Amanita phalloides in Victoria.

Amanita phalloides is found regularly in suburban Melbourne and country areas where old oaks and other deciduous trees are grown as street trees, in parks, and in private gardens. This deadly poisonous mushroom may be mistaken for the edible Agaricus spp.

Heterotopic gastric mucosa in the gallbladder: a cause of chronic abdominal pain in a child.

A 12-year-old boy presented with a 7-year history of intermittent colicky epigastric pain. Serial abdominal ultrasound studies showed a contracted gallbladder, and single and double dose oral cholecystograms demonstrated nonfunction. All other investigation results were normal. At cholecystectomy, there was a fibrotic stricture at the junction of the gallbladder neck and cystic duct. The small, thin-walled gallbladder contained white bile. Histologically, the gallbladder was lined with normal mucous secreting columnar epithelium. The area of stricture showed diffuse fibrosis with islands of heterotopic gastric mucosa containing all gastric mucosal cell types. One year postoperatively, there have been no further episodes of abdominal pain. This is the seventh reported case of heterotopic gastric mucosa in the gallbladder of a child causing symptoms necessitating cholecystectomy. We recommend that a child with abdominal pain and a nonfunctioning gallbladder be considered for cholecystectomy even in the absence of cholelithiasis.

Significance of basement membrane thickening in the human colon.

Collagenous colitis is a rare condition characterised by watery diarrhoea. It is thought to be caused by a thick collagenous membrane found immediately beneath the colonic surface epithelium. We have studied specimens from 457 patients with a wide variety of large bowel diseases in order to determine the frequency, nature, and clinical correlations of the thick membranes. The normal membrane measured up to 3 microns. In 19 (4%) of the patients studied there was significant thickening (greater than 10 mu). In 12 patients the thickening ranged from 10-15 mu, and six of this group had diarrhoea. In seven, the membrane exceeded 15 mu, and six patients had diarrhoea. There was no correlation between the nature of the disease process, bleeding, pain, constipation or previous medication. It did not vary with the age, nor at different sites of the colon. We concluded that no case in this series represented an example of true collagenous colitis but that significant thickening of the membrane occurs in other disease conditions and that a thick membrane, no matter how it arises, is causally associated with profuse watery diarrhoea.

Changes in rat hepatocyte plasma membranes caused by synthetic estrogens.

Livers of rats treated with ethynyl estradiol show hepatocyte swelling, nuclear enlargement, and an increase in size and numbers of nucleoli. Mitotic figures are frequent and there is occasional hepatocyte necrosis. Thin sections (1-micron. thick) show separation of cells with gaps between. Ultrastructurally, these gaps are occupied by cell membrane microville. These microvilli are not a normal feature on cell borders between adjacent hepatocytes. Similar anomalous microvilli are a feature of hepatocytes in regenerating nodules of cirrhosis, regenerating hepatocytes following partial hepatectomy, and in embryonic liver tissue. The significance of this finding and the known relationship of contraceptive agents and liver tumors is discussed.

Carcinoma in situ of the male breast.

Two cases of carcinoma in situ of the male breast are described: in one patient it arose as a complication of gynecomastia; in the other, it occurred 'de novo' and proceeded to infiltration with widespread metastases. We reviewed 233 cases diagnosed clinically and histopathologically as gynecomastia to see if we could discover other instances of malignant transformation but none was found. Thirty-two cases of infiltrating male breast cancer were also examined. In 11 there was associated intraduct change. In only one of the 32 cases was there evidence of associated microscopic gynecomastia.

Solitary pulmonary nodules due to sarcoidosis.

Two patients, a 67-year-old woman and a 33-year-old man, had asymptomatic solitary nodular masses in the lung detected by roentgenographic examination. The preoperative investigations failed to make a firm diagnosis or to rule out the presence of a malignant lesion. In both patients the lesions were resected and found to contain noncaseating granulomas. Electron microscopy and immunochemical studies for lysozyme supported the diagnosis of solitary nodular sarcoidosis. Such roentgenographic presentations of sarcoid are rare.

Iron deficiency prevents liver toxicity of 2,3,7,8-tetrachlorodibenzo-p-dioxin.

The compound 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) causes hepatocellular damage and porphyria in C57B1/6J mice, among a wide range of toxic effects. We compared the effect of TCDD toxicity in iron-deficient mice with that in mice receiving a normal diet. Porphyria did not develop in the iron-deficient animals, and these animals were also protected from hepatocellular damage and certain other toxic effects of TCDD.

Innominate grooves of the colon: morphological characteristics and etiologic mechanisms.

The morphological characteristics of innominate lines and grooves of the colonic mucosa are described. There are three basic mucosal patterns: linear circumferential, network, and mixed. Lymphoid collections occur at frequent and regular intervals along the course of the lines. These collections split the muscularis mucosa, producing a series of perforations in this thin sheet of muscle. Where contractions of the muscle layer are predominantly longitudinal, those occurring between two rows of lymphoid tissue elevate the overlying mucosa to form ridges and grooves. Barium tends to accumulate in the grooves, particularly since the mucosa is thinner in these regions.

Erosion of the pituitary fossa by benign nasal polyps.

This paper presents a case of bone destruction of the walls of the sphenoid sinus including the floor of the sella turcica from benign nasal polyps.

Clinical aspects of atypical mycobacterial infection.

SUMMARY: Atypical mycobacterial infections may give rise to various clinical difficulties. Case reports of six patients--three adult patients with pulmonary lesions, two children with cervical lymphadentis and one patient in whom the atypical mycobacterium appeared to be present as a commensal--illustrate these difficulties. Determination of the significance of the organism and differentiation of condition from tuberculosis and others requires consideration of the clinical picture, the results of skin testing, histologic features and cultural characteristics. Three patients, including the two children, were treated with a combination of surgery and chemotherapy, with satisfactory results. An elderly patient with chronic bronchitis and a pulmonary infection due to M. kansasii was treated successfully with antiuberculosis agents alone. Chemotherapy is being tried on a fifth patient with cavitary disease due to M. intracellulare, but is seems likely that an operation will also be required.