Seidell and Fenger observed very striking seasonal fluctuations in the amount of iodine in the thyroid glands of hogs, sheep and beef, more being present and the gland being smaller during the summer than during the winter season. Fenger confirmed these results. Martin working with sheep glands arrived at similar conclusions. Loeb in studying the compensatory hypertrophy of the thyroid gland of the guinea pig noted that this hypertrophy was considerably less in the summer than in the winter months. We may then assume that during the colder periods of the year the thyroid gland is much more active, perhaps owing to the fact that more demands are made on this organ than during the warmer season. As a result of the lessened need for thyroid hormone during the summer months, iodine, instead of being used in the metabolism of the gland is stored up in the acini. It has now been established that the functional state of the thyroid gland is to a marked extent influenced by a hormone of the anterior pituitary. Following previous observations of Allen, Smith, and Uhlenhuth and Schwartzbach in amphibian larvae, Loeb and Bas-sett observed that in mammals (guinea pigs) injections of extracts of the anterior pituitary cause a marked hypertrophy and hyperplasia of the acinus cells of the thyroid, a liquefaction and absorption of colloid, indications of an increased hormone action (loss of weight), therefore, in general, changes corresponding to those observed in Graves disease. To these changes corresponded a marked rise in basal metabolism under the influence of anterior pituitary extracts. (Siebert and Smith.) Under these conditions it was conceivable that the seasonal variations in the thyroid gland were due to corresponding variations in the activity of the anterior pituitary.
I do not agree with Doctor Bennett, that blowing a wind instrument produces a complete occlusion by the soft palate of the nasopharynx. How much of the nasopharynx is closed off depends on individual anatomy. The closure is rarely complete. The amount of pressure transmitted to the eustachian tubes varies also for individuals, and the fact that it does not happen to Doctor Bennett, does not invalidate my statement. Dr. K. M. Simonton in the Questions and Answers section ofThe Journal(177:534 [Aug. 19] 1961), answers a question on aerotitis media of opening the eustachian orifices and tubes by exhalation against pressure, which is precisely that obtained from blowing a wind instrument. I am sure there are many others who have had like experiences to mine.
Loeb, Bassett, and Hilda Friedman, , have shown that intraperitoneal injections of acid or alkali extracts of the anterior pituitary of cattle cause in the guinea pig a remarkable hypertrophy and hyperplasia of the thyroid gland associated with liquefaction and absorption of colloid. Martin Silberberg has studied the combined effect of KI and this extract on the thyroid gland and W. J. Siebert has determined the effect of various preparations of the anterior pituitary gland on the basal metabolism under various conditions. In our former investigations we used as a criterion of hypertrophy the microscopic changes in the thyroid gland after anterior pituitary injections. The thyroid glands of the injected animals appeared distinctly larger than the normal thyroids. We sought to determine the changes in weight of the thyroid glands produced by these preparations, in order to obtain quantitative data as to the intensity of the hypertrophy and hyperplasia. We carried out 3 experiments, the results of which are shown in the following table. In the first 2 experiments, the average initial weight of the injected as well as of the control guinea pigs was approximately 191 gm. During the period of treatment (5 days for the first experiment and 6 days for the second), the average weights of the injected animals remained almost unchanged, while the controls gained on the average of 10 and 8 gm. respectively. As a result of the injections the thyroid approximately doubled its weight. In the third experiment in which we had to deal with somewhat heavier guinea pigs, weighing on the average 265 and 264 gm. respectively, the average weight of the thyroid of the injected animal is seen to be approximately 2 1/2 times greater than the weight of the gland of the control guinea pig.
Atypical (World Health Organization [WHO] grade 2) and malignant (WHO grade 3) meningiomas have high rates of local recurrence, and questions remain about the role of adjuvant radiation therapy (RT) for patients with WHO grade 2 disease. These patients frequently require salvage therapy, and optimal management is uncertain given limited prospective data. We report on the long-term outcomes for patients with atypical and malignant meningiomas treated with surgery and/or RT at our institution.Data were collected through a retrospective chart review for all patients with WHO grade 2 or 3 meningiomas treated with surgery and/or RT at our institution between January 1992 and March 2017. Progression-free survival (PFS) and overall survival (OS) were described using the KaplanMeier estimator. The outcomes in the subgroups were compared with a log-rank test. A Cox proportional hazards model was used for the univariable and multivariable analyses of predictors of PFS.A total of 66 patients were included in this analysis. The median follow-up was 12.4 years overall and 8.6 years among surviving patients. Fifty-two patients (78.8%) had WHO grade 2 meningiomas, and 14 patients (21.2%) had WHO grade 3 disease. Thirty-six patients (54.5%) were treated with surgery alone, 28 patients (42.4%) with surgery and adjuvant RT, and 2 patients (3%) with RT alone. Median PFS and OS were 3.2 years and 8.8 years, respectively. PFS was significantly improved with adjuvant RT compared with surgery alone (hazard ratio, 0.36; 95% confidence interval, 0.18-0.70). Patients with Ki-67 index >10% showed a trend toward worse PFS compared with patients with Ki-67 ≤10% (hazard ratio, 0.51; 95% confidence interval, 0.25-1.04). No significant differences in PFS or OS were observed with respect to Simpson or WHO grade.For patients with atypical or malignant meningiomas, adjuvant RT was associated with significantly improved PFS, and Ki-67 index >10% was associated with a trend toward worse PFS. Given the long-term survival, high recurrence rates, and efficacy of salvage therapy, patients with atypical and malignant meningiomas should be monitored systematically long after initial treatment.
—The article entitled "Hidden or Unsuspected Bronchiectasis in the Asthmatic Patient" by Drs. Overholt, Walker, and Woods in the Oct. 4, 1952, issue ofThe Journalis misleading to the medical profession. Despite Dr. Overholt's richly deserved preeminence as a thoracic surgeon, I must take exception to his criteria for a diagnosis of bronchial asthma from both the internists' and the allergists' viewpoints. Everyone who wheezes does not have asthma and should not be so labelled. Not one of the patients reported on in this article can be termed asthmatic. Today no one calls bronchogenic carcinoma, inspissated foreign bodies, tuberculous bronchial stenosis, or left heart failure bronchial asthma yet patients with any of these conditions may wheeze and have exertional dyspnea. In the cases reported, however, Dr. Overholt makes the same erroneous diagnosis. Symptomatic bronchiectasis is rare in my experience of bronchial asthma. In the older age
Spasmodic torticollis remains an ill-understood disease. A central deficit in neurotransmitter activity in the basal ganglia may be present in this disorder. In the present study, dopamine-β-hydroxylase (DBH) activity has been evaluated in the plasma of patients suffering from spasmodic torticollis and in their sibship in 4 informative families. In 1 of these families, 2 brothers are affected with torticollis and they have high plasma DBH levels. In the 3 other families the plasma DBH values are within normal ranges in the probands and their first-degree relatives. The genetic study of plasma DBH activity allowed to discriminate between two forms of spasmodic torticollis, one, which is most likely linked to familial torsion dystonia, appears to be associated with altered dopaminergic activity, while the other, nonfamilial with normal sympathetic activity an idiopathic or sporadic form of spasmodic torticollis.
To the Editor:— Recently I had a disturbing experience. I sprayed 0.1% Tyzine nasal solution in the nose of my 22-month-old daughter for an acute upper respiratory infection. Within 30 minutes the entire skin of the child began to go dead white, and in an hour she went into complete vasomotor collapse, with a total loss of consciousness into a flaccid state. There was a dead white color, irregular sighing respirations, and a weak thready pulse. No cyanosis was present. All reflexes were absent. A bilateral Babinski sign was present. Epinephrine hydrochloride, 1:1,000 solution, 0.4 cc., was given subcutaneously, followed immediately by 0.25 gm. caffeine sodium benzoate by hypodermic and 15 minutes later by 0.25 gm. more of caffeine sodium benzoate. Each injection provoked a weak cry. Shortly after the injections wakefulness appeared, with control of voluntary muscles and a bit of voluntary walking and talking. At this point all
In former investigations we observed that by injections of acid and alkali extracts of anterior pituitary of cattle, it was possible to produce in the guinea pig changes in the thyroid gland identical with those in very pronounced cases of Graves' disease in man, namely, a marked hypertrophy and hyperplasia of the acinus cells, softening and absorption of colloid and irregular shape of the acini, associated often with an almost complete disappearance of the lumen of the acinus. There was also a loss of weight induced by these changes which indicated an hyperactivity of the gland. Silberberg found that administration of KI to a certain extent inhibited these changes. This corresponds to the action of this substance in Graves' disease. Siebert noted a marked rise of the basal metabolism in guinea pigs under the influence of acid or alkali extracts and more recently found that simultaneous administration of KI tends to counteract the effect on basal metabolism. Closs, Loeb and MacKay found the changes in the distribution of organic and inorganic iodine in the thyroid gland and blood of guinea pigs injected with acid extract similar to those which occur in Graves' disease.During the winter, 1930-31, we observed that guinea pigs injected with acid extract frequently showed a greater bulging of the eyes than normal guinea pigs. In view of the correspondence of this change to the exophthalmos which is so characteristic of Graves' disease, we followed the alterations in the eyes on a large number of guinea pigs. Our inability to measure these changes accurately or representing them objectively, caused us to hesitate to publish these observations.
