Infectious Recurrence and Mucocutaneous Relapse in Syphilis

Abstract

It is evident that these two cases represent a type of angioma so extensive that surgery would be dangerous. They differ clinically from the small rounded hemangiomatous tumors described by Kramer and Yankauer 8 and others, which are found on the true cords and may be removed by intralaryngeal surgical measures. 59 East Madison Street. ABSTRACT OF DISCUSSIONDr. George E. Pfahler, Philadelphia : I have had no direct experience with the treatment of hemangioma of the larynx, but I have had experience in the insertion of radium directly into other hemangiomas, and if one does not get too anxious to obtain results and allows time to elapse between repeated applications, remarkable results in this type of heman¬ gioma can be obtained. I think it is important to have on record such cases and the method of treatment of them, because no rules can be laid down. If successes of this kind are recorded, it gives a guide for future use.Dr. L. T. Le Wald, New York: I have studied a similar case of tumor measuring about 2J4 by \ / inches, a heman¬ gioma of the pharynx. . Dr. Simpson spoke about the difficulty of determining the size of the growth. In this case the heman¬ gioma was pedunculated, apparently springing from the pos¬ terior lateral pharyngeal wall, but it blocked the pharynx so that the laryngologist, Dr. Huey, was unable to determine the lower border. 1 resorted to the expedient of allowing some iodized oil to trickle down over the tumor and then radiographically one could see the lower border, which could not be made out otherwise. Having then determined exactly what he had to deal with and seeing the pedunculated nature of the growth, Dr. Huey removed it by dissection and a snare. On microscopic examination the tumor was at first reported to be a lymphangioma, but after a second operation a year later for recurrence it was diagnosed hemangioma. The base was not quite satisfactorily healed and it was then treated with radium.Since that time, about three years ago, there has been no further growth. Is there a tendency after removal without radium treatment for hemangiomas in this region to recur?Dr. Edward H. Skinner, Kansas City, Mo. : Because I have not encountered this rara avis, my remarks are prompted by an interesting and successful experience with three cases of hemangioma of the tongue and mouth. The pathologic dis¬ play and career of these cases parallels the cases described by Dr. Simpson. Blood vessels and lymphatic tumors should lend themselves favorably to irradiation. Knowing how susceptible the tunica intima of these vessels is to gamma ray irradiation, it is easy to conceive;, of such structures shrinking from the contraction of the vessels forming them incident to the cicatricial changes in the vessel walls. My first case taught me the futility of securing uniform shrinking of an angioma by inter¬ stitial irradiation, and the second case taught me the value of larger filtered dosage (200 mg. of radium element, contact distance, 2 mm. brass and lead filtration, time one hour) at long intervals. ...

Immunological phenomena of syphilis.

“…Most clinical papers on the subject of relapse or reinfection appear to be devoted to one or other of these two aspects of lack of immunity to syphilis. On the subject of re-infection are the papers of Halley and Wassermann (1928), Stokes, Schoch, andIreland (1931), Schoch andAlexander (1943), Moore (1945), and Beerman (1946). On the subject of mucocutaneous relapse are the papers of Stokes, Besancon, and Schoch (1931), Stokes, Cole, Moore, O'Leary, Parran, andWile (1931), andPariser (1939).…”

Mental Hygiene.

“…Present knowledge of the biology of the disease, and the conclusions drawn from the study of cutaneous and mucosal relapse by the University of Pennsylvania group 31 and the presentation of this problem from the Cooperative Group material 32 have been summarized in the following condensed statement of the principles governing the control of infectiousness in early syphilis. Any standardization of treatment must, it is believed, conform to these principles and take account of these conclusions to be acceptable:…”