Thrombocytopenia in leptospirosis: the absence of evidence for disseminated intravascular coagulation

In a prospective study of human leptospirosis, thrombocytopenia was demonstrated in 54 percent of 24 cases. The only additional laboratory evidence suggestive of disseminated intravascular coagulation lay in a mild elevation of fibrinogen degradation products, but this occurred with equal frequency in nonthrombocytopenic patients. There is therefore no causal relationship between disseminated intravascular coagulation and the thrombocytopenia of human leptospirosis. (AU)

The liver in sickle haemoglobinopathies - abstract

Hepatic structure was reviewed in 107 of 141 (76 percent) autopsies performed on patients with sickle haemoglobinopathies at the University Hospital of the West Indies. Tissue was available from 58 males and 49 females with ages ranging from 0 - 72 (mean 18) years. Genotypes included 78 SS, 9 SC, 2 SB+ thalassaemia and 18 with sickle cell disease of undetermined aetiology. In contrast with 12-29 percent prevalence in necropsy studies from USA and Africa, cirrhosis was present in only 3 (3 percent). Hepatocellular necrosis was found in 17 (16 percent) but in none did this appear to be directly related to the sickle haemoglobinopathy. Iron storage usually of mild degree was present in 48 (45 percent) and appeared not to contribute to the other hepatic structural changes. Cholestasis was seen in 14 without cirrhosis (13 percent) and was unrelated to gallstone disease. The major changes were in the sinusoids, where extramedullary erythropoiesis was present in 13 (12 percent). In 99 (93 percent) congestion of the sinusoids by erythrocytes exhibiting a variable degree of sickling was seen. Sickled cells occurred as nodules in 19 (18 percent) overall, but only in those with definite (17) or probable (2) SS. Nodules which were frequently related to Kupffer cells, were also more common in males (14). In contrast, despite sepsis being the major cause of death in 58 (54 percent) with frequent disseminated infection, Kupffer cell hyperplasia was present in only 5. Similar findings have been demonstrated in percutaneous needle biopsy of the liver in 22 patients with sickle haemoglobinopathies undergoing investigations for increased icterus (AU)

Hepatic ultrastructure in secondary syphilis

We describe the ultastructural findings in liver biopsy specimens from 19 patients with secondary syphilis. These patients were unselected, had negative tests for hepatitis B surface antigen, and were not jaundiced. Most hepatocytes appeared normal; a few showed minor nonspecific changes, including some prominence of lipofuscin. Kupffer cell and endothelial cell hyperplasia were noteworthy in some specimens, occasionally forming clusters with monomuclear cells. However, these findings, have no specificity. Although triponemes were seen in Warthin-stained sections by light microscopy in three instances, no organisms were detected in the blocks selected for electron microscopy.(AU)