Severe hemolysis after incomplete mitral valve repair.

We report 2 cases of severe intravascular hemolysis after mitral valve repair using a Duran annuloplasty ring. In both patients residual mitral regurgitation was present, hemolysis was severe enough to warrant a second operation, and hemolysis ceased immediately after the second operation. We believe that a high-velocity regurgitant jet directed toward the cloth-covered annuloplasty ring was responsible for the hemolysis in both patients.

Hemoglobin C acquired via a blood transfusion. Detection by automated blood counter.

Hemoglobin C was acquired by a 52-year-old man via a blood transfusion. The presence of nonlysis of erythrocytes on the Technicon H6000 (Tarrytown, NY) scattergram after blood transfusions and the absence of this process in the admission peripheral blood count confirmed that this abnormal hemoglobin was acquired and not endogenous to the patient. Homozygous hemoglobin C disease was confirmed in one of the donors of blood received by the patient.

Myoepithelial cells in needle aspirations of two cases of unusual breast lesions: an aid in differential diagnosis.

The observation of myoepithelial cells bordering abnormal epithelial cells in fine-needle aspiration smears of two unusual breast lesions helped to prevent misdiagnosis of these lesions as malignant. The presence of myoepithelial cells has been a well-established criterion for histologically benign lesions. Their presence or absence appears to be equally valuable in fine-needle aspiration smears of breast lesions.

Pancreaticoduodenectomy for duodenal bleeding due to hereditary hemorrhagic telangiectasia.

A variant of hereditary hemorrhagic telangiectasia may be gastrointestinal bleeding with no other classical symptoms. This case demonstrates the effectiveness of surgical resection as treatment of duodenal bleeding from telangiectatic lesions.

Fibrinolysis in health and disease: abnormal levels of plasminogen activator, plasminogen activator inhibitor, and protein C in thrombotic thrombocytopenic purpura.

Thrombotic thrombocytopenic purpura (TTP) is characterized by widespread occluding and persistent microthrombotic lesions. Evidence for both endothelial damage and primary platelet aggregation as possible pathogenetic mechanisms has been produced. Persistence of microthrombi has not been explained satisfactorily. In patients with TTP we studied plasma fibrinolysis and protein C. Tissue plasminogen activator (t-PA) activity levels, measured functionally, were low or unmeasurable in 11 of 12 patients; t-PA antigen levels, measured immunochemically, were normal in all six observed. The level of potent inhibitor of plasminogen activation directed against both t-PA and urokinase was elevated significantly in all 12, whereas the alpha 2-antiplasmin level was elevated in only two. Protein C antigen levels were low in three of six patients observed. Fibrinolysis levels in patients in remission did not differ from those in patients with acute disease. Plasma exchange resulted in temporary reversal of the abnormalities, but achievement of clinical remission was not associated with permanent normalization of fibrinolysis. Inasmuch as all 12 patients had severely depressed fibrinolytic mechanisms it is possible that a defect in the fibrin-clearing system permits thrombus formation to occur and proceed in an unchallenged fashion, thereby contributing to the complex events leading to arterial ischemia in vital organs.

Heparin-induced thrombocytopenia: a prospective study of 142 patients.

In a prospective study of 142 patients receiving intravenous heparin of bovine lung origin, thrombocytopenia developed in nine (6%) patients. In the group of 70 patients with a history of prior heparin therapy, seven (10%) had thrombocytopenia. By contrast, only 2 (3%) of 72 patients with no history of previous heparin treatment had thrombocytopenia, a statistically insignificant difference (p less than 0.5). In this group 58 patients received heparin for less than 10 days, and none of them had thrombocytopenia. Of the remaining 14 patients who were given heparin longer than 10 days, two patients (14%) had thrombocytopenia. This difference was statistically significant (p less than 0.01). Monitoring the platelet count detects the disorder early and prompt cessation of heparin prevents serious complications. All patients undergoing heparin therapy should have determination of pretreatment platelet count. In patients with a history of previous heparin therapy, thrombocytopenia may develop even with short duration of heparin treatment, and hence platelet counts should be monitored throughout the duration of treatment. The platelet count of patients who have no history of previous treatment with heparin should be monitored if heparin is continued for more than 7 days.

Primary chondrosarcoma of the lung. A report of two cases.

This report describes two cases of primary chondrosarcoma arising in the lung. In both cases, the treatment was palliative due to unresectable primary tumours. One patient's tumour appears to have originated in a persistent hamartoma; the other, from lung parenchyma. Primary chondrosarcoma of the lung tends to remain localized. Wide local excision is the treatment of choice when possible. Palliation can be accomplished with radiation and/or systemic chemotherapy.

Selective immunodeficiency and malignant lymphoma of the central nervous system. Possible relationship to the Epstein-Barr virus.

This report presents the findings of a study of a 17-year-old male with a selective immunodeficiency to the Epstein-Barr virus, who died of a malignant lymphoma following clinical infectious mononucleosis. Autopsy findings and immunohistochemical techniques demonstrated a malignant lymphoma with B-lymphocyte characteristics which primarily involved the central nervous system (CNS). The relationship of the Epstein-Barr virus to lymphoproliferation is discussed.

The relationship of central venous and pulmonary artery catheter position to acute right-sided endocarditis in severe thermal injury.

Autopsies of 1,105 burned patients completed from January 1951 through March 1977 were reviewed at the United States Army Institute of Surgical Research to investigate the relationship between central venous and pulmonary artery cannula use and the incidence of endocarditis. The incidence of endocarditis increased from 3.4 to 9.4% after 1969 when cardiac injury attributed to central venous cannula use was first noticed at autopsy. Since 1969, right heart nonbacterial and bacterial endocarditis has dramatically increased and the right heart has become the prevalent site of the cardiac lesions. Review of premortem chest roentgenograms from 14 recent autopsy cases with right heart endocardial injury confirmed that central venous catheter tips were placed in the vicinity of the right atrium or right ventricle in 86% of the cases. Pathogenetically, the majority of the infected right heart lesions are probably the result of cannula-induced injury, with subsequent thrombosis and later bacterial colonization during episodes of bacteremia which are common in burned patients.

Intrasinusoidal bodies in the livers of thermally injured patients.

Acidophilic intrasinusoidal liver bodies appearing at autopsy in cases in which thermal injury occurred were examined by light microscopy using several special stains and by scanning and transmission electron microscopy. Morphologically, these bodies were found to be membrane-bound protein material that were usually present in the hepatic sinuses but were also identified in hepatocytes, spaces of Disse, and Kupffer's cells. Correlation of clinical data with pathologic findings failed to determine a specific cause for the intrasinusoidal bodies.

Infection of a burn wound by Aspergillus niger. Gross appearance simulating ecthyma gangrenosa.

Growth of Aspergillus niger on a burn wound clinically simulated the early (hemorrhagic) phase of an invasive infection by Pseudomonas aeruginosa or ecthyma gangrenosa. Wound biopsy for histologic examination and culture readily yielded a definitive diagnosis of noninvasive mycotic infection of the burn wound. Pigmentation surrounding mycotic hyphae (otherwise typical for Aspergillus spp.) strongly suggested Aspergillus niger. Cultural data confirmed the diagnosis.

An "abnormal" lymphoid proliferation simulating Hodgkin's disease in a burn patient.

A particularly exuberant and unusual lymphoid proliferation in the spleen of a burn patient is presented. Many Reed-Sternberg cell variants and occasional diagnostic Reed-Sternberg cells strongly suggested a diagnosis of Hodgkin's disease. The pattern of distribution and cytology of this lymphoid infiltrate, however, are incompatible with Hodgkin's disease or a non-Hodgkin lymphoma. Morphologic features in this case suggest that the Reed-Sternberg cell is a B lymphocyte. The most probable etiologies of this unusual lymphoid proliferation are reviewed.

An animal model for childhood convoluted T-cell lymphoma.

The light microscopic and ultrastructural characteristics of the AKR-J mouse lymphoma are described in detail. Clinical and histologic facets of convoluted T-cell lymphoma of childhood and AKR-J mouse lymphoma are reviewed. The remarkably close correlation between these two entities is demonstrated. The possibility that this mouse tumor should be utilized as a model for convoluted T-cell lymphoma of childhood is emphasized.

Extensive cutaneous burn complicated by severe necrotizing amebic enterocolitis. Pathogenic factors resulting in severe amebic disease.

A 59-yr-old Mexican-American man developed fatal necrotizing amebic enterocolitis following an extensive cutaneous thermal injury. Those factors in the severely burned patient which predispose to amebic disease are discussed.

"Fruiting bodies" of aspergillus on the skin of a burned patient.

A case of a young man with an extensive total-body-surface burn complicated by wound infection is presented. One of the fungal organisms in the cutaneous burn wound had morphologically characteristic and diagnostic features by development of conidiophores ("fruiting bodies") pathognomonic of Aspergillus spp.

Triiodothyronine-secreting (toxic) adenoma of the thyroid gland: light and electron microscopic characteristics.

A patient with thyrotoxicosis due to a triiodothyronine (T3)-secreting autonomous adenoma is described. The histmorphology of the neoplasms was similar to other neoplasms previously reported. Ultrastructural features of the adenoma are compatible with a very actively secreting follicular cell and are best compared with the ultrastructure of a diffuse toxic goiter. Distinctive features that separate toxic adenomas from various thyroid carcinomas and normal thyroid parenchyma are discussed.

Pineal serotonin N-acetyltransferase activity and melatonin concentrations in prepubertal and adult Syrian hamsters exposed to short daily photoperiods.

Pineal serotonin N-acetyltransferase activity (NAT) and melatonin concentrations were determined at various intervals in prepubertal (35 days old) and adult male hamsters (74 day old) throughout a 24 hour period with the animals kept in a light:dark cycle of 6:18 (lights on at 0600 h and off at 1200 h). In prepubertal animals, daytime pineal NAT activity of 0.20-0.28 nmoles 14C-N-acetyltryptamine/pineal/hour was maintained for 8 hours after the initiation of darkness. Peak pineal NAT activity of 0.46 +/- 0.64 nmoles 14C-N-acetyltryptamine/pineal/hour occurred 13 hours after the onset of darkness and remained significantly elevated until 0400 h (p less than 0.001). Daytime pineal melatonin concentrations of 78-194 pg/pineal gland also were maintained for 8 hours after the initiation of darkness. At 13 hours into the dark period, pineal melatonin concentrations rose to 788 +/- 150 pg/pineal gland (p less than 0.01 vs all other time points except 0230 h and 0400 h). At one hour before the onset of light both the pineal NAT activity and pineal melatonin concentrations returned to daytime values. Adult male hamsters had diurnal pineal NAT and melatonin rhythms which are indistinguishable from those found in the prepubertal animals.