Pulmonary changes following extracorporeal membrane oxygenation: autopsy study of 23 cases.

Extracorporeal membrane oxygenation (ECMO) has become an established mode of therapy in many centers for potentially fatal neonatal respiratory failure refractory to conventional therapy. We reviewed the findings of 23 autopsies of patients placed on ECMO therapy during the period from 1988 to 1992 at our institution in order to document the pulmonary histopathologic changes and to correlate such changes with the duration of treatment. Interstitial and intra-alveolar hemorrhages, as well as hyaline membrane formation, were the most common findings during the first few days of therapy. Reactive epithelial hyperplasia (bronchial and type II pneumocytes), squamous metaplasia, and smooth muscle hyperplasia were observed as early as 2 to 3 days after initiation of ECMO therapy. Interstitial fibrosis was noted only after 7 days of ECMO therapy. In three patients treated for 15, 19, and 21 days there was replacement of the terminal airways and alveoli by tall columnar and mucin-producing epithelium. Alveolar and bronchiolar calcifications were noted in seven of the 23 cases in this series. Pulmonary vascular changes were seen in association with persistent fetal circulation, meconium aspiration, and respiratory distress syndrome. These changes are most likely due to the compounded effect of ECMO and the underlying pulmonary insult.

The intriguing nature of gastric tumors in Carney's triad. Ultrastructural and immunohistochemical observations.

The authors describe clinical and pathologic features present in an adolescent girl who had a gastric tumor and mediastinal mass. The latter was shown to be a paraganglioma, and the gastric neoplasm was classified as malignant "leiomyoblastoma," with the use of current histologic criteria. This tumor had metastasized to the liver but not to the lungs. Although the histologic criteria for leiomyoblastoma were fulfilled, no definite evidence of smooth-muscle cell differentiation was present ultrastructurally or by immunostaining methods. Gastric tumors that form part of "Carney's triad" are known to differ clinically and pathologically in important ways from smooth-muscle cell malignant neoplasms that are not part of this syndrome. Some have been classified as gastrointestinal autonomic nerve tumors, but the current study did not confirm this contention. The nature of gastric leiomyoblastomas in Carney's multitumoral association remains undecided.

Diffuse phlegmonous gastroenterocolitis in a patient with an infected peritoneo-jugular venous shunt.

Phlegmonous gastritis and enterocolitis have been observed in association with alcoholism and hepatic cirrhosis. We report a case of diffuse phlegmonous gastroenterocolitis that occurred 1 yr after the insertion of a peritoneojugular venous shunt (Denver type) in a young male heroin abuser with postnecrotic cirrhosis. Diplococcus pneumoniae was cultured from the occluded distal tip of the shunt and the organism was visualized throughout the inflamed submucosa of the entire gastrointestinal tract. The diagnosis of this condition was not made premortem and the case highlights some of the clinical manifestations of this gastrointestinal disease. The possible pathogenetic mechanisms involved in this inflammatory process are discussed.