Pathogenesis of vertebral artery occlusion following cervical spine manipulation.

Sporadic cases of vertebral artery occlusion following neck manipulation have been reported since 1947. The pathogenesis of occlusion, however, has remained largely speculative. Autopsy examination of the intracranial and extracranial portions of the vertebral arteries in the case presented here clearly demonstrates that intramural hematoma arising within granulation tissue in the tunica media was the acute, occlusive event. Furthermore, prior neck manipulation may have caused asymptomatic development of granulation tissue within the tunica media, thereby predisposing the patient to acute intramural hematoma during subsequent neck manipulation.

CT in iatrogenic cerebral air embolism.

Three patients with suspected iatrogenic cerebral air embolism had cranial CTs performed within 24 hr of onset of symptoms. One was interpreted as normal, one showed a large, right frontoparietal enhancing lesion, and the third showed evidence of bi-thalamic infarction. Follow-up scans 7 to 10 days later showed either single or multiple enhancing infarcts in all patients. Although CT proved a valuable tool in the diagnosis of this condition, one out of three initial studies were negative, necessitating a follow-up scan.

Iatrogenic hepatic injury.

Liver injury produced by therapeutic drugs is common, and has been increasing in incidence. Drug induced injury can mimic almost all varieties of liver disease. These conditions include cholestasis, steatosis, granulomas, acute and chronic hepatitis, cirrhosis, vascular disorders, and tumors. When confronted with a patient suffering from liver disease, it is imperative for the physician to obtain an accurate history of drug administration.

Peliosis: a morphologic curiosity becomes an iatrogenic problem.

Peliosis is a morphologic entity describing a condition of blood filled spaces, most frequently occurring in the liver. In recent years it has evolved from an anatomic curiosity seen at autopsy to a potential clinical problem in view of its association with the administration of anabolic steroid hormones. The pathogenesis and predilection of peliosis for the liver remain unexplained. This article reports five patients with peliosis, four with splenic involvement, all but one of whom received an anabolic steroid preparation. One patient died as a result of rupture of the splenic peliotic spaces. The diagnosis in three cases was established on the basis of surgical material, i.e., liver biopsy or splenectomy. An increased awareness of peliosis in patients at risk, as well as an appreciation for the histopathologic changes in less advanced cases, may become an important issue for the surgical pathologist.

Diagnostic problems in drug-induced diseases.

The evaluation of adverse drug reactions (ADR's) in clinical patients is usually a complex and multifactorial problem. A methodology for this evaluation has been derived from the experience with over 3,000 cases. Illustrative cases are presented to demonstrate in detail a variety of means of linking a drug with an ADR. Emphasis is placed on the frequent diagnostic utility of accurate time-related information, in addition to the use of historical, clinical-laboratory and morphologic findings.

Omental arteriovenous fistula following liver biopsy.

A case of iatrogenic omental arteriovenous fistula attributable to an earlier unsuccessful liver biopsy is presented. The complications of liver biopsy and the role of arteriography in the diagnosis and management of visceral arteriovenous fistulas are discussed.

Squamous metaplasia of tracheal epithelium associated with high-volume, low pressure airway cuffs.

The tracheas of 12 patients, intubated from 2 hours to 20 days with tracheal airways equipped with the newer style, high-volume, low-pressure (HVLP) cuffs, were examined at autopsy. The type and severity of iatrogenic damage to the epithelium and submucosa was determined and compared to that seen in a previous study of 54 patients, who had been intubated with the older-style low-volume, high-pressure (LVHP) cuffed airways. The tracheal epithelial and submucosal damage due to intubation with the HVLP cuffed airways was considerably less than that with LVHP cuffs. The submucosal glands were often spared, and some of the tracheal epithelium even survived 20 days of exposure to the "soft" cuffs. However, the pseudostratified ciliated epithelium, which normally lines the trachea, was often replaced by stratified squamous epithelium. If such a zone of nonciliated epithelium remains in the trachea of a long-term survivor, its detrimental effect on the removal of particulate matter from the tracheobronchial tree may have to be considered.