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Hypothermia and preservative perfusates have been used to decrease ischemic renal injury. This study was performed to identify the preservative function of perfusates independent of the effects of hypothermia. Rats underwent 45 minutes of renal ischemia. Rectal and renal parenchyma temperatures were monitored and maintained within 1 degree C of normal. Perfusates were University of Wisconsin solution (UW), Euro-Collins solution, normal saline solution, and Ringer's lactate solution. A nonperfused ischemic control and a nonischemic control group were also evaluated. Parameters evaluated included serum creatinine and blood urea nitrogen levels, renal ischemic injury grade, renal weight, and gross appearance of the injured kidney. Rats treated with UW solution were found to have a significantly lower creatinine, blood urea nitrogen, and injury grade than the other three perfused groups. The external gross appearance of the UW-treated kidneys was normal, whereas that of the other groups demonstrated moderate to severe injury. Although the mean right/left renal weight difference of the UW-treated group was lower than that of the other three groups, this was not statistically significant. Under normothermic conditions in rats, UW solution affords significant renal protection from ischemia. Euro-Collins, normal saline, and Ringer's lactate solutions display no significant protective effect.

Renal ischemic and reperfusion injury is a significant complication of major aortic and renovascular surgery. The delivery of a preservative agent just prior to reperfusion of an ischemic kidney may decrease the reperfusion injury. The purpose of this study was to evaluate the effects of renal artery perfusates delivered at the termination of an ischemic period. Five groups of rats were evaluated. All rats underwent left nephrectomy. The right kidney was made ischemic for 45 min by occlusion of the renal artery and vein. Ischemic control animals had no renal artery perfusion. Nonischemic control animals had no renal vessel occlusion or perfusion. The other three groups were perfused during the final 4 min of ischemia with one of the following: normal saline (NS), phosphate-buffered saline (PBS), or anti-ICAM-1-antibody (mAb). The blood urea nitrogen (BUN), serum creatinine (Cr), and renal histopathologic injury of each group were compared. The ischemic control group had significantly better renal function than the group perfused with NS or mAb at 72 hr. There was no significant difference between the ischemic control and PBS groups in renal function or morphologic injury. It is concluded that none of the perfusates in the study had protected the kidney from ischemic and reperfusion injury. NS delivered in this manner was injurious to the kidney.

The authors present a patient who experienced cocaine-related thrombotic microangiopathy and patchy renal cortical necrosis, associated with the clinical syndrome of microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure, characteristics of the Hemolytic-Uremic syndrome. The proposed pathogenetic mechanisms include: (1) cocaine-induced vasoconstriction and endothelial damage and (2) procoagulant effects of cocaine.

A case of spindle-cell carcinoma (pleomorphic carcinoma), a rare polypoid tumor of the tongue, is reported. The characteristic clinical, gross, and microscopic features of this peculiar lesion and its common sites of location are presented. Origin and pathogenesis of the sarcoma-like elements of the lesion are discussed and the literature on the subject is reviewed. Sites of apparent transition between the spindle cell elements of the tumor and the overlying epithelium were observed in light microscopic sections, and the electron micrographs of the spindle-cell portion of the lesion demonstrated the presence of tonofilaments and desmosomes in many tumor cells. These findings support the concept that this group of lesions are pleomorphic variants of squamous-cell carcinoma with predominantly spindle-cell pattern. Current evidence in the literature also suggests that metaplastic transformation of the tumor cells into mesenchymal elements may take place in some of these lesions, and that "metaplastic carcinoma" may probably be a more proper designation for them.

A case is reported in which a tumor containing elements of mature and immature ganglioneuroma, Schwannoma, clusters of apparently benign melanocytes and embryonal rhabdomyosarcoma presented as a right-sided facial mass in a six-month-old child. Different elements of the tumor were intimately intermingled without distinct borders. Embryogenesis of the tumor, which is thought to arise from remnants of migratory neural crest cells (ectomesenchyme), showing multidirectional phenotypic expression is discussed. It was felt that the lesion contributed additional evidence in support of pluripotentiality of the migratory, neural crest derivatives, and their susceptibility to mutagenic and oncogenic influences.

Prostaglandins have been reported to exert a protective effect against short-term experimental pancreatic injury. We evaluated the protective effect of PGE 2 using a model designed to maintain pancreatitis over a period of 5–10 days. Acute pancreatitis was induced by daily intraperitoneal injections of DL-ethionine in rats maintained on a proteinfree diet. Test periods of 10 and 5 days (parts I and II, respectively) were employed. In parts I and II, PGE 2 0.1 μg/g body wt was given subcutaneously 30 min before ethionine. In part II, a second daily dose of PGE 2 0.1 μg/g body wt was given 7 h after ethionine. PGE 2 did not protect against the weight loss, decrease in food consumption, alteration in serum amylase, pancreatic necrosis, or mortality induced by ethionine. This study indicates that the protective effect of PGE 2 observed in short-term experimental pancreatitis is not reproducible in a model in which pancreatitis is maintained for 5 and 10 day periods.

As other studies have suggested, the odontogenic adenomatoid tumor is predominately a tumor of young persons under the age of 20 years. There is a marked female preference (7:4), as well as a marked maxillary preference (4.5:2.5). Fully 76 per cent of these lesions occur in the anterior regions of the jaws, and 74 per cent are associated with an unerupted tooth—most commonly a cuspid (68 per cent). It has been shown that the odontogenic adenomatoid tumor has, on occasion, an inductive effect upon the connective tissue and cannot continue to be considered a pure epithelial tumor. A significant number of cases with long-term follow-up has been presented which, in our opinion, offers sufficient support for the widely held concept that the odontogenic adenomatoid tumor is a benign lesion that does not recur after conservative removal.

An unusual "tumor" involving the right lobe of the liver of a young child is reported. Morphologically, the lesion had the features of "inflammatory pseudotumor." We were able to find only one previous report of a similar case in the literature. Unusual changes, which may be designated "occlusive phlebitis," were present in the medium-sized and large veins. Histologically, the lesion, including the vascular changes, had similaritites to the entities included in the group of "multifocal fibrosclerosis." It is believed that these unusual vascular changes, which have also been observed in a case of "inflammatory pseudotumor" of the parotid gland, probably contributed to the disease process.

An adenomatoid odontogenic tumor (AOT) which occurred in the maxilla of an 8-year-old boy was studied by the light and electron microscopy. The tumor was found to contain cells resembling preameloblasts, the stratum intermedium, and the stellate reticulum, suggesting its origin from the enamel organ, in agreement with previous reports. Characteristic ductlike structures are thought to be formed as a result of secretory activity of the tumor cells, rather than degeneration. Duct-lining cells ultrastructurally similar to preameloblasts were found to contain electron-dense granules. These granules are believed to play a role in secretion by tumor cells, a concept not previously considered. The results of previous ultrastructural studies of the AOT are reviewed and summarized.

Tumors of hyaline cartilage occurring in the soft tissues of the hands and feet arise by metaplasia from the synovium of tendon sheaths and have a benign clinical evolution. Although recurrences may develop, they show no tendency to metastasize. The majority of these tumors prove to be diagnostic difficulties because of the alarming histologic atypia they display. We report a case of tenosynovial chondroma of the hand and briefly review the salient features of these lesions.

✓ The combined treatment of surgery and postoperative irradiation is described in a case of a solitary intracranial plasmacytoma involving the inner surface of the dura of the posterior fossa and the tentorium cerebelli. The tumor overlay the left cerebellar hemisphere and extended through the foramen magnum to approximately the C-1 level. Follow-up examination 16 months after treatment showed no recurrence or dissemination of the disease.

Cortical morphologic changes in kidneys of patients with sickle cell anemia include vascular dilatation and engorgement of vessels with red blood cells, glomerular enlargement, hypertrophy and hypercellularity of glomerular mesangial cells, and iron deposits in various glomerular and tubular structures. Occasionally, glomerular sclerosis develops, with resultant end-stage renal failure. In the renal medulla, vascular congestion, edema, focal scarring, and occasional papillary necrosis are seen. Vascular dilatation and engorgement also occur in renal pelvis submucosa, where vessel rupture may cause hematuria. Young patients with sickle cell anemia have increased total renal blood flow while medullary blood flow is probably decreased. Glomerular filtration rate is also increased in young patients. A renal concentrating defect is reversible in younger age groups, becoming irreversible in older patients.

• An umbilical nodule may be an early or late sign of metastasis from an internal location. To our knowledge, we are reporting the first case of carcinoid occurring as an umbilical mass. The occurrence in our patient of idiopathic hyperparathyroidism, diabetes mellitus, and carcinoid suggests the diagnosis of multiple endocrine adenomatosis, type I, which may result from a developmental defect in the amine and amine precursor uptake and decarboxylation cell system. ( Arch Dermatol 114:570-572, 1978)

• A 30-year-old woman had a nontender subcutaneous mass over the left temple that histologically demonstrated a mixed pattern of mature lipocytes and spindle cells, many in a palisading and fascicular pattern, separated by fibrous trabeculations. No cellular atypia or increased mitotic activity was seen, and a predominance of mast cells was noted. This case illustrates the spindle cell lipoma, a benign variant of lipoma that has been confused in the past with both malignant spindle cell and lipocytic tumors. Our case, although atypical in sex, age, and location, serves to identify this entity in the dermatologic literature. ( Arch Dermatol 114:1065-1066, 1978)