Pathogenesis of varicella-zoster angiitis in the CNS.

A 20-year-old man with Hodgkin's disease experienced ophthalmic zoster with dissemination and CNS involvement. At autopsy, he was found to have granulomatous angiitis involving the basilar artery, and electron microscopy revealed virus-like particles in the outer layers of the vessel walls, but not the endothelium. This suggests that granulomatous angiitis of the CNS in varicella-zoster infections results from direct viral invasion of blood vessels, perhaps by contiguous spread from cranial nerves.

Cytomegalovirus encephalitis associated with thymoma and immunoglobulin deficiency.

The clinical and immunologic findings in an elderly woman with thymoma and immunoglobulin deficiency in whom cytomegalovirus (CMV) encephalitis developed are described. The patient had absent serum immunoglobulins and no circulating immunoglobulin-bearing lymphocytes. Complement receptor-bearing lymphocytes were present in the peripheral blood, and circulating T lymphocyte numbers were within normal limits. She was anergic to a battery of skin test antigens, and her lymphocytes in vitro showed a selective unresponsiveness to CMV antigen while responding normally to phytohemagglutinin and streptokinase. The course of the encephalitis was progressive with quadriplegia, aphasia and coma developing within six months of onset of symptoms. This is the fifth reported case documenting an association between CMV infection and the syndrome of thymoma with immunoglobulin deficiency, but the first report of fatal CMV encephalitis in a patient with thymoma and immunoglobulin deficiency.

Herpesvirus hominis type 2 meningoencephalitis following renal transplantation.

Herpesvirus hominis (HVH) type 2 meningoencephalitis, confirmed by isolation of the virus from cerebrospinal fluid and brain biopsy specimens, is described in a 44 year old man following renal transplantation. An HVH type 2 genital infection developed two weeks after renal transplantation, which was followed by meningoencephalitis 10 days later. Subsequently an intracerebral hemorrhage developed with evidence of diffuse vasculitis on arteriography. In a second transplant patient a similar clinical syndrome also developed after an HVH type 2 genital infection, but viral studies were not made to confirm the etiology of the meningoencephalitis. HVH has been recognized as a cause ot mucocutaneous diseases in recipients of renal transplants, but involvement of the central nervous system has not been reported.

Asymptomatic subdural chondrosarcoma. Case report.

This report describes a large, asymptomatic, subdural skeletal-type condrosarcoma originating from the meninges. Distinction between the mesenchymal and skeletal types of intracranial chondrosarcoma is important since they have different prognoses.

Anterior cervical discectomy and interbody fusion. An experimental study using a synthetic tricalcium phosphate.

This study evaluates the histological and histochemical changes and osteogenicity of Synthos (tricalcium phosphate ceramic) implanted in the cervical intervertebral space. The cervical vertebrae from C-3 to C-6 were exposed in 20 dogs, and discectomy was performed at the third and fifth spaces. A dowel of Synthos was inserted into the third space, and a piece of fresh autologous graft from the humerus was inserted into the fifth space. The animals were divided into five groups with four animals in each. Four animals were sacrificed at each of 3, 6, 12, 18, and 22 weeks after the procedure. The C-3 to C-6 vertebrae were removed en bloc. One-half of each specimen was processed for histological examination of bone development, while the other half was processed for the two-color fluorescent labeling technique of Suzuki and Matthews for determination of osteogenesis at the time of operation and sacrifice. Various degrees of compression of the Synthos dowel were noted, with anterior and/or posterior displacement of the implant in 70% of the cases. Results indicate that the Synthos implant was biochemically and biomechanically unacceptable for the purposes of this investigation.

Light microscopic and ultrastructural observations of a metastasizing malignant epithelioid schwannoma.

The light microscopy and ultrastructure of a malignant epithelioid schwannoma are described. Characteristic cells resembling perineural elements with various degrees of differentiation were observed. Primitive epithelioid cells contained scant ergastoplasm, and few tubules and filaments, but did have abundant free ribosomes and Golgi membranes. Also noted were junctional complexes and focal fusion of plasma membranes, basal laminae were absent. Better differentiated cells were completely limited by a well-developed basal membrane and had an abundance of intracytoplasmic filaments and multiple pinocytotic vesicles. The intercellular ground substance was composed of numerous fine collagen fibrils and amorphous, basement membrane-like, electron-dense material. A striking ultrastructural similarity of the tumor cells to those encountered in ethylnitrosourea-induced malignant schwannomas in rats was noteworthy.