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Fr‘e—L WW’ Am); Maflufl/EW/ �INDEX TO ADVERTISERS _ PAGE AAAS ........................................................ 5, 394, 396, Inside Back Cover American Tobacco Company _____________________________________________________ Back Cover Columbia University Press _____________________________________________________________________ 6 Ford Instrument Company ______________________________________________________________________ 391 International Equipment Company _____________________________________________________ 398 Johnson Research Corporation..--__________--_.____-________________-_.-____; ______________ 5 Macmillan Company _________________________________________________________________________________ 8 Measurements Corporation _____________________________________________________________________ 6 Microcard Foundation _____________________________________________________________________________ 392 Oxford University Press, Inc ________________________________________________________________ 391 Rinehart & Company, Inc ________________________________________________________________________ 394 Ronald Press Company ___________________________________________________________________________ 2 Schwarz Laboratories, Inc ______________________________________________________________________ 4 Ivan Sorvall, Inc ______________________________________________________________________________________ 7 Taconic Farms, Inc __________________________________________________________________________________ 394 University of California Press _______________________________________________________________ 393 University of Chicago Press ___________________________________________________________________ 3 D. Van Nostrand Company, Inc _____________________________________________________________ 395 John Wiley & Sons, Inc .......................................................................... 397 399 ���������£32 » . x : ‘ . . . , V ( - 4 ‘ V ‘ ‘ ' . , \ . , - '1' ”:5. .9. ,2; «E a‘ ,7;- 7- \77 ‘- . _ mtg if} m: 34ifv; 5:32;: ;. ‘ , er?” is VF» ‘flh‘flaz: ”r: 91‘;._;.;..,.::_:.»’~~:_V ;‘;,».+~:-.éé ,5». ifp. ,, ..~- .393, - ,_-_».;,-,-« r .- - ' - 2 . . �DEW? 17; 1956 Gamept of Gamma]. Localisafim to Hana Action Effects 1) Certain functionnascribod to CNS are "localiaable", as motor power, motor aphasia; while others, an memory. Judgment, Mm, insight, m1- culation, figure-ground, m nmlocaliuble. 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In studies of head insulin, lobotom and post. apex-nun me! of an or more mths duration, the atudiaa reflsct 100311111313 (cortical) Meats mainly: for the deeper activities am no lager active“ Any defects in hm» cticm am expresaima of specific certioal laculinbla W» mtmst, studiee of brain tumors, immediate post-tnmtie statues, post-v 19mm, and EM (early) are stud-m or active dysfunction - a. cambinntim of the focal and the diffuse defeats. m degmo of: dysmnction depends on the ma In offset, plus the localised defect. �J.A.M.A., Dec. 13, 1958 PNEUMOTHORAX—MAURER ET AL. 2014 ination revealed adherence of the fundus and nodules throughout the adnexa. A diagnosis of pelvic endometriosis was made, and on Aug. 18, 1955, total hysterectomy with bilateral salpingo-oophorectomy was performed. The patient’s postoperative recovery was again uneventful. In the four and one-half years after the thoracotomy, the patient has had no recurrent chest symptoms or pneumothorax. Comment Aberrant endometrial islands have been reported in many locations, including the ovaries, uterine ligaments, rectovaginal septum, sigmoid colon, urihernia umbilicus, bladder, laparotomy scars, nary sacs, appendix, vagina, vulva, cervix, lymph glands, and small intestine, and in bizarre locations, such as the upper and lower extremities, lungs, and pleura.l Sampson’s2 original theory of transtubal regurgitation of menstrual blood and endometrial particles, published in his original paper in 1921, could certainly explain the method of implantation of endometrial growths on the pelvic and intraabdominal viscera, as well as on the inferior aspects of either leaf of the diaphragm. The lymphatic and hematogenous dissemination theory of Halban would be necessary to explain distant endometrial implants in the thigh, lung, and pleura.1a Distant spread without passing through the pulmonary capillaries could occur only by way of the vertebral veins or “lung shunts” which have apparently been demonstrated between the pulmonary arteries and veins bypassing the lung capillaries. In view of the concomitant finding of pelvic endometriosis and the involvement of all layers of the right leaf of the diaphragm, with perforation and supradiaphragmatic seeding demonstrated by thoracotomy, in the present case report, it would seem logical to conclude that the endometrial involvement of the diaphragm must of necessity have occurred as the result of transtubal regurgitation and transperitoneal dissemination. Exact explanation of the method of development of the pneumothorax on the right side is more difficult. However, the clinical observation that all episodes of pneumothorax occurred only during the time of menstruation, and the inability to demonstrate any source of lung leak or primary disorder in the lung which could explain any possible leakage of air into the pleural cavity, would suggest that the recurrent pneumothoraces in the case reported here were the result of erosion and perforation of the right diaphragmatic leaf by endometrial implant and the fa]of the from the of air by uterus way passage lopian tubes into the peritoneal cavity and then by way of the opening in the diaphragm into the pleural cavity, with consequent pneumothorax. Although we are unable to find any reports of spontaneous pneumoperitoneum occurring during the menstrual cycle, the practical possibility of this is suggested by the free anatomic communication between the cavity of the uterus with the peritoneal space by way of the fallopian tubes. Practical application of this knowledge is regularly used in the so-called Rubin test for patency of the tubes. During this procedure, carbon dioxide is passed into the uterus and then by way of the tubes into the peritoneal cavity. During the test, patients may experience shoulder pain and present roentgenographic evidence of pneumoperitoneum. Summary Chronic recurring pneumothoraces resulting from erosion of the diaphragm by endometrial implants during periods of menstruation occurred in a young woman. This was surgically corrected by excision of the involved portion of the diaphragm. The un— anticipated findings encountered at operation in this patient present an additional indication for exploratory thoracotomy in all cases of unexplained, constantly recurring, spontaneous pneumothorax. 827 Union Central Bldg. (Dr. Maurer). References 1. (a) Novak, E., and Novak, E. R.: Textbook of Gyne- cology, ed. 5, Baltimore, Williams & Wilkins Co., 1956, p. 546. (b) Nunn, L. L.: Endometrioma of Thigh, Northwest Med. 48:474—475 (July) 1949. (c) Hartz, P. H.: Occurrence of Decidua-Like Tissue in Lung: Report of Case, Am. J. Clin. Path. 26:48-51 (Jan.) 1956. (d) Hobbs, J. E., and Bortnick, A. H.: Endometriosis of Lungs: Experimental and Clinical Study, Am. J. Obst. & Gynec. 4:832-843 (Nov.) 1940. (e) Nicholson, H.: Endometriosis of Pleura, Thorax 6:75-81 (March) 1951. 2. Sampson, J. A.: Perforating Hemorrhagic (Chocolate) Cysts of Ovary, Arch. Surg. 3:245—323 (Sept) 1921. FUNCTION OF THE BRAIN.-—Any biological view of the function of the brain leads us to an unavoidable conclusion: consciousness is not unique to man, to the primates, or to the mammals: it goes back to the roots of vertebrate history and has been progressively elaborated in content, coloring and complexity roughly in proportion to the evolution of the neuromuscular system. It cannot even be argued that consciousness is a unique vertebrate invention—the crab, the octopus, the butterfly, the ant, all possess sensory devices imparting to them the awareness of their world; all demonstrably engage in integrated time-binding, self-serving action, and it must be presumed that all participate in some proportional measures in conscious awareness of themselves and their environment—H. W. Smith, The Philosophic Limitations of Physiology, Perspectives in Physiology, Washington, D. 0, American THE Physiological Society, 1954. �2013 Vol. 168, No. 15 TO DUE PNEUMOTHORAX SPONTANEOUS RECURRING CHRONIC ENDOMETRIOSIS OF THE DIAPHRAGM Elmer R. Maurer, M.D., James A. Schaal, MD. and F. L. Mendez Jr., M.D., Cincinnati Chronic recurring spontaneous pneumothorax is results which disorder usually common relatively a from rupture of subpleural blebs. Endometriosis of the diaphragm, on the other hand, is an exceedingly has be determined, lesion as and, nearly can as rare never been reported in association with, or as a cause of, unilateral recurring pneumothorax. The following case report is presented because of the extreme rarity of the lesion involved and the unusual association of pneumothorax with the menstrual cycle. It is the first recorded instance of successful surgical treatment of chronic recurring pneumothorax by excision of a defect in the diaphragm that has resulted from endometriosis. communicated This diameter. in 2 cm. was an aperture freely with the peritoneal cavity. The area of disease in the diaphragm, along with the defect, was widely and completely excised. The consequent diaphragmatic opening was 0. size of cotton, sutures mattress with interrupted repaired Examination of the specimen showed that the disease had involved the complete thickness of the diaphragm. Final inspection of the superior surface of the diaphragm revealed which 1 in diameter, nodule, cm. purplish-red a solitary obviously represented a supradiaphragmatic endometrial implant. This also was completely excised. Following reexpansion of the lung and the placement of an intrapleural catheter for water seal drainage, the chest wall was closed of endometriosis diagnosis was The postoperative in layers. the right leaf of the diaphragm resulting in perforation and Report of a Case A 35-year-old woman was first seen in consultation on March 13, 1953, because of pain and dyspnea resulting from a spontaneous pneumothorax on the right side. The patient had had two previous spontaneous pneumothoraces 1952. Nov. 14, occurred first on the having the right, on Findings on the general physical examination were negative except for distant breath sounds over the upper right part of the chest and hyperresonance of the percussion note due revealed chest of the Roentgenograms pneumothorax. to a a very minimal pneumothorax (15%) over the extreme apex and the base of the right lung. No emphysematous blebs were apparent in any portion of either lung. Because of the small quantity of air in the chest and the absence of serious thoratube thoracentesis or of air the by removal symptoms, costomy was not thOught to be indicated. The patient was discharged from the hospital for follow-up care by her attending physician. She was again seen in consultation on March 20, 1954, approximately one year after the original examination, because of 12 new episodes of recurrent pneumothorax on the right side. All pneumothoraces were associated with pain and mild dyspnea and had been verified first the chest. For of the examination by roentgenographic 15 all that information the volunteered the patient time, episodes of spontaneous pneumothorax had come during the period of menstruation. The important clinical signifi— time. the at appreciated not observation this of was cance Because of the chronicity of the lesion, open thoracotomy with possible talc poudrage and excision of any blebs that examinaroentgenographic been on have apparent not may tion was recommended. Right thoracotomy on March 31, 1954, revealed a persistent moderate pneumothorax on the right side. Careful examination of all lobes of the right lung revealed no evidence of blebs. Testing of the lung with positive pressure, while saline solution was dripped over the surface, disclosed no points of air-leak. The lung parenchyma grossly presented a normal appearance and consistency. The most re— markable finding involved the right diaphragm. Near the point of emergence of the inferior vena cava and extending radially and laterally in the central portion of the right leaf of the diaphragm was a circumscribed, oval-shaped area of attenuation which measured 4 by 3 cm. in diameter. Numersurface. this modulations on apparent were purplish-red ous In the central portion of the diseased area in the diaphragm Photomicrograph of excised lesion, showing, endometrial stroma and glands extending through fibromuscular structure of diaphragm. implant of endometrial nodules on the intrathoracic surface of the diaphragm. Microscopic examination of the surgical specimen showed extensive involvement of the fibromuscular stroma of the diaphragm by nests of endometrial stroma and glands (see figure). The single nodule on the supradiaphragmatic surface was composed of endometrial tissue. The postoperative course of the patient was entirely uneventful, and she was discharged from the hospital on her ninth postoperative day, being afebrile and ambulant, and with her right lung completely expanded. Because of pain in the pelvis and dysmenorrhea, the patient was seen by a gynecologic consultant. Bimanual exam- � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Research Files and Unpublished Works Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Consciousness studies (notes), 1956-1958 Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context mfp-03-01-002-5-005 Date A point or period of time associated with an event in the lifecycle of the resource 1956-1958 Creator An entity primarily responsible for making the resource <a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a> Subject The topic of the resource <a href="http://id.loc.gov/authorities/subjects/sh85113021">Research Files</a> and Unpublished Works -- Hillside Hospital, Glen Oaks, NY, 1953-1965 Relation A related resource The Max Fink Collection Description An account of the resource Research papers, files, and related correspondence: notes: consciousness studies Rights Information about rights held in and over the resource <a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a> Source A related resource from which the described resource is derived Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York). Language A language of the resource en-US Format The file format, physical medium, or dimensions of the resource application/pdf Publisher An entity responsible for making the resource available Contributor An entity responsible for making contributions to the resource Research