Lack of efficacy for conventional gamma irradiation of platelet concentrates to abrogate bacterial growth.

The maximum storage time for platelet concentrates is 5 days, owing to the higher risk bacterial contamination with longer storage. The expiration date could potentially be extended if a rapid system to detect microbial contamination or a safe sterilization technique could be developed and easily implemented. Gamma irradiation has decreased bacterial contamination in food products. Conventional doses of gamma irradiation were tested for their efficacy in decreasing bacterial growth during the 5-day platelet shelf life. An initial pilot study determined that bacteria suspended in normal saline at concentrations of 1 to 2 x 10(7) colony-forming units per milliliter showed a dose-related susceptibility to gamma irradiation. Subsequently, four platelet concentrates were pooled, inoculated with a known concentration of Staphylococcus autreus or Serratia marcescens, and divided. The concentrates were exposed to varying amounts of gamma irradiation, ie, no irradiation (control), 25, 50, and 75 Gy, and subjected to typical blood bank storage conditions. The platelet concentrates were sampled daily for 7 consecutive days to monitor bacterial growth by quantitative cultures. An inverse linear dose-related extinction of bacteria was evident in the pilot study with an extrapolated total kill in the 100 to 150 Gy range. There is no difference in bacterial growth with S aureus using irradiation levels from 0 to 75 Gy. A 1-day delay in bacterial growth at 75 Gy was found with S marcescens compared with units irradiated with 0 through 50 Gy. Exposure of bacteria-contaminated platelet concentrates on storage day zero to gamma irradiation at levels up to 75 Gy is ineffective at sterilizing the platelet concentrates. Higher levels of irradiation may be effective in sterilizing platelet concentrates. Function, survival, and sterility after higher than conventional levels of irradiation need further study.

Primary Hodgkin's disease of the sigmoid colon: a case report and review of the literature.

We report the case of an 81-year-old man who underwent a segmental resection of the sigmoid colon for severe diverticular disease. Histopathologic diagnosis revealed extranodal Hodgkin's disease, and the diagnosis was confirmed by immunohistochemistry. The incidence of extranodal Hodgkin's disease is rare and represents an infrequent occurrence as a gastrointestinal neoplasm and primary gastrointestinal lymphoma. A review of the literature for gastrointestinal lymphomas with emphasis on the occurrence of Hodgkin's disease, the diagnostic features, and the site of gastrointestinal tract involvement is reported.

Three cases of fatal firearm use following external hinge removal from locked gun cabinets.

In order to potentially decrease the number of homicides and suicides that result from firearms, one must decrease the accessibility of guns. We describe three cases that were obtained from the Onondaga County Medical Examiners Office in New York that occurred between January 1990 to March 1993. In two suicides and a double homicide, firearms were quietly obtained from commercially manufactured locked gun cabinets by removing the door hinges, which were located on the outside of the cabinet, with a screwdriver. The incidence of obtaining firearms by this method is not known. No other similar cases are reported in the literature. Removing hinges that are placed on the outside of the cabinet may be a common method of obtaining firearms to commit either homicide or suicide in the home, but perhaps not recognized. More information is needed. If additional cases are identified, then prevention in terms of gun cabinet design, may save lives in the future.

An unusual case of synchronous thyroid and parathyroid adenomas.

A 52-year-old woman was evaluated for an enlarging neck mass. Fine-needle aspirate contained Hürthle cells and thyroidectomy revealed two separate thyroid morphologically similar lesions. Immunohistochemical studies confirmed diagnoses of separate Hürthle cell thyroid and oxyphil parathyroid adenomas. Diagnostic pitfalls and the role of immunohistochemistry in diagnosis are discussed.

Complications following butane inhalation and flash fire.

Solvent inhalation is a well-documented form of drug abuse that can cause euphoria and hallucinations. Sudden death involving a volatile substance is most commonly caused by cardiac arrythmias, asphyxia, direct drug effects, and trauma. The victim in this paper suffered superficial partial thickness (12% total body surface area) burns from a flash fire that occurred when lighting a match after inhaling butane in an enclosed vehicle. The victim was admitted to the hospital for 2 days of observation but did not develop any respiratory symptoms under 2 days following her release. The victim died during her readmission, 9 days after the flash fire. Postmortem examination showed extensive epithelial injury from the upper airway and trachea to the terminal bronchioles, most likely due in part to both the initial inhalation injury and the resulting adult respiratory distress syndrome (ARDS) and staphylococcal infection. Many victims with superficial burn injuries may not seek medical attention owing to either embarrassment or fear of legal prosecution. Even those who do seek medical assistance may not reveal solvent abuse as the cause of their injuries. It is possible that delayed death may occur at home following volatile substance abuse but may remain unrecognized even with a thorough scene investigation.

Absence of latent Epstein-Barr virus in cutaneous squamoproliferative lesions after solid organ transplantation.

Recent studies implicate Epstein-Barr virus (EBV) in the pathogenesis of an increasing number of lymphoid and epithelial tumors. EBV-related disorders are particularly prevalent in immunosuppressed patients. The most common neoplasms arising in persons receiving long-term immunosuppressive agents after organ transplantation include non-Hodgkin's lymphomas and skin and lip carcinomas. Because EBV plays a major role in the evolution of post-transplantation lymphoproliferative disorders and was recently identified in a squamous cell carcinoma of the lip in a renal transplant recipient, we examined squamoproliferative lesions of the skin and lips for the presence of latent EBV. Twenty-six paraffin-embedded specimens from 23 different squamoproliferative lesions occurring in 9 solid organ transplant recipients were examined for the presence of latent EBV by in situ hybridization for EBV-encoded small RNA (EBER-1). The squamoproliferative lesions included 16 squamous cell carcinomas, 3 re-excisions of squamous cell carcinomas, 5 basal cell carcinomas, and 2 actinic keratoses. Two lesions from a single patient exhibited clusters of positive dermal lymphocytes after in situ hybridization with the EBER-1 probe. This patient is currently without clinical evidence of a lymphoproliferative disorder 2 years after the first biopsy showing this phenomenon. The squamoproliferative lesions were all uniformly negative. EBV does not seem to play a role in the initiation or progression of the majority of cutaneous squamoproliferative lesions arising in immunosuppressed patients who received solid organ transplants.

Percutaneous needle autopsy sampling.

Despite the recognized advantages of a complete postmortem examination, autopsy rates continued to decline in recent decades. This study compares postmortem needle sampling to the complete, conventional autopsy to determine whether needle sampling is a viable alternative when consent for a complete autopsy is denied. A prospective study where postmortem percutaneous biopsies were obtained from the heart, the lungs, the liver, the kidney, and any other clinically relevant tissue or body fluid before the complete autopsy in 20 consecutive patients is presented. Cultures of the lungs, the spleen, and any other suspicious body fluid were also obtained. Liver and heart were recovered from all 20 of the patients, lung from 18 (90%), and kidney from 16 cases (80%). The cause of death was confirmed in 67% of the patients. Needle sampling correlated with the complete autopsy in 87% of the additional major diagnoses and with equally pertinent negative results. Postmortem needle lung cultures correlated with the complete autopsy in 17 (85%) of 20 patients and 16 (80%) of 20 spleen cultures. Cultures of the brain (one patient), cerebrospinal fluid (two patients), peritoneum (two patients), and serum (one patient) correlated 100% when compared to the complete autopsy. A complete autopsy is the goal of every postmortem examination. Postmortem "biopsies" can be an alternative option in certain situations and may be more acceptable to relatives of the deceased when consent for a complete autopsy is declined.

Large-cell acanthoma of the skin. A study by image analysis cytometry and immunohistochemistry.

Although large-cell acanthoma is a well-known clinicopathological entity, its biologic spectrum and nature are still subject to debate. We studied seven cases of large-cell acanthoma by image analysis cytometry for DNA content and by immunohistochemistry, using antibodies to proliferating cell nuclear antigen (PCNA)/cyclin. The data were compared with individual cases of seborrheic keratosis (SK), actinic keratosis (AK), and Bowen's disease (BD). The DNA distribution of large-cell acanthoma was variable. There were varying peaks at the DNA index values of 1 and 2 (diploid and tetraploid values), but all cases contained a significant aneuploid population between DNA index of 1 and 2. The mean DNA index was 1.44 (1.27-1.77); 1-20% of the cells exceeded 2, and 0-2% exceeded 3. The DNA index for lesions in the other differential diagnostic groups studied was as follows: SK, 1.0; AK, 1.4; BD, 1.8. The percentage of cells with positive nuclear staining for PCNA/cyclin was < 20% in all cases of large-cell acanthoma. The discrepancy between the high number of aneuploid and tetraploid cells observed on the DNA distribution curve and the lack of evidence for significant proliferation based on immunohistochemical stains suggest that these cells are resting cells with abnormal DNA clone. Although these results provide additional information about the biologic nature of large-cell acanthoma, they do not resolve the controversial nosologic status of lesions in this histologic group.