myomas of the gastro-intestinal tract are not at all characteristic, as they are dependent upon the position and size of the growth. However, the more usual symptoms are those due to hemorrhage, ileus, intussusception, and obstruction. To be differentiated from myomas are gastric ulcers, mesenteric thrombosis, and tumors of the ovaries, kidneys, and suprarenal glands. Abstracted histories of several cases and photographs and photomicrographs of specimens are included. BENJAMINR. SHORE Schwannoma of the Stomach, G. JEANNENNY.Schwannome de l'estomac, Gaz. hebd. d. sci. m4d. de Bordeaux 54: 230-232, 1933. A case is reported in a man sixty-nine years of age whose chief symptoms were those of pyloric stenosis. X-ray examination showed almost complete obstruction of the pylorus with failure of the stomach to empty in thirty hours. A gastro-enterostomy was done and subsequently a partial gastrectomy. At the time of the report the patient had been free from symptoms for three years. Schwannomas of thestomach are extremely rare; they are found usually between the ages of forty and sixty years, occasionally in older persons, as in this case. These tumors apparently arise from the fibers of the splanchnic nerve. Tumors of the Small Intestine, T. M. JOYCE.Ann. Surg.'100: 949-969, 1934. The symptoms of tumors of the small intestine are for the most part due to obstruction. This is usually partial and intermittent and is only rarely acute. Intussusception is a complication in about 30 per cent of small intestinal tumors. It is more frequent by far with benign growths than with malignant ones, but its occurrence should not cause the tumor to be classified as benign. Hemorrhage, either gross or microscopic, is another important sign. It is often not observed by the patient, but in most of the benign tumors and practically all of the malignant ones occult blood may he found in the stools. It is wise to keep in mind the possibility of small intestinal new growths in any case of gastro-intestinal bleeding. A palpable mass is probably the most important physical sign to be looked for. This rday not be constant, as in an intermittent intussusception, or may be present and constantly increasing in size, as in the case of other malignant tumors. Mobility is an important characteristic of early malignant and benign tumors of the small intestines. Roentgenograms are, of course, the greatest single aid in the correct preoperative diagnosis. The author reports the histories of nine patients with neoplasms of the small intestines. In the benign group of tumors there were two leiomyomas and two adenomas; all of the malignant group were primary adenocarcinomas. The article is illustrated by photographs of gross specimens and roentgenograms. BENJAMINR. SHORE Carcinoma of the Cecum: What are the Chances for Cure? C. F. DIXON. J. A. M. A. 103: 1605-1607, 1934. Two hundred and twenty-one patients with carcinoma of the cecum were operated on at the Mayo Clinic from 1907 to 1928 inclusive. Palliative operations only were possible in 76 cases and resections were carried out in 146 cases, Of these 145 patients, 60, or 51 per cent, have survived for five or more years after operation. Ths three outstanding clinical features of these 60 cases are marked loss of weight, secondary anemia of varying degree, and a palpable mass in the right lower abdominal quadrant. The prognosis varies with the grade of malignancy and the presence or absence of metastases. In- volvement of the lymph nodes was found in 15 of the 60 cases. The finding of involved lymph nodes justifies a grave prognosis; however, absence of this finding does not necessarily rule out regional extension or metastasis. The growths in the majority of cases were of Grade 11; only three growths were of Grade IV malignancy. Resections of cecal tumors in one stage are reserved for those patients of middle-age in whom loss of weight has not been marked. Patients of advanced age or who are markedly emaciated are operated on in two stages. Temporary ileostomy serves as a worth-while safeguard against distension following any type of intraperitoneal resection of the right half of the colon. The incidence of peritonitis is thought to have been THE DIGESTIVE TRACT 887

lessened by the intraperitoneal injection of vaccine, prepared from streptococci and various types of colon bacilli, seventy-two hours before operation. BENJAMINR. SHORE

Lymphosarcoma of the Cecum in Childhood, C. F. DIXON. West. J. Surg. 42: 216-219, 1934. Helmhola collected a series of 750 cases of malignant lesions in children from the records of the Mayo Clinic (Proc. Interstate Postgrad. M. Assoc. North America, 1931, pp. 209-211) among which was one case of lymphosarcoma of the cecum in a girl of eleven, successfully treated by operative removal. Dixon adds a second case from the same clinic occurring in a boy of twelve who had had symptoms fourteen months before admission. These consisted of increasing attacks of diffuse lower abdominal pain. The appendix was removed six months later and the tumor seen but not removed. Two weeks before admission the tumor was again explored but was thought inoperable. At the clinic a resection of 25 cm. of ileum, the ascending and one half the transverse colon was performed. The boy was in good health eleven months later. GRAYH. TWOMBLY

Lymphosarcoma of Ileum in a Child, Causing Chronic Intussusception, J. CUNY. In- vagination chronique sur un lympho-sarcome du grkle chez un enfant de trois ans; r6section en deux temps; gu6rison, Bull. et m6m. SOC.nat. de chir. 60: 439-442, 1934. A three-year-old boy had begun six months previously to complain of abdominal pain, which soon came on in acute attacks accompanied by vomiting of food and bile. He lost weight and strength. When at last brought to the hospital he was weak and emaciated, and a tumor was palpated in the right upper quadrant. The picture of chronic obstruction led to immediate operation, which revealed an invagination about 25 cm. long, occupying the right colonic angle and the adjacent regions of the transverse and ascending colon. Disinvagination at one sitting seemed impossi.ble, because of the presence of a large mass in the right colon, into which the ileum had been invaginated, and the child’s poor condition, The author did an ileo-transverse anastomosis, and two days later reduced the invagination; the entering ileum bore a tumor, situated 10 cm. from the ileocecal valve, and the second stage consisted in wide resection of this portion of the intestine. The tumor was a lymphosarcoma, showing numerous mitoses. Deep x-ray treatment was given, about 1800 T in two applications with a forty-eight- hour interval. Ten months later the child was in good health. The author cites statistics, chiefly from American publications, indicating the usually bad prognosis of intestinal lymphosarcoma, but believes that postoperative irradiation has improved the chance of prolonged survival. F. CAVERS Sarcoma of the Duodenum Treated by Partial Duodenectomy, C. S. WILLIAMSON. West. J. Surg. 42: 207-210, 1934. A woman of fifty-three complained of loss of strength and appetite, irregularity of bowel movements, and tarry stools, of six weeks’ duration. An exploratory operation disclosed what was thought to be an inoperable carcinoma of the pancreas. Following gallbladder drainage the patient improved for a while but then grew worse and the tumor became palpable. An exploratory laparotomy was done, a sarcoma found, and a posterior gastro-enterostomy performed. Finally, a year after her first operation, the author performed a third operation at which the tumor was successfully removed. This procedure involved ligation of the duct of Santorini and transplantation of the common bile-duct into the duodenal stump, along with removal of the pylorus and first and second portions of the duodenum. The patient recovered and was in good health five months later. The tumor proved to be a fibrosarcoma of the duodenum. GRAYH. TWOMBLY

Polyposis of Duodenum and Jejunum:Report of an Instance, J. M. CASSIDYAND B. J. MACCHIA. Am. J. Digest. Dis. & Nutrition 1: 755-758, 1934. The authors report the case of a twenty-nine-year-old man who died of intussusception and early gangrene of the jejunum. Autopsy showed 17 pol,yps, 8 of which were 888 ABSTRACTS within the first 31 inches of duodenum. The polyps had broad bases and ranged from 1 to 3 cm. in diameter. The largest was 16 om. in circumference and was situated directly opposite the papilla of Vater. Histologic study of the tumors showed them to be adenocarcinomas. The article is illustrated by’a photograph of the gross specimen and roentgenograms. BENJAMINR. SHORE

Neuroblastoma of the Jejunum, 0. CAMESAND J. M. CID. Neuroblastoma del yeyuno, Prensa mtld. argent. 20: 1485-1490, 1933. At operation on a man of fifty-five presenting symptoms of duodenal ulcer, an ulcerated polypoid tumor of the duodenum was removed. This proved to be a neuroblastoma, resembling in detail the tumors arising from the sympathetic nervous tissue of the suprarenal gland. The authors suggest that tumors of this kind occurring in the gastro- intestinal tract are probably often mistaken for schwannomas or even fibromas. Two cases were reported by Ritter (Am. J. Path. 1: 519, 1926)’ and McFarland (Ibid. 11: 118, 1931) collected the cases reported in the literature down to 1930. There are seven good illustrations. F. CAVERS

Ileocecal Invagination due to a Tumor of the Small Intestine, F. MASMONTEIL.In- vagination il6o-ceecale due 8. une tumeur de l’intestin grble, Bull. et m6m. Soc. d. chirurgiens de Paris 25: 51-56, 1933. A man forty-three years of age had repeated attacks of abdominal paip without nausea or vomiting. Roentgen examination indicated an invagination in the first portion of the transverse colon. At operation a portion of the small intestine was found to be invaginated in the ascending colon. A portion of the intestine was resected and was found to be the site of a tumor originating in the lymph follicles of the intestine- a lymphocytoma of inflammatory origin. The patient made a good recovery. Two illustrations accompany the report.

Carcinoma of the Appendix, P. HARDO~~IN.Une observation de cancer de l’appendioe, Bull. et mtlm. SOC.nat. de chir. 60: 491-494, 1934. The author diagnosed appendicitis in & boy of thirteen years who had for some weeks complained of vague pain in the right iliac fossa, followed by acute pain and vomiting. At operation he found the appendix congested and of normal diameter except for a firm spherical tumor at the free end. On removal this was found to be a solid tumor consisting of epithelial cells with numerous mitoses, and was diagnosed as carcinoma. The author attributes the reputed relative benignancy of these tumors to the fact that they are accompanied by inflammation and simulate appendicitis, so that prompt operation is done. In the ensuing discussion MBtivet said he had once removed an enlarged appendix which was not histologically examined because cancer was not thought of; a few months later the patient died with cancer nodules in the lung, which showed typical intestinal structure. Moulonguet, on the other hand, said that he had looked at the author’s sections and believed the tumor was not actually carcinoma but a carcinoid possibly showing early malignant change. F. CAVERS

Carcinoma of the Large Bowel, E.C. BARTELS. Minnesota Ned. 17: 586-589, 1934. The author reports a series of 110 cases of carcinoma of the colon and rectum operated upon from January 1924 to February 1933. Histologic reports were available in all cases. One hundred and four patients have been traced and six have been lost. There were 55 women and 57 men. The preoperative diagnosis was correct in 80 cases and incorrect or not definitely given in 30. The incorrect diagnoses included appendicitis, cholecystitie, ruptured duodenal ulcer, ovarian tumor, fibroids, diverticulitis, carcinoma of the stomach, peritoneal adhesions, and abdominal tumor. There were 88 tumors of the sigmoid, 33 of the rectum, 16 of the cecum, 10 of the rectosigmoid, 0 of the transverse colon, 3 of the hepatic flexure, 2 of the splenic flexure, 2 of the descending colon, and in one case there were multiple tumors situated in the cecum, rectum, and sigmoid. The THE DIGESTIVE TRACT 889

operative mortality for the entire group was 38 per cent. Fifty-seven patients on whom palliative operations or resections were carried out successfully have been traced to January 1933. Eighteen of the patients who died had had resections and 17 had had palliative operations. The duration of life of the 17 patients on whom a palliative operation only was done was one to six months in 8 cases, six to twelve months in 5 cases, eighteen to twenty-four months in 23 cases, and twenty-six months in one case. The average duration of life for these patients was nine months. The average length of life of the 18 patients who died after resections was twenty-one months, and the greatest length of life was seventy-six months. Twenty-two patients are still living and 17 are in good health for from six months to over five years after radical removal of the growth. BENJAUINR. SHOREI

Carcinoma of the Colon, D. P. MACGUIRE. Surg., Gynec. & Obst. 59: 762-765, ‘1934. In any operative procedure for cancer of the colon, pwitonitis stands out as the greatest danger and the most serious complication. For this reason MacGuire does not use clamps or cut the bowel intraperitoneally with a knife or cautery. The mortality associated with surgery of the colon will always remain high if surgeons in general adopt any of the so-called aseptic operative procedures. This term is a misnomer, as in every case in which clamps are applied across the lumen of the colon the wall is so severely traumatized that hordes of bacteria are spilled into the peritoneal cavity. Resection after the technic originally descGbed by Mikulicz, in which the growth is mobilized and extraperitonealized before removal, is recommended as the method of choice in these cases. Several drawings of the operative technic illustrate the article. BENJAMINR. SHORE

Carcinoma of the Colon, R. R. GRAHAM.Am. J. Digest. Dis. & Nutrition 1: 584-588, 1934. The author reports 116 cases of carcinoma of the colon and 105 cases of acute intestinal obstruction, 18 per cent of which were due to cancer of the colon. When the seat of obstruction is definitely located in the colon, 75 per cent of the cases will be due to carcinoma. In all of the author’s cases the obstructing cancers were located in the portion of colon from the splenic flexure to the rectum. Radical resection was possible in 27 of the 40 rectal cases and in 22 of the 33 carcinomas of the sigmoid. ‘ Decompression of the colon preliminary to resection is indicated in all cases in which there are obstruc- tive symptoms. The article is illustrated with several drawings and roentgenograms. BENJAMINR. SHORE

Carcinoma of the Colon, C. W. HEALD. Am. J. Digest. Dis. & Nutrition 1: 693-697, 1934. This is a general article concerning the diagnosis and treatment of carcinoma of the colon. BENJAMINR. SHORE Progress in Radiologic Diagnosis of Cancers of the Large Intestine, R. GILBERT,’8. KADRNKAAND L. BABAIANTZ.ProgrAs r6alis6s dans le diagnostic radiologique des cancers du gros intestin, Arch. d’6lectric. m6d. 41: 451-463, 1933. The authors emphasize the great diagnostic value of a radiographic study of the large bowel by means of the mucosal relief technic. Twelve exceptionally fine radiographs illustrate early lesions of the bowel discovered by this means. WILLIAMJ. HOFFMAN Roentgenographic Dflerentiation Between Diverticulitis and Cancer of the Sigmoid, W. H. STEWARTAND H. E. ILLICK.Am. J. Digest. Dis. & Nutrition 1: 738-742, 1934. This is a general article concerning the radiologic differential diagnosis between diverticulitis and cancer of the sigmoid colon. Several abstracted case reports and roentgenograms are included. BENJAMINR. SHORE 890 ABSTRACTS

Differential Diagnosis between Diverticulitis and Carcinoma of the Rectosigmoid, T. E. HEINZ. Med. Clin. North America 17: 1665-1675, May 1934. A sixty-four-year-old woman had had attacks of abdominal pain for three years, constipation, urgency and frequency of urination, hematuria, and the passage of gas from the urethra, At operation a diverticulitis of the sigmoid with almost complete obstruction and a fistula into the bladder were found and successfully treated by the Mikulicz procedure. A fifty-six-year-old woman had lost forty-five pounds in weight in eight months. She complained, also, of constipation, distention, and increasing amounts of gross blood in the stool. X-rays showed multiple diverticula. At operation an extensive inoperable caroinoma of the sigmoid was found. After giving these histories in detail, Heinz discusses the differential diagnosis of carcinoma and diverticulitis. The latter usually gives a longer history, is less apt to be accompanied by bleeding, causes less loss of weight, and is more likely to cause vesico- colic fistula. GRAYH. TWOMBLY Treatment of Carcinoma of the Right Colon, J. GOSSET. Le traitement du cancer du chlon droit, J. de chir. 43: 34-51, 1934. This is an extract from a book previously published by the author (Le cancer du cBlon droit, Masson, Paris, 1933), who advocates for carcinoma of the right colon a two-stage hemicolectomy, the first operation consisting in midline laparotomy, investigation of the colon and other organs, and an end-to-side ileotransversostomy, while the second is devoted to mobilization and excision of the right colon. The author’s statistics refer to 26 traced cases; there were 2 operative deaths, and 6 patients survived for five years or longer. There are fourteen illustrations of the operative procedure. F. CAVERS Cancer of the Left Colon, VICTORPAUCHET. Cancer du cdlon gauche, Bull et m6m. SOC.d. chirurgiens de Paris 25: 222-224, 1933, In a patient with a large tumor in the left iliac fossa roentgen examination with a barium enema showed involvement of the descending and iliac colon. At operation the tumor and the surrounding peritoneum were found to be adherent to the iliac fascia. An incision was made in the median fold of the mesocolon between the descending and the iliac colon, and the tumor was freed from its attachments by means of the electric knife. When the tumor mass and the colon were completely liberated, resection was done.

Cancer of the Sigmoid Colon in a Woman Twenty-Six Years of Age, FRIARTAND RAHIER. Cancer du donsigmofde chez une femme de 26 ans, Scalpel 86: 377-379, 1933. A woman twenty-six years old had a sudden attack of diarrhea with fetid stools, fever, and vomiting, the cecum and descending colon being painful on pressure. The diarrhea persisted for a time, until the abdomen became distended and signs of intestinal obstruction developed. At operation a tumor was found in the sigmoid, and a colostomy wis done. Autopsy showed an annular tumor of the sigmoid, histologically an adenocarcinoma, The authors point out the importance of considering the possibility of intestinal tumor in young persons with symptoms of subacute intestinal obstruction. Recto-sigmoid Cancer with Acute Gangrene of Pelvic Organs, C. E. HOWARD.Am. J. Digest. Dis. & Nutrition 1: 669-670, 1934. The author reports the case of a fifty-two-year-old man who died one month after a colostomy for a supposedly inoperable carcinoma of the rectosigmoid. Autopsy showed a generalized low-grade peritonitis and acute necrosia of all the pelvic organs. The only tumor identified was in a piece of prostate gland found loose in the pelvis. Whether the extensive necrosis was due to extravasation of urine or to impairment of the blood supply was not definitely established. Two roentgenograms of the colon are included. BENJAMINR. SHORE THE DIGESTIVE TRACT 891

Case of ‘‘ Silent ” Perforation of the Peritoneum by a Rectosigmoid Cancer, A. CHAU- VENET. Sur un cas de perforation silencieuse en p6ritoine libre d’un cancer recto- sigmoide, Gaz. hebd. d. sc. m6d. d. Bordeaux 54: 294-296, 1933. In a woman sixty years of age a rectosigmoid tumor, apparently a carcinoma, was found at operation, with a perforation into the peritoneal cavity. Although the perforation had evidently occurred some time prior to operation, at no time were there symptoms of peritoneal involvement. The Hartmann operation was done and a Mikulicr drain inserted. Death occurred in four weeks, from cellulitis. Pathology and Treatment of Bleeding Polypoid Tumors of the Large Bowel, V. C. DAVID. Ann. Surg. 100: 933-948, 1934. ’ The correct diagnosis of adenomatous and papillomatous tumors of the colon and rectum, even though they appear clinically benign, can be made only by histologic study of the area of attachment of the tumor to the bowel wall. Because of the possibility of malignancy, complete removal of all polypoid tumors of the large bowel is indicated. The slightest evidence of ulceration or induration in these tumors is highly suggestive of malignancy, and radical removal of the segment of bowel containing them is indicated. It is unfair to ask a pathologist to pass judgment on the probable malignancy of one of these tumors unless he shares with the clinician the clinical history of the development of the lesion and its gross appearance, and unless he has a piece of the tumor from near its base for examination. The article is illustrated with photographs of gross specimens, photomicrographs, and roentgenograms. BENJAMINR. SHORE Some Requisites in the Treatment of Cancer of the Rectum, JOSEPHMUIR. Internat. J. Med. & Surg. 46: 548-549, 1933. The author discusses the difficulties of radium therapy of rectal carcinoma. While this mode of treatment has never reached that equality with surgery which it has attained in cancer of the cervix, the implantation of removable radon seeds holds out promise of future usefulness, permitting long-time exposure without danger of overdosage. Technic of Extirpation of Cancers of the Rectum and Pelvic Colon, K. LICETENAUER. Zur Technik der Exstirpation des Carcinoms des Rectum und Colon pelvinum, Arch. f. klin. Chir. 180: 273-276, 1934. The author describes the technic of radical excision of rectal and rectosigmoid cancers in which the rectal sphincters are preserved. The rectal mucosa is separated from the sphincters and, together with the growth, is removed by the sacral route. The sigmoid is divided above the growth and the proximal end is drawn downward through the sphincteric ring. Functional control is said to be good after this type of operation. The article is illustrated by several drawings of the operative technic. BENJAMINR. SHORE Synchronous Combined Method for the Radical Extirpation of Rectal Cancers, M. KIRSCHNER. Das synchrone kombinierte Verfahren bei der Radikalbehandlung des Mastdarmkrebses, Arch. f. klin. Chir. 180: 296-308, 1934. The principal advantages of the radical extirpation of rectal cancers by two surgeons working at the same time, one performing the abdominal part of the operation while the other works on the perineum, are the simplification of the operative technic, and with it, a reduction in the primary operative mortality. The only change which has recently been made in the technic is that the patients are put in stirrups instead of suspended by the legs a.s was the original practice (Chirurg 6: 233, 1934. Abst. in Am. J. Cancer 22: 447, 1934). BENJAMINR. SHORE Experiences with High Rectum Amputation for Carcinoma, H. VOELCKER.Meine Erfahrungen mit der hohen Rectumamputation, Arch. f. klin. Chir. 180: 121-122, 1934. Combined abdominoperineal resection is recommended as the procedure of choice in the eradication of malignant rectal tumors. The major operation follows eight 892 ABSTRACTS days after a preliminary colostomy. The high operative mortality of 30 and 40 per cent which previously accompanied these operations has been decreased in the last four years to 16 per cent. The importance of removal of a large segment of bowel is emphasized by the presentation of three cases in which one or more carcinomas were situated above the low larger growth for which the operation was undertaken. BENJAMINR. SHORE Perineal Resection of Rectal Cancer, S~N~QUE.Epithhlioma du rectum; r4sectfon par voie phrineale selon une nouvelle technique du professeur Cunho, Bull. et m6m. SOC.nat. de chir. 59: 1336-1337, 1933. The author presented a man of fifty-four operated upon a few months previously by a radical perineal route technic attfibuted to CunBo (no citation given). The operation was done in five stages. The advantages claimed are that no artificial anus is made and that a single sphincteric nerve is left intact in order to ensure sufficient continence. F. CAVER~ Abdominosacral Operation for Rectal Cancer, H. SCHNEIRER.Zur abdominosacralen Operation des Mastdarmkrebses, Arch. f. klin. Chir. 180: 126-127, 1934. It is believed that the abdominosacral method of resection is applicable to all rectal cancers which can be considered in any way operable. The technic is described in some detail, but there are no illustrations. BENJAMINR. SHOR~ Modiffcation of tbe Two-stage Resection of Rectal Carcinomas, J. DOBIRER. Modifi- kation des operativen Vorgehens bei der rweireitigen Operation des Rectumcarci- noms, Arch. f. klin. Chir, 180: 271-272, 1934. The author suggests the construction of a permanent sacral anus to drain the blind loop of sigmoid often left in the pelvis after the resection of rectal cancers. In these cases a permanent abdominal colostomy has already been made so that the sacral opening is intended to function simply as a point of drainage for the small loop of sigmoid. Several drawings illustrate the article. BENJAMINR. SHORN Instruments and Technic Used in the Rlectrocoagulation of Rectal Cancers, C. HEN- BCHEN. Regeln und Instrumentarium zur peranalen Elektrokoagulation des Rec- tumcarcinoms, Arch. f. klin. Chir. 180: 264-270, 1934. The author describes several instruments which have been constructed to facilitate more exact visualization of rectal cancers and to aid in more accurate electrocoagulation of these growths. Several drawings illustrate the article. BENJAMINR, SHORE Demonstration of Lymph Node Involvement in Resected Rectal Carcinoma, R. Sou- PAULT, R. LEIBOVICIAND M. PERROT,Cancer du rectum enlev6 par voie abdomino- phrineale, Bull. et mhm. SOC.nat. de chir. 60: 128-133, 1934. This interesting report is based on an anatomic and histologic study of the material removed at operation in two cases of rectal carcinoma. The specimens were fixed in alcohol and treated with xylol to show up the lymph nodes. For photographic purposes the latter were marked by covering them with small pieces of celluloid marked with India ink. Then the specimen was cut into successive slice8, each with its nodes similarly marked, and these were turned aside like the leaves of a book. In this laborious manner all the nodes were mapped out. The enlarged ones were histologically examined, in order to ascertain which were invaded by the tumor and which were merely inflammatory. The authors do not wish to draw conclusions from only two cases, but intend to continue this line of study until more complete data are obtained. There are two illustrations. F. CAVERB Diagnosis and Treatment of Large Adenomas of the Rectum, WIESTHUPIS.Diagnostik und Therapie der grossen Adenome des Rectums, Arch. f. klia. Chir. 180: 309-311, 1934. Large polypoid rectal growths which do not cause stenosis of the rectum and which are not ulcerated can usually be considered benign and treated conservatively. Surely THE BffifARY TRACT 893 this type of growth cannot be included in statistics on rectal cancers even though the more radical type of operation has been performed. There are no illustrations. BENJAMINR. SHORE THE BILIARY TRACT Adenoma and Cancer of the Liver, J. SABRAZ~S.Adhomes et cancers du foie, Gas. hebd. d. sci. m6d. de Bordeaux >5: 226-233, 1934. This is a general account of epithelial liver tumors, calling attention to the fact that any infective inflammatory lesion of the liver predisposes to cancer, and that adenomas are often transformed into cancers. F. CAVERS

Painful Borms of Nodular Cancer of the Liver, PARTURIER,BERNARD, AND A. DEFRENNEI. Reflexions sur les forms douloureuses du cancer nodulaire du foie, J. d. sc. m6d. de Lille 51 : 369-374, 1933. Five cases are reported in which paroxysmal attacks of pain occurred in the early stages of cancer of the liver. In 3 of these cases a diagnosis of hepatic colic was made, and cancer was not suspected until the course of the disease (enlargement of the liver with cancerous nodules) or the operative findings showed the true condition. In the other 2 cases the correct diagnosis was suggested by the discovery of cancer elsewhere, in the breast and sigmoid. In cancer of the liver attacks of pain may occur before there is any definite enlargement of the organ, which makes the correct diagnosis more difficult. Primary Carcinoma of the Liver and Trauma, A. CALCAQNI.Carcinoma primitivo del fegato e trauma, Clin. chir. 36: 311-320, 1933. Calcagni’s patient was a workman, aged fifty-nine, who was struck in the right hypochondrium by a large iron hook and lost consciousness for a few minutes. At the hospital, where he remained for the next few days, ecchymosis in the region where he had been struck was observed. Three months later there was pain in this region for a few days. Five months after this, the pain returned, radiating to the shoulder, and the liver was found to be enlarged. Laparotomy disclosed a hard nodular liver, and autopsy revealed a primary carcinoma of that organ. Two photomicrographs and a bibliography are presented. C. D. HAAGENSEN

Primary Carcinoma of the Liver in a Child, ARMAND-DELILLE,F~VRE AND LESTOCQUOY. Cancer primitif du foie chez une enfant; hepatectomie partielle; gu6rison opera- toire, Bull. SOC.de p6diat. de Paris 32: 292-297, 1934. Following a summary of French literature on malignant disease of the liver in childhood, the authors report a case in which they recently resected a primary carcinoma of the liver in a girl of six years. M. Hall6, commenting on the case, raised the question whether the operation (partial lobectomy) had been radical enough to minimize the danger of recurrence. F. CAVERS Case of Acute, Febrile Secondary Cancer of the Liver, A. M~~EL.Sur un cas de cancer secondaire du foie 8. forme aigug fdbrile, Normandie m6d. 44: 263-268, 1933. A sixty-nine-year-old woman with a history of diarrhea for the past four months was found to have a greatly enlarged, nodular liver, fever, abdominal distention, and pain. She failed rapidly and died three weeks later. A clinical diagnosis of metastatic cancer of the liver was made, although no primary source was found previous to death and no autopsy was obtained. WILLIAMJ. HOFFMAN Carcinoma of the Gallbladder, BICHELER.Le cancer de la v6sicule biliaire, Bull. m6d. , Paris 47: 738-739, 1933. The author urges that since gallstones may cause gallbladder cancer, every case of chronic cholecystitis should be operated upon, especially since the mortality of cholecys- tectomy has been much reduced in recent years. F. CAVERS 894 ABSTRACTS

THE PANCREAS Frequency of Pancreatic Carcinoma in Jews, H, HAMPERL.Zur Frage der Hiiufigkeit des primaren Pancreaskrebses bei Juden, Wien. klin. Wchnschr. 47 : 426-427, 1934. Peller (Ztschr. f. Krebsforsch. 34: 128, 1931. Abst. in Am. J. Cancer 16: abst. p. 506, 1932) stated that carcinoma of the pancreas is more frequent in Moscow and in Vienna than in Germany, and explained this as being due to the much larger proportion of Jews in the population of the former cities. He inferred that in any given area pancreatic cancer is more than twice as frequent in the Jewish as in the non-Jewish inhabitants. Hamper1 gives statistics of necropsies done at the University of Vienna, showing pancreatic cancer in 130 cases. Out of 286 cancers in Jews, 20 occurred in the pancreas (7.58 per cent); out of 3490 necropsy cancer cases in non-Jewish patients there were 110 of pancreatic cancer (3.1 per cent). These figures would appear to support Peller’s statement, but two points should be kept in mind-first, the number of cancer cases in Jews coming to necropsy was only one-fourteenth that of the necropsy cases in non-Jewish patients, and second, necropsies of cancer patients are at least twice more frequent in Vienna than in Moscow. It is therefore unsafe to found generalizations on such small and disproportionate data. F. CAVERS Cyst of the Pancreas, Appearing during Pragnancy, E. DOTTI. Cisti del pancreas, aorta in travaglio di parto, Minerva med. 1: 675-678, 1933. Dotti’s patient wa8 a woman aged twenty-five who, near the end of the second stage of labor, felt a sudden severe pain in the epigastrium and vomited. After delivery the pain gradually diminished but palpation revealed a tense, elastic fluctuant tumor in the left hypochondrium. At operation several days later a large cyst of the pancreas filled with bloody fluid was found and marsupialized. The author believes that the strain of labor caused rupture of the pancreas with subsequent hemorrhage and cyst formation. C. D. HAAGRNSEN

RETROPERITONEAL AND MESENTERIC TUMORS Retroperitoneal Chorione ithelioma in a Man with Positive Aschheim-Zondek Reac- tion, E. FENSTER.tp ber ein extragenitales Chorionepitheliom beim Manne mit positiven Hypophysenvorderlappenreaktion, Frankfurter Ztschr. f. Path. 46: 403-409, 1934. A man of twenty-seven had for about three months had left lumbar pain and a sensation of epigastric fullness. Pyelography showed upward displacement of the left kidney and kinking of the ureter. At operation there was found a nodulated retroperitoneal tumor extending from the diaphragm to the sacral promontory, obviously inoperable because densely adherent to liver, pancreas, left kidney and suprarenal, stomach, and duodenum. An excised piece showed the typical structure of chorionepithelioma. There was no sign of gynecomastia. The patient became increasingly cachectic and died just a year after the first appearance of symptoms. Necropsy revealed metastases in the liver, lungs, and the mesenteric and mediastinal lymph nodes. Fragments of the primary tumor and metastases were implanted sub- cutaneously into mice, and the lung metastases gave a stronger Aschheim-Zondek reaction than the urine, the primary tumor, and the other metastases. The testes were serially sectioned and found to be normal in structure. The author emphasizes that the distribution of metastases in these extragenital tumors corresponds closely with that of uterine and testicular chorionepitheliomas, and that in this case the biological reaction was as strongly positive as in the latter. F. CAVERS Paraganglioma of the Accessory Organs of Zuckerkandl, G. A. MIRKULOW. Ein Fall von einem aus den Nebenorganen von Zuckerkandl entatandenen Paragangliom, Centralbl. f. allg. Path. u. path. Anat. 59: 274-276, 1934. Left nephrectomy was performed in a twenty-six-year-old patient to facilitate the removal of a retroperitoneal tumor. After this had been done, however, it was found THE SPLEEN 895

that the mass was too firmly fixed to permit removal. The kidney was normal and after death, sixteen hours later, autopsy revealed that the left adrenal gland was distinct from the mass. Histological examination showed a paraganglioma which was thought to have arisen from the accessory organs of Zuckerkandl. THEODORES. RAIFORD Mesenteric Cysts Containing Esophagus-like Epithelium, S. FLODERUS.Mesenterial- cyste mit oesophagusiihnlichem Bau, Virchows Arch. f. path. Anat. 293: 608-614, 1934. The author reports the case of a ten-year-old girl from whom a mesenteric cyst measuring 7 by 2.5 cm. was removed. Histologic study of the wall of the cyst showed it to be composed of the normal muscle and epithelial layers found in the gastro-intes- .tinal tract. The lining in places was made up of stratified squamous epithelium resembling that found in the esophagus; in other places the cyst was lined with cylindrical epithelium and beneath this were typical Lieberktihn crypts. The article is illustrated with three photomicrographs. BENJAMINR. SHORE THE SPLEEN Dis lacement of the Kidney Associated with Tumors of the Spleen, H. U. GLOOR. 8ber Verdriingungen der Niere bei Milztumor, Acta radiol. 15: 467-474, 1934. The author reports three cases in which more or less severe disturbances in kidney function, associated with pyelographic signs of kidney displacement and compression, were found later to have been caused by enlargements of the spleen, in no case, however, of neoplastic nature. (1) In a man of fifty-three, of highly cachectic appearance, pyelography suggested a renal tumor, but as the results of urinalysis and indigocarmine injection showed very slight impairment of kidney function, the diagnosis was changed to pararenal sarcoma. Blood examination showed 7,600,000 erythrocytes and normal total and differential leukocyte counts. At operation the kidney was found to be normal, and examination of the removed spleen confirmed the diagnosis of polycythemic splenomegaly suggested by the erythrocyte count. (2) In a man of fifty-one with mitral insufficiency and left pleural effusion, there was palpable, below the greatly enlarged spleen, a hard mass diagnosed as a renal tumor. The urine from the left kidney contained numerous leukocytes and fat cells. Cysto- scopy showed pus flowing from the left ureter, and a ureteral sound was arrested below tJhe renal pelvis. Pyelography showed great distortion of the pelvis and calices. A diagnosis of renal tumor with pyonephrosis was made, and the patient died with uremia a few days later. Necropsy revealed a xanthoma-like mass in the kidney due to chronic streptococcal nephritis; the enlargement of the spleen was evidently coincidental and its etiology could not be determined, since the structure was normal histologically. (3) In a cachectic woman of fifty-three, the history and the blood counts indicated chronic aleukemic myelosis: erythrocytes 2,500,000, leukocytes 8400 (myeloblasts 33 per cent, myelocytes 6, basophils 48, neutrophils 9, lymphocytes 3). The spleen was enor- mously enlarged. No urine was obtained from the left kidney, and the pyelographic findings were extraordinary. The kidney was completely dislocated from its bed, so as to lie mainly on the right of the vertebral column, and was turned anteriorly and downwards so that it lay horizontally; the left ureter crossed in front of the right one, and its neck formed the highest point of the left renal pelvis. Four pyelograms and a diagram are included. F. CAVERS

THE SUPRARENALS Carcinoma of Suprarenal Cortex with Metastasis to Pancreas, L. GRAVANO.Suprar- renoma izquierdo, mettistasis tumoral pancretitico-ganglionar predominante, Semana m6d. 1: 1550-1557, 1934. In a woman of fifty who had five months previously begun to have epigastric pain and vomiting, there was ti large, rounded midline tumor extending from the epigastrium 896 ABSTRACTS

to the umbilicus, obviously deep-seated and post-gastric. The liver was enlarged, nodulated, and displaced to the right. X-rays showed displacement of the entire stomach and the duodenum to the left, but no sign of an intregastric lesion. Laparotomy revealed not only the pancreatic tumor, the size of a child’s head, that had been diagnosed, but a large mass of lymph nodes connecting this with the enlarged left suprarenal gland. The pancreatic and suprarenal tumors being densely attached by adhesions to neighboring organs, the surgeon simply excised pieces of each tumor for histologic examination. This showed in each case the structure of mdignant cortical hypernephroma; the same structure was found in the mass of preaortic lymph nodes and in an enlarged left supraclavicular node. Ten days after laparotomy intense jaundice developed, with choluria, evidently due to extension of the tumor mass to the common bile duct. The further history is not given. There are six good illustrations. F. CAVERS

THE FEMALE GENITAL TRACT Malignant Disease of the Female Generative Organs in the First Three Decades of Life, B. F. SCHREINERAND W. H. WEHR. Surg., Gynec. & Obst. 59: 616-621, 1934. Two thousand four hundred and five patients suffering from malignant disease of the female generative organs had been admitted to the State Institute for the Study of Malignant Disease in Buffalo, New York, up to Oct. 1, 1933. Of these, 114, or 4.6 per cent, were thirty years of age or younger. In this latter group 80 tumors were of the cervix, 23 of the ovaries, 4 of the body of the uterus, 4 of the vagina, and 3 of the vulva. Treatment of the cervical cancers of groups 1 and 2 in these young patients yielded healing in about the same proportion as the general average in cancer of the cervix, but in the tumors of groups 3, 4, and 5 the treatment was only palliative. The sole purpose of this paper is to call attention to the frequency of malignant disease of the female genital tract in patients of thirty years of age or less. BENJAMINR. SHORE Carcinoma of the Uterus, E. S. GROBECLOBE.Virginia M. Monthly 61 : 148-153, 1934. A brief review of the characteristic features of cancer of the uterus is presented. Radiation has been found most satisfactory for cancer of the cervix, while fundus neoplasms respond more satisfactorily to surgery. The importance of early diagnosis and prompt treatment is emphasized. There are no illustrations. THEODORP~S. RAIFORD

Value of the Clinical Grouping of Cervical Cancers, G. D~DERLEINAND H. BAATZ. Der Wert einer klinischen Gruppierung der Collumkarzinome, Zentralbl. f. Gyniik. 58: 22-32, 1934. From August 1928 to August 1933,545 patients with carcinoma of the uterine cervix were treated in the University Woman’s Clinic in Berlin. Two hundred and sixty-five patients received radiation therapy and 280 were operated on, an operability of 51.4 per cent. Clinical grouping of the tumors of the 280 patients before operation placed 154 in Group I and 126 in Group 11. The postoperative clinical grading of these tumors placed 168 in Group I, 102 in Group 11, and 10 in Group 111. It is believed that the wrong clinical grouping of Group I tumors before operation will amount to from 10 to 13 per cent, while that of the Group 11 tumors will amount to about 5 per cent. From a study of this material, it appears that accurate division between Group I and Group I1 tumors is hardly possible. For all practical purposes, the authors conclude that the clinical division of cervical cancers into those which are operable and those which are inoperable is sufficient. BENJAMINR. SHORE

Cancer of the Cervix, G. T. BERNARD. J. M. A. Georgia 23: 195-196, 1934. The traumatism associated with childbearing is a predominant etiological factor in cancer of the cervix. Cases of this disease are easily diagnosed and should be treated . early. Bleeding is the most common early sign. Prevention by cauterization , trachelor- rhaphy, or amputation of the cervix is most important. GRAYH. TWOMBLY THE FEMALE GENITAL TRACT 897

Study of Cervical Erosion and Its Relation to Cancer, P. C. SCHREIER.South. Surgeon 3: 165-170, 1934. In the healing stage of a cervical erosion there is an abnormal growth of the deeper layers of the squamous epithelium which is evidenced by finger-like projections or elonga- tions of the rete pegs extending deep down into the fibrous stroma. As the squamous epithelium creeps over the erosion it often not only covers the mouths of the newly formed glands but may actually grow down into their lumen. At this stage the picture may very closely resemble carcinoma. Eventually the normal reproductive power of the cells may be lost and replaced by the development of abnormal cancer cells. These observations tend to support the long-standing clinical impression that chronic endocervicitis with erosion is a fertile field for the development of carcinoma. The article is illustrated with several photomicrographs. BENJAMINR. SHORE Hereditary Syphilis in the Etiology of Uterine Cervical Cancers, H. PAUCOT.Cancer du col et syphilis h6r6ditaire, Bull. SOC.d’obst. et de gyn6c. 23: 227-229, 1934. The author points out that while the prognosis of cervical cancer is better than it was some thirty years ago, little progress has been made in the direction of prophylaxis, He considers that while vaccines, tampons and similar palliative methods may suppress active infections of the mucosa, it is necessary to extirpate all chronically unhealthy or ulcerated cervical tissue, and the only certain method is to amputate the cervix or to destroy the diseased mucosa by cauterization. Personally he considers syphilis to be the most important single predisposing cause of cancer, though it would be a gross exaggeration to state that cancer is simply a manifestation of syphilis, as some writers have done. In a consecutive series of 14 cases he found 7 in which the patients were syphilitic: in one the syphilis was acquired, in one conjugal, and the remaining five showed evidence of congenital syphilis. In such cases vigorous antiluetic treatment should be given, in addition to treating the local potentially precancerous cervical lesion by radium, electrocoagulation, or amputation. F. CAVERS Influence of Syphilis in the Treatment of Uterine Carcinoma by Radium, H. 0. KLEINE. Zur Frage der Beeinflussung der Strahlenempfindlichkeit durch Lues bei Radium- behandlung von Gebkmutterkrebsen, Strahlentherapie 49: 415-421, 1934. In a series of 20 patients with carcinoma of the cervix and 2 with carcinoma of the uterine body, all of whom were syphilitic, Kleine found that the infection exerted a most unfavorable effect upon treatment by radium. Although 12 of the 22 neoplasms were judged operable, only 4 patients were living after five years. The remainder had died either from recurring cancer or intercurrent complications such as rectovaginal or vesico- vaginal fistula or bladder ulcer. This the author believes was due to an increased sensi- tivityof the normal tissues to radiation and may have been a result of the luetic infection itself, of the inflammatory changes produced by the cancer, or of the inflammatory reaction to the radium. It is emphasized that in the presence of syphilis, the dosage, time of treatment, filtration and other technical details must be adapted to each individual case. Fractional irradiation and intravenous arsenical therapy are advocated as a means of improving the results. There are no illustrations. A short review of the literature is included. THEODORES. RAIFORD Carcinoma of the Cervix in Cases of Uterine Prolapse, J. P. TOURNEUX.Le cancer du col de l’ut6rus prolab6, Gyn6cologie 33: 273-280, 1934. The author summarizes five cases recently reported in French journals, and one reported by himself, of squamous-cell carcinoma occurring in the cervix of a prolapsed uterus. From the French statistics it appears that cancer does not arise any more frequently in prolapsed uteri than in those in which the cervix occupies its normal position. Tourneux believes that in prolapse the cervix is less liable to become infected, and suggests that when the exposed cervix undergoes extensive keratinization this process actually protects it against the development of cancer. F. CAVERS 898 ABSTRACTS

Stenosis of the Ureter in Carcinoma of the Cervix, K. HUFNAGL: Ureterstenose bei Collumcarcinom, Ztschr. f. urol. Chir. 39: 7-19, 1934. That compression of the ureters is not a rare finding in the terminal stages of carcinoma of the cervix is demonstrated by the frequency of such cases in the literature. The author reports five instances illustrating the clinical manifestations of the condition. The effects of urinary retention upon the kidney are emphasized and it is pointed out that about half of the patients with carcinoma of the cervix die from urinary complications. Treatment is palliative. Irradiation may help, but operative removal of the kidney or transplantation of the ureter into the skin may be required. The latter procedure was employed in three of the author’s cases. There are four reproductions of x-ray films. THEODORE8. RAIFORD

Benign Stricture of the Intestine Due to Irradiation of Carcinoma of the Cervix Uteri, E. N. COLLINSAND T. E, JONES.Surg. Gynec. & Obst. 59: 644-649, 1934. Six cases of benign stricture of the intestine have been observed in a series of 422 patients with cervical carcinomas who have received irradiation therapy at the Cleveland Clinic. This represents an incidence of 1.4 per cent. In these cases symptoms of intestinal obstruction became manifest in from five months to three and one-half years after the treatments. Five of the strictures were in the sigmoid colon and one was in a lower loop of small intestine. The possibility of the presence of a benign intestinal stricture must be considered in all patients who show unusual abdominal symptoms several months or even years following irradiation therapy of cervical cancers. Before the disability is attributed to metastatic cancer, sigmoidoscopic examination and a careful roentgen study of the small intestines, provided obstruction is not complete, should be done. Exploratory operation is warranted in those patients presenting symptoms of intestinal obstruction in whom there is no remaining evidence of carcinoma in the pelvis. Ulceration may or may not be present at the time the involved segment of the intestine is removed. The evidences of chronic inflammation found in all the lesions were narrowing of the lumen and thickening of the wall of the intestine, due to granulation tissue, plasma. cells, eosinophils, and varying degrees of replacement by fibrous tissue. If ulceration is present it may involve only the mucosa or it may extend through all the layers of the intestine into the adjacent mesenteric fat. No evidence of acute perforation into the peritoneal cavity was found in this series of cases. All five patients with sigmoid lesions had tenesmus and diarrhea, and passed mucus and blood in the stools for three weeks or longer immediately following irradiation. In the patient in whom an irradiation stricture is forming, unusual constipation super- venes sooner or later, along with other symptoms of intestinal obatruction. Roentgen examination is the most important single means of revealing the lesion in the sigmoid colon. In the cases in which the obstruction is not complete the lesion is represented by an annular filling defect simulating the infiltrating type of carcinoma. In contradis- tinction to the latter, however, the benign stricture usually has an hour-glass deformity, is fixed in position, and shows a more gradual line of demarcation between the normal and abnormal tissue than is usually seen in carcinomatous lesions of this area. Five of the six patients had received both radium and roentgen irradiation. The dosage of radium varied from 2440 to 4240 millicurie hours. Tubes of radon with 1,5 mm. brass filtration enclosed in 2 mm. rubber were used in all cases. Roentgen therapy was administered through 4 portals, each portal alternately receiving 60 per cent of a skin unit dose at a time, the entire dose in each instance being given in from five to seven days. The skin unit dose was 800 roentgens and the estimated 10 em. depth dose was 30 to 40 per cent. The total calculated roentgen dose about the cervix was approximately 800 roentgens. Prevention of these intestinal obstructions after radium and roentgen-ray treatment of cervical canceSg may be obtained in certain cases by stimulation of peristaltic activity of the intestines and by change in position of the patient. When the radium is placed against the cervix or inserted into the cervical tissue, keeping the patient in a constant moderate Trendelenburg position will aid in the maintenance of the proper position of THE FEMALE GENITAL TRACT 899

the radium and at the same time should allow a sufficient area between the radium and the intestine to prevent damage of the latter. The article is illustrated by a roentgenogram and a photograph of a gross specimen. BENJAMINR. SHORE

Carcinoma of Uterine Cervix Showing Unusual Keratinization, J. F. MARTINAND P. CROIZAT.Epithklioma Bpidermoide du col utBrin I% stratification partiellement inversee (k6ratinisation intralobulaire et perilobulaire pr6dominant), Bull. Assoc. franc. p. l’btude du cancer 23: 271-274, 1934. The authors report histologic findings in a case of cervical squamous-cell carcinoma closely resembling those described previously in four cases by Regaud and Gricouroff (Ann. Surg. 93: 360, 1931. Abst. in Am. J. Cancer 15: 2994, 1931). The unusual feature is that keratinization is found at the periphery of the strands and nests of tumor cells, bordering on the connective-tissue stroma, instead of occurring in the central portions as is usually the case in epidermoid carcinoma. In places the central undifferentiated cells were large, recalling the basal cells of the normal cervical epithelium, but had scanty cytoplasm and numerous nuclei, forming a syncytium. There are two photomicrographs. F. CAVERS Carcinoma in the Uterine Isthmus, 0. FRANKL.Karzinom im Isthmus uteri, Zentralbl. f. Gynak. 58: 32-34, 1934. In a forty-nine-year-old woman a vaginal hysterectomy was done for a carcinoma situated in the isthmus of the uterus between the body and cervix. This is the first in 2000 cases of carcinoma of the uterus seen by Frank1 in which the growth has been situated at this point. He believes that the tumor had its origin slightly higher and for this reason should be considered as a tumor situated in the isthmus but not arising from it. One photograph of the gross specimen is included. BENJAMINR. SHORE

Roentgen and Radium Therapy of Malignant Tumors of the Female Genital Organs and Their Complications, S. VIDAKOVI~.Rdntgen- und Radiumbehandlung maligner Geschwiilste der weiblichen Genitalorgane und ihre Komplikationen, Strahlentherapie 51 : 300-304, 1934. From 1923 to 1930, 696 patients with carcinoma of the uterine cervix were treated in the University Woman’s Clinic in Agram; radical operations of the Wertheim or Schauta type were performed on 325 patients. Three-year cures were obtained in 147 or 45.2 per cent of the cases and five-year cures in 104 or 41.6 per cent of the 250 cases treated five or more years previously by radical operation and postoperative irradiation. Of thirty-eight patients with carcinoma of the fundus of the uterus treated surgically from 1923 to 1928, five-year survivals were obtained in 18 or 47.3 per cent. During the years 1931 and 1932,12 patients with carcinoma of the body of the uterus and 267 with carcinoma of the cervix were treated with radium and x-rays. There were 7 deaths in the latter group, giving a mortality of 2.6 per cent after irradiation of carcinoma of the cervix. Six of the deaths were due to peritonitis following rupture of a pyosalpinx and one was due to anuria. BENJAMINR. SHORE Radiation Treatment of Uterine Cancers, F. VOLTZ. Die Strahlenbehandlung der Uteruskarzinome, Strahlentherapie 51 : 453-464, 1934. The author reports 2340 cases of carcinoma of the uterus treated by irradiation in the University Woman’s Clinic in Munich from 1913 to 1928 inclusive. Three hundred md ninety-five, or 19.4 per cent, of 2039 patients with carcinoma of the cervix remained well for five or more years. According to the clinical grouping of these cases, five-year cures were obtained in 45.1 per cent of 370 patients with Group I tumors, 24.1 per cent of 489 patients with Group I1 tumors, and 12.9 per cent of 797 patients with Group I11 tumors. Five-year cures were obtained in 56 of 138 patients with carcinoma of the body of the uterus treated exclusively by irradiation. This method of treatment is believed to give results which compare favorably with those obtained by other methods, while at the same time possessing the advantage of a 0.3 per cent primary mortality compared to 10 per cent associated with the radical surgical treatment. BENJAMINR. SHORE 900 ABSTRACTS

Results in the Radiation Treatment of Uterine Cancers, F. VOLTZ. Weitere Ergebnisse der Strahlenbehandlung des Uteruskarsinoms, Strahlentherapie 50: 576-578, 1934. Also in Zentralbl. f. Gynak. 58: 2466-2468, 1934. During the years 1927 and 1928, 336 patients with cancers of the uterine cervix were seen in the University Woman’s Clinic in Munich. Twenty or 5.9 per cent of these patients had growths too advanced for treatment. At the end of five years 76, or 24 per cent of the 316 patients treated were alive and well. Five-year cures were obtained in 26 of 44 patients with Grade I tumors, 28 of 88 patients with Grade I1 tumors, 22 of 125 patients with Grade I11 tumors, and none of 79 patients with Grade IV tumors. The total number of cases of carcinoma of the cervix Been at the Clinic from 1913 to the end of 1928 is 2202. One hundred and sixty-three or 7.3 per cent of these patients were unsuitable for treatment. Five-year cures were obtained by irradiation in 395 or 19.4 per cent of the 2039 cases treated. The relative curability was 45.1 per cent of the Group I tumors, 24.1 per cent of the Group I1 tumors, and 12.9 per cent of the Group 111 tumors. Eleven of 31 patients with earcinoma of the body of the uterus treated entirely with irradiation during the years 1927-1928 have lived for five or more years. The entire group of patients with cancer of the uterine body treated by irradiation totals 138 cases; 56, or 40.6 per cent of these, have remained alive and well for five or more years. BENJAMINR. SHORE

Radiation Treatment of Uterine Cancer in the St. George Hospital, Hamburg, from June 1929 to December 1931, A. HAMANN,A. G~BELAND K. ENQLMANN.Die Strahlenbehandlung der Gebilrmutterkrebse im Allgemeinen Krankenhaus St. Georg in Hamburg (Juni 1929 bis Desember 1931), Strahlentherapie 50: 529-556, 1934. From June 1929 to December 1931, 476 women with malignant genital tumors were treated in the St. George Hospital in Hamburg. Of these, 78 or 16.4 per cent had been treated elsewhere and at the time they were seen there was no indication for further treatment. Radiation alone was used in 59.2 per cent of the cases, radiation and surgery in 22.2 per cent, and surgery alone in 4.2 per cent. Forty-nine, or 25.7 per cent of the 190 patients with carcinoma of the cervix in whom a course of radiation was completed, have remained well for an unstated period of time. Some of these were treated with radium and x-rays and others were treated with either radium or x-rays alone. Four of eleven patients in whom a complete course of irradiation therapy was given for carcinoma of the body of the uterus have remained well for an unstated period of time. Of the patients subjected to radical surgery, 58 or 44 per eent of 132 with cervical cancers and 17 or 63 per cent of 27 with cancers of the body of the uterus have remained well. The combined use of radical surgery and postoperative irradiation obtained 8 cures, which represented 57.2 per cent of the 14 patients with carcinoma of the body of the uterus so treated. The technic of the radium and roentgen irradiation used in these cases is described in detail. BI~INJAMINR. SHORB Results of the Radiation Treatment of Uterine Cancers from 1926 to 1931, W. DIEITERICH AND A. EDINGER.Ergebniase der Strahlenbehandlung des Gebllrmutterkrebses von 1926-1931, Strahlentherapie 50: 557-565, 1934. From 1926 to 1931,237 patients with genital carcinomas were treated by irradiation in the Radiotherapeutic Department of the City Hospital in Mannheim. On April 1, 1934, 89 or 37.5 per cent of these patients were still living. Of 124 patients with inoperable carcinomas of the cervix treated by irradiation, 23 or 19.6 per cent are living for twenty-eight months or more after treatment. Fifty-four or 59.3 per cent of 91 patients with operable carcinomas of the cervix treated with irradiation have remained well for this same period of time. Detailed analyses of these patients according to age and the years in which they were treated are given in tabular form. BENJAMINR. SHORB THE FEMALE GENITAL TRACT 901

Technic of Treatment of Cancer of Cervix with Radon, F. E. SIMPSON. Radiology 23: 170-172, 1934. The author discusses briefly the different methods of application of radium in the treatment of cancer of the cervix and describes his technic. This consists of combining radon application to the external lesion with insertion of radon in a lead applicator within the cervical canal. The entire procedure is carried out over a period of about three weeks, and the total dosage should not exceed 5,400 millicurie hours. There are two illustrations. THEODORES. RAIFORD Comparison of Various Methods of Radium-Surgery with Other Methods of Treatment of Carcinoma of the Cervix, R. PETIT-DUTAILLIS.Confrontation de diverses mBthodes de radium-chirurgie de 1’6pith6liorne du col avec d’autres modes de traitement de ce cancer, GynBcologie, 32: 5-50, 1933. The author surveys the end-results of treatment of carcinoma of the cervix by radical surgery, by irradiation, and by a combination of conservative surgery and postoperative irradiation. He concludes that the radical Wertheim operation is inferior to irradiation, since its cures are obtained practically entirely in early cases, Grades I and 11. Coupled with its poor results in more advanced cases is an average operative mortality of approximately 19 per cent. This mortality, the author believes, is largely attributable to the painstaking attempt to extirpate the regional lymph nodes. He quotes figures which indicate that the pelvic nodes are involved in only 47.3 per cent of cases operated upon, and that five-year cures are obtained in only 6 per cent of those cases which have actual metastatic involvement. To obtain this small percentage of salvage, a three- fold greater mortality is imposed upon a group of patients, more than half of whom do not require such radical treatment. The creditable results obtained by irradiation, in the opinion of the author, can be bettered if macroscopic cancerous tissue is first curetted away with the actual cautery, following which radium capsules are inserted into the uterine canal and into the crater of the cervix. In a few cases he has introduced radium capsules in rubber sounds along the course of the regional lymphatics by the extraperitoneal route, approached through bilateral perineal incisions. The author’s material consists of 51 cases treated by curettage, cauterization, and irradiation. The operative mortality (one patient) was 1.9 per cent. Thirty-nine of these patients were treated between the years 1913 and 1932. Of these, 25 had no recurrence two years after treatment (64 per cent). Nine had recurrences after periods ranging from two to eighteen years (24 per cent). WILLIAMJ. HOFFMAN

Management of Carcinoma Cervix-Uteri, SUBODHMITRA. Antiseptic 31 : 489-499, 1934. This report comes from a woman’s hospital in Calcutta, where most cases of cervical carcinoma are seen in a very advanced stage. Of 360 patients treated in a period of six years, the youngest was nineteen, while some 25 per cent were in the third decade. In 60 per cent of the cases there was infiltration of the parametria on both sides and in 37 per cent the base of the bladder was involved. In operable cases the authors use the Schauta-Wertheim radical vaginal operation followed by radium and roentgen irradiation. In late cases only radium and roentgen therapy are used. Of 24 patients (both early and late cases) treated over five years ago, 16.6 per cent are reported as alive. Of six patients with operable lesions, 3 or 50 per cent were well after five years. Selective Treatment of Carcinomas of the Uterine Cervix, M. BOLAFFIO. Uber selek- tive Behandlung des Kollumkarzinoms, Strahlentherapie 50: 566-575, 1934. Radical surgical extirpation offers the greatest chance for a cure in all cases of operable cervical cancers. This, however, must be undertaken only in relatively aseptic and early cases. In some instances apparently inoperable growths may become operable after a course of radium irradiation. In all cases in which radical surgical removal of the growth is impossible, intensive radium irradiation is indicated. BENJAMINR. SHORE 902 ABSTRAUTS

Results of Elective Therapy in the Treatment of Carcinoma of the Cervix, F. v. MIKU- LICZ-RADD~CKI.Erfolge der elektiven Therapie bei der Behandlung des Gebarmut- terhalskrebses, Strahlentherapie 49: 407-414, 1934. Elective Treatment of Cervical Cancers, l?. v. MIKULICZ-RADECKI., Elektive Therapie beim Collumkarzinom, Zentralbl. f. Gynllk. 58: 13-21, 1934. As a basis for his report the author has collected statistics for cancer of the cervix from 11 gynecological clinics in Germany during the years 1919-1926. Patients num- bered 6455, and of these 1899 underwent operation, with a total operative mortality of 10.26 per cent. Radical abdominal operation was done in 986 cases; radical vaginal operation in 666; and in the remaining 248 the uterus alone was removed, in 24 for palliative purposes alone. Of cases operated upon, 85 per cent were given postoperative irradiation, There were living and symptom-free at the end of five years 1339 patients, representing 24.5 per cent of the total number treated. This figure is compared with those of Pankow (in Veit-Stoeckel: Handbuch der Gyniikologie, Ed. 3, 1931, vol. 6, pt. 2, p. 404 ff.), who in a review of the literature in 1931 found five-year cures in 16.7 per cent of operated cases and 17.2 per cent of those subjected to irradiation. The author believes that surgical treatment of operable growths with postoperative irradiation, and irradiation of inoperable tumors, are the methods of choice in these growths. The operability of carcinomas of the cervix will vary from 20 to 40 per cent in different clinics. The vaginal is preferred to the abdominal route becsuse, while the end-results are the same, the primary mortality is much less, THEODORE8. RAIFORD

Results of Hysterectomy and Irradiation in Cervical Cancer, H. GAUDIER. Cancer du col ut6rin; hysterectomie; radiotherapie, Bull. SOC.d’obst. et de gyn4c. 23 : 226-227, 1934. The author gives statistics for 30 traced cases of cervical cancer treated during the four years 1925-1928 by total hysterectomy with preoperative or postoperative x-ray or radium therapy, or both. There were two postoperative deaths; 16 patients died with recurrence after from two to four years; the remaining 12 patients remained free from recurrence for from five up to eight years. Although the author is a partisan of hysterectomy, he believes that postoperative irradiation, whether by deep x-rays or radium, improves the chance of prolonged survival. In selected cases, irradiation may give about as good results as surgery, but at present it seems obvious that the treatment of choice is hysterectomy and radiotherapy combined. F. CAVERE

Prevention of Cancer of the Cervix, H. 13. ATLEE. Nova Scotia Med. Bull. 13 : 449-450, 1934. The usual discourse upon early diagnosis and routine examination for prodromal signs and symptoms as a means of lessening the mortality from cancer of the cervix. Nothing new is contributed. THEODORBS. RAIFORD Prevention of Cancer of the Cervix Uteri, L. K. P. FARRAR.Internat. J. Med. & Surg. 47: 427, 1934. A plea for repair of cervical erosion and lacerations and for prompt and thorough examination in all caaes of irregular bleeding.

Lesions of the Cervix Uteri, C. W. DOUGHTIB.Virginia M. Monthly 61: 143-148, 1934. Among the most commonly encountered benign lesions of the cervix are lacerations, ectropion, inflammation, ulceration, granuloma, nabothian cysts, endocervicitis, myoma, polyps, chancre, chancroids, syphilitic ulcers, atresia and stenosis. Eradication of these at an early stage is of great importance, since they so frequently precede cancer. There are no illustrations. THEODORE8. RAIFORD THE FEMALE GENITAL TRACT 903

Carcinoma in the Cervical Stump Following Supravaginal Hysterectomy, L. WALDEYER. Das Cervixstumpfkarzinom nach supravaginaler Uterusamputation, Zentralbl. f. Gynak. 58: 35-44, 1934. The author has studied 14 cases of carcinoma of the cervical stump seen from 1917 to 1933 in the University Woman’s Clinic in Berlin. In 3 cases the diagnosis of carcinoma was made within a year after the supravaginal hysterectomy and in these cases it is highly probable that the malignant tumor existed at the time of operation. In 4 cases, the diagnosis of carcinoma was made from one to five years after operation, and in 7 cases this interval was from six to fourteen years. The growths in 9 of these cases were early enough to be considered operable; radical excision was done in 8 cases and in one primary irradiation was given. Two of the 8 patients operated upon died as a result of the operation, 1 died fourteen months later of an unknown cause, 4 are living and well for varying lengths of time, one more than five years. One of the 6 patients treated with radium and x-ray is alive and well after five years. During the past few years supravaginal hysterectomies have been limited to those patients with supposedly normal cervices, such as virgins and nulliparous women, and to those in whom the cervical stump was useful in the repair of large cystoceles. Conserva- tion of the lower uterine segment and cervix is also attempted, when possible, in young individuals. Of a total of 893 hysterectomies, 69 were of the supravaginal type and 824 were complete. BENJAMINR. SHORE Squamous-cell Carcinoma Arising on Vaginal Scar of Abdominal Hysterectomy done Twenty-six Years Previously, C. ROUHIERAND P. WALTHER.Ddveloppement d’un Bpithdlioma sur la cicatrice vaginale vingt-six ans aprEs une hysterectomie abdominale totale, Bull. et m8m. SOC.nat. de chir. 60: 565-566, 1934. The authors’ patient was at the time of reporting forty-seven years old, and gave a history of total abdominal hysterectomy twenty-six years before, though no details could be obtained as to the nature of the lesion for which this was done. She had noticed vaginal bleeding about eight months before attending the clinic. On the scar in the vaginal roof was a small nodule which bled on slight touch. On removal this was found to consist of nests of squamous-cell carcinoma embedded in edematous, inflammatory connective tissue. On examination three weeks later, several additional nodules were seen in the region whence the first had been removed. Radium treatment was instituted and at the time of reporting the tumors had regressed. F. CAVERS

Sarcoma of the Uterus in the Dutch East Indies, W. J. Roos VAN DEN BERG. Sarcoom van de baarmoeder, Geneesk. tijdschr. v. Neder1.-Indie 73 : 1521-1528, 1933. Also in Nederl. tijdschr. v. verlosk. en gynaec. 37: 21-31, 1934. The author reports three cases occurring in Javanese women aged fifty-five, fifty, and forty. In the first the uterus was curetted, and the patient died four days later. The sarcoma is regarded as having arisen in the endometrium of a non-myomatous uterus. In the second case hysterectomy was done, and the largest of the many myomas present showed in places the structure of myosarcoma, with metastasis to the left ovary. Deep x-ray treatment was given, but cough and hemoptysis developed and the patient died six weeks later. At necropsy metastases were found in both lungs, spleen, and greater omentum. In the third case a spindle-cell sarcom&had developed in a solitary polypoid submucous myoma. Radium was given, followed by hysterectomy, and the patient was well at the time of reporting, a year after operation. The author states that of 175 malignant uterine tumors occurring in Javanese women during the period 1929 to 1933, 10 were sarcomas (nearly 6 per cent). He cites large statistical publications showing the incidence of sarcoma in all malignant uterine tumors to be about 3 per cent, The proportion of uterine sarcomas to carcinomas would appear to be about twice as great in natives of the Dutch East Indies as in Europe. There are seven illustrations. F. CAVERS Angiomyoma of the Uterus, F. 0~~6s.Angiomyoma uteri, Zentralbl. f. Gynak. 58: 122-128, 1934. The author reports the case of a forty-five-year-old woman from whom a uterine tumor about the size of an eight months’ pregnancy was removed. €@tologic study 904 ABSTRACTS showed it to be composed almost exclusively of blood capillaries embedded in a small amount of smooth muscle. The diagnosis of angiomyoma was made. The article is illustrated with several photomicrographs. BENJAMINR. SHORE Cystadenoma of the Wolf3an Duct, H. DWORZAK.Uber ein Cystadenom des Wolffschen Ganges, Arch. f. Gyniik. 157: 162-169, 1934. The author reports the case of a fifty-year-old woman from whom the uterus containing fibroids and a parametrial cyst measuring 7 by 5 by 3.5 om. was surgically removed. The latter cyst was multiloculated and contained dark brown mucus. Histologic study of the wall of the cyst showed it to be composed of connective tissue and muscle fibers, with a lining of epithelium which in places was adenomatous and formed glands. This tumor was considered to have arisen from remnants of the wolffian duct. The article is illustrated with photographs of the gross specimen and photomicrographs. BENJAMINR. SHORE

Torsion of the Fibromatous Uterus, a Surgical Emergency, M. A. MCIVERAND C. L. BUXTON.Surg., Gynec. & Obst. 59: 663-670, 1934. Twists of a pedunculated ovarian cyst or fibroid are relatively common; rotation of a fibroid uterus, on the other hand, is rare. Torsion of the uterus becomes much more likely when this organ is enlarged, rises out of the pelvis, and is only loosely held by stretched ligament5, Approximately 140 cases of torsion of a fibroid uterus have been reported in the literature; 8 of these were seen in the United States. The authors' patient was a sixty-two-year-old woman in whom a large fibromatous uterus was rotated 360 degrees on the cervix. The broad ligaments, tubes, and ovaries were black and gangrenous in appearance and the broad ligaments were distended with extravasated blood; After the torsion was reduced, a supravaginal hysterectomy was done. The patient made a good postoperative recovery. The article is illustrated with several photographs of the gross specimen. Abstracted histories of the other case8 reported in the American literature are included, and there is a bibliography. BENJAMINR. SHORE Torsion of the Fibromatous Uterus, L. COURTY.La torsion des fibromes utbrins, Gyn6cologie 33: 41-57, 1934. The author discusses, with references to the available French literature, the frequency, diagnosis, and treatment of torsion of the fibromatous uterus, which may give rise to intestinal occlusion. In the latter case the real condition of affairs is usually diagnosed and cured because immediate Iaparotomy is generally done. In unoperated cases, or those in which operation is delayed unduly, the mortality is about 70 per cent. The author emphasizes that the condition can usually be diagnosed by carefui examination, and that the only effective treatment is prompt hysterectomy, the mortality of which should not exceed 5 per cent. F. CAVERS Intra-peritoneal Hemorrhage due to Torsion of a Pedunculated Uterine Bibromyoma, S. J. TUREL. Internat. J. Med. & Surg. 47: 240-242,1934. In 1928 Hoffman (Monatsschr. f. GeburtBh. u. Gyniik. 78: 210, 1928) collected 29 cases of intra-abdominal hemorrhage due to a lacerated blood vessel on the surface of a uterine fibroma. The author has found reports of 13 more, bringing the total to 42, 9 of which were due to torsion of the tumor pedicle. His own case brings these figures to 43 and 10 respectively. A woman of fifty-two, an inmate of a mental hospital, had a sudden attack of severe abdominal pain with vomiting. The abdomen was moderately distended, with generalized rigidity and rebound tenderness especially in the appendiceal area. Vaginal examination was unsatisfactory and a diagnosis of ruptured appendix with abscess formation was made. At operation about 500 C.C. of blood was removed from the abdominal cavity by suction. The hemorrhage was found to be due to a torsion of 180 degrees of a pedunculated fibroid tumor. The pedicle was so friable that the tumor became separated from the uterus during manipulation. The bleeding surface was easily -controlled by THE FEMALE GENITAL TRACT 905

sutures. All visible blood clots were removed and the abdomen closed. At the time of the report, several months later, the patient was in good health. The author includes a general discussion based on the literature and a bibliography. Myoma and Pregnancy, G. FROMMOLT.Myom und Schwangerschaft, Ztschr. f. iirztl. Fortbld. 30: 605-607, 1933. A discussion of the diagnoais and treatment of coincidental myoma and pregnancy. The difficultiesin early diagnosis are stressed, and the indications for the various types of therapy pointed out. There are no illustrations and nothing new is contributed. THEODORES. RAIFORD Management of Birth in the Presence of Myoma Praevia, 0. KOLLER. Zur Geburts- leitung bei Myoma praevium, Zentrlbl. f. Gyniik. 58: 1592-1595, 1934. Although interference with birth by a myoma located at the mouth of the uterus is considered rare, the author personally observed 3 such cases. The first was recognized early enough to allow surgical interference. The fetus was removed by section and two myomata on the anterior wall of the cervix were enucleated. The second patient was so far advanced in pregnancy that in order to save her life, the child had to be sacrificed. Following this a large myoma was removed per vaginam from the posterior wall of the cervix. The third patient was delivered by abdominal section, after which the tumor was satisfactorily removed. All three patients recovered. It is emphasized that cases such as these necessitate treatment varying with the individual case and cannot be satisfactorily managed by any hard and fast rule. There are no illustrations. THEODORES. RAIFORD

Fibroma of Lower Uterine Segment in Pregnancy, FAVREAU,BELLE AND FOURNIER. Tumeur et grossesse, Bull. SOC.d’obst. et de gyn6c. 23: 232-233, 1934. The authors consider that when early pregnancy is complicated by ovarian or parovarian cysts it is better to operate at once, since these tumors nearly always cause abortion. In the presence of fibreids, on the other hand, it is wiser, as a rule, to postpone intervention unless painful or inflammatory complications make it necessary. A woman of thirty-seven was seized with violent lower abdominal pain in the fourth month of her first pregnancy. The uterus was greatly enlarged, reaching the umbilicus, and on its anterior aspect there were numerous nodules. In addition, a large, hard, fixed tumor was palpated in the right iliac fossa and cul de Sac. This was found at laparotomy to be a fibroma of the lower uterine segment just above the internal os, and impossible of enucleation. Subtotal hysterectomy was done on the ground that, owing to its position, the tumor would have made normal labor impossible and that postponement of operation was dangerous. F. CAVERS Fibromatous Uterus, Placenta Praevia, Cesarean Section, A. ARTAUD. Placenta praevia et fibrome; c6sarienne mutilatrice, Bull. SOC.d’obst. et de gyn6c. 23: 238-240, 1934. During labor in a woman of thirty-eight, pregnant for the first time, the head could not be engaged, owing to placenta praevia. Abdominal palpation showed the presence of nodules, evidently subserous fibromyomas. A living child, who throve well, was delivered by cesarean section, and owing to the fibromatous condition of the uterus, which seemed certain to preclude a later normal pregnancy, total hysterectomy was done. F. CAVERS Uterine Fibromyoma Causing Puerperal Hemorrhage, R. SCKWARCZ.Hemorragia en el puerperio por fibroma; histerectomfa, Semana m6d. 1 : 1279-1284, 1934. A primipara of thirty-five had slight irregular hemorrhage during the early months of pregnancy, and examination revealed two small subserous fibroids. Labor was prolonged, but the placenta was expelled intact. Three days later there set in hemorrhage which rapidly increased in rate, could not be controlled by plugging, and caused grave anemia, for which blood transfusions were given. A submucous fibroid, which had at the end of labor been felt about-3-cm. above the internal 08, was now found to be pro- 906 ABSTRACTS jecting into the uterine cavity. The author performed hysterectomy, and the patient made a steady recovery, though the anemia persisted for several months afterwards. The traction of the uterine wall had caused a natural process of enucleation of the tumor, with rupture of the endometrial blood vessels. There are two illustrations. F. CAYER8

Influence of Tuberculous Infection upon Fibromyomas of the Uterus, E. BARBANTI- SILVA. Contributo all0 studio dell’ infezione tubercolare dei fibromiomi dell’ utero, Monitore ostet.-ginec. 5: 363-380, 1933. This is a summary of the clinical findings, and a detailed histological description, of a case in which tuberculosis involved the tubes, ovaries, and the uterus. There was also a fibromyoma in the anterior wall of the uterus, and the tuberculous process was most prominent in the mucosa overlying the fibromyoma, and in the portion of the uterine wall adjacent to it. The author reviews the opinions of other writers on the influence of tuberculosis on smyomas of the uterus and includes five not very satisfactory photomicrographs and a bibliography, c. D. HAAGIENSEN Fibromas of the Uterine Cervix with Extension to the Pelvic Floor, R. KILLER. 3% bromes B point de depart cervical d4velopp4s vers le plancher pelvien, Bull. SOC. d’obst. et de gyn4c. 23: 168-169, 1934. Two cases are reported. In the first palpation revealed a tumor mass extending from the cervical canal downwards in the rectovaginal septum. At operation, other fibromas were found having the same site of origin. Hysterectomy was done, but the downward- growing tumor was difficult to remove, as it encroached on the bladder and compressed the pelvic nerves. The latter features explained the frequency of urination and pain in the left thigh of which the patient complained, and which disappeared after operation. In the second case a tumor with similar origin and extension interfered with labor in a woman of twenty-three and necessitated cesarean section. F. CAVERS

Uterine Fibroma Associated with Intramural Abscess, G. PECOAND A. H. MOLFINO. Fibroma del dtero con absceso intramural; v6mica uterina, Semana mOd. 1: 1190- 1192, 1934. A woman of forty-six had for about seven months had frequent attacks of pain in the lower abdomen, each attack being followed by pollakiuria. There was a tumor in the anterior wall of the uterus, a short distance above the internal 0s. Pressure on the tumor caused a flow of pus from the cervix, and a diagnosis of necrotic fibroma with abscess formation was made. The patient was anemic and neurotic, and as the abscess was draining well, at the time of reporting, the authors decided to continue with local antiseptic treatment, in addition to treating the anemia, reserving operation until it should become necessary. F. CAVERS Suppurating Necrotic Uterine Bibromyoma, J. MANC~.Suppuration d’un fibrome sphac616, Bull. SOC.d’obst. et de gyn6c. 23: 214-215, 1934. In a woman of thirty-four whose first pregnancy ended in an abortion in the third month, operation revealed 6 large, soft, necrotic fibroid which had burrowed into the pouch of Douglas and which showed a central cavity containing green pus; a similar but smaller tumor occupied the anterior wall of the uterus. In the author’s experience infection of a fibroid is rare, even when the tumor is necrotic. F. CAVERE Hormonal Treatment of Uterine Mpomata, K. ABEL. Zur Hormonbehandlung der Uterusmyome, Therap. d. Gegenw. 74: 215-217, 1933. Using a preparation of mammary hormone, the author claims to have had remarkable success in the treatment of uterine myomata. In a series of 80 cases treated during the past three years, bleeding was controlled in 80 per cent and, with moderate sized myomas, the uterus returned to normal size in one third of the cases in a period of six months, The theory of the hormonal action is discussed briefly and there is a short bibliography. THEODORES. RAIFORD THE FEMALE GENITAL TRACT 907

Hydatid Mole and Chorionepithelioma, FULCONIS.M61e hydatiforme et chorion- BpithBliome, Bull. SOC.d’obst. et de gynBc. 23: 196-198, 1934. A woman of unstated age had aborted at three months, with expulsion of fetus and placenta, the latter, according to the attending nurse’8 statement, being complete. The patient continued to bleed, vomited repeatedly, and became feverish. When called in, the author found the uterus greatly enlarged and the Aschheim-Zondek reaction strongly positive. After a delay of several days, during which the patient’s condition became worse, the author decided to intervene. A mole weighing over one pound was removed digitally, and curettage was done. Twenty days later the patient again began to bleed. The uterus was again greatly enlarged and was soft, with a large mass on either side and above it [There is no mention of a further Aschheim-Zondek test having been made during this interval.] Subtotal hysterectomy was done, with removal of the polycystic ovaries. The fundus contained a nodulated tumor which had invaded the musculature as far as the serosa, and which proved to be a chorionepithelioma. The patient recovered, and at the time of reporting, seven months after hysterectomy, the Aschheim-Zondek reaction was negative. In the ensuing discussion there was some conflict of opinion as to what should be done in such a case. Pouget thought it better to wait until the mole had been spontaneously expelled, because curettage involves the risk of disseminating cells in process of malignant change. Laffort pointed out that in some cases the expulsion of the mole is delayed owing to its being deep seated and adherent to or invading the musculature. He advocated immediate hysterectomy. Ferrari considered that in a woman approaching the menopause vaginal hysterectomy should be done immediately, though in a young woman it might be permissible to await, for a few days only, spontaneous expulsion. F. CAVERS

Chorionepitheliomas and the Aschheim-Zondek Reaction, H. SCHWALM.Chorion- epitheliom und Aschheim-Zondek-Reaktion, Zentrdbl. f. Gynak. 58: 1212-1218, 1934. Also in Ztschr. f. Geburtsh. u. Gynak. 108: 419-424, 1934. A forty-one-year-old woman began to bleed from the uterus after a period of amenorrhea and possibly a spontaneous abortion. Several months after this a curettage was done because of continued bleeding. Histologic study of the specimen showed several small islands of chorionic cells. Urine diluted 1 to 100 produced only follicle ripening when injected into immature mice. During the next few months the patient continued to bleed and the uterus definitely increased in size. The urine at this time produced follicle ripening in mice in a dilution of 1 to 200. A diagnosis of chorionepithelioma was made and a panhysterectomy and bilateral salpingo-oophorectomy was performed. Examination of the uterus discloeed a chorionepithelioma about 5 cm. in diameter. The urine of this patient thirteen days after operation contained sufficient anterior pituitary hormone to cause follicle ripening when it was injected undiluted into mice. The end-result is not given. The article is illustrated with several photomicrographs. BENJAMINR. SHORE

Fatal Peritonitis Following Perforation of a Chorionepithelioma,GONNET, DARGENT AND A. MOREL. Un cas de peritmite generalis6e mortelle par perforation d’un chorio- BpithBliome, Bull. SOC.d’obst. et de gyn6c. 23: 153-155, 1934. A woman of twenty was admitted to hospital with free-uterine hemorrhage and slight enlargement of the uterus. Four months previously she had had an apparently normal labor. Six weeks after this the periods returned, but the patient had ever since continued to lose blood and clots. The uterus was explored digitally and abundant and very adherent debris removed. [No mention is made of histologic examination of this material, or of an Aschheim-Zondek test.] For some days hemorrhage ceased, then began again. Despite advice the woman left the hospital, but a week later returned, extremely ill, with signs of septic peritonitis. She died next day. At necropsy there was abundant pus and blood in the peritoneal cavity, and on the posterior aspect of the uterus was a hole whence blood flowed. The greater part of the uterine wall consisted of soft, red, putrid material, found histologically to be infected chorionepithelioma. The 908 ABSTRACTS authors add that there was nothing in the case history to suggest incomplete expulsion of the placenta at the accouchem’ent;otherwise they would have made an Aschheim-Zondek test. F. CAVERB

Extragenital Endometriosis, W. SCHARAND S. SCHEIDEGGER.Uber extragenitale Endometriosen, Bruns Beitr. z. klin. Chir. 160: 161-173, 1934. The authors report three cases of extragenital endometriosis. The first patient came to operation for acute intestinal obstruction and was found to have a stenosing endometriosis of the ileum and myomata of the uterus. The second patient, three years after curettage of the uterus for a polyp, showed endometriosis of the umbilicus. The third patient underwent operation for a tuba1 pregnancy. The tube was removed and showed endometriosis. Three theories have been off bred for the origin of extragenital endometriosis : from developmental anomalies, from implantation, and from the serosal epithelium. These lesions exhibit a tendency to enlarge during the menstrual period, a characteristic which frequently leads to a correct clinical diagnosis, Surgical therapy is advocated. There are two illustrations and a short bibliography. THEODORXIS. RAIFORD

Case of Endometrioma of $e Umbilicus, J. LANOSAND FRITZBUSSIR. Sur un cas d’endom6triome de l’ombilic, Bull. et m6m. SOC.d. chirurgiens de Paris 25: 134- 144, 1933. An unmarried woman forty years of age had for more than a year noticed swelling and pain in the umbilicus during the first days of the menstrual period, more recently accompanied by a bloody discharge at the same site. In the last month there had been some purulent discharge in the intermenstrual period. A small tumor of the umbilicus was found on examination and was removed. The patient had no further symptoms. Histological examination showed a typical endometrioma. Genesis of Bladder Endometriosis, G. HASELHORST.Zur Genese der Blasenendometri- ose, Zentralbl. f. Gyniik. 57: 3021-3029, 1933. The author has collected twenty-five cases of endometriosis of the urinary bladder from the literature. In only 3 cases had the bladder tumor originated in a patient without earlier known gynecologic diseases or pelvic operation. Sterility and a definitc predisposition to abnormal connective tissue and epithelial growths seemed to exist in a majority of these cases. In no instance did endometriosis of the bladder occur as a solitary primary condition. In all of the cases the involvement of the bladder was on its posterior wall, usually between the openings of the ureters. It seemed obvious in these cases that the growths originated either in the anterior wall of the uterus or cervix or in remnants of endometrium situated in the utero-vesical septum. The article is illustrated with several photomicrographs. BENJAMINR. SHORE Genesis of Endometriosis of the Bladder and Abdominal Wall, HASELHORST.Zur Genese der Blasenendometriose. Zur genese der Bauchwandendometriose, Arch. f. Gyniik. 156: 382-386, 1933. Short histories of two patients with endometriosis are reported. The first was a thirty-nine-year-old woman with an endometrioma of the bladder. Careful examination showed that this tumor arose in and was directly continuous with the uterine cervix. The second patient was a thirty-one-year-old woman with an endometrial tumor of a fallopian tube which had been drawn into the abdominal wall at a previous operation. There are no illustrations. BBNJAMINR. SHORE

Endometrial Hyperplasia, F. R. FARTHING.J. Missouri M. A. 31: 144-148, 1934. The author discusses our present knowledge of the hormonal control of menstruation and the production of endometrial hyperplasia by the continued secretion of oestrin. He rbts9 cases of this form of endocrine imbalance all proved by curettage. Six of these were cured or improved by injections of the anterior pituitary-like hormone of t, ‘k, THE FEMALE GENITAL TRACT 909

pregnancy urine (antruitrin S). One was cured by hysterectomy, one by curettage, and one, which showed little menorrhagia or metrorrhagia, was not treated. GRAYTWOMBLY Fibroma of the Round Ligament, N. ARENAS. Fibroma del ligament0 redondo, Prensa m6d. argent. 20: 234-236, 1933. The author reports the occurrence of a firm, painful, slow-growing fibroma of the right inguinal region in a girl of eighteen years. It was easily enucleated. F. CAVERS

Results of the Treatment of Ovarian Carcinomas, C. SCHROEDER.Uber unsere Ergeb- nisse bei der Behandlung des Ovarialkarzinoms, Strahlentherapie 51 : 465-476, 1934. Treatment of ovarian carcinomas should consist, whenever possible, in the radical surgical removal of these growths and postoperative irradiation. From 1923 to 1933, 134 patients with ovarian carcinomas were treated in the University Woman’s Clinic in Wiirzburg ; 103 of these tumors were studied histologically. In thirty-one instances the tumors were so extensive that the operative treatment was limited to an exploratory laparotomy and the taking of a biopsy for histologic study. Five-year survivals were obtained in 18 of 56 patients in whom the treatment was begun five or more years previously; three of these patients, however, died of their disease between the fifth and seventh years after treatment. The absolute curability obtained in these 56 cases, therefore, was 26.7 per cent. Five-year survivals were obtained in 60 per cent of the patients in whom radical surgical excision of the growths and postoperative irradiation were possible, in 25 per cent of the patients with incomplete operations and postoperative irradiation, and in 9 per cent of the patients treated by exploratory laparotomy and postoperative irradiation. From these figures it is concluded that prophylactic irradiation is indicated following the surgical removal of ovarian carcinomas. When possible, intra- uterine implantation of radium is a useful adjunct to the ordinary roentgen therapy. The primary operative mortality following the radical surgical removal of the ovarian tumors in this series was 2.7 per cent. BENJAMINR. SHORE

Roentgen Therapy of Malignant Ovarian Tumors, M. JOLY.Consid6rations sur 19 traitement roentgenthhrapique des tumeurs malignes de l’ovaire, Bull. SOC.d’obst. et de gyn6c. 23: 128-132, 1934. Roentgen Therapy of Malignant Ovarian Tumors, P. MOULONGUET.A propos de la communication de M. Joly sur le traitement roentgenothhrapique des tumeurs malignes de l’ovaire, Ibid. 23 : 357-359, 1934. Joly’s paper is practically a summary of an earlier one (Abst. in Am. J. Cancer 21: 452, 1934). He considers that the histologic characters of malignant ovarian tumors often have but little value from the point of view of irradiation, except in the case of seminomas, which are extremely sensitive. In discussing this paper, A. BBclere pointed out that postoperative deep x-ray treatment of ovarian cancer has for more than twenty years been the subject of an extensive literature, especialIy outside of France. Workers in America, Germany, and Sweden have drawn from their experience certain conclusions which should be borne in mind. Exploratory laparotomy should be done in every case of ovarian tumor. If the latter is judged absolutely inoperable, ascites, if present, should be evacuated and a biopsy done. If the tumor is incompletely operable, it should be removed as widely as possible. Deep x-rays should be given in every case, with the addition of radium if the pouch of Douglas is invaded. The x-rays should be very penetrating, and given in fractionated divided doses so as to obtain intensive treatment with high dosage in a short time. Moulonguet remarks that Joly’s statistics, given in three more or less identical publications of the same material, are interesting, but he takes exception to the statement that the histology of ovarian cancers is practically valueless as a criterion of radiosensitivity, and asks why ovarian tumors should be excepted from the rule that there is on the whole a close relation between the histologic picture of a cancer and its response to irradiation. In the case of papillary tumors, there is every stage from benign to frankly malignant histologic structure. As shown by Taylor and Alsop (Am. J. Cancer 16: 1305, 910 ABSTRAUTS

1932), even incomplete removal is sometimes followed by cure. Moulonguet reports a personal case of this kind in which both ovaries were affected and there were numerous vegetative growths on the peritoneum and intestine, with abundant ascites; he removed the ovaries, and five years later there was no sign of recurrence or metastasis. F. CAVERS Hydrometria Following Postoperative Radium Irradiation for Ovarian Carcinomas, E. VOQT. Hydrometrabildung nach postoperativer Radiumbestrahlung wegen Ovarial- karzinom, Strahlentherapie 50: 683-080, 1934. A thirty-three-year-old woman was given intra-uterine radium and roentgen irradiation after the surgical removal of both ovaries for carcinoma. Two years after irradiation a total hysterectomy was performed because of symmetrical enlargement of the uterus due to hydrometria. The uterine cavity contained about 200 C.C. of cloudy hemorrhagic fluid. The endometrium was smooth and the uterine musculature was greatly thinned. This complication after irradiation of pelvic tumors is considered rare. BENJAMINR. SHORE

Embryonal Carcinoma of Ovaries, M. J. FEINAND R. GOLDBERQ.Internat. J. Med. & Surg. 47: 530-532, 1934. A girl of two years fell while playing on the street and a few days later complained of generalized abdominal pain. The abdomen was contused and swollen. It continued to enlarge, nausea and vomiting occurred, and the child became pale and listless and lost weight. At operation the uterus was found to be enlarged; both oJaries were enlarged and solid. The ovaries were removed and on microscopic examination showed a diffuse arrangement of cells having large hyperchromatic nuclei and granular cytoplasm. The cells were arranged in groups and were separated by a net work of fine reticulum in places Elsewhere they were seen running between strands of connective tissue infiltrated with lymphocytes. OccasionaI mitoses were seen. The diagnosis was embryonal carcinoma of the ovaries. The author found only one case reported in a patient younger than his (Hunt and Simon: Ann. Surg. 87: 84, 1928). He does not mention the outcome of the operation.

Ovarian Carcinoma During Pregnancy, SANCHEZ LUCABAND R~BAQO.Carcinoma de ovario y embarazo, Arch. med., cir. y especialid. 37: 864, 1934. A woman was admitted to the hospital in the eighth month of pregnancy, complaining of severe lumbosacral pain. There had been blood-stained sputum, but no tubercle bacilli could be found, and x-rays showed only pulmonary stasis. The patient became very ill, had intense headache, then delirium and hallucinations. A few days later normal delivery occurred, and a large tumor was palpated above and to the right of the fundus. The patient died six hours later. At necropsy the tumor proved to be an adenocarcinoma of the right ovary. The liver was enlarged and showed proliferation of the reticulo-endothelial tissue. Nothing is said about examination of the thorax, cranium, or vertebral column. F. CAVERS Masculinizing Ovarian Tumors (Ovarian Arrhenoblastomas), 2. v. SZATHMARY.Uber eine virilisierende Ovarialgeschwulst (Arrhenoblastoma ovarii), Arch. f, Gynak. 157 : 170-186, 1934. A twenty-five-year-old woman had amenorrhea, hypertrophy of the clitoris, atrophy of the breasts, deepening of the voice, and masculine distribution of the body and facial hair. These symptoms had appeared about eighteen months previously and had gradually increased. Examination disclosed an elastic tumor about 12 cm. in diameter situated in the pelvis. At operation a tumor of the right ovary was found, twisted 180 degrees on its pedicle. After surgical removal of this growth, the patient gained weight and gradually lost all of the masculine symptoms except the increase of hair on the body and face. She began to menstruate four weeks after the operation. Histologic study of the growth showed it to be a typical tubular arrhenoblastoma. Thirty similar cases of ovarian arrhenoblastomas causing typical masculinization THE FEMALE QENITAL TRAUT 91 1

have been collected from the literature. Complete disappearance of the abnormal hair on the face and body after operation was observed in 16 of 21 patients with this symptom. Disappearance of the hair usually began about four weeks after operation but in some instances was not noticed for twenty-one months. Nine of the 12 patients with deepening of the voice regained a normal feminine voice after removal of the tumor. The article is well illustrated with photographs and photomicrographs. BENJAMINR. SHORE

Ovarian Disgerminomas, H. 0. KLEINE. Beitrage zur Klinik des Disgerminoma ovarii, Arch. f. Gynak. 158: 89-97, 1934. The author reports the histories of 7 patients with ovarian disgerminomas. The clinical symptoms associated with these tumors are hypoplasia of the genital organs and general asthenia. All of the patients were between fifteen and twenty-four years of age with the exception of one, who was thirty years old. There was no hermaphrodite. The typical histologic structure of a solid alveolar carcinoma composed of large round cells was present in each case. In five instances the tumor was unilateral, in one bilateral] and in one case a tumor of the left ovary developed shortly after removal of a tumor of the right ovary. The three patients who have been followed for from seven to twenty-four years after operation have remained well. The article is illustrated with photographs and photomicrographs. BENJAMINR. SHORE Pneumo-peritoneum Concurrent with Paracentssis, Its Use in Papillo-cyst Adenomata of the Ovary, L. A. FORTIERAND T. T. GATELY. New Orleans M. & 5. J. 87: 315-316, 1934. In selected cases in which paracentesis for relief of ascites is imperative, injection of air into the peritoneal cavity and subsequent roentgenograms in various positions will offer aid in arriving at a correct diagnosis. One is able not only to demonstrate the original tumor mass but also to determine whether or not metastatic peritoneal implants are present. The latter appear as rounded or irregular masses of varying size projecting into the surrounding injected air. Several roentgenograms illustrate the article. BENJAMINR. SHORE Twisted Pedicles of Ovarian Tumors, G. MBNCH. Experimentelle Versuche zur Stieldrehung der Ovarialgeschwiilste, Zentralbl. f. Gynak. 58: 1338-1341, 1934. The mechanics associated with twisting of the pedicle of ovarian cysts were studied on a model constructed to simulate the conditions of the female pelvis. It was concluded from this study that the natural peristaltic movements of the intestines]especially when associated with a lax anterior abdominal wall, were sufficient to cause the clock- wise rotation of right ovarian cysts and the counter clock-wise rotation associated with the twisting of left ovarian cysts. The article is illustrated with several drawings. BENJAMINR. SHORE Origin of Ovarian Chorionepitheliomas, E. KLAFTEN. Zfber das Vorkommen chorio- epitheliomatoser Strukturen im Eierstock, Arch. f. Gynak. 158: 131-150, 1934. In 180 cases of primary ovarian malignant tumors there were 19 granulosa-cell tumors, 6 disgerminomas, and one chorionepithelioma. The latter occurred in an eleven-year-old girl and was rapidly fatal in spite of surgical extirpation of the growth and postoperative radiiim and roentgen irradiation. The primary tumor was about 15 cm. in diameter and in places showed the typical histologic characteristics of a chorionepithelioma. In other places the cellular arrangement suggested a granulosa-cell tumor. This growth was considered to have arisen primarily in the ovary and probably repre- ' sented an unusual development of chorionepithelioma tissue in a teratoma. The article is well illustrated with photomicrographs. BENJAMINR. SHORE

Krukenberg Tumor, H. M. WEETER. Kentucky M. J. 32: 186-187, 1934. A white female of thirty-four complained of distention and showed on examination a lower abdominal tumor. At operation tumors were found'in both ovaries measuring 0 912 ABSTRACTS

and 3 inches in diameter respectively. On removal these were found to consist of the typical signet-ring cells of the Krukenberg tumor. Five months later an epigastric mass appeared and the patient subsequently died of carcinoma of the stomach. GRAYH. TWoMnLY Cirrhosis with Enlargement of the Spleen Resembling Banti’s Disease Associated with Bilateral Reticulosarcoma of the Ovaries, E. C. CRACIUNAND T. MOISESCU. Cir- rhose splBno-mBgalique rappelant la maladie de Banti associbe avec une double sarcomatose r6ticulBe primitive de l’ovaire, Bull. et mBm. SOC.m6d. d. h8p. Buca- rest 15: 175-180, 1933. A woman twenty-three years of age presented enlargement of the spleen, cirrhosis of the liver, ascites, anemia, amenorrhea, purpura, and slight jaundice. The syndrome suggested the diagnosis of Banti’s disease and splenectomy was attempted, but found to be impossible as the spleen was too friable. The patient died a few days after operation. Autopsy showed sclerosis of the spleen, cirrhosis of the liver, and bilateral ovarian neoplasms. The latter proved to be reticulosarcoma, a type more frequently originating in the lymph nodes than in reticulo-endothelial tissue in other organs. Bilateral Papillary Ovarian Twnors with Coexistent Bilateral Tubal Tuberculosis, N. C. LAPEYREAND H. ESTOR. Bacillose tubaire et tumeurs vBgBtantes des ovaires, Bull. SOC.d’obst. et de gynBc. 23: 311-314, 1934. A woman of twenty-seven had five years previously been operated upon for tuberculous appendicitis. Since then she had suffered continuous pain in the lower abdomen, accentuated during the menses, which were brief and scanty. On the left of the operative scar was a rounded swelling, painful on pressure. Palpation revealed a tumor on either side of the small uterus. X-rays showed deformation, flattening, and fixity of the cecum. At laparotomy the omentum was seen to be adherent to the abdominal wall and to contain numerous cystic nodules. The tubes and ovaries formed a practically continuous polycystic mass, all of which was removed, together with the uterus, except for a portion of the mass lying in the pouch of Douglas and densely adherent to the peritoneum, cecum, and colon. Histologic examination showed tuba1 tuberculosis and bilateral papillary ovarian tumors. The latter showed no histologic signs of malignancy. The omental nodules were of the same structure. An unusual feature was the absence of ascites, despite the presence of implants from the ovarian tumors. F. CAVEI~S Syndrome of Intestinal Obstruction from Compression by a Voluminous Mixed Tumor of the Ovary, C. ODESCALCHI.Sindrome occlusiva intestinale de compressione di voluminoso tumore misto dell’ ovaio, Atti d’Acad. med. Lombarda 21 : 06-72, 1933. A 3500 am. tumor of the right ovary was removed from an eleven-year-old girl with a history of pain and dysuria for one month and complete intestinal obstruction for three days. There were no adhesions. The solid tumor contained a few cystic cavities containing serous fluid and revealed cartilaginous, adenomatous, myxomatous, and fibroleiomyomatous elements in a fibqous trabeculated stroma. The author discusses the Wilms classification and places his case in the category of solid teratoma of the ovary, the rapid growth of which is responsible for intestinal displacement and compression. A photograph of the tumor is included. NELSON€3. SACKETT Large Mucoid Ovarian Cyst Densely Adherent to the Inner Abdominal Wall, J. I,. LAPEYREAND MENDEZ-LLAMOZAS.Kyste de l’ovaire Bnorme et adhBrent, Bull. SOC.d’obst. et de gynBc. 23: 133-135, 1934. In a woman of forty, who had noticed increasing abdominal swelling for about eighteen months, the right ovary was found at operation to be replaced by a huge cystic mass containing about 25 liters of hemorrhagic fluid. This was difficult to remove because of the dense adhesions between the cyst wall and the parietal peritoneum. There is ,one illustration. I?. CAVERS THE FEMALE GENITAL TRACT 913

Interesting Case of Polycystic and Multilocular Ovarian Cyst, M. ABDULLA.Anti- septic 31 : 889-890, 1934. A report of successful removal of a large multilocular ovarian cyst from a woman of seventy-five with evidences of chronic heart disease. The operation was done under neocain anesthesia (subarachnoid block). Torsion of Ovarian Cysts in Children, OBERTHUR.La torsion des kystes de l'ovaire chez l'enfant, Pediatrie prat. 31 : 329-331, 1933. A nine-year-old girl was suddenly seized with recurring attacks of severe pain in the right iliac fossa. The pain was intermittent, and was accompanied by vomiting of food and bile. Several days after onset, the child's temperature was moderately elevated and the pulse was 134 per minute. The right lower quadrant exhibited muscle spasm on any attempt at palpation. A digital examination of the rectum disclosed a round, cystic, movable tumor, the size of an orange. The clinical diagnosis of ovarian cyst with twisted pedicle was verified at operation. WILLIAMa. HOFFMAN Biology of the Irradiated Ovary: An Ovarian Dermoid in a Patient Treated for Carci- noma of the Cervix by Radium and X-Rays, J. GRANZOW.Zur Biologie des Strahlen- ovars : Dermoid im Ovarium einer wegen Kollumkarzinoms mit Radium und Ront- gen Bestrahlten, Strahlentherapie 49: 694-702, 1934. A forty-one-year-old woman received combined radium and x-ray therapy for a carcinoma of the cervix. Amenorrhea promptly ensued, and twenty-seven months after the completion of treatment the adnexa were normal to palpation. Five months later a tumor the size of a fist was felt in the right ovary. At operation, one month afterward, this was found to be a dermoid cyst. Both ovaries exhibited the pathological picture characteristically seen after irradiation. While the appearance of the cyst may have been coincidental, the author believes that it was secondary to the treatment and offers, in support of this, several cases reported in the literature in which tumors have developed in the ovaries subsequent to irradiation. There are no illustrations, A short bibliography is appended. THEODORES. RAIFORD

Recurring Vaginal Tumor in a Child, J. GATE,P. CUILLERETAND M. HENRY. Tumeur vaginale r6cidivante. Sarcome ganglionnaire terminale, Bull. SOC.franp. de dermat. et syph. 41: 140-142, 1934. The authors continue the history of a case reported in 1932 by,Tavernier and Pouzet (Bull, SOC.franp. de dermat. et syph. 39: 833, 1932. Abst. in Am. J. Cancer 19: 754, 1933). The patient was a three-year-old girl, and though the tumor removed at the second recurrence resembled a bunch of grapes, no histologic sign of malignancy was found. Further recurrence took place a year after the operation previously reported, and was found to be invading the vagina more extensively than before. On removal the tumor was found to be a leiomyosarcoma; there was still no sign of lymph node metastasis, and the epidermis overlying the tumor was intact. Two months later, there was a fourth recurrence with vaginal hemorrhage and enlargement of the inguinal nodes; a tumor nodule was also palpable in the left iliac fossa. X-ray treatment was given, but uncontrollable vaginal and rectal hemorrhage set in and the child died in coma. Necropsy was not allowed. [Despite the meager histologic details given in both this paper and the previous one, the original tumor (which was not examined histologically at all) and the recurrences were probably of the " grape sarcoma " type which occurs fairly frequently in the vagina in childhood, and which carries an extremely unfavorable prognosis.] F. CAVERS Vaginal Cysts in Fetuses, E. VILAS. Cysten in der Scheide von Feten, Arch. f. Gyniik. 158: 1-13, 1934. In a 17.5 cm. fetus, sixty small cysts were demonstrated in the vaginal wall. In this case these cysts were thought to have arisen from Muller's epithelium and from the epithelium composing the urogenital sinus. In a 20 cm. fetus, a single epithelial 914 ABSTRACTS cyst, probably arising in the wolffian duct, was found in the vault of the vagina near the cervix. The article is illustrated with several photomicrographs. BENJAMINR. SHORE

Carcinoma of the Vulva Diagnosed During Pregnancy, P. TRILLATAND CONTAMIN. Un nouveau cas de cancer vulvaire avec grossesse, Bull. SOC.d’obst. et de gyn6c. 23: 298-299, 1934. A woman of forty-two noticed, in the fifth month of her sixth pregnancy, a tumor in the left labium major. At one point there was a black patch, suggesting melanoma, but biopsy showed the features of squamous-cell carcinoma. The labium and the enlarged left inguinal nodes were excised, and two tubes each containing 70 mg. of radium were placed under the sutures for forty-eight hours, Fifteen days after labor, which was normal, four small hard nodules were seen in the operative scar and adjacent skin, and were found on biopsy to be carcinomatous recurrences. Radium treatment was given as before, but there was rapid invasion of the vagina, and death occurred eight months later. F. CAVFIRS

Primary Carcinoma of the Bartholin Gland, H. H. M. LYLE. Ann. Surg. 100: 993-995, 1934. Lyle reports the case of a thirty-year-old woman who was operated on under local anesthesia for a small undiagnosed tumor of the right labium major, Histologic study of this growth showed it to be an adenocarcinoma of Bartholin’s gland. Five months after the first operation a small recurrence was noticed in the scar. Radical endo- thermic vulvectomy under a general anesthetic was performed. A postoperative course of roentgen irradiation was given, and the patient has remained well and free from recurrence for over two years. Histologic study of the tumor in this case showed it to be an adenocarcinoma composed of rather small cells which in places formed definite glands. The article is without illustration. BENJAMINR. SHORE Calcified Fibroma of Bartholin’s Gland, MAUCLAIRE.Fibrome calcifi6 de la glande de Bartholin, Bull. et m6m. SOC.nat. de chir. 60:55-56, 1934. A woman of fifty had first noticed a small, hard mass in the left lesser labium five years previously. When seen by the author it was the size of a walnut. It was a fibroma showing disseminated calcification (phosphate and carbonate), not merely a calculus of the gIand. F. CAVERS

THE GENITO-URINARY TRACT

Malignant Tumors of the Kidney, A. HYMAN. Internat. J. Med. & Surg. 47: 205-206, 1934. A discussion based on a series of 179 tumors of the kidney, of which 136 were treated by nephrectomy. The operative mortality in the 135 cases was 9 per cent and the five- year cures are estimated at 20 per cent. A longer discussion of this subject, by the same author, based on a slightly smaller number of cases has been previously abstracted in the American Journal of Cancer (20: 747, 1934).

Tumors of the Renal Pelvis, S. PABCUAL,VAN DEN BRANDENAND J. 8. JOLY. Lea tumeurs du bassinet, J. d’urol. 36: 391-401, 1933. Also in Brit. J. Urol. 5: 323-339, 1933. This is a report of a discussion on tumors of the renal pelvis at the Fifth Congress of the International Society of Urology, held in London, July 15-18,1933. In the operning paper, Pascual emphasized that the renal pelvis is less frequently the site of tumor formation than any other region of the urinary system. Granting that leukoplakia and calculi may play a part in the etiology of these tumors, one cannot attach much importance to chronic inflammation, for, if this played I\ leading r81e, these tumors would be THE GENITO-URINARY TRACT 915 as frequent as tuberculous lesions of the kidney. The great majority of pelvic tumors are epithelial, either benign or malignant papillomas or non-papillary carcinomas. They show a strong tendency to spread to the ureter and bladder, and every pelvic tumor must be regarded as being of grave prognosis, since the histologically benign papillomas may and frequently do undergo malignant change. Van den Branden agreed that little could be said regarding the etiology and therefore the prophylaxis of tumors of the renal pelvis. He emphasized the need for ureteropye- lography as well as cystoscopy in every case of hematuria, and cited from the literature some depressing statistics as to the operative treatment of pelvic tumors. Joly estimated that on the average these tumors form about 7 per cent of all. renal neoplasms. He thought it was generally agreed that calculi occurred more often in association with solid carcinomas than with papillomatous tumors. What makes the prognosis so bad is the frequency of recurrence in the so-called benign papillomas and papillary carcinomas. Cure is rarely obtained in cases of solid carcinoma. Various other speakers took part in the discussion, and there was general agreement with the above statements. When renal pelvis tumor is diagnosed, there should be exploratory laparbtomy with incision of the pelvis, but nothing short of removal of both kidney and ureter holds out hope of success at the present time. F. CAVERS Changes in the Renal Parenchyma in Tumors of the Kidney, A. CIMINATA. Le modi- ficazioni del parenchima renale nei tumori del rene, Minerva med. 1: 879-887, 1933. Ciminata summarizes the clinical findings and describes and illustrates the gross pathology in five cases of tumor of the kidney, but unfortunately fails to include follow-up data, He concludes that most of these tumors originate as encapsulated growths at one pole of the organ, that the renal parenchyma is compressed but only rarely invaded, and that hemorrhage may occur as the result of simple hyperemia. C. D. HAAGENSEN Indications for Irradiation for the Various Malignant Neoplasms of the Kidney, U. V. PORTMANN.J. Urol. 31: 721-730, 1934. In a general discussion the radiosensitivity of the various kinds of renal tumors is described. The treatment of hypernephromata is primarily surgical because these tumors are usually well encapsulated and are radioresistant. Renal carcinomata are said to be characterized by early renal and perirenal invasion, so that complete operative removal is rarely possible. They are radioresistant but should be treated heavily both with external irradiation and interstitially with gold radon seeds to delay the progress of growth. Papillary carcinoma and squamous carcinoma of the kidney pelvis or ureter are best treated operatively in most cases. Embryonal carcinomata and tera- tomata of childhood are very radiosensitive. Portmann believes they should be treated with radiation alone because, though this method has seldom or never cured a case, it delays the course of the disease, while operation may result in stimulation of tumor growth. GRAYH. TWOMBLY Carcinoma of Left Kidney, with Right Sciatic Pain, F. MARSAN.Presentation d’un cancer du rein, J. d’urol. 36: 387-390, 1933. A woman of forty-six complained of hematuria and right sciatic pain dating back about two years, The right kidney showed normal functioning; the left was function- less. Double pyelography showed a normal left ureter, but the pelvis was greatly elongated and its lumen almost obliterated. Nephrectomy was done, and the sciatica disappeared, The entire substance of the enlarged left kidney was occupied by a tumor diagnosed as carcinoma, but not described histologically. There is one illustration. F. CAVERS Case of Hypernephroma of the Left Kidney, L. FERRANNINI.Un caso d’ipernefroma del rene sinistro, Minerva med. 1: 617-620, 1933. This is a report of a hypernephroma of the left kidney occurring in a woman aged sixty-six, diagnosed by means of a distorted pyelogram, and removed by nephrectomy. There is no follow-up. C. D. HAAQENSEN 916 ABSTRACTS

Caverndus Hemangioma of the Kidney, G. GAYET,A. GABRIELLEAND J. F. MARTIN. L’angiome du rein, J. d’urol. 37: 297-311, 1934. The authors refer mainly to English and North American literature in their discussion of renal angiomas, which they say have rarely been reported in the French literature; they mentiog a large recent French textbook of urology in which these tumors are not even mentioned. A physician of thirty-three had several attacks of hematuria, shown by cystoscopic examination to be of renal or ureteral origin. Double pyelography showed the right ureter to be bifid almost throughout its course; the pelvis was also double, and there was distortion of the middle and lower calices. Although the long history of hematuria seemed against a diagnosis of malignancy, nephrectomy was done. The enlarged lower pole contained an extensive hemorrhagic tumor, with the structure of cavernous hemangioma. The patient made a good recovery. There are four illustrations. F. CAVERS

Sarcoma of the Renal Capsule Simulating an Ovarian Tumor, J. RUZICSKA.Uher ein Ovarialtumor vortluschendes Nierenkapselsarkom, Arch. f, Gynak. 158: 14-21, 1934. The author reports the case of a forty-two-year-old woman from whom the left kidney and an attached tumor of the renal capsule were surgically removed. Histo- logic study of the growth showed it to be composed of very slightly differentiated connective-tissue cells with numerous areas of necrosis. In several places there were areas of osteoid tissue with zones of definite bone formation. The diagnosis of osteoblasto- matous fibrosarcoma of the renal capsule was made. The end-result is not given. The article is illustrated with photographs of the gross specimen and photomicrographs. BENJAMIN R. SHORE Demoid Cysts of the Kidney, A. Fmm. Dermoidcyste der Niere, Deutsche Ztschr. f. Chir. 243: 628-629, 1934. The author reports the case of a sixty-nine-year-old woman from whom a pyone- phrotic kidney containing a dermoid cyst and stones was removed. The cyst was lined with epithelium which in places showed some acanthosis. The contents of the cyst were made up of desquamated epithelium. Only six other cases of dermoid cysts of the kidney have been reported in the literature. There are no illustrations. BENJAMINR. SHORE

Lipomatosis of the Kidney with Report of a Case, E. W. WHITEAND H. S. CAMBRIDGE. J. Urol. 31: 699-710, 1934. A woman of fifty complained of frequency of five years’ duration and left lumbar pain, tenderness over the left kidney, and a constant desire to urinate, for three months. Cystoscopy showed obstruction of the left ureter with no urine or dye excretion on that side. A roentgenogram showed a large stag-horn calculus filling the left renal pelvis. A left nephrectomy was done. The specimen showed, in addition to the stone, marked replacement of the kidney tissue by fat, so that a rim of kidney tissue only 0.6 to 1.2 cm. in thickness remained. The authors discuss quite fully this condition of ‘‘ lipomatosis,” which they distinguish from true lipomas of the kidney and of which they say only 35 cases have been reported. They conclude that true lipomas may occur in an otherwise normal kidney either as congenital or acquired tumors and that such tumors are small and usually harmless; that renal lipomatosis is a distinctly different process, somewhat akin to fibrosis, occurring in a kidney which has become hypertrophied following some inflammatory process, and that this fatty tumor is derived from the peri- pelvic fat and not from metaplasia of connective tissue. GRAYH. TWOMBLY Renal Infarct Clinically Simulating a Tumor of the Kidney, D. N. EISENDRATH.Un grand infarctus du rein presentant les signes cliniques d’un neoplasme du rein, J. d’urol. 37: 47-62, 1934. The author gives summaries of 29 cases of renal infarction found in the available literature, and reports a case from the Cook County Hospital, in which infarction of THE OENITO-URINARY TRACT 917

the left renal vein occurred in a man previously operated upon for thrombophlebitis obliterans of the left leg. The patient complained of pain in the right kidney region, with hematuria, and pyelography showed pelvic deformation which led to a diagnosis of renal tumor and to nephrectomy. There are two colored illustrations. F. CAVERS

Contrast Roentgenography in the Diagnosis of Bladder- Tumors, J. SALLERAS.La cistorradiograffa de 10s tumores de la vejiga, Semana m6d. 1 : 1284-1287, 1934. The author found that sodium iodide in 15 per cent aqueous solution gives quite as clear x-ray visualization of bladder tumors as was obtained with lipiodol and various thorium preparations which he also used for this purpose. He gives brief notes on seven cases, in which the histologic nature of the tumors is not stated, and eight fairly good x-ray illustrations. F. CAVERS Aspiration of Bladder Papillomas under Direct Vision, J. LECHNIR. Uber Absaugung von Blasenpapillomen unter Sicht, Arch. f. klin. Chir. 180: 490-493, 1934. Aspiration under direct vision through a cystoscope is recommended for all large papillary tumors and for diffuse papillomatosis of the bladder. Suction is applied to the growth and after it has become engaged in the end of the cystoscope, traction on this instrument will separate the tumor from the bladder wall. Electrocoagulation of the bladder wall may be used after this procedure if necessary. Good results have been obtained in 20 cases in which this method has been used. A photograph of the specially constructed cystwcope and photographs of tumor particles removed are included. BENJAMINR. SHORE

Bone Metastases from Carcinoma of the Urinary Bladder, R. C. GRAVESAND R. E. MILITZER. J. Urol. 31: 769-789, 1934. The authors have reviewed 43 consecutive cases of carcinoma of the urinary bladder observed in the last five and one half years at the Pondville Cancer Hospital (Massa- chusetts). In this group were 4 cases showing roentgenological evidence of bone metastasis, a higher incidence than is usually thought to occur. These four cases together with a fifth case from another hospital and two cases with carcinoma of the bladder plus Paget’s disease*are reported in detail. In one case histologic sections were obtained both from the primary tumor and from the involved bone and photomicrographs of these two specimens are reproduced. All the metastases were of the osteoclastic variety, though two cases also showed evidence of concomitant new bone formation. Aside from the pelvis, there seems to be no predilection for any particular bone as the site of metastasis. [Of 902 epithelial tumors of the bladder reported by the Carcinoma Registry of the American Urological Association (J. Urol. 31: 423-472, 1934), 34 cases were reported as showing bone metastases.] GRAYH. TWOMBLY

Papillomas of the Urethral Meatus, LOUSTE,L~vY-FRANCKEL, CAILLIAU AND SCHWARTZ. Epidermodysplasie verruciforme avec l6sions papillomateuses de la muqueuse urbthrale, Bull. SOC.franq. de dermat. et syph. 41: 270-279, 1934. A man of twenty-five had five years earlier noticed a warty eruption which spread over the greater part of the body, but was especially marked on the backs of the hands and on the urethral meatus. The skin in general now showed dyskeratosis and pigmentation. Biopsy revealed no signs of malignancy, the lesions being described as occupying a middle position between dyskeratosis and papillomatosis. Previous writers have reported cases, mostly congenital, in which during middle or old age these warts showed the structure of squamous-cell carcinoma, hence they are probably precancerous. There are four illustrations. F. CAVERS

Diagnosis and Treatment of Carcinoma of the Prostate, A. J. CROWELL.South. Med. & Surg. 96: 395-396, 1934. This is a general discussion of the diagnosis and treatment of carcinoma of the prostate gland. BENJAMINR. SHORE 918 ABSTRACTS

Transurethral Resection of Prostatic Bars, Hypertrophiesand Cancer, E. G. BALLENQER, 0. F. ELDER,AND H. P. MCDONALD.New Orleans M. & S. J. 86: 651-658, 1934. In view of their success following 240 transurethral resections over a period of twenty- five years, the authors feel that in selected cases this is to be preferred to prastatectomy. ’The permanence of the imprmement depends in great part upon the thoroughness with which the procedure is carried out. All hypertrophied mawes which protrude into the bladder should be removed and the floor of the vesical orifice lowered to the level of the deep urethra and the floor of the bladder. Furthermore, lateral masses pressing into the urethra and tissue overhanging the anterior part of the bladder neck should be removed. To ensure complete removal of all hypertrophied masses, the finger of an assistant should be inserted into the rectum and the gland pressed forward into view. The procedure is rarely accompanied by hemorrhage of severe proportions and can be controlled by coagulation or the administration of ergot. Healing is attended by a minimum of fibrosis. The authors believe that in advanced cases of carcinoma removal of obstructing tumor growth, as necessitated for the relief of obstruction, is superior to suprapubic cystotomy as a palliative measure. Improvement of sexual function rather than impairment is the usual consequence. Complications in the authors’ series were epididymitis in 14 cases, cardiac conditions in 7, pyelitis in 6, and periprostatic abscess in 2. There were only 4 operative deaths. The actual technic is described in detail. Care must be exercised to prevent postoperative infection through the use of proper urinary antiseptics, and catheterization should be employed as indicated. Undue frequency of urination during the healing stage may be allayed by the administration of codeine. Prostatic message should be done once a week, beginning six weeks after treatment, in order to restore the sense of sexual and urinary well-being. The use of sounds is often of value, especially in the presence of urethral stricture. Pyuria is to be expected during the first few weeks and necessitates no special therapeutic measures unless diverticula or pyelitis are coexistent. There are two illustrations but no bibliography. THEODORES. RAIFORD

Lymphosarcoma of the Prostate, F. H. COLBAND L. R. MARTIN. J. Urol. 31 : 803-811, 1934. A fifty-six-year-old man complained of difficult urination and dribbling following an attack of acute retention; also of burning and nocturia. Examinatlbn revealed an enlarged prostate of normal consistenpy. Cystoscopy showed cystitis and an irregular, contracted bladder neck. The symptoms continued in spite of a punch operation, and suprapubic prostatectomy was performed one month later. The prostate was easily enucleated and was firm and cartilaginous. Microscopic sections showed a very malignant round-cell hiatoid tumor closely resembling myeloma of bone, considered probably not primary in the prostate. In spite of deep x-ray therapy, symptoms persisted and a palpable mass appeared in the midline, just above the pubes. A suprapubic cystotomy was finally done and the patient died three weeks latar, nine months after the onset of symptoms. Autopsy showed lymphosarcoma with metastasis in the pancreas. Three photomicrographs show the primary tumor and the pancreatic metastasis. The authors could find only four cases of prostatic lymphosarcoma in the literature which have been thoroughly verified. Many other reported cases are probably highly anaplastic carcinomata. Lymphosarcoma differs clinically from carcinoma in its failure to metastasiae to bone. GRAYH. TWOMBLY Carcinoma of the Penis, P. DESAIVE. Contribution B 1’6tude du cancer de la verge, Cancer, Bruxelles 10: 141-204, 1933. The author reports 21 cases of penile cancer observed at the Li6ge surgical clinic and anti-cancer center. The most important etiologic factor was congenital phimosis (8 cases). Regional adenopathy was present in 14 cases, and metastasis in 2 cases. The treatment was varied: 10 were treated by surgery alone, 4 by radium alone, 5 by surgery combined with radium, one by excision of the nodes and radium puncture of the primary tumor, two by circumcision and electrocauterization followed by radium. Detailed tables are given for these cases, from which it appears that only 7 patients survived for THE GENITO-URINARY TRACT 919 more than three years, 3 of these dying during the fourth year from intercurrent disease. The remainder of the paper is practically a monograph of the subject, with numerous tables of statistics collected from a wide range of the international literature. From his collected statistics concerning methods and results of treatment, the author believes that penile carcinoma is not very highly malignant, provided patients come for treatment before the late stage when spread beyond the immediately adjacent lymph node region has occurred. The method of choice seems to be distance radium therapy. Surgery, especially diathermic, is a valuable adjunct to radium, and should be used in the extirpation of invaded lymph nodes. There are forty-one illustrations, and an extensive bibliography is appended. F. CAVERS Technic of Extirpation of Regional Lymph Nodes in Carcinoma of Penis and Vulva, J. DUCUING.Sur l’extirpation des adhopathies cancereuses de l’aine, Rev. de chir., Paris 53 : 157-186, 1934. Most of what the author advises in this paper is applicable to both penile and vulvar carcinoma. He advocates much more extensive extirpation of nodes than is generalIy considered necessary. The areas of node removal are divided into the inguino-crural, the inguino-abdominal, the pubic, and the origins of the adductor muscles. That is, in order to ensure the removal of every node liable to carcinomatous invasion, the dissection should extend in all directions beyond the triangle of Scarpa. The author describes and illustrates the anatomical distribution of the normal lymph nodes in this extensive region and their relations to nerves, vessels, fasciae, aponeuroses and muscles. The lymphatic vesseIs uniting the superficial and deep nodes pass through the cribri- form fascia, which should therefore be removed, so that at the end of the dissection there should remain in the floor of the triangle only the nerves and blood vessels. In penile carcinoma, block dissection is practically impossible, but fortunately the lymph nodes in the tissue between the root of this organ and the area of accessible node dissection are more often the seat of inflammation than of invasion by cancer. The node dissection must obviously be bilateral. The same rule applies to carcinoma of the vulva, except in those cases, rare in the author’s experience, where the tumor is confined strictly to one labium and is in an early etage of growth. In any case, the dissection should be carried out centripetally and done without injury to the femoral arcade. There are fourteen large clear illustrations. F. CAVERS

Carcinoma of the Testicle, FREDERICKCHRISTOPHER. Internat. J. Med. & Surg. 47: 260-262, 1934. The author briefly reviews the subject of carcinoma of the testicle and reports a case in a patient of twenty years. There was a history of a blow on the right testicle three months prior to admission, followed by tenderness and gradual enlargement. For about two months there had been no further increase in size and the testicle was no longer tender, but the patient complained of backache and pain radiating down the right groin. After a month’s observation, during which the backache became increasingly severe, the testicle was removed and a diagnosis of highly anaplastic cylindrical- cell carcinoma was made. X-ray therapy was instituted, but three weeks later small palpable masses were present in both breasts and a mass was discovered in the abdomen, apparently attached to the liver. This increased in size, and pain in the epigastrium and back became increasingly severe. Death occurred seventeen weeks after operation. There is no mention of autopsy, and no illustrations are included. A Microscopic Carcinoma of the Testis Concealed in Chronic Granulation Tissue, P. J. BRESLICE.J. Urol. 31 : 835-838, 1934. A white man of twenty-four noticed a swelling in the upper pole of the left testis five months before entering the hospital. Six years before he had brusied this testicle while mounting a horse. At first the tumor was painful, but the pain disappeared and the tumor slowly increased in size. Orchidectomy was performed. At the upper end of the testis was a tumor mass 1.5 cm. in diameter. Microscopically this was found to be carcinoma buried in dense fibrous and chronic granulation tissue with numerous plasma cells, lymphocytes, and giant cells in some areas. Possibly the carcinoma developed in 920 ABSTRACTS an old scar, but Breslich thinks the more likely hypothesis is that the inflammatory reaction was associated with chronic irritation from products of tissue necrosis. A photomicrograph shows a section of the tumor, with carcinoma, cells and surrounding granulation tissue. GRAYH. TWOMBLY Seminomas of the Testes and Ovaries, A. B~CLBRE.Das Seminom des Hodens und des Ovariums, Strahlentherapie SO: 597-610, 1934. This is a general article concerning the diagnosis and treatment of seminomas of the testes and certain tumors of the ovaries which histologically resemble these testicular tumors. Careful studies of the urine for the presence of Prolan A are of great value in the diagnosis of these tumors and as a guide to prognosis. The article is without illustration. BENJAMIN R. SHORE

Fibroma of Testicular Hydatid of Morgagni, M. SALMONAND X. J. CONTIADHS.Fi- brome de l’hydatide testiculaire de Morgagni, J. d’urol. 37 : 412-417, 1934. This is a republication of an earlier paper (Ann. d’anat. path. 10: 490-495, 1933. Abst. in Am. J. Cancer 20: 955, 1934). F. CAVERS

THE NERVOUS SYSTEM

Symptomatology and Clinical Diagnosis of Brain Tumors, DE BUSSCHER.Symptoma- tologie et diagnostics cliniques des tumeurs encephaliques, Arch. m6d. belges 86 : 181-203, 1933. It is still the opinion of many that intracranial tumors are exceedingly rare and that therefore the subject can have little practical interest for the general practitioner. Ac- tually, the brain is the fourth most frequent site of neoplasms, following the uterus, stomach, and breast. Increasingly favorable results can be expected with brain tumors only as the fundamental points in their recognition become known to the general practitioner of medicine. The signs and symptoms of brain tumor may be considered in two groups: (1) those due to a general increase in intracranial pressure and (2) focal manifestations of irritation or paralysis of various centers. Considering first the evidence of increased intracranial pressure, headache is often commonly complained of. Its location, duration, and intensity vary greatly, or it may be absent altogether. Particularly is it apt to be absent in children, owing to the adaptability of the cranial bones. The site of headache is not a reliable aid in localization of the tumor. Vomiting, usually of pro- jectile type, is also a common symptom, particularly with cerebellar tumors. Papille- dema or choked disc is an important sign. While the presence of edema of the optic nerve heads is always a threat to vision, there is no definite relationship between the degree of papilledema and the subsequent impairment of sight. This sign may be altogether absent in some cases of intracranial tumors, notably those about the optic chiasm and often with meningioma. Unilateral paralysis of the sixth cranial nerve commonly occurs with brain tumors. While the frequently found unilateral abducens palsy has practically no localizing value, a bilateral involvement points to the presence of a pontine tumor. Vertigo is not infrequently a symptom of increased intracranial pressure, especially with tumors in the posterior cranial fossa. The same is true of alterations in respiratory rhythm. Generalized convulsive seirures are common with frontal tumors but also occur with new growths elsewhere in the brain. The state of consciousness may vary from normal through drowsiness to deep coma. Clinical examination of the cranium sometimes gives important information. With children especially, some actual enlargement of the head may occur. A peculiar resonance upon percussion, known as Macewen’s sign, denotes dilatation of the ventricular system. Roentgenographic evidence of changes in the sella turcica is most important and not infrequently makes possible a definite diagnosis. Other x-ray evidences of brain tumor include calcification within the growth, local changes in vascularity, hyperostoses, and local erosion of special bony landmarks, such as the internal auditory meatus. THE NERVOUS SYSTEM 921

Displacement of the calcified pineal body often makes an approximate localization possible. The focal signs of intracranial tumor vary directly with the location of the growth. In the unusual case in which a localizing diagnosis cannot be made upon the basis of the signs found, ventriculography may be resorted to. There are several conditions that must be taken into consideration in the differential diagnosis of brain tumor. Abscess of the brain may give identical clinical signs, but there is usually a history of focal suppuration to suggest the true condition. Epidemic encephalitis when unaccompanied by fever may resemble brain tumor. The typical ocular palsies and the spinal fluid findings of the former condition usually permit of a correct diagnosis. Meningitis sometimes simulates brain tumor, as may sinus infections. Cerebral arteriosclerosis with headaches and generalized convulsive attacks is sometimes mistaken for brain tumor. The advanced age of the patient and evidence of generalized arteriosclerosis are important differential points. Cerebral hemorrhage contrasts with neoplasm in the sudden onset of the former. In adults one must always consider the possibility of metastatic brain tumor. A thorough physical examination should disclose a primary cancer elsewhere in the body. Diabetes or uremia with con- vulsions and coma must always be though of and excluded. Cerebral syphilis, gumma, intracranial aneurysm, polycythemia Vera, and even pellagra have upon occasion been incorrectly diagnosed as intracranial tumor. EDWINM. DEERY Diagnosis and Treatment of Intracranial Tumors, W. TONNIS. Verweisungen zur Erkennung und Behandlung intrakranieller Geschwiilste, Arch. f. klin. Chir. 180: 35-37, 1934. In 1933, 103 patients with brain tumors were seen in the Neurosurgical Division of the University Clinic in Wiirzburg. Forty-eight of these patients were operated on, with 11 deaths, a primary mortality of 22.9 per cent. In 58 cases histologic or definite ventriculographic evidences of a neoplasm were obtained. It is believed that about 60 per cent of all intracranial tumors can be definitely diagnosed and localized before operation; in 20 per cent of the cases the existing symptoms are not sufficientfor localization, and in the remaining 20 per cent the tumors are situated in a silent area. However, in some of these cases correct localization is possible after ventriculography and arteriography. Of special importance are the diagnosis and correct localization without operation of the malignant tumors of the brain stem and corpus callosum which, because of mechanical reasons, are inoperable. BENJAMINR. SHORE

Diagnosis and Treatment of Intracranial Tumors and Abnormalities of the Blood Vessels, W. TONNIS. Die Erkennung und Behandlung der intrakraniellen Gefass- geschwiilste und Gefassmissbildungen, Arch. f. klin. Chir. 180: 424-427, 1934. This is a general discussion of the diagnosis and treatment of intracranial vascular abnormalities and tumors based on a study of 22 cases. There were 10 arteriovenous angiomas, 3 venous angiomas, and 9 angioblastomas. Twenty-five different operations were performed on 20 of these patients, with 3 deaths. The article is without illustration. BENJAMINR. SHORE

More than One Thousand Cases of Intracranial Tumor Remain Undiagnosed Annually in France, T. DE MARTEL. Sobre 2000 tumores cerebrales gue se deberian operar en Francia cada afio no se operan mhs que 600; mhs de un miliar de tumores no son diagnosticados, Semana m6d. 1 : 1143-1 144, 1934. The author does not state the grounds upon which he bases the statements contained in the title of this paper, that each year only 600 cases of cerebral tumor are operated upon in France out of 2000 which require operation, and that over 1000 cases remain undiagnosed. He proceeds to state that between 400 and 500 cases of cerebral tumor are operated upon in Paris each year; that French physicians believe these tumors to be extremely rare and therefore very seldom diagnose or suspect their presence even when the symptoms are well marked. When a cerebral lesion is suspected, it is usually taken 922 ABSTRACTS for granted that it is a gumma, and precious time is wasted on prolonged antiluetic treatment; or the symptoms of headache and vomiting are attributed to gastro-intestinal trouble and treated medicinally. Physicians rarely take the trouble to make an oph- thalmoscopic examination, including perimetry. They fail to realize that the classic syndrome of cerebral tumor may not be completely present and well marked in the early stages, and that the presence of any two of the classic symptoms should lead to suspicion of possible brain tumor and to thorough investigation or reference of the patient to specialists in neurology and radiography. A fern instances of personally observed cases are presented to illustrate these points. [Assuming the truth of these statements, it is not unjust to infer that malignant tumors in other non-superficial sites fail to be diagnosed or suspected in a high proportion of cases by French physicians. If so, the annual official figures for the ratio of cancer deaths to all deaths in France (almost exactly half those given for Great Britain) must be regarded with greater suspicion than ever. The theory that such an enormous difference in cancer mortality is due to racial (anthropologic) differences must in any case be abandoned until other factors, such as differences in accurate and early diagnosis, have been considered. On the other hand,the author’s statements regarding the diagnosis of cerebral tumors in France may be found to be applicable to other countries.] F, CAVBRS

Ventriculography, C. VINCENT,M. DAVIDAND P. PUECH.Sur la ventriculographie, Rev, neurol. 1: 1031-1069, 1933. Ventriculography, following Dandy’s description of the procedure, was at first used by most neurological surgeons only as a last resource. With increasing experience and an appreciation of the value of this procedure, it is being used more often in all difficult cases. The test should be carried out whenever a localizing diagnosis is not otherwise possible, provided the patient is in reasonably good condition. The risk is not out of proportion to the possible benefits from the patient’s point of view. A benign encapsulated growth may not infrequently exist within the cranium without any localizing signs, and ventriculography may be followed by complete removal and a cure. The general technic is well known. It is important to inject as much air into the lateral ventricles as can safely be accomplished to insure good visualization of the ventricular system. Stereoscopic films should be taken in all the standard positions, as well as special films to demonstrate various portions of the ventricles. When the lateral ventricles are of normal size it is sometimes difficult to find them or, .when found, to fill them adequately with air. With a tumor of one cerebral hemisphere, the ventricle on that side may not be found. However, in such cases the opposite lateral ventricle is usually somewhat dilated and presents no difficulties. With tumors of the corpus callosum or pineal body it may be impossible to find the lateral ventricles. In such cases a second attempt from the frontal region may be successful. Occasionally the lesion sought may prove to be a cystic tumor in one or the other occipital lobe. In this event the needle will encounter yellow cystic fluid instead of clear ventricular fluid in the involved side. After the cystic cavity is emptied, it may be injected with air, making possible films that show the exact outline of the lesion. The writers teach that slow, careful injection of air will minimize the dangers or possible complications of ventriculography, the patient having been given luminal two hours before. They have carried out 250 ventriculography tests in cases of suspected brain tumor, with five deaths which could possibly be attributed to the procedure. All five patients proved to have an intracranial tumor. Of the entire series of 250 cases, 61 cases received a final diagnosis of pseudo-tumor and 179 were verified brain tumors. In the remaining 10 cases verification was not possible. In 91 patients in .whom ventriculography was done but not followed immediately by operation there were 4 deaths. Among 159 cases operated upon within three hours after ventriculography there was only one death attributable to the injection of air. The writers advise craniotomy as soon after ventriculography as possible. [Patients with advanced papilledema upon whom ventriculography is carried out may show no other untoward effects of the test, but may lose vision. This threat to THE NERVOUS GYSTEM 923

sight is a further reason for not delaying operation, once a localization has been established.] Tumors of the third ventricle are relatively rare, but because some of them are curable and because the roentgenographic signs are highly characteristic, they form an important group. These tumors produce marked signs of increased intracranial pressure but rarely can be diagnosed without recourse to ventriculography. The outlines of the normal third ventricle when filled with air resemble a quadrilateral having two small anterior horns and two small posterior horns. Tumors of the anterior part of the third ventricle usually result in a failure of this cavity to fill with air and for the same mechanical reason [obstruction of the foramina of Xlonro] produce dilatation of the two lateral ventricles. Tumors of the posterior portion of the third ventricle usually produce a typical filling defect in that structure. Tumors arising from the hypophysis and chiasmal region growing up, to secondarily distort the third ventricle, usually produce ventriculographic signs similar to primary tumors of the body of the third ventricle. The clinical signs in such cases will often differentiate them from true third ventricle tumors. Case histories are included, together with good illustrations demonstrating third ventricle tumor, glioma of the optic chiasm, craniopharyngioma, suprasellar tumors, neoplasm of the posterior part of the third ventricle, pineal tumor, ependymoma of the aqueduct of Sylvius, pontine tumor, and cerebellar medulloblastoma. EDWINM. DEERY New Method of Ventriculography, H. PEIPER. Eine neue Methodik der Ventrikulo- graphie, Arch. f. klin. Chir. 180: 443-444, 1934. Also in Rontgenpraxis 6: 641-645, 1934. In order to secure better delineation of the ventricular system of the brain, the author has developed a technic by which air is injected directly into the ventricles as spinal fluid is removed through a needle inserted into the subdural space in the lumbar region. One drawing to illustrate this method is included. BENJAMINR. SHORE Verified Tumor of the Temporal Lobe, Critical Review of 52 Cases, S. N. ROWE. Arch. Neurol. & Psychiat. 30: 824-842, 1933. This is a review of the clinical aspects of 52 cases of tumor involving one or the other of the temporal lobes. The temporal lobes of the brain were long regarded RS silent areas. Even to-day the frequency with which a lesion in this locality goes on to attain large proportions, while producing few recognizable symptoms, is well recognized by neurologists and neurosurgeons. The temporal convolutions and the fusiform gyrus are devoted, as far as is known, to the association and correlation of auditory stimuli. Recent work suggests that a vestibular center exists in the temporal cortex. The hippocampal gyrus and the uncus are portions of the archipallium and represent the cerebral centers of taste and smell. The subcortical anatomy is of clinical importance chiefly through the presence of three structures : (1) the inferior horn of the lateral ventricle, (2) the optic radiations which traverse the lobe from back to front, bending around the ventricle in a narrow band, (3) the auditory radiations running laterally from the internal capsule and lying in the upper portion of the lobe, close beneath the auditory cortex. The writer reviews the literature on the subject of temporal lobe symptomatology and then gives an analysis of the clinical aspects of his own series of cases from the University Hospital of Philadelphia. Increased intracranial pressure caused the first symptom in 71 per cent. The gradual development of headache, dizziness, blurred vision, and nervousness was the rule. In only 9 per cent was the first symptom sup gestive of damage to adjacent regions of the brain, i.e. hemiparesis, jacksonian attacks, or neuralgic fifth nerve pains. In 4 per cent the initial symptom was of value in localizing the lesion to the temporal lobe, consisting of a brief attack of aphasia or a dreamy state. The damage to vision caused by the general increase of intracranial pressure was the common factor bringing the patients to the neurosurgeon. Of the signs and symptoms of increased intracranial pressure the most common was headache. This complaint was present in all but 3 patients. Some degree of papilledema was found 924 ABSTRACTS in 42, and some diminution of vision in 21. In about half the series weakness of one or the other abducens nerve existed. It would seem that the sequence of clinical events with most temporal lobe tumors is (a) no symptoms, (b) symptoms of increased intracranial pressure, (c) focal symptoms. In about half the patients there occurred some mental disturbances, primarily those of consciousness. The great frequency of convulsive attacks with temporal lesions has been mentioned by many writers. In the present series these occurred in 36 per cent of the cases. There were generalized seizures in 10 patients, jacksonian attack in 6, dreamy states in 3. Of the localizing symptoms of temporal lobe lesions, aphasia is the best known and the most reliable. In this study, however, it was found in slightly less than one third of the patients having left-sided tumors. Furthermore, the early imprelvsion that a pure sensory aphasia results from a lesion of the temporal lobe is not borne out. Some cases showed motor aphasias. Abnormalities of the auditory system were present in a high percentage. These abnormalities may be divided into two groups. Of subjective changes, tinnitus was the most common, occurring in 14 cases or 27 per cent. Nine patients showed objective partial deafness, the defect being almost entirely contralateral in 5, bilateral in 3, and ipsilateral in one. In general, then, one may conclude that partial deafness, occasionally more marked on the contralateral side, does occur from damage to the auditory cortex with tumor of the temporal lobe. Disturbances of taste and smell were not common in the present series, uncinate attacks being complained of by only 6 patients or 11 per cent. Examples of Jackson’s dreamy state were found only 3 times. Changes in the visual fields are of great importance. They occurred in 32 cases: homonymous hemianopsia in 19, homonymous quadrantanopia in 5. Tumor of the brain rarely causes signs and symptoms from a single lobe. The manifestations due to pressure upon nearby structures are usually a confusing factor in localizing diagnosis. With temporal lobe tumors the chief neighborhood symptoms come from the frontal and parietal lobes, the cerebellum, and the cranial nerves. Of frontal lobe symptoms, the most frequently encountered were jacksonian attacks, hemiparesis, or hemiplegia. Such symptoms were present in about 50 per cent of the cases. Parietal lobe symptoms of astereognosis and objective sensory disturbances on the side opposite to the tumor occurred in 6 patients. Cerebellar signs were present in 53 per cent and were very confusing. They included unsteady gait, a positive Romberg sign, dysmetria, and nystagmus. These are probably caused by general pressure factors, local damage to a vestibular center in the temporal lobe, and indirect pressure upon the temporopontocerebellar fibers. Damage to cranial nerves in the present series was limited to the third, fifth, and sixth nerves. Roentgenography, including ventriculographic studies, often leads to a correct diagnosis. Including 11 cases in which air studies were made, in the present series 20 cases were localized by findings disclosed roentgenographically. It continues to be difficult to formulate a typical syndrome of temporal lobe tumor because of general pressure and neighborhood symptomatology. Early cases of temporal tumor have few or no signs and symptoms. Patients therefore rarely present themselves until a more complicated condition exists. Prominent in the symptomatology of these cases were mental abnormalities. Epi- lepsy was frequent, and aphasia occurred in a third of the left-sided cases. The classical symptoms of aphasia, uncinate attacks, and dreamy states did not occur together in a high percentage. Determination of the visual fields when possible was of great diagnostic significance, as was, likewiple, the information obtained by x-ray studies. Audi- tory abnormalities were present more often than has hitherto been reported. Reports of illustrative cases are included. EDWIN M. DEERY Anatomical Characteristics and Surgical Treatment of Cerebellar Tumors, R. WANKE. Zur Anatomie und Chirurgie der Kleinhirngeschwulste, Arch. f. klin. Chir. 180: 428- 431, 1934. This is a general discussion of the pathology and surgical treatment of cerebellar tumors based on a study of 68 cases. Medulloblastomas and ependymal tumors are THE NEBVOUS SYSTEM 025

the most frequent types seen in this portion of the brain. As a general rule, radical extirpation is possible in only about 50 per cent of all cerebellar tumors. The article is without illustration or case reports. BENJAMINR. SHORE

Technic and Results of the Radical Operation for Acoustic Tumors, H. OLIVECHONA. Technik und Ergebnisse der Radikaloperation bei Acousticustumoren, Arch. f. klin. Chir. 180: 445-448, 1934. In a series of 34 patients with acoustic neuromas operated upon, there were 9 deaths, an operative mortality of 27.7 per cent. Tumors of this type are best removed by means of a unilateral approach, with excision of only that portion of the cerebellum which directly overlies the tumor. Good exposure and decrease in size of the growth by intracapsular curettement are aids in simplification of the complete enucleation of these tumors. The average duration of life for those patients who have survived operation and have not died of other causes is five years. BENJAMINR. SHORE

Hemorrhage into Gliomas, E. OLDBERO. Arch. Neurol. & Psychiat. 30: 1061-1073, 1933. That gross hemorrhage into gliomas commonly occurs and that such an incident explains the apparently sudden onset of clinical symptoms have been generally accepted beliefs. No actual figures could be found, however, except those of Wilson, who in a series of 35 gliomas observed 9 which showed recent hemorrhage (Clifton M. Bull. 13: 117, 1927). Oldberg reviewed 832 consecutive verified cases of glioma and found gross hemorrhage in only 31, those cases in which the extravasation of blood was microscopic or limited to a few petechiae being excluded. Hemorrhage occurred most commonly in medullo-epitheliomas, pinealomas, oligodendrogliomas, and an unclassified group. It was rare or absent entirely in ependymomas, ganglioneuromas, neuro-epitheliomas, and the astrocytomas. In general it is more likely to occur in rapidly growing, degenerative lesions. Cysts associated with glioma were surprisingly immune to hemorrhage, there being but one such instance. The writer reviews the symptoms in the 31 cases with hemorrhage. In only 7 were there any striking clinical features, such as sudden onset or acute exacerbation. The other 24 cases progressed clinically like the usual glioma cases without hemorrhage. Moreover, among the cases in which no hemorrhage occurred there were many examples of acute and critical clinical episodes. Such episodes may be due to blockage of a foramen (foramen of Monro or the aqueduct of Sylvius), acute cerebral edema, or focal j acksonian attacks. Hemorrhage into gliomas occurs in probably less than 1 per cent of all cases. It is obvious that for many reasons a definite clinical diagnosis is difficult. The oft quoted objection to operation because of the likelihood of increasing hemorrhage is based on insecure grounds. Even supposing that decompression were very likely to cause this catastrophe, its comparative rarity would minimize the risk involved. In 22 of the 31 cases in which hemorrhage had occurred a decompression had been done prior to operation or autopsy. This is not taken as serious evidence that the decompression precipitated bleeding, since decompression (alone or as part of a craniotomy) was also carried out in all of the remainder of the 832 cases. Of the 31 patients, 15 were males, 16 females. The average age was thirty-four years; there were 7 cases in children. The blood pressure in all but 2 cases had been within normal limits, The Wassermann test in all patients in whom it was taken was negative. No evidence was gathered from the study which could be used to distinguish clinically the type of case liable to hemorrhage. [A very interesting study in view of the widespread belief that sudden hemorrhage into gliomas is a common occurrence.] EDWINM. DEERY Astrocytoma of Left Prefrontal Region with Cerebellar Symptoms, G. B. AUDO-CIA- NOTTI. Sulla patogenesi dei fenomeni cerebellari e del sintomo della " presa for- zata " nei tumori della regione prefrontale, Morgagni 76: 131-140, 1934. In a man of twenty-five the following symptoms appeared in succession during two months prior to hospital admission: severe frontal headache with intense nausea and 92G ABSTRAUTS vomiting, giddiness, complete loss of memory for recent events, disorientation in space and time, and finally an epileptiform attack followed by deep somnolence. There was marked ataxia of the upper and lower limbs. When the patient was seated with the eyes open irregular oscillations of the trunk occurred, rapidly increasing in amplitude until he fell to the left. When an object was placed on the right palm the fingers were firmly clenched over it with much more force than necessary for such a movement, and out of proportion to the weight of the object. The cutaneous reflexes were normal, the tendon reflexes torpid, the Babinski sign not elicited. The pupils reacted sluggishly to light, but well to convergence; there was bilateral neuroretinitis, with papillrtry Rtasis and numerous whitish and hemorrhagic retinal foci, X-rays showed erosion of the posterior clinoid prbcesses. Lumbar puncture yielded clear fluid under high pressure, containing few cells, mostly ependymal cells and small lymphocytes. The jacksonian attacks became increasingly frequent, and the patient died three weeks after entering the hospital. On removal of the brain, a tumor the size of a hazelnut was found in the left prefrontal lobe, histologically an astrocytoma, with abundant fibrillar elements and so vascular as to give the macroscopic appearance of a cavernouB angioma. The author believes that while the cerebellar disturbances might be attributed to intracranial hypertension, animal experiments have shown that frontal lobe lesions affect various projec- tion tracts, including those leading to the cerebellum. He points out that in any case the accurate diagnosis of frontal lobe tumors has been rendered possible owing to the investigations of Cushing. F. CAVERS

Tendency of Cerebral Cavernous Angioma to Cause Cancer, A. RADOVICI,E. CRACIUN, AND A. URSU. Le pouvoir canc6rig6ne de l’angiome cerebral de type caverneux, Bull. et m6m. SOC.m6d. d. h8p. Bucarest 15: 185-194, 1933. While angiomatous tumors in general are not associated with neoplastic processes in the neighboring tissues, this is not the case in the brain. Here even the most inactive type of angioma - cavernous angioma -may be associated with a neoplasm of the brain tissue. The specimen described in this report showed a polymorphous glioma with an angioma of the thalamus on the left side; the patient had died in coma after repeated epileptic attacks. The angiomatous portion of the tumor was of the cavernous type with no evidence of cellular activity or endothelial proliferation. The neighboring brain tissue showed marked proliferation with cellular polymorphism; this neoplastic process was evidently secondary to the angioma. There are five illustrations, four of which are photomicrographs.

Spheno-occipital Chordoma, Report of a Case, M. CANTORAND L. D. STERN. Arch. Neurol. & Psychiat. 30: 612-620, 1933. A man of fifty-eightyears complained of pain in the right side of the face, decreasing visual acuity, and loss of weight. Examination revealed diplopia on lateral gaze to the right and ptosis of the right lid. Vision was greatly diminished in the right eye, and there was weakness of the right facial muscles. The general neurological examination was negative. The essential findings were, then, signs of impairment of the right second, third, fifth, sixth, and seventh cranial nerves. The condition became slowly worse and a year later, shortly before the patient’s death, there was found a large soft tumor mass pushing the palate downward. At autopsy a soft tumor filled the right orbital and nasal cavities and the maxillary, ethmoid, and sphenoid sinuses. It had destroyed most of the base of the skull. The aygomatic process of the temporal bone was completely replaced by the neoplasm, which also pressed against the frontal lobe of the right cerebral hemisphere causing considerable distortion. The second, third, fourth, fifth, sixth, and seventh nerves on the right side were involved in the tumor. Microscopically the neoplasm consisted of small lobules of cellular tissue or an abundant homogeneous matrix in which were suspended tumor cells of vague outline. The cells were polygonal for the most part and ranged in size from small cells, 14 microns in diameter, to huge vacuolated elements three or four times that size. This case illustrates the essential characteristics of the chordoma. A slowly growing tumor, malignant by position, it has marked invasive and destructive powers, especially THE NERVOUS SYSTEM 927

with regard to bone. It seldom gives rise to metastases. The average duration of life with a spheno-occipital chordoma is about two and one-half years after the onset of symptoms. Malignant chordoma is to be differentiated from the benign ecchondrosis physaliphora of Virchow. The two. types of tumors are microscopically identical, but present differences in mode Qf growth and in gross appearance. The benign ecchondrosis occurs as small jelly-like nodules at the clivus blumenbachii. They produce no symptoms and are found in 1 to 2 per cent of all autopsies, whereas malignant chordomas are rare. EDWINM. DEERY

Impaction of a Neuro-epithelial Cyst in the Third Ventricle of the Brain, C. 0. RINDER AND P. R. CANNON.Arch. Neurol. & Psychiat. 30: 880-883, 1933. Cystic tumors occurring in the third ventricle of the brain associated with the choroid plexus are uncommon and the clinical diagnosis is rarely made, as there are no characteristic signs. Such a growth may be suspected when a patient displays hyper- somnia, visual disturbances, papilledema, a tendency to intermittency of attacks, severe headaches, and vomiting. Changes in position sometimes relieve the headaches and vomiting. A woman of forty-seven years, previously in good health, complained of headaches, nausea and vomiting, vertigo, and drowsiness. After some months the symptoms became less troublesome and finally disappeared, After an interval of nine years there was a sudden reappearance of all symptoms with a fatal termination within twenty-four hours. At autopsy both lateral ventricles were moderately dilated. A spherical cyst 15 mm. in diameter was impacted in the foramen interventriculare, completely occluding the third ventricle. The lesion was attached by a stalk to the anterior margin of the right choroid plexus and could be removed easily from its site of lodgment. The cyst had a smooth wall and contained a grayish gelatinous material. Micro- scopically it proved to be composed of an outer fibrous coat with an inner layer of cuboidal and columnar ciliated epithelial cells, This type of lesion has in the past been described as a colloid cyst. Neuro-epithelial cyst is a more exact term. The lesions probably arise from the paraphysis. The characteristic intermittency of symptoms is probably due to the ball-valve action of the cyst in blocking the foramen of Monro. It is suggested that in the case here reported the cyst may have been small enough during the earlier attacks to enter and leave the foramen interventriculare. When impaction finally occurred, the cyst, unable to dislodge, caused rapid death by acute h ydroceph a1 us. EDWINM. DEERY Meningioma of the Tuberculum Sellae with Hyperostosis, F. E. KREDEL. Arch. Neu- rol. & Psychiat. 30: 952-953, 1933. A man of forty-two years had suffered gradual loss of vision in the left eye for fifteen years and in the right eye for four years, with no other significant symptoms. On examination the left eye was totally blind while the right showed perception of light in the inferior nasal quadrant of the visual field. The basal metabolic rate was minus 16 per cent. Roentgenograms of the skull revealed calcification above the anterior clinoids and thickening of the tuberculum sellae. Death occurred from hemorrhage during operation. At autopsy there was found a large meningioma above the tuberculum sellae, compressing the optic nerves. Microscopic study of the tumor showed it to be a meningo- endotheliomatous type of neoplasm. Microscopic study of the hyperostosis of the tuberculum sellae revealed dense trabeculated bone containing masses of tumor cells in the cancellous spaces. New bone is laid down by osteoblasts and not by the tumor cells directly. Hyperostosis is a rare concomitant of meningiomas in this location. EDWINM. DEERY

Resemblance of Certain Tumors of the Hypophysisto Tumors of the Jaw, E. B. FINK. J. Am. Dental A. 21: 997-1001, 1934. The author reports two cases of pituitary tumors in which the neoplasms possessed the histoIogic characteristics commonly associated with adamantinomas of the jaw. ABSTRACTS

This resemblance may be explained by the fact that these tumors arise in remnants of epithelium of Rathke’s pouch, from which the oral ectoderm is also derived. There are no illustrations. BENJAMINR. SHORE Difficulty of Evaluating Signs of Acromegaly and Destruction of the Sella Turcica in Cases of Brain Tumors, Two Cases of Microscopic Eosinophil Adenomas of the Hypophysis, P. PUECHAND L. STUHL. Sur la difficult6 d’interpr6tation des syn- dromes acrom6galiques et des destructions turciques au cours des tumeurs intra- craniennes, propos de deux cas d’ad6nomes eosinophiles microscopiques de l’hypo- physe, Bull. et m6m. SOC.de radiol. m6d. de France 21: 446-447, 1933. The writers report two unusual instances in which, in addition to an intracranial meningioma, there was present a very small eosinophilic pituitary adenoma also demonstrated at autopsy. In both cases a clinical diagnosis of sphenoid ridge meningioma was made and proved to be correct. In addition there were some evidences of acromegaly and roentgenograms of the skull revealed changes in the outlines of the bony sella turcica. It is apparent that, while the signs of acromegaly can logically be attributed to the presence of the small Pituitary adenoma, the changes in the sella turcica were probably related to the meningioma and general pressure factors. EDWINM. DEERY

Two Cases of Pituitary Tumor Treated by Roentgen Rays, M. MIRANDAGALLINO AND A. A. GALLINO. Consideraciones sobre dos caso8 de tumor de la hipofisis tratados con roentgenterapia, Semana m6d. 1 : 1048-1050, 1934. Two men of thirty-nine and nineteen years showed on radiography complete sellar destruction and moderate prognathism. The first had had diabetes for about five years before the onset of failing vision and headache, In both cases x-ray treatment was followed by complete relief of headache and vomiting, fair improvement in visual acuity, and slight extension of visual fields. There are four illustrations. F. CAVERB Pituitary Tumor, with Jacksonian Epilepsy, R. CANO. Epilepsia jacksoniana por tumor hipofisario, Arch. d. med., cir. y especialid. 37: 637-638, 1934. A man of thirty gave a history of repeated epileptic attacks, followed by impairment of memory and vision. For a time there was considerable symptomatic improvement under antiluetic treatment, but later the attacks recurred. They had continued for two years, during which several periods of polyuria had occurred and sexual impo- tence had developed. There was slight acromegaly, with enlargement of the sella and erosion of the posterior clinoid processes. The urine gave a positive Aschheim-Zondek reaction [no details given]. Repeated x-ray treatment [details not given] was followed by considerable amelioration of symptoms, but a roentgenogram made just before the time of reporting showed further enlargement of the sella. F. CAVERS

Diagnosis and Treatment of Tumors of the Spinal Cord, A. W. ADSON. Jour.-Lancet 54: 464-466, 1934. This paper is based upon a study of 447 tumors of the spinal cord surgically removed at the Mayo Clinic. Twenty-five per cent were extradural, 50 per cent were subdural but extramedullary, and the remaining 25 per cent arose from the spinal cord substance or the filum terminale. Twenty-five per cent were neurofibromas and 24 per cent were meningiomas. The clinical manifestations of these lesions show three cycles, The first cycle is the so-called root cycle and is characterized by pain, which may last from one to four years before paralysis is evident. It is usually localized, is lancinating in character, and is aggravated by lifting, coughing, sneezing and straining at stool. Invariably the patient is awakened by it from four to six hours after going to sleep. It is attributed to the ball-valve action of the tumor as it is pressed downward by the increased pressure of the cerebrospinal fluid above it. Incorrect diagnosis is frequent, Of the author’s cases 10 per cent had been operated upon for intrathoracic or abdominal pathology. The second cycle is characterized by neurologic evidence of spinal cord compression-and the TEE NERVOUS SYSTEM 929

typical Brown-SBquard syndrome. Complete loss of all function below the site of the lesion characterizes the third cycle and may appear from months to years after the second cycle. If the lesion is located below the conus, the clinical syndrome of pain without the Brown-SBquard phenomenon is produced. Reflexes are diminished and loss of motor power ensues. Vesical and rectal functions decrease simultaneously. Neurofibromas of the sacral nerves and chordoma of the sacrum cause localized pain and bladder dysfunction before saddle anesthesia appears. Of the diagnostic means at hand, spinal tap is invaluable. It should be performed in the fourth lumbar interspace and the pressure measured (normally from 12 to 15 mm. of water). Failure of the pressure to rise after compression of the jugular vein or a slow rise and fall of the fluid pressure indicates a block. A dry tap indicates absence of fluid, failure to enter the canal, or puncture of the tumor. Other attempts should be made at different levels. The character of the fluid may suggest the pathology; xanthochromia or increased globulin content is suggestive of tumor. Spinal block alone is not pathognomonic of tumor, as it may be produced by meningitis, myelitis, or vertebral deformities. Roentgen examination may demonstrate calcium in a tumor or erosion of the vertebral bodies, laminae, pedicles, and ribs. Proliferation of bone in the presence of heman- giomas may result in increased size of the vertebrae and laminae and trabeculations in the tumor. Chordomas not infrequently show destructive changes in the sacrum. Radio-opaque oils should be used only when the diagnosis cannot be ascertained by other means, as they invariably produce a chemical meningitis. They are most valuable when observed fluoroscopically, when any deviation of the path of the oil may be visualized. Injection may be made through either lumbar or cisternal punctures or sometimes both. The oil should be removed at subsequent operation as completely as possible to at'oid deleterious effects. There are no illustrations, and treatment is not discussed. THEODORES. RAIFORD Localization of Intraspinal Tumor by Means of Lipiodol Injection. Case Report with Operation and Recovery, C. C. UNDERWOODAND F. R. TEACHENOR.J. Kansas M. SOC.35: 246-248, 1934. A white male of twenty years entered the hospital complaining of progressive ataxia for three months. The tendon reflexes of the lower extremities were markedly exag- gerated and there was moderate diminution of sensation below the umbilicus. The Queckenstedt test demonstrated evidence of a complete spinal block. In an effort to localize the block, 2 C.C. of lipiodol was injected into the cisterna magna. X-rays then showed the lipiodol at rest at the level of the sixth and seventh vertebrae. A laminec- tomy was performed over the sixth, seventh, eighth, and ninth vertebrae, exposing an extradural tumor compressing the cord to the left and anteriorly. The tumor was removed, and the patient made an uneventful recovery. Four months after operation no neurological signs were demonstrable. Pathological examination showed the tumor to be a schwannoma. There are three illustrations and a short bibliography. THEODORES. RAIFORD

Tumors and Developmental Disturbances in Neurofibromatosis (v. Recklinghausen), J. J. TH. Vos. Gezwellen en ontwikkelingsstoornissen bij neurofibromatosis (Reck- linghausen), Geneesk. Tijdachr. v. Nederl. Indie 73 : 1529-1538, 1933. Three cases of neurofibromatosis are described. The patients were a fourteen-year- old Sudanese with an enormous enlargement of three fingers of the right hand; a little Chinese girl with progressive enlargement of the right lower extremity combined with 8 subcutaneous plexiform neurinoma above the right ankle-joint and many light brown spots on the skin; a Sudanese boy with an enlargement and thickening of the right leg, and subcutaneous nodular tumors, one of which, on the forehead, proved to be a neurinoma. Seventeen interesting photographs are included. JOHANNESP. M. VOQELAAR 930 ABSTRACTS

Congenital Cutaneous Neurofibromatosis Showing Aggravation at Puberty and During Two Pregnancies, R. PALLIEZAND L. GERNEZ. Maladie de Recklinghausen et fonctions de reproduction, Bull. SOC,d’obst. et de gynec. 23: 229, 1934. A woman of twenty-nine had since infancy shown dark cutaneous pigmentation and nodules diagnosed histologically aa neurofibromas. At puberty the pigmentation became more widespread and darker, while the nodules increased in number and size. During the first few months of the patient’s first pregnancy there was again exacerbation of the skin manifestations, and at the time of reporting the same had occurred in a second pregnancy, with the appearance of a large tumor apparently occupying the upper inner quadrant of the right breast but found to be lodged in a depression of the right half of the sternum. X-ray examination disclosed no bone abnormalities. F. CAVERS Neurofibromatosis with Sacral Tumor Obstructing Labor and Necessitating Cesarean Section, FRUHINSHOLZ,J. LOUYOT AND J. RICHON. Deux cas de neurofibromatoso g6n6ralisee (maladie de Recklinghausen) cherr, la femme enceinte; dystocie par n6v- rome pravia, Bull. Soc. d’obst. et de gyndc. 23: 318-322, 1934. Two cases are reported, both with interesting features. (1) A woman of twenty- five had shown, since the age of. fourteen, increasing skin pigmentation and nodules, one of which, on the left shoulder, had become very large. During her third pregnancy a biopsy of this nodule showed that it differed from the others (typical neurofibromatosis) in being largely xanthomatous. (2) In the second case, that referred to in the title, a woman of twenty-four, examined during her first pregnancy, showed the typical maculae and nodules of von Recklinghausen’s disease; also, tumors on the course of various nerves, including the right and left sciatic. The latter had become larger and more painful since the first month of pregnancy. When labor began, the cervical 0s dilated very slowly, the fetal head failed to engage, and palpation revealed an ob- structive mass, necessitating Cesarean section, which was successful. The authors could not find a previous report of sacral neuroma obstructing labor. They note, also, that in both of these cases the nodules had increased more rapidly in size during pregnancy. F. CAVERS Atypical Familial Neurofibromatoeis, H. GRENET,R. DUCROQUBT,P. ISAA~-GEORQES AND M. MAC&. Taches pigmentaires et lesions osseuses.. (Formes frustes de la neurofibromatose), Bull. SOC.de pddiat. de Paris 32: 168-167, 1934. The authors report a family in which nearly every member of three generations had pigmented skin patches, cutaneous neurofibromas, neurinomas, and bony deformities, separately or in various combinations. They emphasize that, while pigmentation and skin nodules are often associated with neurofibromatosis, when the former occur alone the case is recognized as an incomplete manifestation of the disease. The increasing attention paid to investigation of the skeleton has shown that various osseous lesions are hardly less frequent components of the neurofibromatous syndrome. F. CAVERS Neuromas in Elderly Persons, H. ZSCHAU. Uber das in hoherem Alter auftretendc Neurinom, Deutsche Ztschr. f. Chir. 243: 752-7.54, 1934. Although neuromas of sufficient size to produce symptoms usually occur in young patients, smaller, symptomless growths of the same character are by no means rare in older individuals. In a study of 214 spinal cords, the author found 24 neuromas; in 23 of these cases, the patients were fifty years of age or over. These tumors in elderly patients are usually small, round or oval, and are most often situated on the secondary bundles of the caudal nerves. Histologically these growths show the typical structure of benign neuromas. The article is illustrated with a photograph of a gross specimen and a photomicrograph. BENJAMINR. SHORE THE BONES AND JOINTS 931

THE BONES AND JOINTS Foundations of Prognosis in Bone Tumors, L. TAVERN~ER.Les bases du pronostic dans les tumeurs des 08, Rev. m6d. franp. 15: 287-292, 1934. In this thoughtful paper the author records impressions drawn from his experience with bone tumors, and compares them with those suggested by acquaintance with the literature of North America, the fundamental importance of which appears not to be realized so widely in France as it ought to be. In general, he has found it easier to establish a moderately accurate prognosis of a bone tumor than an exact diagnosis. Many clinical findings are of little or no importance in either diagnosis or prognosis. Age is sometimes of interest. Roughly, the first twenty years of life form the period of election of both malignant sarcomas and the cysts of bone; myelomas occur mostly between the ages of twenty-one and forty, whereas during these decades osteogenic sarcoma is less frequent; from about fortj-five upwards bone tumors are more frequently metastatic than primary. Site is of slight importance as an indication of the nature of the tumor, since the epiphyses of the long bones are the location of choice for both sarcomas and giant-cell tumors. In general the tumors of the hands and feet are benign; in the foot the relative immunity from sarcoma ceases with the calcaneum, where Ewing’s tumor is rare, while in the hand.it extends to the lower end of the radius, where myeloid tumors frequently occur but sarcomas very rarely. The evolution of the tumor is of importance in the sense that a rapidly growing tumor is almost certainly malignant, but the reverse is far from being true. For instance, Ewing’s tumor may at first show successive periods of rapid growth separated by phases of standstill, and it seems probable that many cases of this tumor are missed owing to this mode of development by spurts. Again, some osteogenic sarcomas may show apparent arrest of growth for months before assuming their terminal phase of rapid development; some of these sarcomas have been diagnosed as benign osteomas because of their slow evolution. Osteomas should be regarded as malignant unless they can be proved to be inflammatory hyperostoses. In view of these clinical difficulties, biopsy has come into favor and is often regarded as an easy and precise method of settling the question. The author’s experience of routine biopsy has led him to be somewhat skeptical in this matter, and to deprecate the complete confidence which surgeons often place in a report from a laboratory to which a small piece of suspected tissue has been sent, often without any clinical information. The interpretation of sections of connective tissue tumors is often extremely difficult and uncertain. The author has seen slides of callus, ossifying hematomas, and inflammatory (especially Iuetic) lesions which showed very close resemblances to those of undoubted bone sarcomas. Again, sections taken from the periphery of an osteogenic sarcoma may show no malignant cells at all. Histologists realize these difficulties more fully than do surgeons. On the other hahd, the x-ray appearances of a bone lesion give much more reliable criteria when there is a doubt as to whether a tumor is malignant or benign, though it may be difficult for a time to decide between malignancy and inflammation. In discussing x-ray treatment of bone tumors, the author says he has used both this and surgery for Ewing’s tumor, With x-rays the longest period of survival was eight years. On the other hand, amputation has given about equally satisfactory results, one case showing an even longer interval of good health before metastasis occurred. The choice is more difficult in the osteogenic sarcomas. Here, roughly, surgery rarely gives survivals of more than two years. At present it would appear that in about one- third of the cases the tumor is radioresistant, irradiation being followed by neither arrest of the growth nor relief of pain. Even in cases which respond well to irradiation one cannot be sure of actual cure. About one-third of the author’s cases treated by x-rays showed recurrence-free survival for more than three years : there were two cases of local recurrence which were treated by amputation and showed subsequent survival for four and seven years. F. CAVERS 932 ABSTRACTS

Arteriographic Diagnosis of Tumors of the Limbs, R. DOS SANTOS.L’arteriographie dens les neoplasies des 0s et des parties molles, Bull. et mem. SOC.nat. de chir. 60: 99-110, 1934. The author and his colleagues at Lisbon have studied by the arteriographic method 37 tumors of the limbs, 30 malignant and 7 benign, the diagnoses having been verified at operation or necropsy. The malignant tumors included 19 in bones and 11 in the adjacent soft tissues, In addition, scores of arteriograms have been made of osteo- myelitis, arthritis, and tuberculous and syphilitic bone lesions, in order to provide a basis for differential diagnosis. The author mentions examples showing that an abundant fine network of newly formed blood vessels is characteristic of neoplasms as compared with inflammatory processes, and shows its richest development in malignant tumors. It is claimed that the differences in vascular development revealed by arteriography are capable of affording a more reliable diagnosis in certain tumors than is ordinary radiography, and that in any cade it forms a valuable adjunct to the latter. There are nine illustrations. F. CAVERS Giant-cell Tumor of Upper End of Tibia, A. MOUCHET.Tumeur 8, mybloplaxes de l’extr6mit6 suptkieure du tibia gauche, Bull. et m6m. SOC.nat. de chir. 60: 435-436, 1934. Following a fall which occurred a month previously a woman of twenty-seven had a swelling of the left knee. X-rays showed a large, round, smooth cavity occupying the greater part of the upper epiphysis of the tibia and separated from the joint surface by a thin layer of bone. The diagnosis of giant-cell tumor was verified at operation, when the cavity was curetted and filled with osteoperiosteal grafts. Despite x-ray treatment [details not given], the cavity continued to increase so rapidly that the author thought it best to amputate at the lower third of the femur. The graft had not become consolidated, and the thin plate of bone forming the former roof of the cavity had disappeared, though the joint cartilage and the menisci had not been invaded. F. CAVERS Giant-cell Sarcomas of the Long Bones, H. W. HOTZ.Uber das Riesenzellensarkom der langen Rohrenknochen, Virchows Arch. f. path. Anat. 293: 493-508, 1934. The author reports the histories of two patients in whom an erroneous diagnosis of benign giant-cell tumors was made from the histologic study of the biopsy specimens and that of a third patient in whom a sarcoma developed near the site of a benign giant-cell tumor. It is concluded from these studies that greater care must be exercised in the diagnosis of benign giant-cell tumors of bones. It is only through the cooperation of clinicians, radiologists, and pathologists that the correct diagnosis can be made in the maximum number of cases. The article is illustrated with several poor photomicrographs. BENJAMINR. SHORE Osteogenetic Sarcoma, CHAS.0. BATES. Internat. J. Med. & Surg. 47: 489-490, 1934. The author briefly reviews the subject of osteogenic sarcoma and reports cases in a boy of fourteen and a girl of the same age. A hip joint amputation was done in each case a few months prior to the report. There was a possibility of preceding trauma in the first case but none in the second. Sarcoma of the Scapula, J. A. NOBLE. Nova Scotia M. Bull. 13: 234-235, 1934. A girl of eighteen bumped her shoulder at a dance, and three weeks later a sarcoma appeared which rapidly increased in size. Diagnosis was by aspiration biopsy only, as the x-ray picture was one of periostitis: and the patient refused amputation. GRAYH. TWOMBLY

Congenital Angiosarcoma of the Forearm, P. LOMBARDAND LE GENWSEL.Contribu- tion B. l’dtude des tumeurs malignes congenitales des membres. Sarcome congenital de l’avant-bras B. allure d’angiome caverneux, Rev. d’orthop. 21 : 297-300, 1934. A child was brought to the hospital about twenty-four hours after birth because of a large swelling of the left forearm, covered by purple skin. The authors diagnosed THE BONES AND JOINTS 933

cavernous hemangioma and gave repeated intratumoral injections of formol. This having no effect, they tried x-rays (total dosage 3000 Solomon R). The swelling was reduced in size for a short time, but then grew bigger than at first. It proved fairly easy to enucleate, and was found histologically to be a spindle-cell sarcoma, with blood- containing spaces suggestive of hemangioma. Three months later several similar nodules appeared on and near the operation scar. The parents refused to permit amputation; the child became increasingly cachectic and died two months afterwards. There are two illustrations. F. CAVERS

Myxosarcoma of the Thigh Showing High Radiosensitiveness, N. PUENTEDUANY AND A. PAULTRDTORRENS. Sarcoma de las partes blandas de la cara posterior del muslo con exquisita sensibilidad a las radiaciones, Bol. Liga contra el chcer 8: 299-306, 1933. A man of forty-four had five years previously noticed a swelling in the right popliteal space, which grew rapidly and hifldered movement of the knee. Two years later the tumor was excised, but soon it recurred and within a year was larger than before (size of a fetal head). It was again excised, and during the next two years again recurred. One of the authors performed the second operation, the tumor being diagnosed histologically as a myxosarcoma. The authors now gave x-ray treatment, 80 per cent of an erythema dose on each side and posteriorly. The tumor regressed within a few weeks to half its original size. Two needles each of 2 mg. radium were inserted in the tumor mass, and this was followed by more intensive radium mould application over the popliteal space. At the time of reporting, two months after the last radium application, no tumor was palpable. There are two poor illustrations. F. CAVERS

Primary Liposarcoma of Bone, L. BARNARD.Arch. Surg. 29: 560-565, 1934. Barnard reports the case of a thirty-year-old woman who was first seen because of pain in the left shoulder, of four months’ duration. At that time roentgenograms showed a rarefaction of the greater tuberosity and upper two centimeters of the humerus, with a bulging of the cortex over the tuberosity. Neither perforation of the cortex nor formation of new bone was visible. Roentgenograms one week later showed marked progression of the process with destruction of a large portion of the greater tuberosity of the humerus, Histologic study of a biopsy specimen showed a definitely malignant tumor, which, because of its high lipoid content, was considered to be a liposarcoma. The patient died six hours after a radical shoulder girdle amputation. Autopsy showed numerous small metastatic tumor nodules in the lungs which had the same histologic characteristics as the primary growth. The clinical and pathologic evidences in this case strongly suggest the origin of this tumor from the fatty elements of the bone. The article is illustrated with a roentgenogram, photograph, and photomicrographs. BENJAMINR. SHORE Myelosarcoma of the Ribs with Extensive Metastasis, P. FOULON.Un cas de mydo- sarcome, Bull. Assoc. franc;. p. 1’6tude du cancer 23: 131-138, 1934. A man of fifty-five had three years previously noticed a swelling over the middle lcft ribs, which was partly excised and treated with x-rays. The swelling persisted and grew progressively larger, and shortly before attending the author’s clinic the patient became dyspneic and noticed soft swelling of both arms and legs, and swellings in the right armpit. The mass on the right hemithorax was a hard tumor attached to the ribs. X-rays showed enlargement of the mediastinum. Left pleurisy developed, and the serofibrinous fluid withdrawn contained abundant lymphocytes, erythrocytes, and albumin. A blood count gave 4,390,000 erythrocytes and 21,800 leukocytes (polymorphonuclears 95.4 per cent, monocytes 4, myelocytes 0.4, lymphocytes 0.2). The patient became cachectic, with increased rapidity and irregularity of heart action, and died from asphyxiation six weeks after hospital entry. Necropsy revealed a tumor surrounding the fourth and fifth left ribs and extending to the pericardium, with nodules in the right ventricle, both auricles, the spleen, right suprarenal, and numerous abdominal lymph nodes. Both spermatic cords were in- 934 ABSTRACTS vaded, while the prostate and the testes were normal. The tumor cells were large, with a large rounded nucleus with one or two nucleoli, and granular cytoplasm giving a basophil or neutrophil reaction. In places there was considerable polymorphism of the tumor cells, many of which resembled polymorphonuclear leukocytes, bone marrow cells, myelocytes, plasmocytes, and normoblasts. The author thinks the term myelosarcoma probably the most suitable for this case, though it showed features suggestive of myeloma and myeloid leukemia. There are two illustrations. F. CAVERB Apparently Metastatic Malignant Tumor of the Bony Pelvis, M. J. DUPAS. Sur un cas de tumeur osseuse secondaire du bassin. MBtastase d’un cancer viscBral mB- connu, Rev. d’orthop. 21: 13-26, 1934. In a man of fifty-four, complaining of pain in the right loin, which had begun five months previously and had become increasingly severe, x-ray examination showed an irregular area of rarefaction at the junction of the right ilium and ischium. Deep x-rays were given for a month, and the pain was relieved, but radiography showed extension of the rarefied areas. Rectal palpation failed to reveal a tumor, and further clinical examination proved negative. Meanwhile the patient became increasingly cachectic, and successive radiographs showed extension of bone rarefaction to the entire pelvis and the head of the right femur. Death occurred ten months after hospital admission. Necropsy was not permitted, but from the x-ray appearances the author believes this was a case of metastasis from a latent primary carcinoma, though he admits that the case is unusual in the limitation of metastases to the bones of the pelvis. There are seven good illustrations. I?. CAVERS Roentgen Therapy of Bone Metastases Following Carcinoma of the Breast, J. C. PEDEN. J. Missouri M. A. 31: 310-312, 1934. The author reports the histories of four patients with skeletal metastases from carcinomas of the breast, in whom satisfactory palliative results were obtained with roentgen irradiation. All of the patients are now dead, the duration of life following treatment being from one to three and one-half years. It is possible that these patients would have lived as long without treatment, but certainly their life was made more bearable and comfortable. BENJAMINR. SHORE Osteomas of the Mastoid Process, K. H. PREUSSE.uber Osteombildung am Warzen- fortsatz des Felsenbeins, Beitr. 5, prakt. u. theoret. Hals-, Nasen- u. Ohrenh. 31: 203-215, 1934. The author reports the case of a thirty-five-year-old patient from whom an osteoma of the mastoid process was removed. The tumor measured 2 cm. in diameter and had eroded a large portion of the normal mastoid. Only nine similar cases of osteomas of the mastoid have been reported in the literature. There are no illustrations. BENJAMINR. SHORE Radiologic Diagnosis of Amyloid Tumors of the Skull, K. VOQELER.Amyloidtumor des Schadels im Rontgenbilde, Arch. f. klin. Chir. 180: 37-39, 1934. The author reports the case of a fifty-two-year-old man with multiple, firm, non- tender tumors of the skull. Roentgenograms showed multiple areas of lessened density in the calvarium which in places involved the cortex and obscured the outline of the bone. Histologic study .of a biopsy specimen showed the tumors to be composed of masses of amyloid. The patient has had no special treatment and has remained well for the three years during which he has been under observation. The article is without illustration. BENJAMINR. SHORE

Juvara Operation for Benign Tumorp of the Knee Joint, I. GRIQORESCUAND A. VASILIU. Die chirurgische Behandlung der benignen Tumoren des Kniegelenks mittels der Juvaraschen Operation, Bruns’ Beitr. 5. klin. Chir. 160: 575-587, 1934. The authors describe in detail the technic of conservative resection of benign tumors involving the lower end of the femur or the upper end of the tibia. The essential feature THE BONES AND JOINTS 935

of the procedure is that the skeletal defect in the femur is closed by a graft from the tibia of the same side of the leg or, if the tumor involves the tibia, the defect after resection is closed by a graft taken from the lower end of the femur. The article is illustrated by roentgenograms of patients before and after resection of the growths and by drawings of the operative technic. Abstracted histories of five cases are also included. BENJAMINR. SHORE Solitary Bone Cysts and Their Treatment, P. DUCHAMP.De l’evolution des kystes essentiels des 08, Rev. d’orthop. 21 : 97-112, 1934. The author means by “ essential ” bone cysts all cysts which do not form part of a general systemic disease such as hyperparathyroidism. . He gives a good genera1 account of 41 cases collected from recent French literature. Of 33 operated cases, 24 were cured by curettage and bone grafting. A large portion of the paper is occupied by twenty-two good illustrations. No new cases are reported. F. CAVERB

Bone Cyst of the Humerus, D. TADDEr. Ciste ossea dell’omero, Rassegna internaz. d. clin. e terap. 14: 1084-1100, 1933. Taddei describes a solitary cyst of the upper third of the humerus which caused a pathological fracture in a child eight years old. Curettage was done. A long theo- retical discussion of the etiology of such cysts is included. C. D. HAAGENSEN

Meniscal Cyst of Knee in a Child, E. SORRELAND H. BENOIT. A propos d’une kyste du m6nisque interne du genou chez un enfant, Bull. et m6m. SOC.nat. de chir. 60: 275- 282, 1934. Meniscal Cyst of Knee, P. MOUREAND R. MARTIN. Kyste m6niscal du genou, Ibid. 60: 504-507, 1934. Following an excellent review of meniscal tumors, with references to publications in the English and German languages, especially the former, as well as in French, Sorrel and Benoit report a case occurring in a six-year-old boy. A swelling of the inner aspect of the right knee had appeared spontaneously about six months earlier. On incision a tumor, the size of a hazelnut, was found attached by a slender stalk to the outer margin of the anterior horn of the meniscus. On cutting the base of the stalk, this part of the meniscus was found to contain numerous cysts, and was removed. There are four good illustrations. Moure and Martin report a case occurring in a young soldier who, after jumping over a wall, had sudden pain in the right knee. A year later he had to fall out in a route march because of sudden pain in this knee, which became locked in extension. Next daf the knee was greatly swollen; the army surgeon punctured the swelling and injected the serofibrinous fluid into a guinea-pig, with negative results. After six years of intermittent swelling and locking of the joint, the patient was referred to the authors, who removed a sessile cyst and the anterior half of the meniscus. The authors agree with ’ most other writers that%rauma is an almost invariable etiologic factor in these cases, and suggest that a hematoma is first formed and later undergoes organization. They point out that cartilage in general shows little tendency to proliferation; for instance, trauma to most cartilages, such as those of the nose, results in necrosis, not proliferation. F. CAVERS

Generalized Osteitis Fibrosa; Removal of Parathyroid Adenoma, 0. COPELLOAND P. M. BARLARO.Un caso de hiperparatiroidismo, Prensa m6d. argent. 20: 626-635, 1933. A man of forty-six had for about fourteen years suffered from increasing pain in the hands and feet, and had latterly been unable to walk without assistance. He had meanwhile attended two hospitals, each time on account of fractured bones following slight trauma. At the first a fracture of the right tibia was treated by splinting. At the second, a year later, a fracture of the left shoulder was treated again by splinting; the region was examined by x-rays and an area of rarefaction found at the site of fracture. In both hospitals, and also for some time after attending the authors’ clinic, the 936 ABSTRAUTS

patient was given antiluetic treatment, though nothing is said of a Wassermann test. As this treatment was badly tolerated, thorough x-ray investigation was made, and revealed widespread cysts and rarefactions of bone. Three tests of blood calcium, made at intervals of about five weeks, gave 15, 18, and 16 mg. per 100 C.C. No parathyroid tumor was palpable, but at operation the lower left parathyroid was found to be enlarged and red. Its lower end was retrosternal, and it was easily removed; histologically it was a typical parathyroid adenoma. Two days after operation symptoms of tetany set in and became severe, persisting for twenty days despite the administration of parathormone (Collip), irradiated ergosterol, and oral and intravenous calcium chloride. The intravenous calcium chloride, in doses in one gram daily, is said by the authors to have had the most marked influence in controlling the tetany. A month after operation the blood calcium had fallen to 10 mg. per 100 c.c., and at the time of reporting, three months after operation, the patient could walk pretty well and had gained considerable weight, while x-ray examination showed a fair degree of recalcification of the affected bones. There are eight excellent illustrations. F. CAVERS

Generalized Osteitis Fibrosa with Parathyroid Adenoma,. L. COURTYAND J. CALLENS. Ostkite fibreuse kystique gbn8ralis6e avec adhome parathyroldien, (Maladie de Recklinghausen), Bull. et m6m. So,. nat. de chir. 60: 777-783, 1934. A woman of sixty complained of symptoms for the past two years. They had become steadily worse, with emaciation, muscular weakness, and pain in both lower limbs. Unfortunately the authors were unduly influenced by a diagnosis of rheumatism previously made by one specialist and a positive blood Wassermann reaction reported by another, and continued for three months with antiluetic treatment until the patient’s rapid decline forced them into making a thorough examination. X-rays showed widespread bone lesions, especially in the lower extremities. No parathyroid tumor could be palpated. The blood calcium was slightly increased (12 mg. per 100 c.c.) ;the urinary calcium was 16 mg. per 100 c.c., and the daily output 288 mg. Two days after x-ray examination there was spontaneous fracture of the right femur. The patient, though in an extremely feeble state by this time, agreed to operation, when a small parathyroid adenoma was removed from the left lower thyroid region. The blood calcium fell to 7.9 mg. per 100 C.C. The patient became increasingly weak and drowsy, failing to respond to injections of calcium preparations, and died while an injection of parathyroid extract was being given, F. CAVBIRS Extirpation of Parathyroid Glands in Cases of Generalized Osteitis Fibrosa, NORDMANN. Exstirpation der EpithelkSrper bei Ostitis fibrosa generalisata, Arch. f. klin. Chir. 180: 137-138, 1934. The author reports the case of a thirty-nine-year-old woman with generalized osteitis fibrosa in whom marked improvement was obtained after the removal of three parathyroid glands. No mention of a distinct enlargement of these structures is made. The patient has remained in good health for eighteen months after operation. The article is without illustration. BIINJAMINR. SHORE Generalized Osteitis Fibrosa Without Hypercalcemia or Discoverable Parathyroid Tumor, 8. LABORDB,H. WELTIAND F. LEPENNETIER.A propos de l’observation d’une ost6ite’fibro-kystique gkn6raliske, Bull. Assoc. franp. p. l’ktude du cancer 23 : 139-154, 1934. In 1913 a woman, then aged twenty-three, had right infraorbital neuralgia and soon afterwards noticed a bony swelling in this region, The tumor was removed in the same year by a surgeon who made a diagnosis of osteosarcoma, without histologic examination. Some years afterwards the tumor recurred, causing downward bulging of the palate, and in 1922 the same surgeon removed the recurrent growth by curettage. Again no histologic examination was made. In 1926, following a violent injury to the left elbow [interval not stated], there appeared a swelling of the lower end of the humerus. In 1930 a fall caused fracture at the site of this swelling, and a radiologist was consulted, who x-rayed the elbow and then referred the patient to the authors, with a diagnosis of a THE BONES AND JOINTS 937 cystic lesion. The fracture healed within two months, but the bone remained swollen. Shortly afterwards the patient complained of painful swellings in the sacral region and the right knee. In 1932 a thorough investigation was made by Mme. Laborde, who found various bone lesions, involving the sacrum, fifth lumbar vertebra, both iliac bones, both femora, and the cranium. All these showed decalcification and fibrosis, with persistent trabeculae of normal bone. The tumor in the lower end of the left humerus, however, presented the appearance of a giant-cell tumor. The blood and urinary calcium and phosphorus contents were well within normal limits, a finding verified on repeated tests. At exploratory operation all four parathyroids were found to be normal in site, size, and appearance. However, one was removed, as was, also, a small nearby mass suspected of being an accessory parathyroid. Histologically the former showed normal parathyroid structure, the latter that of a normal lymph node. During the two years following operation the disease continued its course, the blood and urine calcium remained normal, and x-rays showed increasing decalcification. The authors attribute the absence of hypercalcemia to the fact that the disease had presumably lasted for twenty-one years and shown very slow development. There are ten excellent x-ray illustrations. F. CAVERS

Relation of Trauma to Osteitis Deformans, E. LOOSER. Ostitis deformans und Unfall, Arch. f. klin. Chir. 180: 379-386, 1934. In 37 cases of osteitis deformans observed by the author there were 2 in which trauma appeared to be an etiologic factor. One patient was a forty-year-old man in whom evidences of osteitis fibrosa localized in the right tibia were demonstrated radiologically and proved by histologic study of a biopsy specimen ten years after an injury to the right lower leg. The other patient was a sixty-year-old woman in whom the diagnosis of osteitis fibrosa of the tibia was made from roentgenograms and histologic study of a biopsy specimen four weeks after a local injury. Eight years after the injury roentgenograms showed more diffuse changes in the tibia which were typical of osteitis fibrosa. The relation of trauma to the development of the bony lesions is not so definite in this as in the first case. The article is illustrated with roentgenograms and photomicrographs. BENJAMINR. SHORE

THE LEUKEMIAS, HODGKIN’S DISEASE, LYMPHOBLASTOMAS, MYELOSIS Leukemias in Relation to General Problems in Pathology, H. v. KRESS. Die Leukamien im Rahmen allgemein pathologischer Probleme, Deutsches Arch. f. klin. Med. 176: 359-390, 1934. The author briefly reports four cases, one of lymphatic and three of myeloid leukemia, none showing unusual features. He then discusses the various modifications presented by the peripheral blood and by the spleen, liver, bone marrow, and lymphoid tissue in the leukemias; the probable relationship between polycythemia and myeloid leukemia suggested by Weber and Bode, and on the other hand the fairly frequent association of aplastic anemia with the leukemias (see article by Weber and Weisswange, abstracted below, p. 939); and the possible relations between the leukemias and the reparative phenomena in infective and other diseases. He attributes the anemia accompanying the leukemias to hemolytic processes. On the other hand, the myeloid and lymphatic metaplasias which occur in the blood-forming qrgans in the course of infective diseases show such close resemblances to the processes observed in the leukemias as to make it probable that the latter arise from a process of infection. F. CAVERS Treatment of Leukemia, D. Y. KEITH. South. M. J. 27: 318-323, 1934. A general review of the clinical manifestations of leukemia and its treatment. Radiation therapy is advocated and its mode of action discussed briefly. Of significance in the treatment of myelogenous leukemia are the spontaneous leukocytic crises occurring as a result of the direct action upon the hemopoietic system, the reversal of the 938 ABSTRACTS sensitivity ratio of red and white cells by means of a liberated leukotoxin, and the survival of the irradiated myelocytes by the action of protein decomposition products on the blood-forming system. In 27 cases treated with both high-voltage and low-voltage therapy, it was found that the former produces a prompt response, although the time elapsed since treatment was insufficient to judge of its permanency. Four oases are reported in which the response to treatment was prompt and satisfactory. There are no illustrations. A short bibliography is appended. THEODORES. RAIFORD

Acute Leukemia in an Infant, A. J. REVELLAND H. E. MARCHBANRS.J. Kansas M. SOC.35: 296-297, 1934. The authors report the unusual occurrence of acute leukemia in an infant of six months. The clinical manifestations wel'e profuse head sweats, listlessness, diarrhea, and watery nasal discharge. Examination was essentially negative except for tender, swollen gums and palpable axillary and inguinal lymph nodes. Blood findings revealed a marked secondary anemia and a leukocytosis of 218,400, with 98 per cent lymphocytes. Liver and spleen were both palpable. A series of x-ray treatments brought about reduction of the leukocytosis and relative lymphocytosis, but the infant grew progressively weaker, developed petechiae, and died nine days after admission. No autopsy was available. There are no illustrations. THEODORE5. RAIFORD

Intussusception in Lymphatic Leukemia from Enlargement of Peyer's Patches, K. W. KRAMER.Invaginationsileus bei lymphatischer Leukllmie infolge Schwellung der Peyerschen Plaques, Centrlbl. f. allg. Path. u. path. Anat. 60: 273-276, 1934. The patient, aged twenty-seven, entered the hospital with a radiologic diagnosis of gastric tumor. At operation no tumor was found in the stomach but both the gastro- hepatic and gastrocolic ligaments contained very large lymph nodes. Biopsy of one of these led to a diagnosis of aleukemic lymphadenopathy and radiation was advised. The blood picture at this time showed a leukocytosis of 11,700, with 31 per cent lymphocytes. The patient returned six months later in a moribund condition, presenting the typical picture of intestinal obstruction. At this time there were markedly enlarged nodes in both axillae and inguinal regions. The obstruction was thought to be due to compression of the small intestine from intra-abdominal lymphatic masses. Operation was precluded by the death of the patient. Autopsy demonstrated marked distention of the jejunum and upper ileum and an intussusception of the ileum 100 cm. above the ileocecal valve, produced by a submucous mass. All lymph nodes were enlarged, especially those of the mesentery and along the lesser curvature of the stomach. Histo- logically these were lymphatic tissue, manifestly of aleukemic lymphatic leukemia. The nodule in the intestine was of a similar type and was thought to have arisen from a Peyer's patch. There are three illustrations. THEODORE8. RAIFORD

Chronic Lymphatic Leukemia, R. DENIS,A. P. HEUDTLASSAND 0. GARRI. Leuceinia ganglionar crbnica, Prensa m6d. argent. 20: 1093-1097, 1933. The patient was a woman of forty-one, with widespread superficial adenopathy, no palpable enlargement of spleen or liver, and 160,000 leukocytes per c.mm., 95 per cent being lymphocytes. The authors tried administration of benzol and a liver preparation, neither with any obvious effect, and now intend to give x-ray treatment. There is one illustration. F. CAVERS Periosted Ossification in Myelogenous Leukemia : Report of a Case Associated with Acute Rheumatic Fever, J. C. EHRLI~HAND S. FORER.Arch. Int. Med. 53: 938-952, 1934. The' authors report the case of an eleven-year-old girl with acute myeloid leukemia and acute rheumatic fever. Autopsy showed the lesions characteristic of both these diseases. The periosteal changes in the left humerus observed at the beginning of the illness were found to have occurred as a result of repeated subperiosteal leukemic infiltration, with secondary ossification in layers. The article is illustrated by a roentgenogram, photographs of gross specimens, and photomicrographs. BENJAMINR. SHORE LEUICEMIAS, HODGIiIN ’S DISEASE, LYMPHOBLASTOMAS, MYELOSIS 939

Aplastic Anemia Coexistent with Lymphatic and Myeloid Leukemias, F. P. WEBERAND W. WEISFWANQE.Aplastische Anamie und Leukamie, Deutsches Arch. f. klin. Med. 176: 422-424, 1934. The authors report two cases. (1) An anemic man of thirty-one had bleeding of the gums after an attack of influenza. There were no signs of purpura, no enlarged nodes, and the liver and spleen were not enlarged. A blood count gave 770,000, erythrocytes, 20 per cent hemoglobin, and 4900 leukocytes (lymphocytes 72 per cent, myeloid forms 17, polynuclears 9, monocytes 1). Blood transfusion was followed by amelioration, but the leukocyte count never reached 10,000, the myeloid cells increased to 44 per cent, and a hemorrhagic diathesis developed before death. At necropsy the bone marrow was infiltrated with myeloblasts, with large amounts of hemosiderin. (2) An eleven-year-old boy, with anemia, gave a blood count of 2,520,000 erythrocytes and 6000 leukocytes (including 79 per cent lymphocytes and 17 per cent polynuclears). He had profuse nosebleeds. The erythrocytes and total leukocyte count fell rapidly. Three blood transfusions led to temporary amelioration, but the nosebleeds began again and the lymphocyte percentage rose to 97 before death. F. CAVERS Acute Aleukemic Leukemia Resembling in its Earlier Phases Agranulocytic Angina and Aplastic Anemia, G. W. SMITH. U. S. Naval Med. Bull. 32: 347-356, 1934. The author reports in detail the case of a twenty-five-year-old man with a rapidly fatal acute aleukemic leukemia. The difficulty of differentiation between agranulocytic angina, aplastic anemia, and acute aleukemic leukemia, while the disease is in the leukemic stage and before the immature white blood cells are thrown into the general circulation, is emphasized. BENJAMINR. SHORE

Aleukemic Lymphomatosis of the Stomach in a Child, R. CIBILSAQUIRRE, D. BRACHETTO BRIANAND J. J. MURTAQH.Sobre un tumor de est6mago excepcional en la infancia (linfomatosis aleucemica), Prensa m6d. argent. 20: 734-753, 1933. Also in Arch. argent. de pediat. 4: 381, 479, 1933. For about three months a twelve-year-old girl had complained of pain in the middle of the spine, which led the family physician to suspect Pott’s disease. Latterly she had epigastric pain and vomiting. Repeated x-ray examinations at different angles showed a diffuse vegetating tumor occupying the greater part of the stomach, except the fundus, and suggesting papillomatosis or cauliflower carcinoma. At laparotomy the stomach wall was found to be irregularly thickened, with intervening thin and friable areas, and numerous adjacent lymph nodes were enlarged. The condition seemed to preclude gastric intervention of any kind, and ileostomy was done. A blood count showed 4,400,000 erythrocytes and 6000 leukocytes (polymorphonuclears 57 per cent, lymphocytes 36, transitional forms 7). The child died two weeks after operation, and necropsy confirmed the x-ray and laparotomy findings. The gastric wall was studded with irregular papillary and sessile nodules, some of them ulcerated. Histologically these consisted of submucosal masses of lymphoid cells separated by a scanty fibrous stroma. The authors give a good discussion of lymphoid gastro-intestinal tumors associated with leukemic and aleukemic lymphadenosis. In their case post-mortem examination of the stomach alone was permitted, and the only enlarged lymph nodes found were those in the neighborhood of that organ. There are seven good illustrations, and an extensive bibliography is appended. F. CAVERS

Leukopenic Aleukemic Chloromyelosis, U. STRASSER.Aleukamisch-leukopenische Chloromyelose, Wien. Arch. f. inn. Med. 25: 133-144, 1934. A woman of fifty-eight returned to the hospital because of Getrorrhagia recurring two years after x-ray treatment for fibroids. She gave a vague history of digestive troubles, and blood was found in the stool. She was very anemic, and was given serum and calcium treatment. Blood examination showed 1,300,000 erythrocytes, hemoglobin 30 per cent, leukocytes 1100 (polymorphonuclears 34 per cent, lymphocytes 48, myelocytes 12, myeloblasts 4, monocytes 2). After blood transfusion (400 c.c.) the leukocytes fell to 340 per c. mm. (100 being myeloid cells). During the next few days of life the 940 ABSTRACTS leukocytes rose to about 2000, the myeloid elements increasing to over 50 per cent. Necropsy showed luetic aortitis and myocarditis, and typical green chloromatous deposits in various bones (base of skull, clavicles, ribs, sternum, femora! vertebrae). . The author gives details of the x-ray treatment two years previously, and does not think that this played a part in producing the extreme leukopenia. He adds an interesting discussion of the chloromas, containing nothing new. F. CAVERS Hodgkin’s Disease, J. W.MACINTOSH. Nova Scotia M. Bull. 13: 181-182, 1934. A white male twenty-six years of age presented the clinical picture of enlarged cervical, subclavian, axillary, inguinal, and mediastinal lymph nodes and moderate splenomegaly. There were 20,800 white blood cells, with 81 per cent neutrophiles. No biopsy was taken. X-ray therapy brought about rapid disappearance of all glandular swelling, and three months later the patient presented no sign of disease. [This report is of little value since, in the absence of a biopsy, the diagnosis cannot be accurately ascertained, and the duration since treatment is not sufficient for a claim to permanent cure.] THEODORES. RAIFORII

Mediastinal Type of Hodgkin’s Disease, J. A. KOLMER. Med. Clin. North America 18: 177-189, 1934. In a white female twenty-seven years of age, who complained of cough, dyspnea, pain in the left chest, intermittent fever, anorexia, and general malaise, x-rays revealed a large mass arising in the mediastinum and encroaching upon the right lung. Response to radiotherapy was prompt and marked, the mass being reduced to one fourth its original size. The symptoms, however, gradually increased in severity, and biopsy of an enlarged right cervical lymph node showed Hodgkin’s disease. Death took place three years after the first admission. At autopsy a large maw was found in the upper mediastinum, surrounding the trachea and large vessels and extending well up into the neck. It had also invaded the upper lobe of the left lung, forming a globular mass 6 cm. in diameter. The middle lobe of the right lung was densely infiltrated by the process, The neoplastic tissue was yellow in color, soft, and friable. Histologic studies showed a morphology typical of Hodgkin’s disease. It is emphasised that diagnosis can be made accurately only by means of histological study, and even then it is not always possible to distinguish the condition from other lesions of the lymphoblastoma group. There are five illustrations. THEODORES. RAIFORD

Generalized Torulosis Associated with Hodgkin’s Disease, M. S. FITCHETTAND F. D. WEIDMAN.Arch. Path. 18: 225-244, 1934. The authors report the fourth known case of widespread generalized torulosis, a disease which heretofore has usually been described as being confined to the cerebrospinal nervous system. It occurred in an eighteen-year-old negro who had had symptoms of Hodgkin’s disease for three years. In forty-four cases of torulosis collected from the literature there have been two other instances in which the histologic picture of Hodgkin’s disease was approached, but only in the one here reported has the full symptomatology of weakness, anemia, and massive adenopathy of Hodgkin’s disease been recorded. Nevertheless, it would be premature to regard Torula infection’as one of the causative agents of Hodgkin’s disease, although certain features were highly suggestive of such an etiology. Patients with Hodgkin’s disease with meningeal symptoms should be examined for Torula infection. The article is well illustrated with photomicrographs and photographs of the yeast cultures. BENJAMINR. SHORE

Lymphoblastoma in Small Intestine of a Child, J. L. LITTLE. Chinese M. J. 48: 148-152, 1934. Little reports the unusual finding of two primary lymphoblastomata in the ileum of a child twelve years of age. The condition was clinically manifested by abdominal distention, anorexia, nausea and vomiting, and fever. Examination revealed a palpable elongated mass running transversely across the abdomen. There was an advanced secondary anemia. A diagnosis of intussusception was made, and operation was under- STATISTICS 941 taken. Two large pedunculated tumors were found in the lower abdomen, apparently arising from the mesentery. These were removed, and on further examination a peculiar knuckle of bowel was observed within which a firm tumor could be palpated. Accord- ingly eight inches of bowel were resected and anastomosis was done. Following the operation signs of obstruction again developed, and six days later the abdomen was re-explored. This time an intussusception was found two feet above the site of the previous anastomosis. A similar tumar was found within the ileum and a second resection was performed. Convalescence was uneventful and on discharge the patient had regained her appetite and suffered no discomfort. Pathological examination showed firm whitish tumors in both resected portions of the bowel @hioh were histologically lymphoblastomata. The two pedunculated tumors were somewhat similar in gross appearance, but no histological description of them is given. However, the author apparently regards them as secondary metastases. The infrequency of lesions of this type is illustrated by the findings of Nunn (North- west Med. 30: 497, 1931. Abst. in Am. J. Cancer 17: 235, 1933), who observed sap- comata (with which the lymphoblastomata are grouped) in only 1.42 per cent of all alimentary canal malignancies. Sutton (Canad. M. A. J. 26: $1, 1932. Abst. in Am. J. Cancer 17: 1040,1933) found the incidence to be less than one per cent. The differentiation of lymphomatous tumors is discussed briefly and it is emphasized that the localization of small primary lesions at the sites of Peyer’s patches suggests this tissue as a likely origin. Surgical removal followed by x-ray therapy is advocated, but prognosis must be regarded as poor. There are five illustrations. THEODORES. RAIFORD

Chronic Myelosis in Children, with Report of a Case, A. A. ELSENBERGAND H. WALLER- STEIN. J. Lab. & Clin. Med. 19: 713-723, 1934. That chronic myelosis in children is an extremely rare entity is attested by the fact that only thirty authentic cases were found by the authors in a thorough perusal of the literature. From a study of these cases they conclude that while the chronic forms of the disease are more frequent in adults, the converse is true among children. A’ striking feature in the clinical picture is the history of quite frequent infections. The most common symptoms in early cases are weakness, lassitude, and pallor. In late cases the spleen is always enlarged, and the liver in a large percentage of cases. Neither adenopathy nor fever is a common finding. Although the blood picture is variable, there is perhaps a greater tendency for the appearance of the myeloblast forms. The aleukemic form of the disease is quite rare. Anemia is practically always present and frequently severe. Prognosis is hopeless, although many patients have lived as long as five years. Prior to death signs of hemorrhagic diathesis usually appear. The most satisfactory forms of treatment are benzol, thorium, and deep x-ray therapy, the latter producing a beneficial result in almost all instances. A case is reported in a child of nine years. The response to x-ray therapy was satisfactory for two years, but following his sixth transfusion, the patient gradually weakened and died, in all probability as a result of the increased fragility of the leukocytes. There is a comprehensive bibliography, and four illustrations are included. THEODORES. RAIFORD

STATISTICS

Present Status of Cancer in Spain, G. PITTALUOA.Internat. J. Med. & Surg. 47: 89, 1934. ’ The Spanish cancer mortality figures are given for the years 1901 to 1930. In the latter year there were 16,481 deaths from cancer, a rate of 69.85 per 100,000 of population. Cancer of the stomach and liver accounted for over 7,000 deaths. Tumor Conditions Encountered in South America, WILLIAMH. WHITE. Internat. J. Med. & Surg. 47: 313-314, 1934. This is a report of the author’s observations in a region of Colombia, known as Intendencia Choco, with a population of some 100,000, many of whom are Indians. 942 ABSTRACTS

Malignant growths are said to be rare, though the author states that autopsies are very difficultto obtain and few biopsies are done. Quebec and the Cancer Situation, J. LE BLOND. Internat. J. Med. & Surg. 47: 314, 1934. The cancer mortality in Quebec for the last decade is placed at 19,817, as compared with 31,445 deaths from tuberculosis. There is a radium institute in Montreal and 2,223 mg. of radium are available in the province. Cancer Survey of Kansas, F. L. RECTOR. J. Kansas M. SOC.35: 253-269, 300-308, 321-325, 343-348, 354-362, 1934. In this voluminous report the author presents the data obtained from a statistical study of malignant disease in the state of Kansas. While much of the information is concerned with more or less insignificant details, of minor interest to the student of cancer, a few salient points are brought out. Thus in the past thirty years cancer has risen from sixth to second place as a cause of mortality. Of the total number of persons dying of cancer, in almost half the disease involved primarily the gastro-intestinal tract or peritoneum. The necessity of early diagnosis, adequate treatment, and education of the profession and laity, if this mortality is to be reduced, is duly emphasieed. The remainder of the article is concerned largely with bettering the organization of institutions and increasing the facilities for the control of cancer. There are numerous statistical tables. THEODORES. RAIFORD

Is Cancer on the Increase? A. S. PRICE. Internat. J. Med. & Surg. 47: 530, 1934. Comparing the figures of the pathological laboratories of the New York Polyclinic Medical School for two five-year periods, the author concludes that such increase in the incidence of cancer as was observed is apparent rather than real.

EDUCATION Results of Cancer Education: A Cliical Study of the Cancer Problem in Relation to Cancer Propaganda, B. KARITZKY.Das Ergebnis der Krebsaufklarung. Ein klinischer Beitrag zum Krebsproblem und zur Krebspropaganda, Deutsche Ztschr. f. Chir. 243: 560-583, 1934. A study of the 1814 patients with neoplasms treated from 1920 to 1933 in the Uni- versity Surgical Clinic in Freiburg was undertaken in order to ascertain the possible effects of cancer education of the laity on the types of tumors seen. From this study it is concluded that the propaganda for the early diagnosis and treatment of malignant tumors has neither influenced the morbidity rate nor altered the age groups of patients with cancer. With the exception of patients with tumors of the skin, the period of time allowed to elapse between the appearance of the first symptoms and the institution of suitable treatment has not been lessened nor has the operability been increased. An- alyses of the data according to years, types of growths, and their operability are included in tabular form. BENJAMINR. SHORE Problem of Cancer Control, F. MEDER. Zum Problem des Kampfes gegen den Krebs, Zentralbl. f. Gynak. 57: 999-1001, 1933. Campaign against Cancer: Comment on Meder’s Paper, E. PUPPEL.Zuin Kampf gegen den Rrebs. Bemerkungen zu der Arbeit von Meder, Ibid. 57: 2433-2435,1g33. Campaign against Cancer: A Reply to Puppel’s Reply to Meder, K. E. FECHT. Zum Kampf gegen den Krebs. Eine Entgegnung zur Entgegnung von Puppel auf die Arbeit Meders: Zum Problem des Kampfes gegen den Krebs, Ibid. 58: 63-64, 1934. These three articles represent the individual opinions of the authors regarding the most efficient means of combatting the frequency and mortality of cancer, In general certain definite points are agreed upon. Thus all concur in the opinion that EDUUATION 943 early diagnosis is essential to successful therapy. Puppel, however, is more pessimistic than his colleagues and feels that little more can be accomplished. While public education and frequent routine examinations could undoubtedly lower the mortality, he regards the fear of the disease which would be thereby instilled into the patient of more serious consequence than the disease itself and warns against the dissemination of a widespread cancer psychosis or phobia. Fecht and Meder, on the other hand, attack this view as being extreme. They believe that educational measures properly put before the normally intelligent person would result in a better understanding of the disease and increased cooperation between patient and physician. All agree that the abolition of quackery is essential to successful management of cancer. THEODORES. RAIFORD

Organization of the Anti-cancer Campaign in Germany, F. BLUMENTHAL.Die Organisa- tion der Krebsbekiimpfung in Deutschland, Bull. d. Schweis. ver. f. Krebsbekiimf. 1: 33-47, 1933. This article concerns itself with a description of the work which is being done in the various societies and institutes throughout Germany in the attempt to decrease the mortality from malignant disease. THEODORES. RAIFORD

Problem of Cancer, RAYMONDP. SULLIVAN.Internat. J. Med. & Surg. 47: 310-311, 1934. The author touches briefly upon the importance of popular education on the subject of cancer even at the risk of producing a fear-complex; the harm attributable to irregular practitioners and charlatans, and the need of a world-wide investigation of the cancer problem supported by the public.

Cell Constitution and Cancer, LEONELLC. STRONG.Internat. J. Med. & Surg. 47: 51-52, 1934. A suggestion that studies on fundamental biology, such as the transplantation of normal embryonic tissue, may produce the evidence necessary to solve the fundamental nature of the cell and thus throw light on the cancer problem. Oral Hygiene in Cancer Control, H. A. SOLPMON.Clin. Med. and Surg. 41: 275-277,

--- 1934. : 'a'. a. . . ::..*: : ** ..".. .. . An outline of some activities of the A&&fad:&&$$'$$' the Control of Cancer, especially along the lines of education of the profession. Responsibility in Cancer Control Work, I. 1. KAPLAN. Med. Record 139: 71-72, 1934. An address urging the erection of a new cancer unit at Bellevue Hospital, New York. GRAYH. TWOMBLY

The Cancer Situation in California, ALBERTSOILAND. Internat. J. Med. & Surg. 47: 206-207, 1934. A brief statement of educational efforts to combat cancer in California.

Biophysics and Cancer, FOVEAUDE COURMELLES.Biophysique et cancer, NBoplasmes 13: 193-227, 1934. This is a general review, containing no new material. WM. H. WOGLOM 944 ABSTRACTS

What You Should Know about Cancer, W. P. HEALY.Bull. Am. Coll. Surgeons 18: 8-9, 1934. Some of the more salient features of malignant disease with special reference to its origin, nature and therapy are reviewed for the lay public. THEODORES. RAIFORD Cancer, in Relation to Life Insurance Medicine, HAROLD.M. FROST.Internat. J. Med. & Surg. 47: 51, 1934. A brief note setting forth present opinion as to the basis of issuing life insurance to persons who have undergone operation for cancer. No policies should be issued during the first five years after operation for carcinoma or sarcoma and extra mortality should be assumed thereafter. For epithelioma not diagnosed as basal-cell a four-year period, and for basal-cell epithelioma a one-year period should be allowed to elapse hefore granting insurance, and extra mortality should be assumed after this,