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Persistent atelectasis of the left lung was the chief finding in an elderly woman who had no background of chronic lung disease. At operation lower lobectomy was necessary because of irreversible parenchymal changes, but it was possible to salvage the upper lobe. Pathologically, the process was found to be mucoid impaction of the bronchi (MIB). Although this condition rarely involves an entire lung, its recognition is important because treatment with intrabronchial acetylcysteine may be definitive and surgery, if required, should be conservative.

1. Treatment of normal human red cells with various proteolytic enzymes, cholera vibrio filtrate, influenza virus, and periodate ion results in red cells susceptible to acid hemolysis in compatible normal human serum. 2. The kinetics of hemolysis of these artificially altered red cells resembles in many respects those observed in paroxysmal nocturnal hemoglobinuria (PNH). 3. While the observed differences in behavior between these artificially altered cells and PNH cells do not allow direct comparison, it is felt that these models may offer some clues in the understanding of PNH cell hemolysis, and some insight into the nature of the red cell lesion in paroxysmal nocturnal hemoglobinuria.

INTRODUCTION When, in a given patient, there has been established a firm diagnosis of a relatively chronic condition that may be expected to terminate fatally because curative treatment is either not known or not applicable, the case may properly be considered "hopeless." Under these circumstances medicomoral problems are almost inevitable; they are accentuated when the pathogenesis is obscure, when remission is rare, and when the general health of the patient is apparently good. Almost by common acceptance the prototype "hopeless case" is the patient with incurable malignancy. Unfortunately there are many other diseases, such as central nervous system neuropathies, that may readily be included in this baleful category. It is evident, but nevertheless of considerable significance, that the term "hopeless" in this context is relative—its limits are defined by the current state of medical knowledge. Scientific progress has narrowed these boundaries in some areas and expanded them in others. Pernicious

Fifty-three lung cancers with a pathologic diagnosis of bronchiolo-alveolar carcinoma were reviewed, particular attention being paid to the validity of the diagnosis and prognosis. Twenty-one cases were acceptable as primary lung tumors on the basis of complete necropsy study (nine cases), long-term survival following operation without recurrence (eight cases), and recurrent disease with unusually long survival times (four cases). Origin of these tumors from bronchiolar mucosa could not be proved. Contrariwise it is likely that an occasional tumor with characteristics of the terminal bronchiolar type may arise from the mucosa of small bronchi. The most consistent pattern believed to represent a bronchiologenic proliferation is the “fibroelastic” form; an associated elastica proliferation or condensation was found. Scar cancers of the classical type, i.e., central scar and peripherally oriented carcinoma, offer reassurance that the tumors are primary in the lung; their peripheral location implies that the mucosal type proliferation arises in a bronchiole. (A fibroelastic pattern was seen in some of the scar cancers in this series.) Contiguity of tumor and bronchiolar mucosa favors a primary origin for the tumor, but is not a conclusive finding at this time. A spectrum of bronchiologenic proliferation was noted, ranging from benign hyperplasia to infiltrating and destructive adenocarcinoma. Tumor growth along alveolar walls is interpreted as a superficial spreading phenomenon (“epiphytic” growth). Invasion, as opposed to superficial spread, is not always obvious with ordinary stains, but can be identified readily by elastic stains. Predominantly mucinous “epiphytic” adenocarcinomas are the ones most likely to be mimicked by metastatic cancer. Unfavorable histologic features are the presence of destructive-type invasion, intra-alveolar tumor cell clusters, multifocal tumor, blood vessel invasion, and lymph node metastases. There is a strong suggestion that scar cancers and tumors of the fibroelastic type are more amenable to resection as a group. The routine use of elastic stains will probably identify scar cancers of the condensation type that otherwise might be missed.

THE. HE RARER lesions responsible for the radiographic appearance of solitary pulmonary nodule include plasma cell and mast cell "tumors." On routine histologic study, plasma cells may be indistinguishable from mast cells, suggesting the need for reevaluation of instances reported as "solitary plasmacytoma of lung." In addition, the discovery of the mastocytosis syndrome has spurred investigation of the mast cell and its diseases. It is the purpose of this paper to report the second case of solitary pulmonary mast cell granuloma and to discuss its place in the spectrum of mast cell disease as well as its relationship to plasmacytoma. REPORT OF A CASE A 68-year-old white woman entered University Hospital on Aug 4, 1964, for evaluation of an asymptomatic lung lesion. A routine chest x-ray film taken on July 2, 1964, had demonstrated a 2-cm nodule located just above the right side of the hilum (Fig 1A). A

A case of severe neuropathy associated with a benign tumor of the thymus is reported. The patient developed dizziness without vertigo, difficulty with walking, and difficulty with depth perception. These symptoms cleared immediately on removal of the benign thymic tumor. Although it appears certain that there was a direct relationship between the tumor and the patient's symptoms, the mechanism remains unknown.

The mystique of the dressing as a crucial factor in wound healing is apparently an ineradicable part of our surgical heritage. In point of fact, the experience of modern surgery suggests that a dressing may be superfluous—if not actually counter-productive—in many situations. A recent article1 in a trade journal presents an elegant rationale for the use of some kind of dressing under virtually all circumstances. While acknowledging the special requirements that may exist with burns, grafts, and wounds crossing joints, for example, I should like to indicate that, in the case of the clean incised surgical wound, prolonged postoperative use of a dressing is not only disadvantageous but potentially hazardous.For the past 20 years it has been my practice to employ a minimal, loosely applied dressing for every clean thoracotomy incision and to remove it promptly on the morning after surgery. Bacteriologically speaking, wounds are probably effectively sealed

The first edition of this venerated work appeared in relatively placid 1930 and the fifth during the maelstrom of World War II. The interval had witnessed exciting advances in many aspects of emergency surgery, all painstakingly—one might even say lovingly—detailed by Bailey. In the earlier prefaces, he stakes his claim: "When to operate, when not to operate, and how to operate under emergency conditions is the theme of this work. While writing it, I pictured a patient stricken with an urgent surgical condition and a comparatively isolated surgeon called upon to carry out appropriate treatment." It was perhaps inevitable that the passage of time should make it more difficult for his successors to accomplish this worthy task. In any event, confusion of purpose and uncertainty as to audience seem to mar the present work, which is a multi-authored tome somewhat inaccurately labeled the "ninth" edition.It is hard to imagine

TO THE EDITOR: In the paper, "Closure of Boxing Lacerations Between Rounds" (Arch Surg 86:295 [Feb] 1963), the author correctly emphasizes the paradox of a fighter who is ahead on points losing by a technical knockout because of a facial laceration. Would it be invidious to point out a greater paradox, that of a plastic surgeon whose art is primarily directed not at preventing or correcting deformity but at permitting a contestant to continue longer in the meat grinder than might otherwise be possible?It should also be noted that the author shares with John Boyle O'Reilly (O'Reilly, J. B.: Ethics of Boxing and Manly Sport, Boston: Ticknor & Co., 1888.), that ancient admirer of John L. Sullivan, the myth that padded gloves reduce the chances of injury to the participants. There is little doubt that gloves are a protection to the wearer's hands rather than to his opponent's head

Although I have enduring respect for the discernment of the book editor, I must confess to initial bewilderment—a not uncommon state for a thoracic surgeon—upon receiving his request to review Advances in Internal Medicine. Was it a tribute to the catholicity of my medical tastes? Or just a secretarial error? Neither, I decided, after sober reflection. For, like its predecessors, Advances is perhaps more attuned to the noninternist who wants a deeper view into what is going on in the mother specialty than it is to the seasoned practitioner of medicine. But this is not to say that any active internist will read Advances without gaining new knowledge—or, more importantly, new insights.Indeed, in his preface to volume 15 (1969) the then-new editor signaled a change to an editorial policy directed at producing "an annual volume which every internist should read in its entirety and by so doing may continuously

To the Editor.—In their recent article, Cameron and Zuidema (219:1194, 1972) appropriately emphasize the problem of aspiration pneumonia and the clinical settings in which it is most apt to occur. I should like to suggest one addition to their litany of likely situations—the unrecognized, forgotten, or ignored sliding esophageal hiatus hernia in the patient undergoing surgery for another condition. Even under normal circumstances the patient with this problem runs some risk of bronchopulmonary aspiration; in the postoperative milieu, the risk is incalculably increased.Report of a Case.—A 54-year-old man was admitted to the hospital because an x-ray film of the chest had shown a density in the right upper lung field. Coincident barium study had demonstrated a sliding hiatus hernia with moderate reflux. The usual diagnostic studies included bronchoscopy and were unproductive. Brief consideration was given to the possibility that the lung lesion represented a focus of chronic

If the appearance in 1948 of Norbert Wiener's "Cybernetics" was not in itself a major biologic breakthrough, it did confer a sort of ontologic and semantic validity on a concept long known to workers in nonbiologic sciences. Indeed, it helped pave the way for an interdisciplinary approach to biology long before that adjective had lost its respectability. Cybernetics—"control and communication in the animal and the machine," as Wiener would have it—concerns itself with self-regulating feedback systems. The fly-ball governor of a steam engine is a classic example of a negative feedback arrangement. So, too, is a thermostatically regulated electric oven—the hotter it gets, the less current is supplied—thus, negative feedback. And, of course, such systems are at the heart of the newer computer technology. Biologically, cybernetics constitutes an approach to understanding integrated function in living organisms—someting evident to the ancients but awaiting modern insights before earning a scientifically reputable name