Archives of pathology最新文献

A 73-year-old man with bilateral recurrent pleural effusions had relief of symptoms with intrapleural instillation of quinacrine hydrochloride and talcum powder. At postmortem, examination of the lungs showed granulomatous consolidation of a portion of the lower lobe of the left lung. The granulomatous reaction was in response to large numbers of talc and quinacrine crystals within the pulmonary parenchyma. A review of the literature disclosed no reports of pulmonary damage following the intrapleural administration of these two agents. This unusual complication of therapy may have resulted from the aspiration of crystals through a small, undetected bronchopleural fistula.

Fluoride is concentrated in the bones of patients with chronic renal failure when fluoridated water is used during hemodialysis. Excessive osteoid is produced that is not normally mineralized and severe osteomalacia occurs. Electron microscopical examination of iliac crest bone biopsy specimens from four patients suggests that fluoride induces the synthesis of disarrayed collagen by the activated osteoblasts. Collagen fibers were found to be normal in size and in axial periodicity.

The administration of sulfobromophthalein sodium (BSP) to manganese-loaded animals had been found to prevent effectively the cholestasis normally created by bilirubin infusion following manganese loading. Measurement of bilirubin levels in blood, liver, and bile in manganese-bilirubin animals with and without BSP fails to provide convincing evidence for a BSP-induced shift in site or magnitude of total bilirubin concentration as an explanation for this anticholestatic action of BSP. Nevertheless, increasing the dose of bilirubin partially reinstitutes the cholestasis. The results are important in that they demonstrate (1) that under certain circumstances intrahepatic cholestasis can be immediately and directly prevented by a pharmacologic agent (by a means not as yet defined) and (2) that the cholestatic activity of bilirubin is, to some extent or under some circumstances, separable from its concentration in blood, liver, and bile.

We describe a case of membranous nephropathy in a patient with pulmonary, splenic and hepatic sarcoidosis. The patient was asymptomatic, and edema was absent notwithstanding the proteinuria (over 8.0 gm/100 ml daily). Prednisone cleared the pulmonary and splenic complications, but the proteinuria, although diminished, persisted. Adjunctive therapy with cyclophosphamide caused further diminishment of the proteinuria. We have reviewed the relationship between the nephropathy and the sarcoidosis and suggest that a causal relationship exists between the two diseases.

Thyroid tissue from two patients with Batten-Spielmeyer-Vogt disease (BSV) was studied for peroxidase enzyme activity and for morphological abnormalities by light and electron microscopy. Diagnosis was confirmed by the demonstration of intracytoplasmic material identical to that described in other reported cases of BSV. There was a substantial decrease in peroxidase activity in the thyroid tissue from both patients. An abnormally low level of peroxidase activity had previously been demonstrated in the white blood cells of these patients. Thyroid biopsy offers obvious advantages over brain biopsy, provides adequate tissue for enzyme analysis, and allows the demonstration of the intracytoplasmic structures characteristic of BSV.

In order to identify a subclinical dystrophy, muscle biopsy specimens from 15 mothers of boys with Duchenne muscular dystrophy were studied by electron microscopy. Genetic investigations and biochemical determinations were not conclusive for a diagnosis of the carrier state. The fine structural lesions were sufficient to vertify the diagnosis of a subclinical dystrophy, and our findings were in agreement with other investigators. However, original intranuclear filamentous formations were noted in one case.

At autopsy, the adrenal zona reticularis showed linear hyaline fibrosis in 19 cases of cancer, after averages of six months and 5,000 roentgens of irradiation to the abdominal, lumbar, or pelvic regions. The associated roentgen dose was significantly greater than when postirradiation adrenal fibrosis was absent. Primary radiation damage to the reticular vascular plexus is suspected.

A pituitary adenoma with amyloid deposits was studied by light and electron microscopy. The amyloid material was radially oriented, deposited in the extracellular space, and often intermingled with small vesicles. It was surrounded by histiocytes with deep cytoplasmic invaginations. The histiocytes contained large autophagic vacuoles in which amyloid was also present. These features are similar to other forms of amyloidosis and suggest a histiocytic origin of the amyloid.

Spironolactone bodies were observed in an adrenal cortical adenoma that was removed from a patient with primary hyperaldosteronism (Conn syndrome) treated preoperatively with spironolactone. The electron microscopical evaluation of this adrenal cortical adenoma shows origin of spironolactone bodies from whorls of endoplasmic reticulum in cells with the cytoplasmic features of those from the zona glomerulosa of the adrenal gland. There was no evidence that the bodies were derived from mitochondria, which confirms recent ultrastructural findings in patients treated with spironolactone. These bodies have been described in the adrenal cortex only in patients who have received spironolactone, and the pharmacologic specificity of the bodies strongly suggests a direct mode of action by spironolactone on aldosterone production by cells of the adrenal zona glomerulosa.

Transplantation of insulin-secreting tissues is currently being evaluated as a possible method of treating diabetic patients. Isolation of islets of Langerhans from the rat pancreas is now routinely accomplished, and methods for islet isolation from the human pancreas are being explored. Transplantation of isolated islets into isologous rats is capable of reversing streptozotocin-induced diabetes. Unfortunately, isolated islets are not immunologically privileged and various immunosuppression regimens have not effectively obviated the rejection phenomena seen in rat allograft experiments.