Neuromyelitis optica (Devic's syndrome) and pulmonary tuberculosis.

Neuromyelitis optica and acute necrotic myelopathy occur in association with pulmonary tuberculosis. We studied 8 patients with either neuromyelitis optica (6), acute myelopathy (1), or acute optic neuropathy (1) in close temporal association with pulmonary tuberculosis, but with no evidence for CNS tuberculosis. Neurologic symptoms preceded the use of antituberculosis medication in 5 patients. Different patients showed similar clinical features, suggesting a consistent disease pattern. Autopsy examination (1 patient) revealed extensive spinal cord and optic nerve demyelination. We identified only 5 additional patients seen over the same period with idiopathic neuromyelitis optica, thus suggesting that the close temporal relationship to pulmonary tuberculosis is not coincidental. The syndrome is most likely due to an immune reaction to tuberculosis rather than the use of antituberculosis medication.

Granulomatous uveitis in Crohn's disease. A clinicopathologic case report.

Recurrent episodes of uveitis occurred in a young male patient with clinical as well as radiologic and histologic evidence of Crohn's ileocolitis. His left eye became blind and painful, and was enucleated. Histopathologic examination of the eye revealed a panuveitis with evidence of granuloma formation in the choroid. While granulomatous inflammation has previously been demonstrated in extraintestinal sites, to our knowledge, this is the first histopathologic evidence of granuloma formation within the eye in Crohn's disease.

Alterations in levels and interrelations of plasma apolipoproteins induced by diet.

Diets high in carbohydrates increase the rates of hepatic secretion of VLDL in man. VLDL particles are secreted in greater numbers; they also tend to contain more triglycerides and to be larger in size. Comparable changes in intestinal secretion of chylomicrons and VLDL accompany fat absorption. We studied the metabolism of the ApoC apoproteins under these circumstances because in vitro studies suggest that these apoproteins may play important roles in the catabolism of VLDL. ApoA-I and ApoB were also examined because of their importance in HDL and VLDL structure, respectively. The fasting plasmas of 16 normolipemic young adults were examined before and after they had been fed high carbohydrate diets for 4-5 days. ApoA-I and ApoB were measured by radioimmunoassay. The relative proportions of ApoC-II and ApoC-III in VLDL were determined by disc gel electrophoresis. Lipids in plasma and in individual lipoproteins were determined chemically. Lipoproteins were isolated by ultracentrifugal and precipitation methods. VLDL-TG and VLDL-chol and VLDL-protein rose by factors of 2.4, 1.67, and 1.88, respectively. (Final value divided by initial value.) Since TG rose more than the others, VLDL became enriched by TG. LDL-chol fell by a factor of 0.78 while LDL-TG and LDL-ApoB remained constant, i.e., LDL became relatively enriched in TG and ApoB. HDL-TG rose by 1.42 and HDL-chol fell by 0.74, i.e., HDL too became TG enriched. Plasma Apo-A-I fell by 0.84. Thus, there were alterations in both the levels and compositions of all lipoproteins. The proportion of ApoC-II relative to ApoC-III in VLDL increased in each subject on the carbohydrate diet (mean rise was 1.55-fold). The increases in ApoC were detectable after as little as 48 hr of diet, and the same results were obtained in two people who were each tested twice on two separate occasions several months apart. Thus, the changes in ApoC were reproducible. Proportions of ApoC-II were greater in SF greater than 400 than in SF 20-400 subfractions of VLDL on ad lib diets. Proportions of ApoC-II rose in both density subfractions on carbohydrate diets. The changes in both subfractions suggest that rises of ApoC-II in total VLDL (SF greater than 20) fraction were not due solely to the accumulation of SF greater than 400 particles of unaltered ApoC composition in postdiet plasma. The changes following carbohydrate could have been due to secretion of altered lipoproteins or due to diet induced alterations in apoprotein catabolism. Three subjects were given 150 gm of corn oil to drink. Lipoproteins were analyzed, as above, at 0 and 3-12 hr after the drink. In spite of several-fold rises in the SF greater than 20 TG and proteins, the relative proportions of ApoC-II and ApoC-III remained constant. Thus, an acute dietary fat load and 2-4 days of carbohydrate diets provoked different responses. The fluctuations in the levels and relative proportions of ApoC support the notion that the ApoC group may have importance in vivo in the metabolism of VLDL.

Secondary localized amyloidosis of the cornea associated with tertiary syphilis.

Secondary corneal amyloidosis is a rare finding and only 17 cases have been reported in the literature. A case of unilateral secondary localized corneal amyloidosis is presented in a patient with bilateral interstitial keratitis and other stigmata of tertiary syphilis.

Ciliary body malignant melanoma in a black child.

Uveal malignant melanoma is uncommon both in children and in black patients. There has been only one previous report of this type of tumor occurring in a black child. This paper presents the case history of a 5-year-old black girl who presented with a mass arising from the ciliary body and choroid. This was found to be a malignant melanoma on histological examination. The difficulties in diagnosis are discussed and the histological features presented.

Nasopharyngeal lipoma--a rare clinico-pathological entity.

A lipoma situated within the posterior wall of the nasopharynx is reported. Only three lipomas of the nasopharynx in adults have previously been reported. The value of CT scan and cytology in making the preoperative diagnosis of a lipoma at this location is discussed.

First coloured South African with multiple sclerosis confirmed by necropsy.

The clinical details and neuropathological findings of a Coloured South African with multiple sclerosis are presented. The interest of this case lies in the fact that this is the first proven case of multiple sclerosis in a Coloured South African.

Calcification of glutaraldehyde-fixed porcine xenograft.

The clinical and light and electron microscopic findings are reported in a 14-year-old patient who died 12 months after mitral valve replacement with a Hancock prosthesis. Severe cusp calcification had led to immobilisation of the valve and stenosis. Calcification involved the substance of the valve cusps. The cause of the calcification in this patient is unknown.

Urokinase-type plasminogen activator in alveolar macrophages and bronchoalveolar lavage fluid from normal and smoke-exposed hamsters and humans.

Our purpose was to identify and characterize plasminogen activator (PA) activity in alveolar macrophages (AMs) and lower respiratory tract fluid from hamsters and humans. Freshly harvested hamster AMs had barely detectable PA intracellularly and no detectable activity in concentrated lavage fluid. PA secretion was detected in conditioned media of hamster AMs. Secretion was enhanced sixfold by phorbol myristate acetate (PMA) and suppressed by dexamethasone. In contrast to hamsters, PA activity was readily detected in lysates of freshly harvested human AMs and lavage fluid. However, secretion of PA by human AMs was not detected, and neither PMA nor dexamethasone affected PA activity. PA from hamster or human AMs has a urokinase-type enzyme with molecular weights of 49,000 or 55,000, respectively. Cigarette smoking did not alter PA activity by hamster or human AMs.