GIGANTISM 837 



Localized Giant Growth. Hemihypertrophy 



It is not within the scope of this article, which deals primarily with 

 growth disturbances of endocrin origin, to discuss the innumerable varie- 

 ties of malformations in which localized overgrowth of certain parts has 

 taken place. They are largely referable to amniotic adhesions and other 

 accidental disturbances during fetal life, but in some instances we must 

 assume a vitium pnmw formationis, back of which there may be endocrin 

 factors. There are transitional forms between cases of quite general 

 congenital overgrowth of the extremities, like that of Salle, which we 

 have discussed in the chapter on acromegaly, and the more localized ones. 

 Among well studied cases are that of Busch of enlargement of the left 

 foot, with huge deposits of fat; that of Widenmann of enlargement of 

 the right leg, beginning at the age of six years, associated with cryptor- 

 chidism, nevi, and exophthalmos ; Max Hofmann's case of enlarged right 

 foot in connection with which the question of congenital acromegaly is 

 raised. As an example of! this kind we will relate the following case: 

 Wieland describes in great detail the features of the congenitally hyper- 

 trophic left foot of a male child, otherwise normal and of good heredity, 

 who was observed from the time of birth. Even then the hypertrophic 

 distal part of the foot was sharply denned from the proximal normal part. 

 Later this line of demarcation developed into a deep furrow. The big 

 toe was of enormous size and the fused second and third toes were equally 

 large, while the fourth and fifth were of normal size. At the age of 

 eight months the enlarged p>art suddenly began to grow and reached almost 

 double size in a month. Two months later a similar sudden growth took 

 place and amputation was performed. Histologic examination led to 

 the conclusion that there was a genuine hypertrophy and hyperplasia of 

 all tissue elements in the 1 affected portion and the most active overgrowth 

 had taken place in the adipose tissue. Only the skin and muscles were 

 atrophic. The bones showed both hyperplastic and regressive changes. 

 On account of the peculiar combination of hyperplastic and regressive 

 changes the author proposes to designate this type as the dystrophic form 

 of partial giant-growth. 



He admits that the presence of a distinct line of demarcation between 

 the hyperplastic and the normal parts in his case and those of Busch, 

 Friedberg and others suggest amniotic bands, but he believes that the 

 skeletal changes are not explained on this theory. He believes that there 

 must be a specific vitium primce formationis: in other words, a faulty 

 anlage. 



