Giant cell myocarditis--a case report.

The authors described a case of giant cell myocarditis treated by heart transplantation.

Ambiguity of morphological criteria of myocarditis in cardiac biopsy specimens.

Myocarditis is diagnosed when leukocytic infiltrate is accompanied by myocyte degeneration or necrosis. Endomyocardial biopsy is evaluated as the main diagnostic method. The purpose of the present study was to examine the individual elements of a histological picture and specify morphological criteria of diagnosing myocarditis in cardiac biopsy. The Dallas criteria were the point of reference. In the cardiobiopsies from 70 patients with clinically suspected myocarditis or congestive cardiomyopathy an active myocarditis was found in 19 cases, significantly more frequently in the group clinically classified as having myocarditis. Contraction bands, endocardial changes and vasculopathy were more frequent in cases histologically classified as active myocarditis than in borderline myocarditis. In our opinion the Dallas criteria include certain ambiguities concerning mainly differences of individual types and phases of myocarditis as well as their relations to congestive cardiomyopathy. The sensitivity and specificity of the diagnosis are related both to methodological limitations (material selection) and difficulties occurring mainly at the level of perception, evaluation and interpretation of changes. It is possible to improve the efficacy of cardiac biopsy in diagnosing myocarditis if a new techniques better revealing myocyte damage and more unequivocally determining the cellular composition of the stroma have been developed.

Cardioprotective properties of hydrophilic pollen extract (HPE).

Pharmacological effects of hydrophilic pollen extract (HPE) are unknown. The results of our previous studies suggest their cardioprotective influence. The purpose of the present study was to evaluate biochemical and morphological effects of HPE in adrenaline-induced myocardial damage. The study was carried out in 40 Wistar rats. Group A was intoxicated with adrenaline in a dose of 100 micrograms/kg i.p. Group A + HPE was given simultaneously HPE and adrenaline. Group K consisted of control animals. Analysis of blood enzymes and histological examination of myocardial tissue were performed 24 hours after the onset of the experiment. The activity of SGOT, CPK and AP was measured using an automatic analyzer. Whole transversal myocardial sections were obtained for histology. We evaluated cellular infiltration of the endocardium, microfocal myocyte damage, wavy myofibers, cellularity of the stroma and perivascular infiltrates. The results were compared using statistical methods. In group A the levels of SGOT and CPK were significantly higher than in groups A + HPE and K. Histological examination also revealed marked differences among these groups. The present study despite confirming cardioprotection by HPE does not provide grounds for unequivocally defining its mechanism. This problem and a possible use of HPE in cardiology require further studies.

Evaluation of plasma cyclic GMP assay as a screening test for detection of acute cardiac allograft rejection.

Our aim was to assess the value of a single determination of plasma cyclic guanosine 3',5'-monophosphate (cGMP) in noninvasive screening for acute cardiac allograft rejection warranting augmentation of immunosuppression. Plasma cGMP levels were measured in 26 patients 1 to 13 months after heart transplantation on the same day the endomyocardial biopsies were performed. Acute moderate rejection (ISHLT 3A or 3B) was found in 10 out of 17 subjects (59%) with plasma cGMP >5 nmol/L, whereas there was mild or no rejection (ISHLT 0 to 1) in 8 from among 9 subjects (89%) with cGMP <5 nmol/L. Because cGMP levels <5 nmol/L appear to argue against the presence of acute rejection requiring therapy modification, our preliminary results suggest that a single plasma cGMP assay might be helpful in establishing indications for endomyocardial biopsy in heart transplant recipients.

Carcinoid tumor as a part of mature teratoma of the testis.

A rare case of primary carcinoid tumor in otherwise mature teratoma of the testis which occurred in a 70-year-old male is reported. The patient was treated by unilateral orchiectomy. The pathological specimen showed morphological characteristics of carcinoid in the teratomatous tumor. The immunohistochemical studies revealed positivity for chromogranin and neuron-specific enolase. Grimelius staining showed argyrophil granules in cells. Symptoms of a carcinoid syndrome were not noted. The patient remains disease free after surgery.

[Long-term observation of patients with biopsy proven myocarditis or dilated cardiomyopathy]. / Odlegle obserwacje chorych z potwierdzonym biopsja endomiokardialna zapaleniem miesnia sercowego lub kardiomiopatia rozstrzeniowa.

Dilated cardiomyopathy (DC) and myocarditis (MCD) are still cardiac diseases of unknown etiology and pathogenesis. Due to uncertain natural history of MCD also treatment remains controversial. We observe long-term outcome of 30 pts with biopsy-proved MCD (group I) and 25 pts with DC (group II). The diagnosis of MCD was established on Dallas criteria of MCD. Almost all pts presented symptoms of congestive heart failure. All group I pts were treated with immunosuppressive agents: azathioprine 1.5 mg/kg/d and prednisone with initial dose of 1.5 mg/kg/d. After tapering off 0.75 mg/kg/d of prednisone and initial dose of azathioprine were given up to 6 months. All pts obtained digitalis, diuretics, ACEI, antiarrhythmic drugs if necessary. We studied the survival and clinical status (NYHA class) of treated pts. Clinical improvement was observed in 93% of pts with MCD within 6 months, but 20% of pts deteriorated within the next 6 months. Almost all pts survived 1 year. Out of 30 pts with MCD, 16 pts remain in lower NYHA class (NYHA I-II) between 26 and 69 months of follow-up. Within the group II (DC) 28% of pts died in the first year of observation. Out of 15 pts in 14 pts advanced chronic heart failure (NYHA III-IV) is presented in the end of observation. Echocardiographic parameters of pts with congestive heart failure and biopsy-proved MCD or DC did not differ significantly. We observed correlation between improvement of the LV echocardiographic parameters and improvement of clinical status of treated pts.

[A case of toxic epidermal necrolysis with a low level of IgA in serum]. / Przypadek toksycznej nekrolizy naskórka z niskim stezeniem IgA w surowicy.

A case of the toxic epidermal necrolysis in a 52-year-old woman treated for hypoxia of cerebral trunk during the severe attack of bronchial asthma and the bacterial infection of respiratory system was described. The pause of toxic epidermal necrolysis was treated with ceftriaxone and cefuroxime. The woman died on the 20th day of disease.

Polymorphism of spermatocytic seminoma. A morphometric study.

Spermatocytic seminoma (SS) is one of the testicular tumours. It is distinguished from other germ cell neoplasms by a special type of polymorphism. The aim of the present study was a morphometric analysis (Microplane II image system) of this phenomenon. In histological slides we measured the profile area of nuclei in about 500 adjacent cells. The basic material consisted of 12 cases (c.) of infiltrating SS, and the comparative material included intracanalicular SS (IcSS-1c.), other types of seminoma--typical (TS-2c.), anaplastic (AS-2c.) and spermatogenesis in an elderly man (Sg-1 c.). We carried out a statistical analysis of the populations of cellular nuclei: we determined nuclear population similarities and differences, as well as their relation to various types of standard distributions such as Erlang, gamma, lognormal, normal and Weibull. Part of the SS histograms including IcSS showed similarities. The mean value of the profile area range from 32.5 to 56.5 microns2. In other types of seminomas this value was much higher. The Kolmogorov-Smirnov two-sample test showed differences between the compared nuclear populations. Lack of the differences was found only between certain SS (including IcSS). The results of comparisons of the populations studied with standard distributions showed that the analysed nuclear populations can be successfully described by more than one theoretical distribution. However, among the spermatocytic seminomas analysed, in contrast to TS and AS, we found distributions not corresponding to any of the standard distributions. The results of our findings argue also against the occurrence of haploid nuclei in SS cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrastructure of donor heart muscle prior to transplantation.

Biopsy samples obtained from right ventricle (septum) of donor heart just at the moment of procurement and few hours later after implantation, was examined under electron microscopy. Our study revealed in both biopsy groups the presence of mild cytoplasmic changes similar in character but different in the intensity and extent. The anomalies are unspecific and similar in their character to changes described in disease states or toxic damage. Lack of damage to the membrane system in the cardiac myocytes indicates a reversible character of changes. Further studies are required to compare the present findings with ultrastructural myocardial features after reperfusion.

Microfocal myocardial lesions in cardiac allograft recipients.

Endomyocardial biopsy has been widely accepted as a method for diagnosing acute heart transplant rejection. However, disperse and microfocal changes due to a smaller specificity, cause difficulty in histological differential diagnosis. The purpose of the present study was to morphologically assess microfocal lesions, to determine their relative incidence and their specificity in relation to the time of onset after cardiac transplantation and to compare these data with those concerning more extensive changes. We examined 658 samples in 152 endomyocardial biopsies obtained from 45 posttransplant patients, including 311 samples identified as containing focal lesions of varying size, and 33 as containing diffuse lesions. Samples with focal and diffuse lesions (344 samples) were submitted for further studies which revealed that microfocal changes in the transplanted heart show more enhanced polymorphism in the composition of cellular infiltrates than more extensive changes. Furthermore they are frequently seen in biopsies in the first two months after transplantation and as single changes. Necrosis and cellular infiltrates at that time are more diversified than those seen in later biopsies. In our experience differential diagnosis of microfocal myocardial lesions in cardiac allograft recipients is difficult. Potentially microfocal lesions may be a result not only of acute rejection but also a result of myocardial alterations in the course of intensive therapy both in the donor and in the recipient, cold ischemia, reperfusion, and inflammation. The morphological picture in some cases is not sufficient to make an unequivocal diagnosis. This indicates the need for improvement of diagnostic methods and criteria on the one hand, and a suitable approach to the problem on the other hand. Our experience shows that a temporary solution could be establishing of a separate classification category for these types of changes and defining them as nonspecific microfocal lesions.

Histologic analysis of myocardial biopsies from donor hearts before transplantation.

Myocardial biopsy is an accepted diagnostic tool in the assessment of acute heart transplant rejection. An important element of this assessment is the so-called zero (0) biopsies. The purpose of the present study was histologic analysis and comparison of these biopsies. We examined biopsy specimens obtained from 35 hearts of donors aged 15-46 years. 0-1 biopsy was obtained during organ procurement and 0-2 biopsy immediately before coronary reperfusion after implantation. Histologic analysis of changes was carried out by two observers. 0 biopsies in 8 out of 35 cases were histologically normal. In 23 cases minute histologic changes were found. They included myocyte enlargement, perinuclear vacuolization, interstitial and perivascular edema and fibrosis. Sporadically (4 cases) we encountered also signs of cardiac myocyte damage (microfocal necrosis and/or myocyte disruption). Differences were seen both between individual donors as well as 0-1 and 0-2 biopsies obtained from the same donor. 0-1 and 0-2 biopsies differed more clearly in the appearance of interstitium and microvessels. Interstitial edema was more frequent in 0-2 than in 0-1 biopsy and it was usually more severe. Differences between 0-1 and 0-2 biopsies with respect to changes in cardiac myocytes and interstitium were as expected and may result from progress of changes due to hypoxia. In contrast, endothelial swelling was more frequent and more severe in 0-2 than in 0-1 biopsies. This phenomenon may be accounted for by easier penetration and greater effect of perfused preservation solutions on endothelial cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Malignant fibrous histiocytoma in the course of chronic osteomyelitis.

Malignant fibrous histiocytoma (MFH) was found in the femur of a 28-year-old man who had suffered from chronic osteomyelitis. The patient had undergone surgery for a valgus knee deformity and the procedure was complicated by chronic osteomyelitis which lasted for 12 years. Four months after the onset of painful symptoms related to the occurrence of MFH, gross bone destruction with pathologic fracture and pulmonary metastases were present. The patient died 4 months later. Histopathological and immunohistochemical examinations indicated the diagnosis of MFH.

[Myocardial biopsy in morphologic diagnosis of myocarditis]. / Kardiobiopsja w morfologicznej diagnostyce zapalen miesnia sercowego.

The term "myocarditis" refers to a process in which leukocytic infiltration is accompanied by cardiac myocyte necrosis or degeneration. It has been recognized largely by using endomyocardial biopsy whose usefulness in the diagnosis of myocarditis is still being verified. Samples of the septal part of the right ventricular wall obtained by venous approach are examined mainly in light microscopy. Despite certain possibilities of using special staining and immunohistochemical methods, hematoxylin and eosin remain basic stains. For the diagnosis of myocarditis it is important to find the signs of the myocyte injury (myocytolysis, vacuolization, disruption) in the contact with inflammatory infiltrates. This has been included in the diagnostic criteria established in Dallas. However both, these criteria and other elements of cardiac biopsy procedure are a subject of increasing doubts and controversies, especially because of incomplete problem's solution of material eligibility and not best clinical--morphological correlation. On the other hand the studies of myocarditis indicate lack of comprehensive approach to its biology. Potential progress depends on the improvement of methods that visualize cardiac myocyte injuries, on the identification of peptides that are markers of genome dysfunctions and on more profound investigation the role of immune cells in the process of myocardial injury and repair.