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Twenty-four hour urine samples from patients with hydatidiform moles were analyzed by gas chromatography for estrone, estradiol, and estriol. The individual estrogen levels were far below the expected value for comparable periods in pregnancy and approximated those of normal menstruating nonpregnant women. However, the E 1 /E 2 ratio varied greatly from both the normal nonpregnancy and pregnancy ranges. The low estrogen levels and the abnormal E 1 /E 2 ratios appear to be sensitive indices of severe placental dysfunction as early as the twelfth week of gestation.

Enzymatic activities related to steroidogenesis were studied in six common ovarian cancers by incubating the combined microsomal and soluble fractions of tissue homogenates with radioactive steroids. Transformation steroids were isolated from the incubation media and identified by chromatography and recrystallization to constant specific activity. In four cancers, 17α-hydroxylases, desmolases, and Δ 5 -3 β - ol hydroxysteroid dehydrogenases were found. Two of these were capable of aromatization steroid precursors. The possible sites of steroid production within the cancerous tissues are discussed.

Introduction Histochemical observations on the distribution of various substances such as glycogen, protein-bound sulfhydryl groups, mucoprotein, glycoprotein, hyaluronic acid, and polysaccharides have been made in the normal and the diseased breast. 5,7,8,13,15 However, observations on the distribution of hydrolytic and oxidative enzymes in this organ have been limited to that of alkaline and acid phosphatase, nonspecific esterase, and succinic dehydrogenase. 1,5,7,9,13,14 We undertook to study, histochemically, the distribution of a group of enzymes in the surgically resected breast, to observe the normal pattern and its alterations in disease. Furthermore, an attempt was made to correlate these findings with the morphologic pattern observed with hematoxylin and eosin stains and with the clinical findings. Also, the results were briefly compared with those obtained biochemically by other investigators. Material and Methods Fifteen surgical specimens (nine cancer, seven fibrocystic disease and three fibroadenoma) were collected immediately after excision. These were either subjected to neutral

T H E P A T I E N T was a newborn Negro male infant, delivered at 39 weeks' gestation of a 25-year-old, gravlda 6 para 5 mother. The mother's health had been good except for a urinary tract infection during the pregnancy. The birth weights of her previous infants were 6 pounds 9 ounces, 8 pounds 12 ounces, 7 pounds 14 ounces, 7 pounds, and 9 pounds, respectively. She was admitted to The Chicago Lying-In Hospital in false labor at 37 weeks' gestation. Urinalysis showed 2+ albuminuria. She had 1+ ankle edema. Blood pressure was 110/70 ram. Hg; previously recorded blood pressures had been normal, and there had been neither albuminuria nor glycosuria. She was readmitted in active labor 2 weeks later. She gave a history of being febrile for the previous 4 days. She was treated immediately with ampicillin intravenously, and subsequently with cephalothin. The temperature became normal on the third hospital day. KlebsieIla pneumoniae and Staphylococcus albus were cultured from a catheterized specimen of the urine. Urinalysis shortly thereafter revealed approximately 10 red and 8 to 12 white blood cells per highpower microscopic field. She had also complained of an upper respiratory infection and cough, and on admission her breath sounds were described as "coarse." The blood pressure was 130/75 mm. Hg. The fetal

Summary Injection of normal human blood constituents into neonatal rabbits resulted in immunologic tolerance to those constituents. Subsequently, the rabbits were immunized with a series of injections of buffy coat from patients with granulocytic leukemia. Tests of these rabbits' serum were done in Ouchterlony plates, and in most cases, showed a response to buffy coat from patients with acute myelogenous leukemia, without a comparable response to normal human buffy coat. Skin tests generally confirmed the Ouchterlony plate findings. It appears that buffy coat from patients with acute myelogenous leukemia is adequate both for inducing heterologous antibody formation, and for combining with such antibodies in the test situations used. On the other hand, buffy coat from patients with chronic myelogenous leukemia appears to be adequate only for inducing heterologous antibody formation, but not for combining with such antibodies in the test situations used. Some of the implications of these observations are discussed.

T UE morphologic and histogenetic criteria distinguishing congenital from neoplastic vascular lesions of the brain have been alternately assailed and upheld. Cushing and BaileS ,s designated hemangioblastomas of the brain as true neoplasms, for they were composed of mature and immature vascular elements which enlarged by proliferation and supposedly contained no glial cells. Thereafter Bailey and Ford 1 demonstrated the presence of astrocytes in such a tumor which infiltrated the cerebellum. Hemangioblastomas of the brain occur most commonly in the cerebellum. 5,15,1s,19,~1 They are usually characterized grossly by a cyst of variable size, filled with clear or xanthochromic fluid, in which a mural nubbin of tumor is found. Microscopically, these mural tumors are composed of variable proportions of adult and immature vascular elements. In some cases the solid mass is composed almost exclusively of adult capillary or cavernous structures and in other instances primarily of vasoformative tissue. In other cysts, careful search is necessary to identify minute buried or sclerosed nodules of tumor. The characteristic cystic development is caused by an inherent line of differentiation of the immature cellular elements of the solid mural nodule. 13 The cyst is the result of the process of differentiation of blood vessels and the formation of primitive plasma from masses of angioblasts. This line of vascular differentiation gives even solid tumors a grossly spongy appearance. When hemangioblastomas of the brain are associated with tumors of the eye, skin, spinal cord or viscera, 2-4, 9-11 the patient may present a distinct clinical syndrome with a familial history. Unfortunately, many clinical variants or anatomical associations of lesions have been dignified by proper names. This cumbersome, although flattering, nomenclature, through sharp selection of cases, tends to obscure the underlying interrelationship of the variants. The occurrence of multiple tumors in a patient with a known hereditary predisposition suggests an arrest or defect in maturation of one or more tissues at a particular time in embryological development. Thus, morphologic variations of vascular tumors may merely reflect a level of maturation of primitive vascular mesenchyme.

The ability to taste phenylthiocarbamide (P.T.C.) is believed to be genetically determined. In normal Caucasians the ratio of tasters to nontasters is approximately 70:30. Altered taste responses have, however, been observed in serveral disease entities, notably those affecting the thyroid gland. Fifty-three patients with cystic fibrosis and 308 normal subjects were tested for ability to taste P.T.C. There were approximately 70 per cent tasters and 30 per cent nontasters among the control group. In the patients with cystic fibrosis, however, 45.3 per cent were tasters and 54.7 per cent were non-tasters. A test of the families of 22 patients with cystic fibrosis revealed no alteration in the taste response of the parents and normal siblings. It is possible that in these patients there are local pathophysiologic conditions that may be responsible for the altered taste response.

ConclusionIn neonatal rabbits, a substantial degree of immunologic tolerance has been produced to all the antigens in normal human serum.

Studies were done of in vitro transformation of C 14 and H 3 -labeled steroids by a primary papillary serous cystadenocarcinoma of the ovaries associated with a virilizing syndrome in a postmenopausal woman. A microsomal preparation from the tumor tissue converted progesterone to testosterone and androstenedione. Pregnenolone and 17-hydroxypregnenolone were converted to dehydroepiandrosterone. Aromatization of the substrate steroids apparently did not occur, since no steroid radioactivity was found in the phenolic fraction. Symptoms and signs of virilization gradually disappeared following surgical removal of the tumor and post-operative radiation therapy.

Enzymatic activities related to the synthesis of androgens and estrogens in postmenopausal ovaries were studied by incubating the combined microsomal and soluble fractions of ovarian tissue homogenates with various radioactive steroid precursors. The results of the experiments are highly suggestive that the postmenopausal ovary secretes predominantly androgens rather than estrogens. All twenty-two postmenopausal ovaries examined showed various degrees of cortical stromal hyperplasia; six ovaries contained areas of luteinized theca cells. There was no correlation between the “profiles” of radioactive steroids formed from the various substrates and the morphologic appearance of the ovarian stromal cells. Also, the pattern of “profiles” of the transformation products in ovarian tissues obtained from patients with endometrial carcinoma did not differ from that obtained from patients with normal postmenopausal endometrium. In 2 out of 4 patients with postmenopausal adenomatous hyperplasia evidence of estrogen production was demonstrable in vitro. It is speculated that postmenopausal ovaries do not always produce estrogens per se, but are more frequently indirectly involved in estrogen production in extraovarian tissues by adding significant amounts of estrogen precursors to the general plasma pool.

A story is written in a "fable" format that helps students understand the principles behind chromatography.

Linkage politics—a state's making its course of action concerning a given issue contingent upon another state's behavior in a different issue area—is of interest to policymakers as well as to those theoreticians who employ an issue—area approach to the study of international politics. However, there has been little discussion of the circumstances and conditions of linkage, or of its bargaining strategies. In this paper, 2 × 2 games are used as a model of strategic interaction to delineate the situations amenable to linkage, the forms of linkage, and relevant strategies. Coerced, threat-induced, and mutual linkage are illustrated and distinguished.

The surgically resected gallbladder is a difficult organ to evaluate because of the lack of clinicopathologic correlation. However, there is an increasing awareness of the high incidence of gallstones present in patients without significant clinical complaints. 5 Approximately 5%-15% of patients with radiographically demonstrable gallbladder dysfunction and/or calculi prove to be clinically not benefited by cholecystectomy. Furthermore, the pathologist has long been cognizant of the high incidence of gallstones and chronic inflammation in the gallbladder observed incidentally at necropsy. 9 In an effort to seek suitable criteria for evaluation, the pathologic alterations of the 178 gallbladders removed surgically at the Albany Hospital in 1954 were reviewed. Of these specimens (145), 92% revealed chronic disease with calculi. These organs were first classified according to their gross features (Table 1). After careful review of the histology, the most consistent anatomic change characteristic of significant chronic disease was observed in the mucosa. Two

During the past year, major congenital anomalies of the urinary tract were discovered in three children as a result of urologic investigation of the tract because of hematuria which followed minimal trauma to the region of the kidneys. Usually attention is directed to these abnormalities of the kidney as a result of a tumor, recurrent fever, repeated episodes of urinarytract infection, enuresis, or other findings which lead to early diagnosis and institution of therapy. On occasion, silent lesions of the kidneys, such as hydronephrosis and neoplasms, suddenly become clinically manifest after traumatic rupture with resultant hemorrhage and shock.* Although there has been an increasing awareness of the frequency of genitourinary anomalies, we feel that hematuria following minimal renal trauma has not been sufficiently stressed as a sign of congenital uropathy. Our recent experience has been so impressive that we feel that full investigation of hematuria following renal trauma in children

The distribution of a group of enzymes was determined histochemically in the surgically resected auricular myocardium of 5 cases of rheumatic and 6 cases of congenital heart disease. The enzymes studied included succinic dehydrogenase, diphosphopyridine nucleotide diaphorase, adenosine triphosphatase (ATPase), glucose-6-phosphatase, alkaline and acid phosphatase, and nonspecific esterase. The only abnormality noted was the apparent marked reduction in ATPase activity in the myocardium.

Cystic hygroma is a benign tumor of lymphatic origin 2 usually seen in the first two years of life. 3,4,6 Although common during the latter period, there are only occasional case reports of cystic hygromas in adults in the American literature. 1,2,6,7,9 A review of cystic hygromas seen in adults at the Albany Medical Center Hospital was prompted by the opportunity to treat a cervicomediastinal cystic hygroma in a 54-year-old female patient. The paucity of information on this subject in the current literature suggested the desirability of this brief report. Twelve patients, 16 years of age and older, were operated upon for cystic hygromas during the period 1935-1960. The cases were studied to determine the location, treatment, and course of the disease. The clinical charts, including the gross and microscopic reports of the surgical specimens, and the microscopic sections were reviewed in each case. Follow-up was obtained in 11 of

To the Editor:— In the necropsy, we have gained competency in the gross art and supported it by a two-dimensional antiquated visual tool, the microscope. Our cloak of decency has been woven of empirical and qualitative stains and we have gloried in reliving Virchow's experiences. But, today, in a scientific community this is not enough! We can only begin to recapture our true role in the medical community if we recognize and utilize some of our advantages. First, in surgical pathology we have relatively unlimited access to fresh normal and diseased human material. Second, in each of our hospitals we have a large self-supporting primate colony. Each of these patients can be studied before and after the removal of tissues and fluids with the most sophisticated means in the institution. The tissues are fresh, and can be used for physiologic or pharmacologic studies at the organ or cellular level and

This report is an extension of the study by Wilson and associates 1 on the teratogenic effects of Asian influenza. The original report included only 126 of the 738 pregnancies with serological data regarding Asian influenza. Since the results of our early report and other investigations 1-7 have not been conclusive regarding the teratogenic effects of Asian influenza, we decided to search for the medical records of the pregnancies in our original cohort which had not been examined. Our original cohort represented a large number of patients with serological evidence of influenza infection. Few studies have had such substantiating serological data. 5,7 Other studies have used primarily medical history for evidence of influenza in the mothers, which is not completely satisfactory. In fact, our data showed that history of influenza and serological titer in the mothers were not correlated. Sixty percent of the mothers who denied having had influenza were