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Objective: The purpose of this study was to compare smear quality and endocervical cell recovery of four cervical smear sampling devices. Study design: Two thousand fifteen patients undergoing routine cervical smears at the University of Tennessee Obstetrics and Gynecology clinics were randomly assigned to a cotton swab-spatula, Cytobrush-spatula, Cervex-Brush, or Bayne Pap Brush. The cytopathology laboratory, blind to method, used specific criteria to grade smears as being optimal, adequate, marginal, or inadequate. Statistical analysis was by the χ 2 and analysis of variance tests. Results: No statistical differences occurred among the groups for nonpregnant patients. For pregnant patients smear quality was improved with both Cytobrush-spatula and Bayne Pap Brush versus cotton swab-spatula ( p = 0.0301 and 0.0004, respectively); cotton swab-spatula had fewer endocervical cells than the Cytobrush-spatula ( p = 0.0001), Cervex-Brush ( p = 0.0288), and Bayne Pap Brush ( p = 0.0081). Conclusions: The cotton swab-spatula and Cytobrush-spatula appear to be the most effective screening methods for nonpregnant and pregnant patients, respectively.

Chromodynamics with $n$ flavors of massless quarks is invariant under chiral $\mathrm{U}(n)\ensuremath{\bigotimes}\mathrm{U}(n)$. It is shown that in the limit of a large number of colors, under reasonable assumptions, this symmetry group must spontaneously break down to diagonal $\mathrm{U}(n)$.

A case of Paget's disease of the anal mucosa with an underlying carcinoma demonstrating mucoepidermoid features is reported. The histopathologic characteristics of both extramammary Paget's disease and mucoepidermoid carcinoma are noted. Special histochemical staining procedures were consistent with the diagnosis. The actual histogenesis of extramammary Paget's disease and mucoepidermoid carcinomas are controversial topics that are briefly discussed in this paper.

This report describes a 17-yr-old female who developed acanthosis nigricans, hirsutism and amenorrhea concurrently at age 15. Plasma androstenedione (A) was extremely elevated ranging from 3500 to 5000 ng/100 ml. Plasma testosterone (T) and urinary 17-ketosteroids (17-KS) were also elevated at 357 ng/100 ml and 32–42 mg/24 hr respectively. Plasma A and T were not reduced by dexamethasone (Dex), but human chorionic gonadotropin (hCG) increased plasma A to 23,500 ng/100 ml, plasma T to 3666 ng/100 ml and the 17-KS to 156 mg/24 hr. Ethinyl estradiol (EE) plus Dex reduced LH to a nondetectable level, A to 72 ng/100 ml and T to 10 ng/100 ml. ACTH did not increase A or T. The patient was treated for 7 months with 0.15 mg/day of EE and there was marked improvement of the acanthosis nigricans associated with correction of the hyperandrogenism. Because of menorrhagia, EE was discontinued and the high levels of A and T returned and the acanthosis nigricans worsened. Exploratory laparotomy was performed and...

Seventeen cases of adenoid cystic carcinoma of the cervix are presented. The long-term survival was in early stage IB–IIA. Patients with more than stage IIB had no survival rate over 5 years. One thing of interest was the fact that lung metastasis was 29.4%.

Light and electron microscopic observations of the testes in male pseudohermaphrodism due to deficiency of 17-ketosteroid reductase demonstrate an increased thickness of the walls of the seminiferous tubules. Although the seminiferous tubules are filled mostly by Sertoli cells containing crystalloids of Charcot-Bottcher, clusters of spermatogonia and spermatocytes are located at infrequent intervals along their lengths. Differentiation of spermatogenetic cells beyond the spermatocyte stage was not observed. Hyperplasia of Leydig cells, which are structurally similar to those of the normal testis, was pronounced. Pigment bodies were present in Leydig cells, whereas crystals of Reinke were not observed. The decreases in plasma androstenedione, testosterone and estrone following orchiectomy and the presence of a well-developed system of organelles (smooth endoplasmic reticulum and mitochondria containing tubular cristae), typical of steroid-secreting cells, indicate that the Leydig cells were active in steroid hormone synthesis, albeit deficient in 17-kestosteroid reductase activity.

The malignant potential of carcinoma in situ (CIS) of the uterine cervix has been the subject of great controversy. Despite refinements and additions to knowledge in this area, few reports on the long-term course of the disease have appeared in the past decade. Recent developments in diagnostic and therapeutic techniques coupled with changes in the patient population with this disease have prompted renewed interest in conservative management. Results of long-term observation of a group of patients followed initially without ablative therapy are reported. The data indicate that CIS of the uterine cervix is not the inevitably progressive disease that it has been considered to be. Unequivocal invasive cancer develops in only a small percentage of cases and can be controlled, if not cured, by current therapeutic modalities. The intraepithelial lesion, however, tends to persist despite conization, and eventually requires ablative therapy in most cases. Conservative procedures should be regarded as temporizing, at least until their long-term benefits can be recorded.

A 31-yr-old hirsute female with oligoamenorrhea since menarche had markedly elevated peripheral plasma testosterone (T) concentrations of 250-255 ng/100 ml (normal 20-60 ng/100 ml), which lacked a diurnal rhythm, were not suppressed by dexamethasone, were decreased by ACTH, and were massively increased to 2,530 ng/100 ml by human chorionic gonadotropin (hCG). The binding capacity of T-binding globulin (TeBG) was 0.2 mug/100 ml (normal = 1.1-3.3 mug/100 ml). Plasma delta 4-androstenedione (A) was elevated at 374-681 ng/100 ml (normal = 90-135 ng/100 ml). Plasma estrone (E1) and estradiol (E2) were normal. The endometrium was proliferative. A T-secreting tumor was suspected because the plasma T levels were higher than those observed in polycystic ovarian disease. Exploratory surgery revealed bilateral polycystic ovaries and a pure thecoma in the right ovary which was not visible on surface examination. The thecoma did not contain granulosa cells. Plasma T in the right ovarian vein, draining the tumor, was 28,200 ng/100 ml and in the left ovarian vein was 2,600 ng/100 ml. Plasma A was elevated in both ovarian veins: 11,170 ng/100 ml on the left and 8,360 ng/100 ml on the right. The thecoma contained 1.35 mug/g of T and only 0.014 mug/g and 0.007 mug/g of E2 and E1, respectively. Plasma A and T after bilateral oophorectomy and removal of the thecoma were normal at 184 ng/100 ml and 40 ng/100 ml, respectively.1) This pure thecoma produced primarily T rather than E1 OR E2 and was gonadotropin-responsive. 2) A very high plasma androgen level in a female is an important clue to the presence of a tumor. A T-secreting tumor should be ssupected when the peripheral plasma T is over 250 ng/100 ml and when plasma T increases to over 1,000 ng/100 ml following hCG stimulation. 3) Tumors cannot be classified as estrogenic or androgenic on the basis of the character of the endometrium.

Surgical staging was done in 355 patients with carcinoma of the cervix. Periaortic node biopsies, peritoneal cytology, and/or biopsy were obtained to determine the need of extended field irradiation. Forty-one patients received extended field irradiation. On review, 38 of these patients were shown to have cancer in the periaortic nodes or peritoneal cavity. Of these patients, 5 have survived longer than 5 years, 3 with metastatic cancer in the periaortic nodes and 2 in the peritoneal cavity. Irradiation to extended fields was 4500 rad or less for the first 17 patients. Since then 5100 rad has been delivered at the rate of 850 rad per week. The incidence of bowel complications was not excessive, utilizing a suture technique to exclude small bowel from the pelvis. Control of the cancer occurred in one patient with massive metastatic periaortic disease. A safe and effective dosage level for radiation therapy has been established with the described limited surgical exploration.

Two families containing 41 women with hirsutism and/or oligomenorrhea were studied. Ovarian histology of eight demonstrated hyperplasia of theca cells in atretic follicles, a paucity of primordial and developing follicles, and stromal hyperplasia. Elevated levels of androstenedione and/or testosterone and luteinizing hormone (LH) were found. Estradiol and follicle-stimulating hormone (FSH) were low. Following bilateral ovarian wedge resection, the LH and FSH levels of the proband of Family I were normal. Three men of Family I had low plasma testosterone and an abnormally high LH/FSH ratio similar to that of the women. Conclusions were: (1) Ovarian hyperthecosis can be inherited; (2) the inheritance is consistent with an autosomal dominant pattern, but X-linked inheritance cannot be ruled out if the males are excluded; (3) the abnormal LH/FSH ratio can serve as a biochemical marker; (4) ovarian wedge resection corrected the abnormal LH/FSH ratio in one case; and (5) ovarian hyperthecosis may be a type of gonadal dysgenesis.

There have been few published studies concerned with the clinical behavior and natural history of oral dyskeratotic lesions. In the present investigation, fifty-six patients with sixty-seven oral lesions biopsied and diagnosed as showing moderate or marked epithelial dysplasia were studied with regard to age at which original lesion occurred, use of tobacco, site of lesion, and sex of the patient. Follow-up study of forty-five of these patients for periods of 1 to 8 years showed that these lesions may be cured surgically, may recur after removal, may increase in size or severity, may regress or disappear without surgical treatment, may remain static, or may undergo malignant transformation.

Pigmented nevi of the oral cavity have been found in 0.1 per cent of the Negro patients examined at this medical center. The pigmented nevus of the oral cavity is a relatively common lesion which is usually overlooked becuase of its small size and innocuous behavior. The most common intraoral location of pigmented nevi is the buccal mucosa, and the most common vervus found is of the intradermal type. The first case of the nevus of the intraoral neural type is reported.

Chromodynamics with $n$ flavors of massless quarks is invariant under chiral $\mathrm{U}(n)\ensuremath{\bigotimes}\mathrm{U}(n)$. It is shown that in the limit of a large number of colors, under reasonable assumptions, this symmetry group must spontaneously break down to diagonal $\mathrm{U}(n)$.

Gell-Mann(1) recently introduced a theory of the components of strong interactions involving a new symmetry, called "unitary symmetry." The principal purpose of this note is to use this symmetry to express the magnetic moments of all the baryons in terms of those of the neutron and proton. We also derive a relation among baryon electromagnetic mass splittings.

We show that for a wide class of Euclidean scalar field equations, there exist non-trivial solutions, and the non-trivial solution of lowest action is spherically symmetric. This fills a gap in a recent analysis of vacuum decay by one of us.

A 49-yr-old virilized woman had a peripheral plasma testosterone (T) concentration of 783–911 ng/100 ml with a normal plasma concentration of androstenedione (A) and normal urinary 17-ketosteroids (17-KS). Plasma LH was below normal and FSH was low normal. Plasma T was not changed by dexamethasone 2 mg/day and the 17-KS were not normally suppressible. The administration of 5,000 units of human chorionic gonadotropin (hCG) increased plasma T to 3,744 ng/100 ml and also increased A and the 17-KS. Based on these results an ovarian source of T was suspected and bilateral oophorectomy was performed. Bilateral ovarian cortical stromal hyperplasia was found. Removal of both ovaries did not correct the hypertestosteronemia. Because an adrenal lesion was suspected, an 8-hr ACTH infusion test was done. Plasma T was decreased 42% and LH 31% at the sixth hour of the ACTH infusion. Plasma T was again increased by hCG to 2,379 ng/100 ml after the ovaries were removed. Both adrenals were explored and a 4 cm × 3...