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Colonoscopic findings among 16 patients with histologically proved antibiotic-associated pseudomembranous colitis (PMC) were analyzed. The characteristic endoscopic changes of PMC with pseudomembranes were observed in only 5 (31%) out of 16 patients by sigmoidoscopy but in 11 (85%) out of 13 patients in whom colonoscopy was also performed. The findings suggest the importance of colonoscopy in the early diagnosis of PMC and indicate that the typical endoscopic changes of PMC are limited to the colon above the rectosigmoid area in most patients with antibiotic-associated colitis. It is emphasized that colonoscopy should be performed at least in clinically suspected PMC cases, in which the early diagnosis of PMC might be missed if sigmoidoscopy alone is performed.

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The occurrence of intestinal metaplasia with colonic-type sulphomucins: (abbreviated: s-IM or s-positive IM) in the gastric mucosa was studied in 125 patients with gastric carcinoma (GCA), 62 patients with pernicious anemia (PA), 301 and 183 first-degree relatives of GCA and PA patients, 406 outpatients and in 358 controls matched from a large population sample. The sulphomucins (s-mucins) were demonstrated histochemically in endoscopic biopsy specimens by using high iron diamine and Alcian blue (pH 1) methods. The prevalence of s-IM, especially the strongly s-positive IM, was significantly higher in GCA patients than in other series or controls of the same age group. Further, s-IM was significantly more common in PA patients and its prevalence higher in GCA relatives and outpatients than in other series or controls. The occurrence of s-IM was also age-dependent and dependent on the extent of IM. It was suggested that the occurrence of s-IM can be used as a sign of lesions that are more closely associated with GCA than IM is in general.

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Light microscopical histochemical methods known to demonstrate the hormone storage granules of the hypophyseal ACTH/MSH cells were applied to study 14 oat cell carcinomas of human lung with special reference to assessment of the applicability of these techniques in the detection of the reported endocrinological activity of these tumors. Lead-hematoxylin, masked metachromasia and PAS reactions gave negative results for hormone storage granules in all cases studied. Argyrophilic granules were found in two tumors. The above methods, thus, were interpreted to be far too insensitive to be applicable for the demonstration of endocrinological activity. Fluorescence histochemical demonstration of the NH2-terminal tryptophyl-peptides, shown to be present in the hormone storage granules of the hypophyseal ACTH/MSH cells, yeilded positive results in three of the five studied cases. Two of these positive cases were found to have a pronounced adrenal hyperplasia. Conclusion was drawn that the used fluorescence histochemical technique for the demonstration of the NH2-terminal tryptophyl-peptides might offer new possibilities in the diagnosis of obscure human lung tumors, and it might be a valuable aid in the demonstration of the endocrinological activity in general.

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Three hundred and two carcinomas of the female breast were studied histologically with special reference to the morphologic aspects of the tumor, its surrounding host tissue and the regional lymph nodes. The nuclear grade of the tumor was positively correlated with the five year survival rate of the patient. Tumor metastases in the regional lymph nodes were observed to be a sign of a poor prognosis. The stromal lymphocyte and mast cell reactions did not correlate with the frequency of nodal metastases or the five year survival rate. Sinus histiocytosis in the lymph nodes was a sign of favorable five year survival because of its presence in cancer-free nodes only. The paracortical activity of the lymph nodes was an important determinant of whether or not tumor metastases appear in the node.

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In the clinical part of the study routine neck PA radiographs taken with the mouth open were compared with soft tissue films with the mouth closed for detection of calcification in the carotid arteries. Only 5.5% of 90 hospitalized patients showed foci of calcification in routine films. But foci of calcification were seen in 22% of the soft tissue radiographs of the whole series. In the autopsy part of the study large foci of calcification were found at the carotid bifurcations in 12 out of 20 cadavers by radiography. In an additional five cases contact radiographs also showed smaller foci of calcification. The vascular endothelium over the calcification was often ulcerated. The significance of the large arterial foci of calcification demonstrated in the neck radiographs as a sign of atherosclerosis and as a source of cerebral thromboembolism is discussed.

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Eighty-seven colorectal carcinomas were studied histologically with special reference to grade of tumor, reactions of stromal tissue, and the morphology of regional lymph nodes. A special search was focused on the morphologic manifestations of possible host factors. The most interesting findings were: 1) nuclear grade of the tumor correlated with five-year survival; 2) the content of tumor-derived mucus was not a prognostic determinant; 3) the intensities of stromal lymphocyte and mast-cell reactions correlated with survival; 4) an active lymph-node paracortical area was almost incompatible with the appearance of nodal metastases.

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One hundred and thirty-eight adenocarcinomas of human kidney were assessed histologically with special reference to the tumor malignancy as indicated by the 5-year survival of the patients. Four different grading systems were used; the classification based on the histologic type of tumor growth, the grading of malignancy according to Arner et al., the grading based on the nuclear structure of carcinoma cells and finally a combined grading system based on the nuclear structure and the demarcation of the tumor from the surround tissue. The histologic type of growth was observed to be an inappropriate basis for grading of renal carcinoma. The grading system of Arner et al. was an appropriate method of malignancy grading despite its somewhat low reproducibility. The grading system based on the nuclear structure of the tumor cells was an accurate measure of the intrinsic malignancy of renal carcinoma and gave an excellent correlation between tumor grade and the 5-year survival rate of the patients. The combined grading system was an equally accurate method in estimating the 5-year prognosis of ranal carcinomas and indicated that the poor demarcation of the tumor from the surroundings in an unfavorable prognostic sign.

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Twenty-two consecutive cases of renal adenocarcinoma were graded histologically according to the nuclear structure of the tumor cells. The ultrastructural characteristics of these tumors were then evaluated and the findings were compared with the results of the nuclear grading. No ultrastructural characteristic was found which would have been specific for either Grade I, II, III or IV carcinomas. There was no ultrastructural features that could have been used as a basis for malignancy grading. The results show that electron microscopy has nothing to add to the nuclear grading system of renal adenocarcinoma and the value of this grading system is to be emphasized.

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One hundred and thirty eight gastric carcinomas were studied histologically with special reference to the morphology of the tumor, its surrounding tissues and the regional lymph nodes. A special search was focused on the morphologic manifestations of possible host factors in association with gastric carcinoma. The most prominent findings were as follows: 1. The nuclear grade of the tumor was positively correlated with the 5-year survival rate of the patients. 2. The content of tumor-derived mucus was not a prognostic determinant. 3. The intensity of the stromal lymphocyte and plasma cell reactions did not affect the prognosis but was inversely related to the frequency of nodal metastases. 4. Sinus histiocytosis and nodal mast cell reactions were an important determinant of whether nodal metastases appear or not. 5. An active paracortical area of the lymph node was almost incompatible with the appearance of nodal metastases.

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Familial nephronophthisis was diagnosed in a son and two daughters of a mother who herself died in uraemia at the age of 29 years. The son died at 33 years, two daughters are alive at 30 and 33 years. Our cases suggest a dominant autosomal type of inheritance because the mother married twice; the affected son was from the first marriage and the affected daughters from the second marriage. There was no known consanguinity between the parents. The pathogenesis of the disease can be explained by a slowly progressive process that leads to complete or partial obstruction of the tubules in the corticomedullary area, and also, therefore, to cystic dilatations. Histological evidence for this is provided by the proliferation of fibroblasts around the collecting ducts and other tubules, prominent thickening of the tubular basement membrane, and fibroblasts and collagen fibrils in or inside the thickened basement membranes. An ultrastructural description of affected kidneys is given.

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DBA/2 mice were treated with four successive subcutaneous injections of rabbit anti-theta-gamma-globulin followed by the subcutaneous implantation of chemically induced mastocytoma (P-815-X2). Another series of animals received rabbit anti-thymus-gammaglobulin according to the same schedule and still another series of animals served as non-treated controls. A definite augmentation of the tumor growth, as evidenced by the dissemination of the tumor into the spleen, liver and kidney, was evident in the globulin-treated series. Such dissemination was not observed in the control animals, where the metastases were limited to the reginal lymph nodes. The studied gammaglobulins were different in two important respects; the death rate of animals and the frequency of thymic metastases were higher in the anti-theta-globulin series. These findings advocate the conclusion that anti-theta-globulin, prepared against the brain tissue, is the more specific and more potent T-lymphocyte suppressor of these two globulins studied. T-lymphocyte population seems to play an important role in host resistance against experimental neoplasia.

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One hundred and thirty eight gastric carcinomas were assessed histologically with special attention focused on the nuclear grade of the tumor, the stromal lymphocyte reaction, and the morphology of the paracortical areas of the regional lymph nodes. Nuclear grade of the carcinoma was closely correlated with the 5-year survival rate of the patient, but no favorable prognostic influence could be attributed to the stromal lymphocyte reaction. The activity of the regional lymph node paracortex was directly positively correlated with the survival and inversely related to the appearance of the nodal metastases which were ominous prognostic signs. The value of the morphology of the regional lymph node paracortex in assessing the criteria of host resistance in association with gastric carcinoma is emphasized.

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One hundred regional lymph nodes from 55 patients with gastric carcinoma and the same number of regional nodes from 51 patients with ulcer of the stomach were evaluated histologically by using the standardized reporting system of Cottier et al. (9). A special attention was focused on the immunological response in these nodes. The cellular elements of the antibody-response were found to be active more often in the ulcer-series than in the cancer-series. On the other hand, the elements of the cell-mediated immune system were depressed more often in the nodes of the carcinoma-patients. The significance of the different immune response evoked by these two diseases is discussed, and the applicability of the standardized reporting system used is emphasized.

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