Equine herpesvirus-1 strain KyA, a candidate vaccine strain, reduces viral titers in mice challenged with a pathogenic strain, RacL.

The equine herpesvirus type-1 (EHV-1) strain Kentucky A (KyA) has a long history of repeated passage either in vivo in the Syrian hamster or in vitro in mouse L-M fibroblast tissue culture. This repeated passage in cells other than those of the natural host has caused genomic alterations of the KyA chromosome resulting in deletion of several genes or portions of open reading frames (ORFs). This report presents in vivo data from a mouse model of EHV-1 infection demonstrating the attenuated nature of EHV-1 strain KyA and that intranasal infection with KyA protects animals from subsequent challenge with a pathogenic strain, RacL, by reducing RacL viral titers in the lungs of the challenged animals. Mice infected with KyA exhibit no clinical manifestations of EHV-1 disease and do not experience the wasting that occurs with RacL infection. KyA-infected mice clear virus from the lung by day 5 post-infection (p.i.), whereas RacL infected mice have substantial virus titers (5 x 10(5) pfu/lung) at this time point. Intranasal infection with KyA followed by a challenge with RacL 4 weeks post-KyA infection resulted in a significant (P = 0.0079) reduction in the lung titers of the RacL virus. RacL was identified as the virus present in the lungs of the challenged mice by a PCR assay employing primers to amplify the EUS4 gene which differs in size by 1.2 kilobase pairs (kbp) in the two strains. Importantly, the protection afforded by KyA is long lasting in that challenge with RacL 15 months after KyA infection, results in reduced virus titers and viral clearance by day 5 post-challenge. These results support the further consideration of EHV-1 KyA as a live virus vaccine.

Pityrosporum isolate from the upper respiratory tract.

A 49-year-old white man experienced maxillary sinus osteitis after removal of a portion of the maxilla containing root tips from a previous molar tooth extraction. After the patient had received long-term antibiotic therapy for that infection, a yeast-like organism was observed on smears from the patient's left nasal passage and its surgically enlarged communication with the maxillary sinus. The fungus has appeared on all subsequent smears, but early attempts to culture the organism were unsuccessful. A lipophilic yeast-like fungus, morphologically similar to the organisms seen on the direct smears and consistent with the genus Pityrosporum, was isolated in culture at this facility. Electron microscopy of the organism revealed cellular morphologic features believed to be unique to the Pityrosporum genus, thereby confirming the identity of the isolate as a member of that genus.

Malignant lymphoma occurring in a family.

Three patients, a 57-year-old man, his 60-year-old sister, and 81-year-old mother, developed non-Hodgkin's lymphoma within an interval of 12 months. There were histologic similarities of the biopsy material from these patients, but the clinical response was variable. Two patients achieved a sustained remission, and one expired after similar chemotherapy. Studies revealed slightly decreased numbers of circulating T lymphocytes in both surviving patients, and decreased cellular reactivity to mitogens in the man. HLA typing was not conclusive; HLA haplotypes were not the same as those reported in other families with non-Hodgkin's lymphoma. Electron microscopy of biopsy material revealed no viral inclusions. Except for the familial relationship, no common etiologic factors were identified.

Thecomas and granulosa-theca cell tumors of the ovary: an analysis of 51 tumors,.

A retrospective study of 51 thecomas and granulosa-theca cell tumors of the ovary seen at Confederate Memorial Medical Center in Shreveport, Louisiana, is presented. Endometrial tissue was available for study in 38 of the 51 patients. The relation of these tumors to endometrial morphology suggests an excessive estrogenic stimulation in most cases. The microscopic pattern and degree of pleomorphism was of no value in predicting which tumors would behave in a malignant fashion. The incidence of endometrial malignancy associated with these tumors was only 7.8%, which was less than was anticipated. The addition of irradiation and/or chemotherapy is, in our opinion, difficult to evaluate since many of the women with these tumors die of unrelated causes before a recurrence is evident.

An evaluation of uterine scar integrity after cesarean section in rabbits.

Cesarean sections were performed on 30 rabbits at term pregnancy. Two incisions were made in each of the two uterine horns, and each incision was closed according to a predetermined method (continuous, everted; continuous, inverted; interrupted, everted; or interrupted, inverted). Tissue from the uterine scar region was sampled at three different time periods (5-8 days, 12-15 days, or 28-30 days) post-surgery to evaluate the degree of uterine healing by a variety of histologic criteria. The initial healing response in the scarred region occurred around 28-30 days post-surgery. The different uterine closure techniques did not appreciably influence the healing response in this study. We evaluated tensile strength in 36 uterine muscle specimens containing the scar obtained from nine animals in the 28-32-days post-surgery group. Of these 36 specimens, 86.1% tore through the muscle instead of through the scar when tension was applied to the muscle.

Valvular xenografts in the inferior vena cava.

The unsolved problem of valvular incompetence is a common denominator to chronic venous insufficiency. Cardiac experience with tissue valves suggests the potential for their use in more peripheral locations. The current initial work evaluated 22 valvular xenografts placed in the inferior vena cavas of 22 dogs. Patency extended to 28 months in 12 valves. There was a plausible explanation for failure in 8 of the 10 unsuccessful units. Patent valves functioned with minimal pressure gradients at moderate flow with no evidence of pulmonary emboli. Retrograde valvulograms showed acceptable functional competence in six of eight units examined despite autopsy evidence of leaflet fibrosis and anatomic incompetence. The study establishes the feasibility of long-term patency of valvular xenografts in the inferior vena cava, but also raises questions concerning design requirements for prosthetic venous valves.

Kaposi's sarcoma involvement of the bone marrow.

Kaposi's sarcoma (KS) is a predominantly cutaneous malignancy with several clinical variants. Extracutaneous sites of involvement are uncommon in all disease variants except epidemic KS (human immunodeficiency virus related) and the African lymphadenopathic variant. Extracutaneous KS usually involves the lymph nodes, gastrointestinal tract, and respiratory tract. The authors report the first description of a patient with classic KS to have bone marrow involvement. Two additional patients with KS variants and bone marrow involvement have been described. Bone marrow tumor invasion should be considered in patients with KS and hematologic abnormalities.

Comparison of fine-needle aspiration cytology and core biopsy for diagnosis of breast cancer.

Both fine-needle aspiration (FNA) cytology and core biopsy are useful in the diagnosis of breast cancer. In order to compare the sensitivities of these procedures, we reviewed 209 patients with breast cancer who had either FNA, core biopsy, or both, and also either mastectomy or lumpectomy. Sensitivities for FNA and core biopsies for diagnosing breast cancer were calculated and compared. Sensitivity for FNA or core biopsies interpreted as either atypical or malignant was 93.8% for FNA and 90.1% for core biopsy (P > 0.05). Sensitivity for FNA or core biopsies interpreted as malignant was 65.4% for FNA and 88.7% for core biopsy (P < 0.0001). Sensitivities of FNA interpreted as either atypical or malignant were 92.4% for FNA performed by pathologists and 100% for FNA by nonpathologists (P > 0.05). Sensitivities of FNA interpreted as malignant were 75.8% for FNA by pathologists and 20.0% for FNA by nonpathologists (P < 0.00001). Both FNA and core biopsies are sensitive procedures for the detection of breast cancer. There was no significant difference between sensitivity of FNA and core biopsies interpreted as either atypia or malignancy, although the sensitivity of core biopsies interpreted as unequivocal malignancy was greater than that of FNA. FNAs performed by pathologists were more sensitive than FNAs performed by nonpathologists in making an unequivocal diagnosis of breast cancer.

Cytohistologic correlation between AGUS and biopsy-detected lesions in postmenopausal women.

OBJECTIVE: To evaluate histologic findings in patients aged 50 and older whose cervical smears revealed atypical glandular cells of undetermined significance (AGUS). STUDY DESIGN: Computerized records spanning a four-year period were retrospectively analyzed. Thirty patients over age 50 had cervical smears interpreted as AGUS and had follow-up biopsies within 12 months following the abnormal smear. The most important histologic diagnosis from the biopsy specimens was correlated with the subcategory of the cervical smear. RESULTS: Five smears interpreted as AGUS, favor reactive, revealed abnormal histology in four cases: three endometrial polyps and one squamous carcinoma. Two smears interpreted as AGUS, favor dysplasia, revealed squamous intraepithelial lesions on biopsy in both cases. Seventeen smears interpreted as AGUS, favor endometrial cells, revealed abnormal histology in 13 cases: 1 endocervical polyp, 6 endometrial polyps, 3 endometrial hyperplasias and 3 adenomyosis. Six patients with smears interpreted as AGUS, unclassifiable, revealed abnormal histology in five cases: two endocervical polyps, one endometrial polyp, one endometrial carcinoma and one ovarian carcinoma. CONCLUSION: The presence of AGUS in cervical smears from women over 50 was highly predictive of abnormal lesions detected by histologic examination. Although three cancers were detected on histologic follow-up, the most common lesions detected were endometrial polyps.

Cytologic characteristics of adenoid cystic carcinoma of the cervix uteri.

Cytologic characteristics of three cases of adenoid cystic carcinoma of the cervix uteri are reviewed. The clusters of malignant cells tend to form large acini and mimic the pattern seen in histologic sections. The resemblance to cells of adenocarcinoma of the endometrium is noted. When the acinar pattern is recognized in cervical smears, adenoid cystic carcinoma of the cervix may be suspected.

Regressing malignant melanoma.

Malignant melanoma may undergo spontaneous regression. This phenomenon may cause difficulty in clinical or pathologic diagnosis. The cases reported in the literature as complete spontaneous regression of primary malignant melanomas have been diagnosed only in retrospect, after the patient presented with metastatic malignant melanoma. Two cases of malignant melanoma with partial regression are reported. In these cases the areas of complete regression cannot be recognized as malignant melanoma. The definitive diagnosis of malignant melanoma can be made only in the areas with at least two of three characteristic features of melanoma, (1) melanocytic cells with atypical nuclei and prominent nucleoli, (2) mitoses in melanocytic cells, and (3) invasion of the epidermis by atypical melanocytic cells. Clinical features suggesting regressing malignant melanoma include changes in color, especially areas of depigmentation, variations in color in different areas of a pigmented mole, and decrease in size of a mole. Histopathologic features of regression include loss of melanin pigment from the epidermis, melanophages in the dermis, telangiectasia of capillaries in the dermis, and lymphocytic infiltration in the dermis in a band-like or perivascular pattern. These histologic findings may also be found in inflammatory lesions such as lichen planus and in regressing benign melanocytic nevi.

Use of psychoactive substances by medical students: a survey.

The use and abuse of alcohol and other psychoactive substances is of concern to the medical profession and to medical educators. Sixty-eight members of the sophomore class at LSU Medical Center in Shreveport participated in a substance use survey. Ten students (14.7%) described themselves as abstainers from alcohol consumption. Although none described themselves as heavy or abusive drinkers, 9 (13.2%) drank 6-10 alcoholic beverages on a weekend if there was no examination scheduled for Monday or Tuesday, and 3 (4.4%) consumed more than 10 alcoholic beverages on such a weekend. At a large school social event, 9 students (13.2%) drank 6-10 alcoholic beverages and 3 (4.4%) drank more than 10 alcoholic beverages during the event. Nine students (13.2%) used marijuana at least 1-3 times per year. Tobacco was used by 17.6% of the students sampled. Only 4 students (5.9%) avoided caffeine completely. Twelve students (17.6%) drank 5-10 caffeinated beverages daily. The use of cocaine (2.9%), amphetamines (4.5%), and unprescribed sedatives (6%) was small in this student sample. More education concerning effects of psychoactive substances is encouraged.

Tubal ectopic pregnancy: a histologic, morphometric, and statistical study.

Pathologists are occasionally asked for medicolegal reasons to estimate the gestational age of an ectopic pregnancy based on morphologic findings. We evaluated the correlation between the gestational age and the maximal diameter of the resected fallopian tube, the average diameter of chorionic villi, the number of chorionic villi per square millimeter of the microscopic section, the number of degenerated villi per square millimeter, the number of syncytial knots per square millimeter, and the average number of layers of cytotrophoblastic cells covering the villi. There was a significant correlation between the diameter of the fallopian tube and the gestational age, with a correlation coefficient of 0.41 and a P value of .05. There was no significant correlation of the gestational age with any of the microscopic parameters measured. The findings indicate that an approximate estimation of the gestational age of tubal ectopic pregnancies may be made using the diameter of the resected fallopian tube.

Retroperitoneal necrotizing fasciitis.

We present a case of retroperitoneal necrotizing fasciitis treated by urgent abdomino-perineal resection of the rectum with permanent colostomy. We can find no prior case in the English literature treated in this manner. Retroperitoneal occurrence of this disease is unusual. The process originated from perianal sepsis following chemotherapy for head and neck cancer.

Pulmonary fibrosis as the initial manifestation of scleroderma.

We report a patient who developed pulmonary fibrosis before the appearance of cutaneous scleroderma. This unusual clinical presentation has been infrequently reported in the English literature. Recognition that pulmonary disease may occur before extensive skin changes in scleroderma is important to ensure proper management.