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Massive amyloid infiltrates in both breasts and on the skin of the abdomen developed in a 60-year-old woman in the course of long-standing rheumatoid arthritis. This is only the second report in the English literature describing amyloidosis occurring in nonneoplastic breast tissue. Although the amyloid deposits are probably secondary to the chronic inflammatory process and possibly part of a subclinical generalized amyloidosis, the pattern of organ involvement is very unusual for secondary amyloidosis.

Of 141 cases of plasma-cell myeloma, 24 cases (17%) presented as nonosseous, the largest number of such cases in a single series in the literature. This points to the importance of early soft-tissue and organ involvement in the disease prior to bone involvement. The varied modes of presentation are discussed.

In cases of malignant lymphoma (Hodgkin's disease [HD], reticulum cell sarcoma [RCS], lymphosarcoma [LS]) a great variety of organs and tissues may be demaged. This can take place 1. primarily and 2. secondarily from involved lymphnodes a) by continuous growth and b) by dissemination.

Summary 6,000 necropsy reports of lung cancer were collected from medical schools in Britain. Note was made of the number of organs with macroscopic metastases, eight organs being catalogued for this purpose. In almost ⅓ of the cases none of the listed organs revealed any deposits. One organ alone was reported to be invaded in 1,823 cases; two organs in 1,165, three in 617; four in 276; five in 113; six in 25; seven in 6 cases; and all eight organs in only one patient. So infrequent indeed was metastasis to several organs in any one patient that only 2·6% of the patients had more than four organs attacked. The average rate of organ involvement was only 1·3. The low incidence of demonstrable deposits is such that the metastatic pattern must be considered anomalous, if the current theory of predominantly blood-borne metastasis is true. The pattern of metastasis in lung cancer is more compatible with lymph-borne than with blood-borne spread.

Chronic disseminated tuberculosis is a prolonged disease which involves several organs of the body. It is not easily recognized. Any person with prolonged undiagnosed fever, weight loss and positive tuberculin deserves a trial with antituberculosis drugs. Eleven cases are presented to illustrate the multiple organ involvement in chronic disseminated tuberculosis and the results obtained with antituberculosis drugs. Treatment of this disease must be generalized and prolonged. Residuals in involved organs after prolonged drug administration should be treated by procedures recommended by appropriate experts.

Summary A case of malabsorption syndrome caused by progressive systemic sclerosis of the small intestine is described. The patient presented no extra-alimentary symptoms during life, although he ultimately had both x-ray and endoscopic evidence of esophageal involvement. Microscopic evidence of multiple organ involvement was found at autopsy. The clinical features of small intestinal progressive systematic sclerosis have been reviewed, with emphasis upon the symptoms resulting from disturbed motility and absorption, the typical x-ray changes, and the characteristic laparotomy finding. They form a clinical which warrants recognition even in the absence of cutaneous and other manifestations of the disease.

The currently recognized staging classification of malignant lymphoma, which was formulated in Ann Arbor in 1971, is a result of the revision and extension of the 1965 Rye Classification.

Although the three species of schistosomas produce characteristic illnesses, unusual organ involvement may occur, as illustrated by a case ofS japonicainvolvement of the female genital tract. This case, the third reported to date, was apparently successfully treated with sodium antimony tartrate. Schistosomiasis of all types is a leading public health problem, affecting approximately 5% of the world population. The most serious infestation isS japonicabecause of its greater virulence and resistance to treatment. Physicians should be alerted to this disease. It may be encountered in protean forms in Africa and Asia and among persons coming to the United States from endemic areas.

A case of melanoma of the gallbladder has been presented. The tumor was polypoid, was attached by a pedicle to the gallbladder mucosa, and partially filled the gallbladder lumen. There was no evidence of other organ involvement. The tumor was demonstrated in the gallbladder by intravenous cholangiography. It was successfully removed.

Summary This review of 370 cases of hydatid disease reveals that 34 of the patients were under 15 yr of age. In these children, the organ most frequently involved was the lung (65%) but multiple organ involvement, noted in 8% of the adults, was absent. Children comprised 43% of the patients with hydatidosis of the brain, 15% of those with cysts in the lung, and 3% of those with cysts in the liver. Of the eight children for whom the three serological tests (Casoni, Weinberg, and indirect hemagglutination) were done, six showed negative reactions to all three tests. In four cases, errors were made in diagnosis and the children, on operation, proved to have hydatid cysts of the lung in two cases, of the liver in the third, and of the kidney in the fourth. Correct diagnosis calls for a combination of the three serological tests and radiological procedures. The treatment of hydatidosis should include the prevention of spillage of untreated hydatid fluid into the surrounding tissues the use of scolecidal agents, and resection. Frequent postoperative physical checkups are recommended.

Lupus is a serious, potentially life-threatening disease. Its natural history is to culminate in a crescendo of autoimmunity and organ involvement. Difficulty arriving at the diagnosis may delay institution of therapy, which although helpful brings new problems. The fundamental understanding of this disease has made major strides. There is no consensus on the likely etiological agent(s), though evidence implicates Epstein-Barr virus, and the genetic approach to understanding etiology is in its infancy. Nevertheless, efficacious treatments are anticipated in the plethora of new biologics likely to have therapeutic effects in lupus, essentially a disease of immune dysregulation.

Lupus is a serious, potentially life-threatening disease. Its natural history is to culminate in a crescendo of autoimmunity and organ involvement. Difficulty arriving at the diagnosis may delay institution of therapy, which although helpful brings new problems. The fundamental understanding of this disease has made major strides. There is no consensus on the likely etiological agent(s), though evidence implicates Epstein-Barr virus, and the genetic approach to understanding etiology is in its infancy. Nevertheless, efficacious treatments are anticipated in the plethora of new biologics likely to have therapeutic effects in lupus, essentially a disease of immune dysregulation.

This report is concerned with the results of a prolonged study of a group of 18 patients (12 female and 6 male) with acute disseminated lupus erythematosus treated with corticotropin (ACTH) and cortisone and followed for 3 to 20 months thereafter. In several previous papers1we have reported on the prompt response of the fever, rash, arthritis, pleuritis, and pericarditis to treatment with these agents, in contrast to the persistence of L. E. cells and renal damage.1c,dSince these earlier reports, further studies have provided an opportunity to evaluate the hazards of therapy in patients with varying degrees of organ involvement and have served to clarify those clinical features that are of prognostic importance. The major clinical manifestations present in this group are listed in table 1. The ratio of females to males was 2:1, the incidence in males being much greater2than has been previously

Although the plea of domestic jurisdiction has been entered with great frequency in discussions of disputes and situations before international organs, the development of its effectiveness, or ineffectiveness, has been confined to a few leading cases. Beginning with the Tunis-Morocco Nationality Decrees case during the League period, these cases will be described in this and the following chapter. They are presented as an elaboration and substantiation of the failure of the plea of domestic jurisdiction as a means of avoiding international obligations which has been described in the preceding chapter. Since the cases in this chapter collectively describe the trend in international organs to expand their jurisdiction horizontally to include additional topics that are subject to the discussion and recommendation functions of international organs, each can be described with some brevity. The subtleties by which the Congo crisis illustrates a vertical expansion, or direct international organ involvement in the affairs of a state, require the more detailed coverage of the following chapter.

Cutaneous manifestations associated with visceral carcinoma are not common. The recorded statistics of this occurrence vary from 2.7% to 4.4%. Carcinoma of the prostate rarely metastasizes to the skin. Our two patients, who had carcinoma of the prostate, developed cutaneous metastasis which occurred in a zosteriform distribution. In a series of 2031 autopsies of various types of carcinoma, Gates 9 found cutaneous metastases occurred in 58 cases in which there was internal organ involvement; an incidence of 2.8%. There was only one case of carcinoma of the prostate associated with cutaneous lesions in this series of cases. Four patients having cutaneous involvement associated with carcinoma of the prostate were mentioned by Arnheim, 2 while Barenghi 4 and Huggins 10 each reported one case. A patient who had carcinoma of the prostate with metastases to the scalp which simulated "turban tumors" was described by Ronchese. 20 Only one

In the early part of this century, Landsteiner showed that chemicals of small molecular weight could function as antigens when coupled to protein carriers of large molecular weight. He correctly anticipated the subsequent course of research on the problems of drug allergy, which in his day were comparatively minor. In this text, a comprehensive review of the problem of hypersensitivity to drugs is taken. Numerous aspects of drug allergy, beginning with the affinity of the various drugs to proteins, the reactivity in terms of formation of covalent bonds with proteins, the immune response, and the various aspects of drug hypersensitivity in terms of organ involvement, are discussed in considerable detail. The book is divided into two sections that deal with the principles of drug hypersensitivity including most of the subjects just mentioned (chapters 1 through 7) with the reactions in specific organs and organ systems caused by drug hypersensitivity.

Four illustrative cases are presented in which the first indication of cutaneo-visceral hemangiomatosis appeared on the skin, including the first report in the dermatologic literature about Gorham's disease (massive osteolysis). Other types of multiple organ involvement are reviewed.

Excerpt Although studies of organ involvement of systemic lupus erythematosus have been reported and are well known, these studies have been directed to kidney, joints, liver, and heart; little att...