Acute necrotizing Meckel diverticulitis due to biliary enterolithiasis.

BACKGROUND: Acute abdominal pain due to complicated Meckel's diverticulum is an unusual event. Even the presence of biliary enterolithiasis at the onset of inflamed congenital diverticulum has rarely been reported previously. RESULTS: Despite this unusual presentation, an episode of gallstone passage through the biliary tract has not yet been described. CONCLUSIONS: Whether the stones were primarily formed in the diverticulum as enterolithiasis, or secondary to gallstone passage is discussed. The complications of Meckel's diverticulum requiring surgical treatment are reviewed, focusing on the unusual finding of biliary stones in Meckel's diverticulum and the etiogenic mechanism of enterolithiasis.

Infective complications after minor operations in patients infected with HIV: role of CD4 lymphocytes in prognosis.

OBJECTIVE: To find out the incidence of wound infection in patients with HIV and reduced counts of CD4 lymphocytes. DESIGN: Open study. SETTING: University hospital, Spain. SUBJECTS: 70 patients with HIV infection and enlarged lymph nodes. INTERVENTIONS: Biopsy of lymph nodes and withdrawal of a sample of blood for counts of CD4 lymphocytes and neutrophils. MAIN OUTCOME MEASURE: Development of infection at the biopsy site, and correlation of infecting organism with culture taken at the time of biopsy. RESULTS: Patients were divided into three groups depending on their CD4 count: more than 500 cells/ml (n = 26), 200-500 cells/ml (n = 24), and less than 200 cells/ml (n = 20). Their neutrophil counts were 5.1, 3.8, and 2.5 x 10(9)/1, respectively. There were found four wound infections (6%); 2 were in the group with more than 500 CD4 cells/ml, and these were caused by Staphylococcus aureus (which had been grown from nodes in 6 patients at the time of biopsy). The other 2 were in the group with less than 500 cells/ml and these were caused by Mycobacterium tuberculosis; cultures of the nodes had shown Staphylococcus epidermidis (n = 3) and M tuberculosis (n = 17). There were no infections in the group with 200-500 CD4 cells/ml, in which S epidermidis (n = 5) and M tuberculosis (n = 8) had been cultured from the lymph nodes. CONCLUSIONS: The CD4 count was of no prognostic importance in the development of wound infection, but severe depression of the CD4 count may increase the risk of atypical wound infections.

Combined histochemical stains in the differential diagnosis of Cryptococcus neoformans.

Three combinations of histochemical stains were used to study 69 routinely processed tissues containing various "yeast-like" fungal organisms (Cryptococcus neoformans, Blastomyces dermatitidis, Coccidioides immitis, Histoplasma capsulatum, Paracoccidioides brasiliensis, and Candida albicans). Fontana-Masson stain combined either with mucicarmine or Alcian blue produced distinctive staining of C. neoformans (Fontana-Masson-positive wall and mucin-positive capsule) that was not identified in other fungi. The Alcian blue stain combined with periodic acid-Schiff reaction also was useful for fungal classification, because the Alcian blue component reacted with only C. neoformans (capsule) and B. dermatitidis (wall) and the periodic acid-Schiff reaction reacted with the cell wall and body of each fungus. We concluded that the combined histochemical stains used in conjunction with morphologic study of hematoxylin and eosin- and Gomori methenamine silver-stained sections are helpful in the differential diagnosis of yeast-like fungal organisms.

Primary osteosarcoma of the lung. A reappraisal following immunohistologic study.

Five neoplasms were initially believed to represent primary osteosarcomas of the lung. Of the five cases, two were reinterpreted as carcino-sarcomas based on the identification of epithelial elements on further histologic sectioning and immunohistologic study in one and on immunohistologic study alone in the second. The differential diagnosis of carcinosarcoma should be considered for any lesion believed to represent a primary sarcoma of the lung, and in some cases carcinomatous elements may only be demonstrable by immunohistologic means.