Gastric outlet obstruction due to X-linked chronic granulomatous disease.

Children with chronic granulomatous disease (CGD) may develop a peculiar form of gastric outlet obstruction due to involvement of the stomach wall with granulomatous tissue. An illustrative case is presented (which occurred despite adequate control of infection with antibiotherapy), including details of surgical management, distinctive radiographic and pathologic findings, and a review of other reported cases.

Ultrastructural study of a postinflammatory "tumor" of the lung.

A typical postinflammatory "tumor" of the lung was resected from an asymptomatic 22-year-old white woman. Light and electron microscopic studies showed the lesion to be composed of metaplastic pneumonocytes, proliferated stroma, and chronic inflammatory cells. These findings confirm the inflammatory nature of the lesion and serve to distinguish this lesion from the neoplastic pulmonary sclerosing hemangioma.

Dose-response characteristics of the human larynx with carbon dioxide laser radiation.

The carbon dioxide surgical laser has become increasingly valuable in the management of various aerodigestive, gynecologic, and dermatologic problems. The histopathologic effects of laser radiation on human tissue have received only minimal attention, however. In an attempt to more precisely define the dose-response characteristics of the normal human vocal cord to carbon dioxide laser radiation, a normal larynx was exposed to varying intensities of laser radiation in situ and studied histologically. Tissue destruction varies with alterations in wattage and time exposure. The biologic effects of laser radioation are reviewed.

The role of electron microscopy in the management of surgical patients.

This report records a 12-month experience with 49 neoplasms submitted to the hospital pathologists for electron microscopic (EM) diagnosis as a part of routine clinical surgical practice. Twenty-five specimens were from a private community hospital and 24 from a university hospital. In 40 of 49 cases (82%), EM confirmed a tentative light microscopic (LM) diagnosis. In 11 of these 40 cases, EM provided a more specific histogenetic diagnosis than was possible by LM. In three cases (6%), EM corrected the original LM diagnosis. In two cases EM did resolve a diagnostic dilemma. EM is a beneficial adjunct to the correct diagnosis of selected tumors. Although in general EM does not help differentiate benign from malignant tumors, it is helpful in identifying the cell of origin of poorly differentiated neoplasma. A more precise histogenetic diagnosis was judged to be clinically helpful in 56% of th cases studied in this experience. EM is a relatively inexpensive ($115-250) and prompt (three to five days) adjunct to surgical care. It should be routinely available to the practicing surgeon for help in determining the cell type of confusing tumors. EM is no longer simply a research tool.

Soft tissue calcification in chronic dialysis patients.

Autopsy protocols and microscopic slides of 56 dialyzed and 18 nondialyzed chronically uremic patients were reviewed to assess the presence, extent, and severity of extraosseous soft tissue calcification. Calcification was identified in 79% of the dialysis patients and 44% of the nondialysis patients (P iss less than .025). Soft tissue calcification most frequently involved the heart, lungs, stomach, and kidneys. Lesions were severe in 36% of the dialysis patients and, when strategically located within the myocardium, were life-threatening. The deaths of 6 dialysis patients were attributed to severe calcification of the cardiac conduction system and/or myocardium. The presence and severity of soft tissue calcification was not related to duration of dialysis, patients' age, degree of parathyroid gland hyperplasia, radiographic evidence of soft tissue calcification, serum calcium and phosphate levels, Ca X P products, or type or severity of metabolic bone disease.