Immunochemical CK-MB assay for myocardial infarction.

The diagnostic efficiency of an immunochemical assay for CK-MB (I-MB) was compared with that of an electrophoretic procedure for this isoenzyme (E-MB) in 215 consecutive patients in whom acute myocardial infarction (MI) was clinically suspected. All patients were investigated with a standard protocol consisting of serial assays of total creatine kinase (CK) and lactic dehydrogenase (LD) activities, CK-MB and LD1 isoenzymes, and electrocardiograms. Technetium pyrophosphate cardiac scans were obtained for eleven patients; autopsy was performed in six cases. The diagnosis of acute MI was established in 45 patients. The coefficients of variation for the intra-assay and interassay precision of I-MB assay ranged from 2.05%-7.2%. Concordance between the I-MB and E-MB results at the decision values for acute MI was observed in 203 of 215 patients (94.4%). At the cut-off point of 10 U/L, the I-MB assay was 95.5% sensitive and 95.3% specific for acute MI; the corresponding rates for the E-MB test were 93.3% and 94.7% respectively. The test efficiency rate for I-MB assay was 95.3% and that of E-MB procedure 94.4%. A complete time-based isoenzyme protocol for the diagnosis of acute myocardial infarction has several variables; the need for interpretation of individual profiles and for the preparation of a formal report is discussed.

Dissociation between hepatosplenic and marrow iron in liver cirrhosis.

Histochemical study of tissue iron in the various parts of the reticuloendothelial system in 15 subjects with cirrhosis was performed. Stainable iron in the liver and spleen sections, generally in large quantities, was found in 13 of 15 cases. Paradoxical association of hepatosplenic siderosis with depletion of marrow iron reserves was observed in seven subjects. In all seven, gross gastrointestinal blood loss had occurred during life and the source of bleeding from one or more anatomic lesions was identified at the time of autopsy. Depletion of marrow iron reserves in these seven subjects can be attributed to two factors: first, the available marrow iron stores were used for erythropoiesis; second, the ample hepatosplenic iron deposits could not be mobilized for transport to the bone marrow. Thus, hepatosplenic iron in cases of cirrhosis seems to be sequestered from its normal metabolic pathways.

Failure of serum ferritin levels to predict bone-marrow iron content after intravenous iron-dextran therapy.

The relation between serum ferritin levels and stainable-iron deposits in the liver, spleen, and bone marrow was investigated in 36 patients with chronic renal failure who died after being on haemodialysis for 1-103 months. Elemental iron (mean, 5450 mg) had been given intravenously as iron dextran to patients in a long-term subgroup, who had been on dialysis for more than 3 months. The results of semiquantitative histochemical assessment of tissue iron in slides obtained at necropsy (scale 0 to 4+) were confirmed by chemical analyses of tissue iron. Serum ferritin levels correlated well with the degree of hepatosplenic siderosis but did not always correlate with bone-marrow iron stores in these patients. Serum ferritin concentrations were raised in 10 marrow-iron-depleted subjects (mean, 1336 ng/dl). The paradoxical association of hepatosplenic siderosis with marrow iron depletion was observed in most of the patients on dialysis for less than 40 months. The histochemical data show that the bulk of intravenously injected iron dextran is taken up by the liver and spleen; that the hepatosplenic stores fail to be mobilised to the bone marrow; and that intravenous iron-dextran therapy, by-passing the intestinal mechanism for the regulation of iron absorption, carries a high risk of long-term hepatosplenic siderosis.

Immunochemical LD1 assay for myocardial infarction.

The diagnostic efficiency of an immunochemical assay for LD1 (I-LD1) was compared with an electrophoretic procedure for this isoenzyme (E-LD1) in 100 consecutive patients hospitalized for a clinical suspicion of acute myocardial infarction (MI). All patients were investigated with a standard protocol including serial determinations of total creatine kinase (CK) and lactic dehydrogenase (LD) activities, CK and LD isoenzymes, and electrocardiograms. Thirty-two patients were diagnosed to have acute MI on the bases of positive CK-MB or EKG or both. The coefficients of variation for the intraassay and interassay precision of I-LD1 assay ranged from 3.12% to 7.69%. Direct correlation between the I-LD1 and E-LD1 was very satisfactory (r = .961; P = less than .001). When the results of these two procedures were compared in terms of decision values for acute MI, there was agreement between them in 87 patients. At the cut-off point of 90 U/L, I-LD1 assay was 100% sensitive and 89% specific for acute MI; the corresponding figures for E-LD1 were 81% and 91%, respectively. The diagnostic efficiencies of the I-LD1 and E-LD1 procedures were 93% and 88%, respectively. A substantial saving in technologist time with the I-LD1 assay over the E-LD1 procedure was documented in this study.

Primary signet-ring cell carcinoma of the urinary bladder: review of the literature and report of a case.

A case of primary signet-ring carcinoma of the urinary bladder treated with total cystectomy and clinically disease-free three years and nine months after surgery is described. The signet-ring cell carcinoma of the bladder is a rare neoplasm; among the five cases found in the literature, the neoplasms pursued a fulminant course, diffusely invaded the bladder wall without forming intraluminal growths, and could not be controlled by segmental resection, radiotherapy, and chemotherapy alone or in combinations. The pathogenesis of mucus-producing signet-ring cell carcinoma in the urinary bladder, an organ that normally contains no mucogenic elements, is discussed. The histologic evidence for the origin of this neoplasm from the totipotent urothelium is illustrated.

Intraventricular thrombosis in polycythemia vera: A cause of intractable cardiac failure.

The occurrence of thrombotic events is central to the course of polycythemia vera. Myocardial, cerebral, peripheral, and pulmonary infarctions are frequent and are consequences of throbmoses in small and medium caliber arteries. Thrombosis in large caliber arteries is a rare event. Thrombosis within the chambers of the heart has not been hitherto reported. This report documents the occurrence of massive left ventricular thrombosis in a patient with polycythemia vera. The throbmus reduced the left ventricular capacity by about 75% and caused intractable congestive heart failure.

Fibromatosis of the breast.

Two cases of fibromatosis of the female mammary gland treated by local excision and with a follow-up of 11 and 3 years, respectively, are described. Fibromatosis confined to the breast and not involving the underlying fibroaponeurotic fascia is a rare lesion. Among the handful of cases reported in the literature, diagnostic errors are known to have led to unnecessary mastectomy. In the breast, fibromatosis behaves in the same fashion as in the soft tissues: an aggressive infiltrative lesion with a proclivity for local recurrence following inadequate excision but without potential for distant metastasis. Clinically, it may simulate carcinoma; when suspected histologically during frozen section study, surgical resection should be limited to wide local excision and a definitive plan of therapy deferred until the lesion can be examined carefully with permanent sections.

Metastatic carcinoma simulating linitis plastica of the colon. A case report.

Reported herein is the case of a 70-year old woman with metastatic breast carcinoma presenting as linitis plastica of the ascending colon. The breast tumor was diagnosed nine years previously. The clinical, roentgenographic and pathologic features of colonic linitis plastica and the preoperative diagnostic difficulties are discussed. There is no difference in the morphologic features of primary and secondary linitis plastica. The latter may result from anaplastic carcinoma of the stomach, gallbladder or breast.

Oxalosis in hemodialysis patients: a pathologic study of 80 cases.

The incidence and distribution of deposition of oxalate crystals were studied in various organs of 80 patients with chronic renal failure maintained on hemodialysis for periods ranging from three weeks to seven years. The most frequently involved organs were the kidneys, thyroid, and myocardium. Less prominent deposit was found in the spleen and the lungs. Moderate to severe renal oxalosis was encountered more frequently in patients maintained for longer periods on hemodialysis. The therapeutic implication of distinguishing secondary from primary oxalosis is stressed. The identification and the mechanism of deposition of oxalate in tissues are discussed.

Malignant apudoma of the liver with symptomatic intractable hypoglycemia.

This report documents a case of a fatal primary malignant neoplasm of the liver with metastases to the lymph nodes of the porta hepatis and the pubic bone. Profound, intractable hypoglycemia was seen during the course of the disease. No immunoassayable insulin was found in the blood during episodes of severe, symptomatic hypoglycemia. The neoplasm was composed of uniform polygonal cells with distinct cytoplasmic borders growing in broad strands with a tendency toward nesting and was morphologically similar to neoplasms of neural crest derivation. The presence of osmophilic, membrane-bound granules in the neoplastic cells was documented by ultrastructural studies. The tentative conclusion that the hypoglycemia was produced by the secretion of a substance with insulin-like activity, probably a polypeptide, by the secretory granules in the neoplastic cells is supported by clinical and laboratory data.

Necrotizing vasculitis of the gallbladder and the appendix. Similarity in the morphology of rheumatoid arteritis and Polyarteritis nodosa.

Two patients with rheumatoid arthritis (RA) and polyarteritis nodosa (PN) presented with abdominal pain. Both revealed necrotizing vasculitis of the gallbladder and the appendix respectively. The controversial role of corticosteroids in the pathogenesis of rheumatoid arteritis, the rarity of rheumatoid arteritis of the gallbladder and the morphologic similarity of the vascular lesion in the gallbladder and appendix are discussed.