Two methods are used to estimate ultrasound attenuation in liver. These were based on amplitude change and frequency change as a result of depth dependent attenuation. Evaluation of the two methods against a family of calibrated phantoms yielded correlation coefficients of 0.98 and 0.99, respectively. Liver attenuation in 26 control subjects was 0.50 and 0.52 dB/MHz/cm, respectively. Liver attenuation was estimated in 50 patients who later underwent liver biopsy. Comparison with quantitative histologic results showed that the presence of fat alone accounted for the increased attenuation associated with cirrhosis. Similar high attenuation values were found in patients with fatty infiltration. Fibrosis alone did not result in elevated liver attenuation. Cirrhotics without fatty infiltration had attenuation similar to that of the controls. Mechanisms of action are discussed.

The accessory navicular is usually considered a normal anatomic and roentgenographic variant. The term may refer to two distinct patterns. First, a sesamoid bone may be present within the posterior tibial tendon (Type 1); this is anatomically separate from the navicular. Second, an accessory ossification center may be medial to the navicular (Type 2). During postnatal development this is within a cartilaginous mass that is continuous with the cartilage of the navicular. At skeletal maturity the accessory center usually fuses with the navicular to form a curvilinear bone. The Type 2 pattern may be associated with a painful foot, particularly in the athletic adolescent, and should not be arbitrarily dismissed as a roentgenologic variant in the symptomatic patient. The clinical, radiologic, pathologic, and surgical findings in ten cases are reviewed. Roentgenographically the ossicle is triangular or heart-shaped. 99mTc MDP imaging may be of value when the significance of the ossicle is uncertain. Even when the roentgenographic variant is bilateral, increased radionuclide activity occurs only on the symptomatic side. Histologic examination of surgically excised specimens reveals inflammatory chondro-osseous changes in the navicular-accessory navicular synchondrosis compatible with chronic trauma and stress fracture. Nonsurgical treatment with orthotics or cast immobilization produces variable results and resection of the accessory navicular may be the treatment of choice.

an outbreak of toxic liver disease has been associated with exposure to dimethylformamide in the workplace. The diagnosis of toxic liver disease was established by the clinical histories, negative viral serologies, an enzyme pattern of ALT levels being greater than AST levels, epidemiologic data on coworkers, and liver biopsy specimens. The high prevalence of unsuspected liver enzyme abnormalities in these workers suggests that occupational liver disease may occur more frequently than is generally recognized.

In a review of more than 1000 patients with osteogenic sarcoma of bone, the vertebral column was the site of the primary tumor in 10 patients. The vertebral osteogenic sarcoma in 4 of the 10 patients was secondary; to Paget's disease of bone in 3, and to irradiation received for a prior cancer in 1. Frequently, cord compression caused severe neurologic symptoms. Prognosis was always poor. Seven patients died of their disease within a year of histologic diagnosis. The differential diagnoses between osteogenic sarcoma and three benign tumors are reviewed, osteoblastoma being the tumor most frequently confused with osteogenic sarcoma. The radiologic and histologic criteria for distinguishing between the two are discussed.

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Previous analyses of findings from the Gastrointestinal Tumor Study Group (GITSG) study G I 6175, a four-arm randomized trial of patients with adjuvant colon cancer, have revealed no efficacy for chemotherapy or immunotherapy, but Dukes' Stage was found to have prognostic significance in both survival and disease-free survival. In this study, the exophytic tumor as primary type, maximal tumor dimension, and degree of differentiation were examined for prognostic importance. In a model simultaneously including treatment effects, significance levels for prognosis in total survival were: Dukes' stage (P < O.OOOl), exophytic tumors (P = 0.05), maximal dimension (P = 0.005) ' and well versus poor differentiated tumors (P = 0.06). This observation about tumor length, adjusted for stage and morphology, provides evidence that size is prognostic in colonic tumors. In addition, an interaction between tumor morphology and immunotherapy, adjusted for Dukes' stage, was noted. In 100 patients with exophytic tumors, significant survival and disease-free survival benefit (P < 0.02) from immunotherapy occurred. Tumor morphology is found to be an important prognostic variable and should be carefully considered in the construction of future trials in this disease site. and was terminated in 1979 when the goal of 130 evaluable patients per arm was achieved. Median follow-up now exceeds 5.5 years. No significant effects were attributable to any individual treatment arm. When patients were grouped by "chemotherapy versus no chemotherapy" or "immunotherapy versus no immunotherapy" again no definitive differences attributable to therapy could be defined. To investigate the importance of tumor morphology and pathology in these study patients, the effects of exophytic primary tumors (those with a polypoid morphology extending into the luminal space), maximal tumor dimension, venous and lymphatic invasion, and the degree of tumor differentiation were evaluated as prognostic factors.

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We studied 164 cases of Stage I endometrial adenocarcinoma to determine the relative prognostic value of International Federation of Gynecology and Obstetrics (FIGO) and nuclear grading systems. Other factors known to be of prognostic value in endometrial carcinoma also were evaluated. Both the FIGO and nuclear grading systems correlated with five-year mortality rate from cancer. Nuclear Grade 3 proved to be a superior predictor of fatal outcome (nine of 13 [69%] ) over FIGO Grade 3 (four of 13 [31%]). We advocate the combined use of FIGO and nuclear grading systems, along with other prognostic parameters, for the detection of most patients with fatal cancer.