Prevention of induced atherosclerosis by peroxidase.

Hepatocatalase peroxidase, an active peroxidase-oxidase subunit isolated from beef-liver catalase, prevents cholesterol deposition and aortic atherosclerosis in cholesterol-fed rabbits and has no apparent toxicity or undesirable de effects. No allergic or immunological reactions have been observed. The participation of this enzymatic subunit in homeostatic control mechanisms and its potential pharmacological value in the control of human atherosclerosis are suggested.

On the renal basis for essential hypertension: nephron heterogeneity with discordant renin secretion and sodium excretion causing a hypertensive vasoconstriction-volume relationship.

We propose herein that there are two functionally abnormal nephron populations in essential hypertension: (1) a group of ischemic nephrons with impaired sodium excretion which chronically hypersecrete renin. Numerically, these ischemic nephrons comprise a minor subgroup since most patients with essential hypertension exhibit no overt evidence of renal insufficiency. (2) In reaction to this, a more numerous group of normal nephrons appears in adaptive hypernatriuresis. They have an increased distal sodium supply and consequently, a chronically suppressed renin secretion. One difference between patients with renovascular hypertension and those with essential hypertension is the intermingling of these two populations of nephrons. In our hypothesis, the adapting hyperfiltering normal nephrons accomplish the hypernatriuresis in response to saline infusion, that is characteristic of all essential hypertension. However, the unsuppressed secretion of renin, that arises from the ischemic nephron population attenuates this compensatory natriuresis in the following ways: (1) by inappropriately acting on the hyperfiltering nephrons to enhance proximal tubular sodium reabsorption; (2) by activating TGF-mediated afferent constriction in these nephrons, and (3) simultaneously, the reactive secretion of renin from ischemic nephrons is diluted by non-participation of the adapting hypernatriuretic nephrons so that plasma renin settles at a level which is insufficient to fully compensate GFR in the ischemic nephrons. These adaptive responses provide a basis for the observation that the inhibition of renin activity with converting enzyme inhibitors in essential hypertension increases renal blood flow and sodium excretion. They also explain why converting enzyme inhibitors can effectively reduce blood pressure, even when renin levels are not absolutely elevated, since any circulating renin imposed upon the adapting hypernatriuretic nephrons inappropriately impairs their sodium excretion. In addition, the theory explains why basal renin secretion is either not suppressed or inadequately suppressed in patients with essential hypertension. As a result, whole kidney homeostatic function is compromised because individual nephrons are responding to their individual stimuli to fulfil their individual need, rather than acting in concert with other nephrons. The net effect of this uncoordinated response is to shift total renal function so that systemic arterial hypertension is sustained by abnormal sodium retention for the inappropriately high plasma renin level, or vice versa.(ABSTRACT TRUNCATED AT 400 WORDS)

Mediastinal lymph node hyperplasia, hypergammaglobulinemia, and anemia.

An adolescent girl with retarded development, delayed puberty, and hypergammaglobulinemia had anemia unresponsive to iron therapy that was cured when a mass of mediastinal giant lymph node hyperplasia was removed surgically. Rapid growth and development of secondary sexual characteristics occurred after operation. Follow-up studies made 20 years after operation showed compensated increased erythrocyte hemolysis and increased serum IgM. When mediastinal giant lymph node hyperplasia with abundant plasma cells is seen in childhood, there may be refractory anemia and immune disturbances. Similar giant lymph node hyperplasia without plasma cells may be found in an asymptomatic child or adult. The pertinent features of the few symptomatic cases reported are reviewed.

Renal pathology of essential hypertension.

Microscopic analysis of over 2,000 renal biopsies taken at surgical sympathectomy operations has been correlated with blood pressures in essential hypertension. Statistically significant relationships exist between the average diastolic pressure and the degree of afferent renal arteriolar thickening and narrowing. Postoperative prognosis was favorable with all but the most severe and diffuse arteriolar sclerosis, and vascular fibrinoid necrosis did not affect survival. Juxtaglomerular cell hyperplasia and inferred renin hypersecretion were significantly involved in the kidney biopsies of essential hypertension. Diabetic juxtaglomerular cell atrophy and sclerosis reduced this component of hypertension. After age 80, kidneys at autopsy showed no evident relation between arteriolar lesions and hypertension.

Mucosal-cell counts in ulcerative and granulomatous colitis.

Epithelial and connective-tissue cells were counted in rectal mucosal biopsies from 215 patients with ulcerative colitis, 98 patients with granulomatous colitis, and 50 controls. The results were analyzed statistically. Significantly decreased mucous goblet cells were found both in sigmoidoscopically abnormal ulcerative colitis and in granulomatous colitis, and they increased during the healing process. More pyknotic and karyorrhectic epithelial cells occurred in active ulcerative colitis than in granulomatous colitis. Inactive ulcerative colitis still manifested histologic evidence of acute and chronic inflammation, while sigmoidoscopically normal granulomatous colitis biopsies after previous gross rectal disease showed significantly increased macrophages in the lamina propria. Cell counts were valuable for differential diagnosis after the sigmoidoscopic appearance became normal. The acute inflammation of ulcerative colitis, as indicated by neutrophils, was decreased most notably following therapy with prednisone or 6-mercaptopurine. Chronic inflammation associated with fewer plasma cells was decreased after salicylazosulfapyridine as well as either of the other two drugs; macrophages, indicators of healing, increased most after 6-mercaptopurine combined with another anti-inflammatory agent.

3-D reconstruction of endometrial carcinoma in situ.

Reconstructions in 3-D of 4 of 18 endometrial carcinoma in situ specimens demonstrated a simple branching tubular pattern, distinctively different from atypical adenomatous hyperplasia and invasive endometrial adenocarcinoma. A clonal origin of carcinoma in situ was suggested.

Microgranulomas in grossly normal rectal mucosa in Crohn's disease.

Rectal biopsies of sigmoidoscopically normal mucosa from 99 patients with Crohn's disease of the ileum, colon, or both were studied histologically, with particular reference to the presence of granulomas. Among the 14 cases of granulomas, some were of the usual sarcoid type and could easily be detected. Other microgranulomas were less well defined and were found only by mid- or high-power microscopic screening of serial sections. The morphologic characteristics, the relationship to ordinary Crohn's-disease granulomas and the possible significance of microgranulomas are discussed.

Vascular invasion as a prognostic factor in stage IB cancer of the cervix.

One hundred ninety-one cases of histopathologically confirmed invasive carcinoma of the cervix were available to study. Until early diagnosis is made routinely and treatment instituted with a predictable promise for cure, attention must be devoted to studying the natural history of disease, its histologic and nuclear grading, stromal reaction, and whether lymphatics and/or blood vessels are involved. The results are impressive since patients with Stage IB carcinoma with lymphatic and/or blood vessel involvement treated by radical hysterectomy have had a 59.4% 5-year survival rate which has increased dramatically to 90% when there was no involvement. Other features which were analyzed, including tumor type, histologic and nuclear grades, size and number of nucleoli, and stromal leukocyte reactions showed no significant statistical relationship to survival. This may represent a bias because of the small number of cases in each group. This study helped identify the patient at high risk. The high-risk group as outlined by the parameters listed should receive additional therapy. Since the cancer had invaded a vascular channel, the authors selected these patients for combination anticancer chemotherapy. Those patients for combination anticancer chemotherapy. Those patients have not been followed long enough to evaluate the results of the treatment.

Neuroendocrine carcinoma of lung associated with bradycardia and episodic cardiac asystole.

A neuroendocrine carcinoma of the lung associated with bradycardia and episodic cardiac asystole is reported. Cardiac dysfunction may have been caused by a hormonal factor produced by a carcinoma developing in the pulmonary neuroepithelial bodies because the bradycardia and periods of asystole disappeared after pneumonectomy, only to return months later when pleural metastatic tumor developed. No neoplastic involvement of the heart was present. Implications of a cholinesterase isoenzyme involvement in the cardiac dysfunction are discussed.

Alimentary tract biopsy lesions in the acquired immune deficiency syndrome.

The surgical pathology of the alimentary tract complications of the acquired immune deficiency syndrome (AIDS) is described and illustrated by a review of one year's material accessioned at a New York Community Hospital. Cytomegalovirus, Cryptosporidium and Mycobacterium avium-intracellulare were particularly notable among diverse opportunistic infectious agents. Visceral Kaposi's sarcoma and malignant lymphomas were the principal malignancies recognized, and their occurrence in young men should alert clinicians to the possibility of AIDS.

Kidney pathology in endemic nephropathy.

Histopathologic analysis was made of kidneys from seven cases of typical endemic nephropathy and five cases of probable endemic nephropathy or upper urinary tract carcinoma from Yugoslavia. Glomeruli usually had an increased mesangial matrix and abnormal lobulation, sometimes with vacuolar degeneration. Particularly the straight ascending, descending and Henle loop tubules showed increased epithelial degeneration and regeneration. A network of interstitial scars and a subcapsular stratum of notable cortical degeneration contributed to severe renal atrophy. Unusual intrarenal vein thickening with or without obliteration was notable. Reactive glomerular, Bowman's epithelial and convoluted tubular alterations were ascribed to a filtered toxic material with carcinogenic properties which was considered eventually responsible for renal atrophy, fibrosis and some attributes of an autoimmune reaction.

Metastatic potential of gastric leiomyosarcoma.

Metastatic and lethal gastric leiomyosarcoma in 12 of 30 surgically treated cases was found most closely correlated with larger size tumors. A highly statistically significant correlation (p less than 0.0001) between tumor diameter and success or failure of surgical extirpation was demonstrated for the total of 241 gastric leiomyosarcomas in the present series and collected from the literature. Six other gross and microscopic attributes analyzed, including mitotic counts, did not provide equally useful prognostic indications. Inadequate sampling may be responsible for lack of correlation between histological criteria and tumor progression.

Chronic aortitis following furosemide therapy.

A significant increase in histopathologic nonspecific chronic aortitis was found when 100 autopsy specimens from 1965 were compared with series from 1974 and 1980. The chronic aortitis was correlated with furosemide diuretic administration during the last hospitalization. Furosemide is albumin bound, produces vasodilation, and is suspected of having induced a subclinical haptenic immunologic reaction in about one third of those treated.

Estrogen-progesterone therapy in perimenopausal women.

A retrospective study was made of 74 women who had received estrogen continuously, cycled with progesterone, for menopausal symptoms over an average 57-month period. Treated patients were compared with control patients from the same private practice. Vabra endometrial aspiration biopsies showed no statistical differences between 25 treated and 28 untreated patients in the frequency of normal, inactive, hyperplastic or neoplastic specimens. The most common finding in the treated group was a secretory response, which suggests that progesterone exerts an antiestrogen effect even when estrogen is given on a continuing basis. There is evidence that the vaginal maturation index in the postmenopausal patient, although helpful in determining the current state of her systemic estrogen activity, may not reflect the effect of estrogen on the endometrium. Estrogen therapy has no absolute predictable correlation with endometrial histology. Thus, the information from routine endometrial curettage is essential to evaluate the status of all treated patients. Among all hormone-treated patients (74), weight decreased over time, blood pressure, blood sugar and cholesterol levels were relatively unchanged, and Papanicolaou smear classes improved.

PIP: Estrogen-progesterone therapy in perimenopausal women was investigated. The study included 74 women who had received estrogen continuously, cycled with progesterone, (1 mg estradiol benzoate and 20 mg testosterone propionate, im; 1.25 mg oral Premarin) for menopausal symptoms over an average 57-month period. The mean age of the treated women was 54 years, and the mean age of the controls was 49 years. Vabra endometrial aspiration biopsies revealed no marked differences between 25 treated and 28 untreated patients in the frequency of normal, inactive, hyperplastic, or neoplastic specimens. The most frequent finding in the treated group was a secretory response, which suggests that progesterone exerts an antiestrogen effect even when estrogen is given on a continuing basis. The data suggest that the vaginal maturation index in the postmenopausal patient, although helpful in determining the current state of her systemic estrogen activity, may not reflect the effect of estrogen on the endometrium. Estrogen therapy has no predictable correlation with endometrial histology. Therefore, information from routine endometrial curettage is essential to evaluate the status of all treated patients. The treated patients' weight decreased over time, while blood pressure, blood sugar, and cholesterol levels were unchanged, and Papanicolaou smear classes improved.