Hypersensitivity pneumonitis due to native birds in a bird ringer.

A bird fancier who had only been exposed to native birds, mostly owls, developed a sever hypersensitivity pneumonitis with a very insidious onset.

Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland.

Between September 1, 1981, and August 31, 1982, all patients with suspected or confirmed pneumonia among the 46,979 inhabitants of four municipalities in the province of Kuopio, Finland, were reported to a pneumonia register by their attending physicians. In addition, two study pathologists reported all cases of pneumonia found at autopsy, and two permanent registers were checked for retrospective identification of patients. Chest radiographs were obtained from 97% of all patients. The final diagnosis was based on radiologic or autopsy criteria. A total 546 patients (323 males and 223 females) had community-acquired pneumonia; of these, 37% were less than 15 years of age, and 31% were 60 years of age or older. Nineteen percent of the patients had defined chronic conditions, and 42% were admitted to hospital. The case fatality rate was 4%. The overall incidence of community-acquired pneumonia per 1,000 inhabitants per year was 11.6 (13.9 in males, 9.4 in females). The age-specific incidence per 1,000 inhabitants per year was as follows: age < 5 years, 36.0; age 5-14 years, 16.2; age 15-59 years, 6.0; age 60-74 years, 15.4; and age > or = 75 years, 34.2.

Simultaneous hepatoblastoma in identical male twins.

Identical male twin infants who in 1987 presented with hepatoblastoma at the age of 7 months are reported. Twin B was admitted for investigation due to enlarged liver and spleen. He was found to have an inoperable hepatoblastoma of fetal type and was treated with chemotherapy and local irradiation. However, 7 months after the chemotherapy the tumor recurred. The asymptomatic twin A was examined because of the known familial cases, and he proved to have an identical tumor. He was successfully radically operated on and 2 years after the chemotherapy is still doing well with no evidence of tumor. As the mother and the maternal grandmother had polyps in the colon, quite probably the hepatoblastomas of the twins were associated with familial adenomatous polyposis.

Vocal cord paralysis caused by a cyst in extraglandular thyroid tissue. Case report.

A 37-year-old woman presented with hoarseness two days after developing pain while undergoing physiotherapy for tension in her neck. Computed tomography showed a probably benign mass near to the left lobe of the thyroid, which was found at operation to be attached to the recurrent laryngeal nerve. The nerve was dissected free, the tumour removed, and the patient and her voice recovered fully. Histological examination confirmed a benign cyst in extraglandular thyroid tissue and the patient is well two years later.

Prognostic value of ovarian carcinoma grading methods--a method comparison study.

The prognostic value of subjective histological and morphometric grading was studied in 75 primary ovarian carcinomas. Histological grading methods recommended by Czernobilsky and by Russell and the morphometric method of Baak and co-workers were compared in a two-observer system. The 5-year survival could be correctly predicted in about two-thirds of the patients with all three methods. When mitotic counting (volume corrected mitotic index, M/V-index) was compared with the above grading methods by using a receiver operating characteristic curve) the M/V-index was generally superior in its prognostic power regardless of the sensitivity/specificity level chosen. The morphometric grading method and the grading method based on the M/V index were also shown to be readily reproducible.

Acute febrile neutrophilic dermatosis (Sweet's syndrome) in association with myelodysplastic syndromes: a report of three cases and a review of the literature.

Three patients with acute febrile neutrophilic dermatosis (AFND, Sweet's syndrome) in association with myelodysplastic syndromes (MDS) are described and, in addition, another 10 published cases are reviewed. In the reviewed patients the male/female ratio is 2:1. The great majority of the patients had decreased or normal leucocyte counts at the time the syndrome developed. Chromosome analysis was available in eight cases: in three the karyotype was normal while five patients had a clonal abnormality. No clinical or laboratory parameters seemed to predict the response to steroids: all but one of the treated patients responded promptly. Moreover, three patients recovered spontaneously. Shortly after the appearance of Sweet's syndrome nine patients developed acute leukaemia and one patient died with hypoplasia. Development of Sweet's syndrome in association with MDS may not be an uncommon clinical finding. The occasional MDS patient developing AFND will often progress into acute leukaemia and thus the occurrence of AFND warrants a bone marrow examination and close follow-up of the patient.

Prognosis of ovarian carcinomas: prediction by histoquantitative methods.

Prediction of prognosis of ovarian carcinomas by morphometric, histopathological and clinical indices was estimated in 105 tumours. Morphometric parameters included mitotic activity index, volume-corrected mitotic index (M/V index), volume fraction of neoplastic epithelium, nuclear area, nuclear perimeter, shortest and longest nuclear axis and form factor of nucleus. Cox's multivariate regression model showed that the clinical stage was the best predictor of prognosis followed by the M/V index, which expresses the mitotic activity as the number of mitotic figures per square millimeter of neoplastic epithelium in the microscope field. In all tumour subgroups studied the M/V index was the best prognostic factor and for stage I tumours it was the only parameter selected by the Cox's model as a significant and independent prognostic predictor. We conclude that the M/V index can be used as a significant prognostic factor in ovarian carcinomas.

Pulmonary and immune responses to a Thermoactinomyces vulgaris antigen respiratory sensitization in C57BL/6J mice.

Lung histology and immune responses were followed during a six month period of Thermoactinomyces vulgaris antigen respiratory sensitization of C57BL/6J mice. Histologically, the mice developed a picture resembling the subacute stage of human farmer's lung. At the early phase of the sensitization a T-cell response was seen in vitro, characterized by an increased spleen but no peripheral blood lymphocyte reactivity to T-cell mitogens at the same time as increased reactivity to the sensitizing antigen was detected. An increase in the percentage of T-cells in the lavage cell population was also seen. The sensitization was associated with the appearance of both IgG and IgA antibodies in lavage and in serum of which lavage IgA antibodies were found to follow the course of the sensitization most accurately. The increase in antibody titers was not, however, reflected in lavage cytology or in lymphocyte reactivity. The results suggest that different immunological reactions may be predominant at different stages of farmer's lung.

Experimental allergic alveolitis in mice induced by Thermoactinomyces vulgaris.

A model of allergic alveolitis was developed in inbred mice. Antigen suspension prepared from Thermoactinomyces vulgaris was applicated intranasally in C3H/He mice. Lung histology, serum IgG and IgA antibodies and serum lysozyme were followed during the course of sensitization. The lung histology showed an increased number of intra-alveolar macrophages and leucocytes in sensitized mice. Interstitial peribronchiolar and perivascular infiltration of mononuclear inflammatory cells and a few granulomas were also detected. An increase in the prevalence as well as titers of IgG and IgA antibodies was recorded during sensitization. An elevation in serum lysozyme level was also observed in sensitized mice. The lung histology of control animals was essentially normal and no increase in antibody titers or lysozyme levels was detected. Intranasal application of antigen prepared from Thermoactinomyces vulgaris seems to produce in mice allergic alveolitis resembling human farmer's lung.

Antenatal screening for congenital nephrosis in Finland by maternal serum alpha-fetoprotein.

In the Kuopio and North-Karelia districts of Finland 10724 pregnancies were screened for congenital nephrosis by maternal serum alpha-fetoprotein (AFP) measurement. Outcome was known for 10504 (98%) pregnancies, of which 509 (4 X 8%) had a serum AFP level greater than or equal to 2 X 5 multiples of the normal median (MoM) at 15-18 weeks gestation. After exclusion of those women who had a normal serum AFP level (less than 2 X 5 MoM) in a second sample, 'wrong dates' or multiple pregnancy, 267 (2 X 5%) remained with a high serum AFP level. Amniocentesis was carried out in 225 (2 X 1%) and 16 women had an amniotic fluid AFP level greater than 10 SD above the normal mean. In this group there were six fetuses with congenital nephrosis (four confirmed and two suspected), six other serious malformations (including an intrauterine death) and four without obvious abnormality. In the 98% pregnancies followed up there were no infants with congenital nephrosis that had been missed. Babies with congenital nephrosis require permanent hospitalization and have a mean survival of 8 months. In Finland, within certain areas, the birth prevalence is as high as 1 in 2600 per year. In such areas maternal serum AFP measurement appears to be a useful method of screening for congenital nephrosis. The service was also well accepted since 94% of the women with raised serum AFP levels wished to be screened again in a future pregnancy.

Ischemic heart disease and heart weight.

Separate weights for heart ventricle walls and interventricular septa were analyzed in 110 hearts with autopsy findings of ischemic heart disease (coronary atherosclerosis, recent or old myocardial infarcts) and with no other cardiac or systemic causes of cardiac enlargement. In hearts with coronary atherosclerosis alone (without old or recent myocardial infarcts) no weight increase was observed in the left ventricle when compared to 29 controls. Patients having infarcts associated with nonstenosing atherosclerosis (less than 50% of the luminal diameter narrowed) of the coronaries had normal heart weights as well. On the contrary, infarcts associated with stenosing coronary sclerosis (narrowing more than 50%) showed significant signs of left ventricular weight increase, which is interpreted as compensatory heart hypertrophy. The greatest degree of hypertrophy was observed in hearts with left ventricular aneurysms.

Sjögren's syndrome in systemic lupus erythematosus and rheumatoid arthritis: immune effector cells in salivary glands.

A simultaneously capturing azo dye method for acid alpha-naphthyl acetate esterase was used to characterize the cellular infiltrate in labial salivary glands in 25 patients with Sjögren's syndrome (SS). There was no significant difference in the T-pattern lymphocyte percentage in situ between the untreated group with SS and the group treated with 10 +/- 2 mg prednisone/day. There was a significant correlation (P less than 0.05) between the T-pattern lymphocyte percentage in situ and the focus-score value. In secondary (2 degrees) SS in cases of systemic lupus erythematosus (SLE) and rheumatoid arthritis, respectively, 55% +/- 4% (range 41-69) and 43% +/- 7% (range 15-80) of all inflammatory cells in the periductal lymphocyte-rich infiltrates were T-pattern lymphocytes. In other SS patients the corresponding value was 28% +/- 7% (range 4-50). The T-pattern lymphocyte percentage in situ was dependent on the disorder associated with SS (P = 0.07). The present results indicate the dominance of T-lymphocytes in situ in 2 degrees SS with SLE and suggest that there are differences in cell-mediated immunity in different clinical subgroups of SS.

Oral lesions in lichen planus and systemic lupus erythematosus. A histochemical and immunohistochemical study.

The present study aimed to characterize and compare the inflammatory cells in the oral lesions in lichen planus and systemic lupus erythematosus. The inflammatory cell subtypes were identified by the combined use of morphological criteria and intracellular markers. In lichen planus 70-90% of all lymphocytes in a band-like submucosal infiltrate were acid alpha-naphthyl acetate esterase (= ANAE)-positive T lymphocytes. The lymphocyte band was sandwiched between mature tissue macrophages and plasma cells. In systemic lupus erythematosus (SLE) the lymphoid cell infiltrate pattern was more variable with extension of the infiltrate to the deeper connective layers and with a more patchy arrangement. The number of ANAE-negative (B) lymphocytes equalled the numbers of ANAE-positive T lymphocytes. In addition, large numbers of plasma cells were present in some lupus patients. In both diseases IgG was produced by 80% of all plasma cells in situ and there were equal portions of cells containing kappa and lambda light chains.

Acute pancreatitis caused by closed duodenal loop in the rat.

Closed duodenal loop was created in the rat by obstructing the duodenum on both sides of the common bile duct. Acute haemorrhagic pancreatitis developed in these animals within 24 hours. Increased serum amylase activity, pancreatic acinar cell necrosis, pancreatic oedema and haemorrhages, and intra-abdominal fat necroses, together with formation of ascites fluid containing high levels of amylase, were observed in the experimental animals. The findings support the view that reflux of the duodenal contents into the pancreatic duct is an important early pathogenetic mechanism in the development of acute pancreatitis. The closed-loop technique in the rat offers a simple and reliable experimental model for studies on acute pancreatitis.