Hyperventilation and hypophosphataemia.

We describe a case where extensive investigations were utilized to identify the aetiology of hypophosphataemia in a patient presenting with non-specific symptoms. The diagnosis of hyperventilation-induced hypophosphataemia was eventually established. Hyperventilation is a relatively common cause of isolated hypophosphataemia, but is easily overlooked as a cause.

Renal transplant pathology: bahrain experience.

A ten-year retrospective study on renal transplant biopsies performed at the Salmaniya Medical Complex, Bahrain was performed. The histological changes were classified according to Banff 1997 working classification of renal allograft pathology. A semi quantitative scoring was also given as per the guidelines. Out of a total of 26 cases, 10 belonged to hyperacute and acute forms, while 11 could be categorized to chronic sclerosing allograft nephropathy. In the remaining five, the graft pathology was unrelated to the rejection process. Despite effective management, four cases underwent nephrectomy due to severe vascular rejection. An interesting feature was recorded in two cases in whom transmural arteritis followed chronic histological changes. Presence of tubular atrophy and interstitial matrix increase were considered useful parameters for assessing the severity in cases with chronic allograft nephropathy.

Correlation of the growth fraction, nucleolar organizer region counts and epidermal growth factor receptor with histomorphological prognostic criteria in breast cancer.

A total of 60 cases of breast cancer were studied to find the correlation between newer parameters of prognosis viz growth fraction (GF), nucleolar organizer region (AgNOR) counts and epidermal growth factor receptor (EGFR) positivity with the various histomorphological factors such as tumour size, nuclear grade, histological grade and mitoses. Growth fraction measured by Ki67 monoclonal antibody varied from 3.6 to 73.7 percent. AgNOR counts ranged from 1.2 to 16.9 dots per tumour cell nucleus with a mean of 6.26 dots. EGFR positivity was seen in 66.7% of cases. Ki67 score correlated with all prognostic variables studied except the presence of axillary metastases. AgNOR counts correlated with size of tumour, axillary lymph-node metastases and Ki67 score but no correlation was seen with histologic or nuclear grade. EGFR positivity correlated strongly with size of the tumour and weakly with Ki67 score, AgNOR counts and mitoses.

Morphologic and arteriographic changes in the pulmonary vasculature in children with congenital heart disease.

This study was undertaken to determine the morphologic changes occurring in the pulmonary vasculature in congenital heart disease. Autopsy was performed in twenty cases of congenital heart disease ranging in age from newborn (full term) to 14 years. Postmortem arteriography was performed in most of them followed by histomorphometry. It was found that medial hypertrophy of the muscular pulmonary arteries was the most consistent change and the smallest muscular arteries were the most severely affected. The lesions were focal and randomly distributed. Hence, morphologic observations on open lung biopsies may not be accurate.

Morphologic changes in pulmonary vasculature with arteriographic correlation.

During fetal life the pulmonary circulation is one of high resistance. Soon after birth with the onset of breathing and thereafter, sequential structural changes in pulmonary vasculature take place. Several authors have reported differently on this structural remodeling. This study describes the changes in the pulmonary vasculature occurring following birth. Twenty-five cases submitted to autopsy with ages ranging from newborns up to fourteen years were studied. Postmortem arteriography was undertaken in most of the cases and arterial morphology was quantitated by histomorphometry. It was found that the thick-walled pulmonary arteries of the newborn show a reduction in medial thickness over a period of one month, the reduction being most rapid in the first three days. After one month there is no significant change in medial thickness until fourteen years of age.

Primary IgA nephropathy: a preliminary report.

A total of 106 renal biopsies were examined. Each biopsy was processed for routine paraffin sectioning and frozen sectioning. Direct immunofluorescence was done by the conventional method. The immunofluorescence patterns were correlated with histopathological changes and clinical presentation. Fourteen biopsies revealed weak to strong IgA staining and out of these, 11 seemed to fulfil the criteria of primary IgA nephropathy. These cases were diagnosed in a brief period of eleven months and there had not been any earlier published series from India.

Non-surgery related aspergillus native valvular endocarditis: report of two cases.

Two unusual cases of aspergillus valvular endocarditis without any history of cardiovascular surgery found at autopsy are reported. As there is a chance of dissemination, early diagnosis is important. Clinical awareness can lead to early recognition and effective treatment of this potentially lethal condition.

Pattern of hypertrophy of left ventricle--a histometric analysis of eighteen cases.

The pattern of myocardial hypertrophy in different sites of the left ventricular wall was morphometrically analysed in aortic stenosis (6 cases), hypertensive hypertrophy (5 cases), mitral incompetence (4 cases), and dilated cardiomyopathy (3 cases). The diameter of individual circumferentially oriented mid wall (or middle) fibre was significantly greater than those of subepicardial and subendocardial zones. Thus, hypertrophy does not affect the entire left ventricular myocardium uniformly. It seems to vary according to the spatial configuration of the fibrosis in relation to the cavity.

Class specific antinuclear antibodies in systemic lupus erythematosus.

The incidence and significance of class specific antinuclear antibodies (ANA), specially with relevance to clinical manifestations of arthritis, renal disease and serositis was studied in 40 patients of systemic lupus erythematosus by the indirect immunofluorescent method. Clinical activity was scored by Morimoto's scoring system. A significant correlation was obtained between IgD ANA and clinical activity of the disease and IgG ANA exhibiting lupus pattern of immunofluorescence and serositis.

Autopsy findings and clinical diagnoses: a review of 1,000 cases.

The protocols of 1,000 consecutive adult patients autopsied during the period June 1983 to December 1988 were retrospectively analyzed and the findings were compared with clinical diagnoses. The autopsy rates during this period ranged between 23% and 27% of hospital deaths. Eighty-seven percent of the autopsied patients were between 15 and 59 years of age. Major discrepancies between the autopsy reports and the clinical diagnoses were present in 31.7% of all autopsy reports reviewed. Infectious diseases were the most common cause of death (46.8%), followed by cardiovascular diseases (17.1%) and neoplastic diseases (14.3%). Infections were clinically recognized in 66.7% of cases and were missed or found to be incorrect in 33.3% of cases. Tuberculosis comprised 33.8% of the major bacterial infections and was clinically diagnosed in 82% of cases. Eighty-nine percent of the major fungal infections were not suspected clinically. Rheumatic heart disease (43.8%) was the most common cardiovascular disorder and was clinically diagnosed in 93.3% of cases. Pulmonary vascular episodes were the least common cause of death and were not suspected clinically in 62.9% of cases. Malignancies were incorrectly diagnosed in 25.8% of cases. We conclude from this study that routine autopsies revealed major unexpected findings that are of clinical importance, and that a continued emphasis on autopsy evaluation is necessary for the improvement of the quality of patient care.

Intracardiac autonomic ganglion cells in leprosy and dilated cardiomyopathy.

Disturbances in cardiac autonomic functions are known to occur in patients of lepromatous leprosy and dilated cardiomyopathy. We have analyzed the number of cardiac autonomic ganglion cells in patients of lepromatous leprosy (2 cases), dilated cardiomyopathy (2 cases) and compared with those of control subjects (2 cases). The average number of ganglion cells in cases of dilated cardiomyopathy (1164) and leprosy (1138) did not show any significant deviation from the average neuronal number of control subjects (1352).

Hereditary nephritis (Alport's syndrome)--clinical profile and inheritance in 28 kindreds.

Sixty-three patients, (52 males and 11 females) from 28 kindreds of hereditary nephritis (Alport's syndrome) were identified over a 14-year period from 1977 to 1991. Group I included 51 patients with (a) positive family history of haematuria with or without chronic renal failure, (b) characteristic GBM changes on electron-microscopy, (c) characteristic ocular signs, and (d) high-frequency sensorineural deafness. Group II included 12 patients with a negative family history. All of them had evidence of renal disease with characteristic ocular signs and deafness and four had characteristic GBM changes on electron-microscopy. The main clinical features were haematuria in 96.8%, deafness in 82.5%, and diminished visual acuity in 66.7% of affected subjects. Hypertension was present in 71.4% patients. Pure tone audiometry revealed high-frequency sensorineural deafness in 96.8%. Ocular examination showed bilateral anterior lenticonus in 37.8%, retinal flecks in 22.2%, cataract in 20%, and keratoconus in 6.7% patients. Proteinuria (> 2.0 g/24 h) was detected in 31.8%. Sixteen (57.1%) of the 28 index patients (all males) were diagnosed for the first time when they presented with end-stage renal disease. Serum creatinine in the overall group ranged from 0.9 to 18.7 mg/dl(7.81 +/- 5.37 mg/dl). Adequate renal tissue was obtained by biopsy in 14 patients. Light-microscopy revealed focal segmental glomerulosclerosis in five, mesangial proliferation in four, chronic interstitial nephritis in three, and mesangiocapillary and crescentic glomerulonephritis in one each. Electron-microscopy showed characteristic changes in the GBM in seven specimens.(ABSTRACT TRUNCATED AT 250 WORDS)

Visceral leishmaniasis with cysticercosis.

A chest wall nodule in a boy with relapsed proven kala-azar was found to contain a cysticercus. In the fibrous wall with lymphohistiocytic aggregates were mononuclear phagocytes containing amastigotes of L. donovani.