British Journal of Tuberculosis and Diseases of the Chest最新文献

The existence of a lymphatic drainage for the brain is disputed. In consequence, the current view is that lung cancer metastasises to this organ via the arteries.

Theoretically, arterial scattering of tumour emboli should result in an even distribution of deposits on either side of the brain. Similarly, lymphogenous dissemination to the brain would lead to ipsilateral preponderance of deposits.

Two hundred and fifty cases of brain metastases following lung cancer are analysed. The cases in the series are those in which metastases occurred either wholly or mainly in one cerebral or cerebellar hemisphere.

It is found that the metastatic trend is ipsilateral rather than even. A statistically significant result was obtained, for there were 143 growths which were wholly or mainly ipsilateral as against 107 contralateral ones.

Fifty-five cases collected from the literature also exhibited a statistically significant ipsilateral preponderance. Five cases illustrative of this trend in metastasis are appended.

Corroborative evidence is adduced from the literature:

• 1.

  Supradiaphragmatic tumours metastasise to the brain more often than infradiaphragmatic growths.

• 2.

  The relatively nearer cerebellum is a site of metastatic predilection.

• 3.

  Multiple macroscopic metastases occur only twice as often as the solitary.

• 4.

  The histopathology of metastatic brain tumours points to the importance of perivascular and subarachnoid spaces.

It is concluded that a unitary theory of metastasis to both the lymph nodes and organs like the brain and adrenal is possible and may be of fundamental importance.

While studying the comparative anatomy of mammalian respiratory tissue certain peculiarities in the lung of the guinea pig, an animal so frequently used for experiments, were noted. The respiratory tissue is primitive and the bronchial tree as well as the pulmonary artery contains an excess of musculature. The conclusion is reached that the guinea pig should not be used for certain experiments.

Two groups of patients have been treated with isonicotinic acid hydrazide (INAH) with 5-bromosalicylhydroxamic acid (T40) or p-aminosalicylic acid (PAS) for three months.

One group of 119 was treated with INAH + T40, a second group of 48 was given INAH + PAS.

Resistance of mycobacteria Tb towards INAH has been followed in the course of treatment.

Before treatment 75 patients in the group INAH + T40 and 24 patients in the group INAH + PAS showed a full sensitivity of bacteria towards INAH.

After treatment, in 40 cases (53·3 per cent.) out of 75 patients of the first group and in 14 cases (58·3 per cent.) out of 24 of the second group bacteria remain sensitive towards INAH.

Both figures are essentially the same (t=0·43).

The number of cases where strains of bacteria developed resistance towards INAH (at concentration 5–25 mcg./ml.) were:

A woman of 55, who lived in Ohio from 1926 to 1934, and has since lived in Lancashire, was found to have scattered infiltrates and fibrotic changes throughout both lungs, associated with a strongly positive histoplasmin test. She died of cor pulmonale after many years of respiratory crippling: pathological examination of the lungs showed gross fibrosis with emphysema.

Her husband, who lived in Ohio for a similar period, has scattered calcified opacities in the right lung, with a calcified hilar gland, and a violently positive histoplasmin test. He is entirely free of symptoms.

The possibility is presented that these radiological changes are consequent upon infection with Histoplasma capsulatum acquired during the patients' residence in the United States. The extensive studies of this disease in the United States during the last ten years, arising from the importance there of pulmonary histoplasmosis in the differential diagnosis of tuberculosis, are briefly reviewed.