Vitamin B12-binding substances elaborated by the mucous membrane of the stomach]

Accurate electrocardiographic diagnosis of myocardial ischemia or infarction is difficult in patients with the Wolff-Parkinson-White syndrome; however, myocardial ischemia may also have profound effects on the electrophysiologic characteristics of the bypass tract in these patients. Comparison of studies performed during and two months following an episode of significant myocardial ischemia demonstrated substantial prolongation of the refractoriness of the bypass tract during the period of ischemia. Bypass refractoriness was prolonged by 196 msec, yet atrioventricular nodal refractoriness was not significantly different from normal. These studies, therefore, suggest that, on occasion, the presence of acute myocardial ischemia may, in fact, obscure the electrocardiographic diagnosis of the Wolff-Parkinson-White syndrome.     

Osteoma of the base of the tongue

A 14-year-old girl developed a firm mass at the base of the tongue. Computed tomography indicated marked density suggesting either a foreign body or bony tissue. A thyroid scan confirmed the presence of a normally sized and positioned gland. The mass was removed in toto and found to be an osteoma. This is the first report of a case in which the diagnosis of this rare developmental lesion of the tongue was achieved preoperatively based on clinical and radiologic information. This experience should lead to greater awareness of this entity in the future. Recognition of this entity in the pediatric age group is especially useful in avoiding misdiagnosis of other, potentially more aggressive types of tongue mass lesions. Our case demonstrates that it is possible to detect this entity using computed tomography. The dense calcification is truly characteristic of the tumor and may be relied upon to exclude alternative soft tissue mass lesions. While other forms of osseous and cartilagenous neoplasms, such as extraskeletal osteosarcoma and chondrosarcoma, have been reported arising in the tongue, their malignant nature should otherwise be readily apparent. Osteoma of the tongue is the favored diagnosis when mature bone tissue is imaged at the base of the tongue.     

Gingival involvement in mucous membrane pemphigoid

A 60-year-old woman with clinical features of desquamative gingivitis had a history of painful, blistering gingival lesions for more than 2 years. There were no other accompanying mucosal or skin lesions. Clinical examination revealed erythematous and edematous gingiva with ulcerated areas and evidence of intact and ruptured bullae. White plaquelike lesions were also noted. Gingival manipulation caused epithelial desquamation. Light microscopic examination of biopsy specimens from the perilesional gingival tissue showed separation of the oral gingival epithelium and connective tissue at the margin of the collapsed bulla. A moderately intense inflammatory infiltrate was present in the connective tissue. Direct immunofluorescent microscopy revealed a continuous linear deposition of immunoglobulin G and C3 at the basement membrane zone. On the basis of clinical, histopathologic, and immunofluorescent findings, the diagnosis of mucous membrane pemphigoid was made.     

Endoscopic resection of the mucous membrane in esophageal tumors

The authors report a 47-year old patient with an intraepithelial esophageal cancer diagnosed by endoscopy. Using Toluidine blue staining it seemed that the tumour was multifocal. The lesions were taken out by biopsy and endoscopic mucosectomy. The results of defined histological examinations: in situ squamous cell cancer, middle grade dysplasias and hyperkeratosis. At mucosectomy the authors used a new type of polypectomy snare with good results.     

Primary esophageal melanoma

Three cases of cartilaginous choristomas of the tongue are presented. Two lesions occurred in women of 71 and 28 years of age whose lesions were located in the middle third of the dorsum. The other lesion was found on the left lateral border in a 27-year-old man. The clinical, microscopic and immunohistochemical features are described. The lesions were easily excised with no recurrence after follow-up periods of at least 6 months. The histogenesis and the differential diagnosis are discussed, and the literature is reviewed.     

Primary leptomeningeal melanoma

A 25-year-old man suffered from a sudden severe headache followed by loss of consciousness on 29 March 1993. Cranial computed tomography was performed at a local hospital and arteriovenous malformation was suspected. An open biopsy was performed on 7 July 1993 and malignant melanoma was discovered. Radiotherapy was given in August 1993. The patient's condition continued to deteriorate and he died of bronchopneumonia about 7 months after the initial diagnosis. Autopsy confirmed primary leptomeningeal melanoma.     

Primary malignant melanoma of the vagina

We report two cases of primary malignant melanoma of the vagina explaining the essential clinical pathological and therapeutic features. They themselves, added those represented in literature, might constitute a further contribution to best definition of the unusual genital pathology, especially as regards prognostic and therapeutic aspects.     

Primary malignant melanoma of the oesophagus

We report the case of a 74-year-old female patient in whom a primary malignant melanoma of the oesophagus was detected at the time of investigation of phlebothrombosis. Therapy of choice for this extremely rare tumour is radical surgical resection of the oesophagus. Even after surgical resection, primary oesophageal melanomas have a very poor prognosis. According to the present state of knowledge, it remains unclear to what extent the prognosis could be improved by adjuvant therapeutic procedures with radiotherapy or chemotherapy and immunostimulation.     

Development of the bi-directional ultrasound system for base of tongue imaging

The use of conventional ultrasound systems to image the upper airway has been limited because ultrasound energy is attenuated by the air column. In an attempt to study upper airway geometry, we developed a computer controlled bi-directional ultrasound system which combines two conventional ultrasound devices with computer image processing to yield images of upper airway structures. Human studies and cadaver studies were performed to evaluate the system. Images acquired by the bi-directional ultrasound system were comparable to images from 3D volume rendered CT scans. This system may provide valuable data in the study of upper airway physiology and pathology.     

Cicatricial pemphigoid (benign mucous membrane pemphigoid)

Cicatricial pemphigoid is a chronic mucocutaneous bullous condition. It is a heterogenous autoimmune disease, characterized by the production of autoantibodies against basement membrane zone antigens. The target antigens in cicatricial pemphigoid appear to be lamina lucida proteins involved in human keratinocyte adhesion to extracellular matrix. Cicatricial pemphigoid primarily affects persons older than 40 years and appears to have a 2:1 predilection for women, without racial or geographic bias.     

Arteriovenous malformation of the base of tongue: case report and literature review

Arteriovenous malformations of the head and neck pose a challenging therapeutic and reconstructive problem. In this report we describe a rare case of an arteriovenous malformation of the base of tongue. The patient, a young adult female, was treated with embolization followed by surgical resection using a lateral pharyngotomy approach. Reconstruction of the extensive base of tongue defect was accomplished using a radial forearm free flap. Currently, the patient is decannulated, articulates clearly, tolerates a normal diet, and is without recurrence. Our treatment approach is discussed in detail and compared with alternative techniques.     

Primary melanoma of the esophagus. 2 new cases

Primary melanoma of the esophagus is rare. Until 1990, eight cases had been reported in Spain. We report two patients, 50 and 61-year-old men. Melanomas were located in the distal esophagus and were polypoid (5-6 cm), pediculated and pigmented. Endoscopic biopsy was diagnostic in both cases. Fontana staining technique and monoclonal HMB-45 and S-100 antibodies were used. A revision of clinical characteristics, treatment and survival of the patients with primary melanoma of the esophagus in our country is made.