Aortic orgin of the left pulmonary artery. Variant of tetralogy of Fallot.

A case of tetralogy of Fallot with aortic origin of the left pulmonary artery is presented. This rare malformation should be suspected in a child with stunted growth, cyanosis, a continuous murmur over the pulmonary area and a hypervascular left lung on chest roentgenogram. Final diagnosis depends upon cardiac catheterization and angiocardiography. During surgical correction of the tetralogy, the left pulmonary artery can be divided from the aorta and anastomosed to the main pulmonary artery.

Possible association of acute inflammatory exudate in chorioamnionitis and amniotic squamous metaplasia.

Reported is a case of placental chorioamnionitis in which a dramatic absence of focal inflammatory response is observed in areas of local squamous metaplasia of the amnion. The authors do not think this observation has been reported in the literature. They describe their search to find a repeat occurrence and discuss possible implications of this finding.

Histochemical similarities between newborn and leukaemic myeloid cells and their possible significance.

The neutrophilic alkaline phosphatase activity of 40 newborns was determined and found to be frequently raised, similarly to a leukaemoid reaction. The newborn neutrophil has strong alkaline phosphatase activity and is unlike the myeloid leukaemia cell which has no alkaline phosphatase activity.

A comparison of the biocompatibility of three absorbable hemostatic agents in the rat middle ear.

Absorbable gelatin sponge (Gelfoam) has been used for many years in middle ear surgery. Although the sponge is generally well tolerated, fibrosis occasionally forms in the mesotympanum; some studies indicated that the absorbable gelatin sponge may be responsible. Many of these studies lack statistical analysis. We prospectively studied three absorbable hemostatic agents in the middle ear of adult male Sprague-Dawley rats to determine which promotes fibrosis to the greatest degree: absorbable gelatin sponge (Gelfoam), absorbable gelatin sheet (Gelfilm), or absorbable collagen sheet (Instat). The materials were implanted in the middle ear through a post-auricular approach and the temporal bones were serially harvested at different time intervals so we could examine histologic changes. The nonimplanted ear served as surgical control. Examination of the specimens at 6, 8, and 10 weeks by light microscopy revealed that although absorbable gelatin film and collagen-absorbable hemostat are well tolerated in this animal model, absorbable gelatin sponge promoted the presence of fibrosis to a significantly greater degree, (p = 0.0344). We conclude that absorbable gelatin sponge promotes fibrosis more frequently than do collagen-absorbable hemostat and absorbable gelatin film in this animal model.

Pelvic actinomycosis.

Case report of tubo-ovarian abscess due to Actinomyces israeli is presented with revision of the literature with regard to pathogenesis, diagnostic difficulties and treatment. Diagnosis was established by culturing the organism from exudate obtained during surgery. The pathogenesis of pelvic actinomycosis is still controversial. Penetration of the GI tract with subsequent infection of the pelvic viscera seems to be the most likely mode of infection. Penicillin has an important role in the treatment of this disease. It does not cure, but retards the course of the infection. Surgical extirpation of infected tissue in combination with penicillin offers the best therapeutic results. When chronic pelvic inflammatory disease does not respond to therapy, when the sedimentation rate remains high, and the patient's general debility is progressive, an actinomycotic infection should be suspected.

Tissue ferritin concentration in carcinoma of the breast.

Ferritin concentration was measured in cytosol extracts of 44 mammary carcinomas and 14 benign breast tissues. A six-fold difference was observed (mean, 364.6 +/- 223.3 ng/mcp in malignant tissue versus mean, 60.2 +/- 42.1 ng/mcp in benign tissue P less than 0.001). Thirty-five malignant tissue specimens were reviewed independently by a pathologist without knowledge of their ferritin contents. Higher concentrations of ferritin were present in malignancies with greater degrees of epithelial proliferation and plemorphism suggesting the malignant epithelium as the major site of the increased ferritin. There was no correlation between desmoplastic reaction within the tumors or inflammation within or adjacent to the tumors and ferritin concentration. Ferritin in breast tissue may be important as a marker of neoplasia, a source of elevated serum ferritin, an indicator of clinical prognosis or an immunosuppressive substance.

The effects of topical instillation of adriamycin in bladder tumors of rats fed with FANFT.

Topical bladder instillation of adriamycin was evaluated in FANET produced rat tumors produced by diets containing (N-[4-(5-Nitro-2-Furyl)-2-Thiazolyl] Formamide). The drug was ineffective in either preventing or eradicating tumors. The failure of response in this animal model may be related to drug schedule, biological potential of this tumor, or ineffectiveness of Adriamycin in this tumor.

Molecular markers in Paget disease of the breast.

BACKGROUND AND OBJECTIVES: Molecular markers are increasingly being analyzed in tumor specimens because of their relevance to both prognosis and choice of therapy. Paget disease of the breast is an uncommon form of breast cancer, in which molecular markers have not been well characterized. The objective of this study was to investigate the expression of c-erbB-2, p53, Ki-67, Cyclin D1, Bcl-2, estrogen receptors (ER), and progesterone receptors (PR) in mammary Paget disease. METHODS: Archival tumor tissues from 14 patients diagnosed between 1990 and 1999 with Paget disease of the breast were analyzed for these molecular markers by using an automated immunohistochemical assay. Both the intraepidermal Paget cells and the underlying carcinoma were assessed for these markers. RESULTS: The majority of Paget cells were positive for c-erbB-2 (92.9%), Cyclin D1 (100%), and Ki-67 (85.7%), but very few were positive for Bcl-2 (14.3%). p53 was overexpressed in 42.9% of the cases, and only 28.6% were positive for ER and PR. The rate of expression of these biologic markers was similar in both the Paget cells and the underlying intraductal and/or ductal carcinoma cells. CONCLUSIONS: Tumors from patients with Paget disease of the breast were positive for c-erbB-2, Cyclin D1, and Ki-67, molecular markers commonly associated with more aggressive tumor behavior and poorer survival in breast cancer patients. Few of these tumors expressed Bcl-2 or ER and PR, which are generally associated with a better prognosis. Similar expression of these markers in both Paget cells and the underlying carcinoma supports the theory that these cells are the result of an intraepidermal spread of ductal carcinoma.

Age-dependent pathogenicity of group B coxsackieviruses in Swiss-Webster mice: infectivity for myocardium and pancreas.

Coxsackieviruses B1-B4 were inoculated intraperitoneally into 48-hr-old, 14-day-old, and three- to five-month-old Swiss-Webster mice. Immediate death occurred only among mice less than 48 hr old, which died from fulminant encephalitis. Older mice usually survived. Myocarditis ensued in mice less than 48 hr old that were infected with coxsackieviruses B1 and B4. Several of the surviving mice developed left ventricular aneurysms, which resulted from transmural necrotizing myocarditis. In this group (coxsackieviruses B1 and B4), pathologic changes in the heart were synchronous with maximal cardiac titers of virus. Fourteen-day-old mice infected with coxsackieviruses B2 and B3 developed nontransmural necrotizing myocarditis in which maximal pathologic changes followed peak cardiac titers of virus by several days, whereas three- to five-month-old mice infected with coxsackieviruses B1, B2, B3, or B4 showed maximal susceptibility to destructive lesions in the exocrine glandular pancreas. Therefore, specific susceptibilities to infection with coxsackieviruses group B vary with age of the mouse, virus type (and strain), and organ.

Tissue ferritin concentration and prognosis in carcinoma of the breast.

Seven year follow-up data were available on 36 of 40 breast carcinoma patients in whom breast tissue ferritin concentrations at the time of surgery were known. 18 patients were alive and free of recurrence or second tumor (Group 1) and 11 died with breast cancer (Group 2). Patients with lower tissue ferritin concentrations defined as less than 319 ng/mcp (nanograms of ferritin/milligram of cytosol protein) were at reduced risk: 86% of patients with low tissue ferritin concentration survived free of recurrence or second tumor vs. 40% of patients with high tissue ferritin concentration (P = 0.0056). Mean breast carcinoma tissue ferritin concentration was 295 +/- 52 ng/mcp in Group 1 and 444 +/- 55 ng/mcp in Group 2 (P = 0.036). Lymph node involvement was predictive of mortality from breast carcinoma (P = 0.0003), but did not correlate with mean tissue ferritin concentration (P = 0.082). 10/10 (100%) patients who had both low tissue ferritin concentration and absence of lymph node involvement were in Group 1. The correlation of breast tissue ferritin concentration with histopathologic dedifferentiation and with prognosis suggests tumor tissue ferritin as a marker of malignant potential.

Coxsackievirus B4 myocarditis in mice: valvular changes in virus-infected and control animals.

Suckling, weanling, and adult HaM/ICR and Swiss-Webster mice were inoculated intraperitoneally with the TC631 and Dowell strains of coxsackievirus B4. Vero cell-inoculated and uninoculated control mice were also studied under code. An intense, necrotizing myopericarditis was produced in suckling mice; it was less severe in weanlings. Myocarditis did not occur when coxsackievirus B4 was inoculated into adult mice. Progressive sclerosis and thickening of all valves in both strains of mice were observed with equal frequency in infected and control mice. There was no evidence that coxsackievirus B4 induced a specific valvular or endocardial lesion.