Light and electron microscopic identification of Cyclospora species in the small intestine. Evidence of the presence of asexual life cycle in human host.

This is the first case of cyclosporiasis in which the parasite was clearly demonstrated in a duodenal biopsy by light microscopy. Electron microscopy identified the stages of sporozoite, trophozoite, schizont, and merozoite. Although only asexual forms were identified in our case, the sexual cycle must have taken place in the human host, because oocysts were detected in stools of the patients. Therefore, it appears that Cyclospora species require only a single host to complete its entire life cycle. Despite the heavy infection, only enterocytes were invaded. The lamina propria and submucosa were not involved. The morphology of Cyclospora in the intestine is similar to that of Isospora, but differs from that of Cryptosporidium. The morphology of the oocyst of Cyclospora resembles that of Cryptosporidium, but differs from that of Isospora. Thus, a combined study of both stool and intestinal biopsy should readily distinguish Cyclospora from Cryptosporidium and Isospora.

Time-dependent effect of glutaraldehyde on the tendency to calcify of both autografts and xenografts.

To determine mechanisms responsible for the reduced calcification in short-term glutaraldehyde (Glu)-treated autologous pericardial bioprostheses, we studied the time effect of Glu on subsequent calcification and differences in calcification of autograft and xenograft implants in a rat subcutaneous implantation model. In experiment 1, four groups of bovine pericardial pieces (1 cm2) were prepared: (A) fresh bovine pericardium without Glu, (B) with 15-minute Glu, (C) with 60-minute Glu, and (D) with 120-minute Glu. Seven young male Sprague-Dawley rats were used; each received four bovine pericardial pieces from group A, B, C, or D for subcutaneous implantation. Calcium content of the implants (microgram/mg dry weight) 45 days later was 4.8 +/- 2.9, 29.8 +/- 13.6, 106.3 +/- 13.7, and 176.3 +/- 85.5 in groups A, B, C, and D, respectively (p < 0.05 between any two groups). Experiment 2 used 8 young male Sprague-Dawley rats from different mothers. Each received five subcutaneous skin implants. The five skin implants were prepared as follows: (1) fresh self skin, (2) self skin with 30-minute Glu, (3) self skin with 48-hour Glu, (4) fresh skin of others, and (5) skin of others with 48-hour Glu. After 45 days of implantation, the calcium content of the implants was 1.4 +/- 1.1, 57.9 +/- 35.4, 142.7 +/- 61.4, 1.5 +/- 1.1, and 94.9 +/- 24.1 micrograms/mg dry weight in groups 1, 2, 3, 4, and 5, respectively (p < 0.05 for 1 versus 2, 3, or 5; 2 versus 3, 4, or 5; 3 versus 4; and 4 versus 5).(ABSTRACT TRUNCATED AT 250 WORDS)

Non-Hodgkin's lymphoma during pregnancy.

A rare case of non-Hodgkin's lymphoma stage IE complicating pregnancy is presented. The diagnosis was made by biopsy at 28 weeks gestation and treated with 2635 rad of external radiotherapy with abdominal and pelvic shielding beginning at 30 weeks gestation. Following delivery, the patient received combination chemotherapy and is disease-free 6 years later. The baby, weighing 2015 g, was delivered by cesarean section at term. The effects of radiotherapy on a fetus are reviewed and the factors that were considered in the treatment of this patient are discussed. Radiotherapy with protective shielding can be an effective initial modality of treatment in this setting.

Mesenteric desmoid of the appendix--a case report.

A case of an isolated mesenteric desmoid (fibroma) is presented with two unusual characteristics. First, it arises from the mesentery of the appendix. Second, it presents as a twisted desmoid. The CT and US characteristics are presented. This patient was without risk factors for mesenteric fibrosis such as Gardner's syndrome or previous surgery.

Acute necrotizing gastritis in a patient with peptic ulcer disease.

Gangrene of the stomach is a rare, often fatal disease which may be due to vascular, chemical, mechanical, or infectious etiologies. The infectious type, acute necrotizing gastritis, is thought to be a variant of phlegmonous gastritis, which has been associated with recent large intake of alcohol, "gastritis," and upper respiratory tract infections. Our patient, who had a history of peptic ulcer disease and gastric outlet obstruction, presented with abdominal pain, hypotension, and pneumomediastinum.

A biologically active parathyroid hormone-like substance secreted by an adenosquamous carcinoma of the transverse colon.

Recently, controversy has emerged as to whether paraneoplastic hypercalcemia in nonparathyroid tumors is due to ectopic production of a parathyroid hormone (PTH)-like substance. A sensitive DNA hybridization technique was unable to reveal PTH mRNA in a collection of such tumors. However, there is growing evidence that squamous differentiation of tumors favors the expression of PTH-like substances. We report the case of a 41-year-old woman with an adenosquamous carcinoma of colonic origin associated with severe hypercalcemia. The squamous component of liver metastases showed immunoreactivity with two different PTH antisera, suggesting the production of a PTH-like substance.

Hepatocellular carcinoma in a long-term survivor of acute lymphocytic leukemia.

Hepatocellular carcinoma (HCC) occurred in a 28-year-old woman treated for acute lymphocytic leukemia (ALL) with methotrexate (MTX) and 6-mercaptopurine (6-MP), off all therapy for 15 years, who was also heterozygous for alpha-1 antitrypsin (alpha-1 AT) deficiency. MTXD is responsible for the development of HCC in this patient. The literature concerning the incidence of HCC in patients treated with MTX and 6-MP and in alpha-1 antitrypsin deficiencies is reviewed.

Localization of parathyroid hormone-like substance in squamous cell carcinomas. An immunoperoxidase study with ultrastructural correlation.

Histologic sections of squamous cell carcinomas of four hypercalcemic patients were investigated for the presence of parathyroid hormone (PTH)-like substance. None of the patients had clinical or radiographic evidence of bone metastases. The Sternberger-peroxidase-antiperoxidase-immunoperoxidase technique utilizing monospecific antibody to whole (1 to 84) bovine PTH demonstrated immunoreactive material in all cases. Electron microscopy of the four tumors revealed dense-core secretory granules resembling those seen in parathyroid chief-cell adenomas. The patients did not have elevated serologic levels of PTH or evidence of bone metastases; however, in two cases, osteoclastic bone resorption was seen in bone marrow biopsy specimens. All patients became normocalcemic after definitive tumor resection. The hypercalcemia associated with some nonmetastatic squamous cell carcinomas is associated with the production of PTH-like substance.

Secondary osteonecrosis in osteoarthritis of the femoral head.

Secondary osteonecrosis was found by pathologic examination in nine (6 per cent) of 150 femoral heads removed surgically for osteoarthritis. The changes were morphologically distinct from the remodeling deformities that supervene late in steroid-induced or idiopathic osteonecrosis. They appeared as infarcts confined to previously eburnated tissue. There were no distinctive clinical or radiologic characteristics. The findings do not lend weight to the hypothesis that unrecognized osteonecrosis is a major etiologic factor in apparently primary osteoarthritis.

Hepatitis B surface antigen and hepatocellular carcinoma in the People's Republic of China.

Eighteen cases of heptocellular carcinoma from the People's Republic of China were investigated for the presence of hepatitis B surface antigen (HBsAg) in the cytoplasm of hepatocytes and tumor cells. The Sternberger-PAP immunoperoxidase technique utilizing monospecific antibody to HBsAg and a modified orcein method demonstrated cytoplasmic HBsAg in hepatocytes of 15 cases (83.3%) and tumor cells of 3 cases (16.7%). Thirteen of these cases were also investigated for HBs antigenemia and of these 11 were positive (84.6%). These hepatomas were often associated with macronodular cirrhosis and/or a persistent inflammatory process in the hepatic parenchyma. The high association of HBsAg and hepatoma indicates that the hepatitis B virus plays an important role in the pathogenesis of this malignancy in China. It is concluded that a major public health effort to eradicate endemic hepatitis B infection is the most reasonable way to decrease the incidence of this cancer, which is common in China.