Augmentation of the virulence of murine coxsackie-virus B-3 myocardiopathy by exercise.

Coxsackievirus B-3 myocardiopathy was induced in weanling mice by intraperitoneal and intracerebral inoculations of the Nancy strain. Acute mortality was 5.5%. The cardiomyopathy is characterized by an early phase lasting about 9 days with myocardial necrosis, associated inflammation, and healing by fibrosis and calcification involving 25 to 50% of the contractile fibers in each affected mouse. Infectious coxsackievirus may be recovered from the heart during this phase. Continuing myocardial inflammatory lesions follow during the later phase, but infectious virus is no longer present. When mice were forced to swim in a preheated pool (33 degrees C) during both phases of their myocardiopathy, virulence was strikingly augmented. Fully half of the mice died of congestive failure, the majority while swimming. Hearts were dilated, hypertrophied, and grossly necrotic. The myocardium was transformed to a completely necrotic, inflammatory, calcifying mass. At the peak of the infectious phase, myocardial replication of coxsackievirus was increased 530 times in nurslings which had been forced to swim. Myositis in hind limbs was more frequent, and inflammatory lesions in perirenal and pericardial fat were more severe in the mice which were forced to swim. When swimming was begun on the 9th day after infection, the virulence and lethality (13.8%) of infection were moderately increased.

Peripheral blood elements found in an Egyptian mummy: a three-dimensional view.

Intact peripheral blood elements were found within an intracranial mass, possibly eithern an antemortem subdural hematoma or a postmortem blood clot, removed from a 2200-year-old Egyptian female mummy. Surface topographies of neutrophils and lymphocytes were similar. Some erythrocytes partially retained their biconcave disk shape; others were spherical. Individual platelets exhibited pseudopodia.

Pituitary carcinoma mimics the ectopic adrenocorticotropin syndrome.

A middle-aged man presented with weight loss, hypokalemic alkalosis, diabetes, hypertension, and generalized melanosis. Marked elevation of urinary free cortisol (655 micrograms/24 h) and plasma ACTH (2445 PG/ML) SUGGESTED THE DIAGNOSIS OF ECTOPIC ACTH syndrome. The plasma concentrations of cortisol and urinary 17-hydroxycorticosteroids increased paradoxically during the administration of dexamethasone without a corresponding change in the plasma ACTH level. Metyrapone administered over 24 h also markedly incrased both urinary free cortisol and 17-hydroxycorticosteroids. Selective venous sampling of plasma ACTH did not reveal a gradient between jugular vein and peripheral venous blood. The laboratory findings supported the diagnosis of ectopic ACTH syndrome. However, belated occurrence of visual changes necessitated surgical exploration, resulting in the diagnosis of pituitary carcinoma. A fluorescent antibody to ACTH reacted strongly with the atypical pituitary cells. This rare case documents that severe melanosis in Cushing's disease can occur without prior adrenalectomy and is consistent with the diagnosis of pituitary carcinoma. Furthermore, melanosis observed in patients with pituitary carcinoma is associated with ACTH levels similar to those occurrring in the ectopic ACTH or Nelson's syndrome.

Candida pachymeningitis with multiple cranial nerve pareses.

A 66-year-old woman complained of right-sided headache and was found to have progressive dysfunction of cranial nerves V and VIII through XII on the right side. At autopsy, there was a granulomatous pachymengitis involving the floor of the right middle and posterior cranial fossae due to Candida tropicalis infection. Inflammatory tissue compressed the clinically affected cranial nerves.

Stroke in patients with fusiform vertebrobasilar aneurysms.

We studied seven patients with brainstem infarction and large fusiform vertebrobasilar (VB) aneurysms to clarify the clinical, radiologic, and pathologic features. All presented with pontine infarcts; one also had a cerebellar infarct. VB TIAs preceded brainstem infarction in four patients. Angiography and CT documented VB fusiform aneurysmal dilatation. Four had intraluminal thrombi and one had severe basilar artery stenosis. Two distinct clinical pictures emerged: unilateral pontine infarcts with favorable outcome, presumably related to obstruction of a pontine penetrating artery at its origin from the posterior wall of the aneurysmal basilar artery, and major fatal bilateral pontine infarcts from basilar artery occlusion. Two patients came to autopsy. One had thrombus in the dilated basilar artery and a posterior cerebral artery branch embolus with hemorrhagic occipital infarction; the other had basilar artery thrombus with aneurysmal rupture and subarachnoid hemorrhage. Fusiform VB aneurysms caused brainstem stroke by intraluminal thrombus, local embolism, atherostenosis, and obstruction of paramedian penetrating arteries. Subarachnoid hemorrhage is an uncommon complication.

Osteosarcoma of meninges: clinical, light, and ultrastructural observations of a case.

A primary osteosarcoma of the meninges based on clinical, light, and ultrastructural findings is reported. The neoplasm appears to complete Cushing and Eisenhardt's postulate and expectation of a malignant counterpart of osteoblastic meningioma. The neoplasm lends support to the concept of a primitive multipotential mesenchymal cell in the meninges capable of giving rise to every variety of neoplasms within that potential.

Focal myositis of the neck.

Focal myositis is a recently defined, rapidly growing, inflammatory pseudotumor of skeletal muscle. It is characterized by marked myopathic changes of muscle fibers, hypocellular fibrosis of perimysium and endomysium, and an intense inflammatory reaction in the fibrous septa. This report describes the first instance involving the neck muscle of a 40 year old man. A brief discussion of other histologically similar subcutaneous lesions is also presented.

Angiographic features of gliosarcoma.

Gliosarcoma is a brain neoplasm that is being recognized with increasing frequency. We discuss the radiographic findings in 14 pathologically proven cases. At angiography in nine cases, four showed mixed dural and pial vascular supply to the lesion. Early cortical venous drainage, irregular tumor vessels, and a prominent vascular stain with well-defined tumor margins were seen in the majority of cases. CT showed an irregular enhancing rim surrounding a necrotic center in 14 cases. Most lesions were peripherally located and invaded dura.

Immunoblastic sarcoma (histiocytic lymphoma) of the brain with B cell markers. Case report.

A group of central nervous system neoplasms, previously known as reticulum cell sarcoma or microglioma, and recently classified as malignant lymphoma, histiocytic type, not infrequently occur in patients with immunodeficiency, either primary or induced by immunosuppressant drugs. The authors report such a neoplasm in a patient with idiopathic thrombocytopenic purpura immunosuppressed with azathioprine and prednisone. The neoplasm was studied with several immunological techniques and by electron microscopy. The neoplasm had B lymphocyte membrane markers and showed plasmacytic differentiation. These features suggest that it was a tumor of transformed B lymphocytes (immunoblasts).

Histological structural abnormalities of superficial temporal arteries used for extracranial-intracranial anastomosis.

Histological evaluation of the superficial temporal artery resected at the time of extracranial-intracranial anastomosis was performed in 64 consecutive patients. A neuropathologist who was not aware of the medical condition of these patients studied all specimens under light microscopy with hemotoxylin and eosin, Verhoff, and Mallory strains. Intimal proliferation was observed in 62 samples, intimal fibrosis in 56, fragmentation of the internal elastic lamina in 45, splitting of the internal elastic lamina in 41, fragmentation of the media in 38, and fragmentation of the minimal external elastic tissue in 17. Stenosis of the vessel was observed, and graded from 0% to 50%, with a mean of 20%. The development of intraluminal stenosis was considered to be secondary to the development of intimal fibrosis and hyperplasia. The changes observed were progressive and conformed with those previously described; there was no evidence of correlation with sex, diabetes, or hypertension. The implications for the development of occlusion of the anastomosis or stroke, and for patient survival are discussed.

Meningioma in the parotid region.

Meningiomas occurring ectopically in the neck are exceptional. We report two patients who presented as parotid and parapharyngeal masses and analyze them along with 27 previously reported cases. Typical patients present with parotid or parapharyngeal masses and cranial nerve palsies. Meningioma is not considered in differential diagnosis. The tumor is an extension of an unsuspected intracranial mass, occasionally with associated multiple meningiomas or other neurogenic tumors. Ectopic meningiomas should be considered in patients with parotid and parapharyngeal masses, particularly those with cranial nerve deficits; jugular foramen syndrome is most characteristic. Associated occult intracranial and temporal bone tumors and the cranial form of neurofibromatosis should be suspected. Treatment of cervical meningiomas is excision. The most important aspect of intracranial-extracranial lesions is recognition and treatment of the intracranial portion.

Adult form of subactute necrotizing encephalomyelopathy.

Subacute necrotizing encephalomyelopathy (SNE) usually appears before the age of 2 years. Variability in its clinical presentation make antemortem diagnosis difficult. The morphologic diagnosis depends on the present of necrotizing lesions with a characteristic distribution within the CNS. We describe a patient with the uncommon adult form of SNE. The pathologic changes are those accepted as diagnostic of the more common infantile SNE, and permit a separation from Wernicke's encephalopathy. In the adult, the disease is thought to be due to a less severe thiamine-related metabolic defect than that of the infantile form. The infrequent clinical recognition in the adult form may be due in part to lack of medical awareness.

Cytogenetic findings in pituitary adenoma: results of a pilot study.

Pituitary adenomas are the most common tumors of the sellar region and are, with rare exception, benign neoplasms. The natural history of these lesions is only poorly understood and, although histologic, immunocytologic, and ultrastructural characteristics have been well established, predicting the natural history of individual tumors is, at best, unreliable. In an effort to better characterize pituitary adenomas, we have analyzed the karyotypes of 18 surgical specimens and attempted to correlate with the morphologic appearance and the clinical data, for example, endocrinologic subtypes, histology, and tumor invasiveness. Most hormonal subtypes were studied including seven growth hormone-prolactin (GH-PRL), two Prolactin (PRL), two Adrenocorticotrophin (ACTH), seven nonsecretory (NULL). No correlations with morphology or invasiveness could be made. Of 7 null cell adenomas, five (71%) had normal karyotypes, whereas of 11 hormone-secreting adenomas three (28%) were normal. Of seven tumors with mixed GH-PRL activity, six had abnormal karyotypes. At least three chromosomes harbored abnormalities shared by more than two tumors. The results demonstrate that chromosome abnormalities are also found in benign tumors. These findings, however, suggest that hormone-secreting adenomas may be more likely to be associated with karyotypic abnormalities especially those of the GH-PRL variety. Genetic abnormalities associated with chromosomes 1, 4, 7, and 19 were common and warrant further investigation.

Aggressive choroid plexus papilloma.

A young woman, who was initially treated for an Arnold-Chiari malformation, was found 7 years later to have a posterior third ventricular tumor. A superior cerebellar approach allowed total resection of the mass, which was an aggressive choroid plexus papilloma. The patient was treated with whole cerebrospinal axis radiation. There is no clinical or computed tomographic evidence of recurrence after 4 years. The literature is reviewed and a discussion of aggressive choroid plexus papilloma (carcinoma) is presented.

Secondary intracranial subarachnoid hemorrhage due to spinal missile injury.

Fresh intracranial subarachnoid hemorrhage may occur secondary to blast-type injury of the spinal cord. This phenomenon is demonstrated in four cases of gunshot and shotgun wounds involving the spinal column. The significance of such a finding is that the subarachnoid hemorrhage should not be construed to represent an independent injury. Such an erroneous conclusion could jeopardize a theory of self-defense in a homicidal shooting.