Intracellular mucous inclusions. A feature of malignant cells in effusions in the serous cavities, particularly due to carcinoma of the breast.

Three cases of carcinoma of the breast are described, in which similar tumour cells were found in pleural or peritoneal fluid. The cells were characterized by the frequent presence of 'bull's-eye' vacuoles, in which a central spot was deeply stained by Giemsa, eosin or periodic acid-Schiff (PAS). In one of these it was shown by electron microscopy that the vacuoles are lined by microvilli, and that their mucinous content is condensed in the central area, presumably as a result of failure to discharge the secretion.

Spindle-cell tumours and hypoglycaemia.

The light microscopy and clinical features of two patients with extrapancreatic tumours and hypoglycaemic episodes are described-together with the electron microscopy findings in one patient. The primary tumour of one patient arose within the skull and later metastasized to the liver, while the other patient had a locally recurrent intrathoracic tumour. Neither the intracranial origin nor the ultrastructural features support the concept of a mesothelial origin for these tumours, and they should be referred to as spindle-cell tumours associated with hypoglycaemia. There are ultrastructural similarities between these neoplasms and those of the pancreatic beta cells.

Renal tubular necrosis due to shock: light and electron-microscope observations.

The renal biopsy findings in a 76 yr-old woman suffering grom anuria due to acute tubular necrosis are described. The glomeruli were normal on light- and electron microscopy. Immunofluorescent studies failed to reveal any fibrin or immunoglobulins in the glomerular capillaries. Extensive focal areas of necrosis were seen in the tubular epithelium often exposing the lumen of the tubule directly to the tubular basement-membrane. In some areas necrotic cells lay adjacent to normal or near normal cells. The proximity of the necrotic tubular epithelium to the oedematous interstitial tissue and the peritubular capillaries, together with the finding of normal glomeruli is compatible with the theory of back diffusion as a mechanism for the oliguria.

Chronic myeloproliferative disorders: a quantitative assessment of platelet ultrastructure.

In patients with chronic myeloproliferative disorders (MPD) and impaired in vitro platelet aggregation, a quantitative assessment of platelet ultrastructure showed reduced numbers of alpha granules and excessive dilation of the open canalicular systems. After 10 days of aspirin therapy, some abnormalities were significantly reduced. The implications of this finding are discussed.

The timing of histological damage following a single challenge with gluten in treated coeliac disease.

Two treated subjects and one healthy volunteer have been challenged with a single dose of fraction B of gluten administered intraduodenally. Serial biopsy specimens were obtained by means of a Quinton hydraulically operated biopsy instrument immediately before challenge and repeatedly thereafter. The biopsy specimens were studied by light microscopy, electron microscopy, immunofluorescence, immunoperoxidase staining and disaccharidase assay. The two coeliac subjects showed pronounced mucosal changes which developed a few hours after challenge and which showed the features of an Arthus-type reaction. The healthy volunteer was unaffected. It is concluded that the lesion of coeliac disease is the result of an Arthus-type reaction induced by ingested gluten in susceptible subjects.

Identifying toxic fractions of wheat gluten and their effect on the jejunal mucosa in coeliac disease.

THE TOXICITY OF THREE FRACTIONS (A, B, AND C) OBTAINED BY ULTRAFILTRATION OF A PEPTIC: tryptic digest of gluten has been assessed by serial feeding experiments in patients with treated coeliac disease. The first fraction (A), which contains amino acids and oligopeptides, produced no damage to the jejunal mucosa. The other two fractions (B and C) both caused mucosal damage. Fraction B, which contains the products of digestion of smaller molecular weight, consists of polypeptides which are concentrated in the region of 8000 molecular weight. It contains no gliadin (molecular weight 50 000) or gluten. Ultrastructural evidence of damage was visible six hours after challenge with fraction B and by 10 hours histological abnormalities were also present. Ultrastructural abnormalities occurred early in the epithelial cells and preceded changes in the basement membrane and capillaries. The disaccharidases showed a pronounced depression in all three subjects by 24 hours. The rapid onset of damage after challenge, coupled with the evidence of recovery as soon as 72 hours later, is more in keeping with a direct action on the surface epithelial cells rather than an immune mechanism.

Cirrhosis associated with the Australia antigen in an infant who acquired hepatitis from her mother.

A 19-week-old English girl developed acute viral hepatitis, which became chronic with persistent hepatosplenomegaly and abnormal liver function tests. Liver biopsy at 1 year showed an active cirrhosis with multinucleated giant cells. The Australia (Au) antigen was detected repeatedly in the infant's serum by immunodiffusion and by electron microscopy at the time of the acute attack and during the development of cirrhosis. She had apparently acquired the hepatitis from her mother, who had had jaundice at the end of pregnancy and for one month thereafter, and who was subsequently shown to be a carrier of Au antigen. Particles with surface projections resembling paramyxoviruses were observed in two of the later specimens of the infant's serum.