Frequency of portal and systemic bacteremia in acute appendicitis.

BACKGROUND: Acute appendicitis is the most common condition requiring an emergency abdominal operation in childhood. In the present study, we analyzed the frequency of portal and systemic bacteremia in 42 patients with acute appendicitis and determined the microbial agents responsible for an acute appendicitis and for portal and systemic bacteremia. METHODS: Appendectomies were performed on 50 young patients (5-18 years of age), as well as clinical and bacteriological tests. Six independent samples from each patient isolated from the peripheral vein, superior mesenteric vein, appendix and peritoneum were obtained prior to surgery, during surgery and after surgery for biochemical, immunologic and bacteriologic examination. RESULTS: Pathohistology confirmed the diagnosis of appendicitis in 42 patients, while in the other eight patients there were no obvious pathologic findings, so they served as a control group. Of 50 patients with a clinical appearance of acute appendicitis, in 19 patients (38%) we detected portal bacteremia in the mesenteric vein, while in only three cases (6%) did we find systemic bacteremia detected from the peripheral vein. Furthermore, bacteriologic analysis revealed that Bacteroides spp. and Escherichia coli were the predominant species isolated. CONCLUSIONS: The results presented in this paper suggests that portal bacteremia did not influence peripheral blood reactions. Furthermore, in the present study we have found a positive correlation between the smear and bacteremia of the superior mesenteric vein, but not with the bacteremia of systemic blood.

A case of syphilitic interstitial pulmonary fibrosis.

Diagnosis of late pulmonary syphilis was made in a 72-year old woman on the basis of her medical history of untreated genital syphilis, serological and radiological findings, and the response to therapy. The diagnosis was confirmed two years later by autopsy findings. There was a good correlation between chest x-ray radiography, computed tomography scans, and autopsy findings. In the diagnosis of sarcoidosis and other diseases with similar radiological interstitial lung pattern, syphilitic interstitial pulmonary fibrosis should be carefully excluded.

Unusual features of metastatic atypical carcinoid of the larynx.

This report describes a case of atypical carcinoid of the larynx with metastatic tumor to cervical lymph nodes showing features similar to paraganglioma. Immunohistochemically, both the primary and metastatic tumor were positive for epithelial membrane antigen, cytokeratin, neuron-specific enolase, chromogranin, synaptophysin, calcitonin and carcinoembryonic antigen. The sustentacular cells in pseudo-cell ball ("Zellballen") formations were shown by a positive S-100 marker. Electron microscopic analysis revealed numerous neuroendocrine granules measuring 150-250 nm in diameter. Clinical features, histological appearance, histochemical, immunohistochemical and ultrastructural findings, as well as differential diagnosis are discussed.

Invasive breast carcinoma with granulomatous stromal response.

An unusual case of invasive ductal carcinoma of the breast associated with epitheloid granulomas is reported. Multinucleated giant Langhans'-type giant cells were found in the epitheloid granulomas in breast carcinoma, but there were not present in the breast tissue and axillary lymph nodes. Congo-red deposits were found haphazardly in the stroma between tumor cells and granulomas. Numerous mast cells were found surrounding granulomas. The patient lacked any clinical evidence of the systemic granulomatous disease. The presence of epitheloid granulomas, amyloid deposits and numerous mast cells in invasive breast carcinoma could be related to a host immune response towards the tumor.

Ciliated metaplasia in a patient of Mediterranean origin with gastric adenoma.

We report here the first case of ciliated gastric metaplasia in a Croatian patient. This is also the first case of ciliated metaplasia reported in a patient of Mediterranean descent. Cilia were found in slightly cystically dilated gastric glands underneath a gastric adenoma with severe dysplasia. They were visualized by desmin immunohistochemical stain. Cells that presented with cilia were columnar cells, some of them with vacuolization of the cytoplasm. This case report shows that ciliated metaplasia occurs in patients of Southern European origin.

Splenic-gonadal fusion of the continuous type in an adult female.

The first case of a continuous type splenic-gonadal fusion in an adult female is described. This extremely rare anomaly occurs more often in the male where the abnormality may be associated with skeletal abnormalities or cryptorchidism. The few cases of splenic-gonadal fusion in the female previously described were found mainly in infants. The present case of splenic-gonadal fusion occurred as a duct, approximately 10 cm long, extending from the inferior pole of the spleen to a junction in the left ovarian suspensory ligament. The superior two-thirds of this tubular structure consisted of splenic tissue, while the caudal one-third of the duct was composed of fat and fibrous tissue. In addition, two blood vessels, an artery and a vein, were present throughout the entire length of duct, and were located extracapsullary to the spleen in the cranial portion of this anomaly. The patient had no associated malformations in contrast to the majority of patients with continuous-type splenic-gonadal fusions.

[Vaginal mixed tumor or spindle cell epithelioma--a case report]. / Vaginaler Mischtumor oder Spindelzellepitheliom--ein Fallbericht.

A case of mixed tumor of the vagina or spindle cell epithelioma is presented and the literature on this rare type of tumor is reviewed. Immunohistochemical findings suggest an epithelial origin. Follow-up studies indicate benign behavior. However, recurrent tumors were reported suggesting careful follow-up observation after excision of extended primary tumors.