Clinical commentary: granulocytic fragments in sepsis.

Granulocytic fragments have been described in the peripheral blood of patients with sepsis and the systemic inflammatory response syndrome (SIRS). Although initially proposed as a morphologic clue for distinguishing the leukoerythroblastosis of sepsis from that of myelophthisis or marrow replacement by tumor, granulocyte-derived fragments may be part of a spectrum of cellular fragmentation associated with pathological inflammation and thrombosis, and thus play an important role in the pathophysiology of sepsis and SIRS. Pathologists, hematologists, and medical technologists should be aware of their existence, the morphologic features that distinguish them from macrothombocytes and schistocytes, and their potential significance.

Intimal thickness and layering, and smooth muscle cell phenotypes in aorta of youth.

Proneness to the lesions of atherosclerosis varies along the length and circumferential topography of the aorta. Smooth muscle cells, in particular those of the 'modulated' synthetic phenotype which are able to proliferate and synthesize matrix proteins, are considered to play an important role in lesion progression. We report on a study of the aortic intima at a lesion-prone site from abdominal aorta and a lesion-resistant site from thoracic aorta in young humans to determine (1) whether the histologic structure and the smooth muscle cell composition show quantitative differences between lesion-prone and lesion-resistant aortic sites; (2) whether there are gender differences, and (3) whether any differences increase in degree with increasing age in this young population. Material for this study was obtained as part of the NIH-funded multicenter study on Pathobiological Determinants of Atherosclerosis in Youth (PDAY) from autopsies of male and female subjects between the ages of 15 and 34, victims of unexpected sudden death, usually from trauma. The samples consisted of strips of abdominal and thoracic aorta, all derived from the same anatomical sites standardized in the PDAY studies. The thickness of total intima (TI) and its elastic hyperplastic (EH) layer was measured. Smooth muscle cells of all types (SMC) and separately those of the synthetic phenotype (SynSMC) were quantified in each site using immunohistochemical procedures in replicate sections of uniform thickness. The intima of the atherosclerotic lesion-prone dorsal half of the abdominal aorta (AD) shows significant differences from the lesion-resistant ventral half of thoracic aorta (TV) in that (1) its EH layer is significantly thicker; (2) its EH layer has a comparatively higher number of both total SMC and SynSMC, even when adjusted for intimal thickness, and (3) the age-related increase in thickness of both TI and EH layer of AD is much greater than that of TV.

Fatal thrombocytopenic coagulopathy after cardiopulmonary bypass: clinicopathologic correlations implicating heparin.

Heparin-associated thrombotic thrombocytopenia after cardiopulmonary bypass is frequently lethal. The propensity for this syndrome generally goes unrecognized because thrombocytopenia is common in the early postoperative period and because testing for heparin-induced platelet antibody may not distinguish between patients with thrombocytopenia alone and those in whom associated thrombi (the white clot syndrome) may develop. Moreover, differentiation between heparin-associated thrombotic thrombocytopenia and a consumptive coagulopathy may be difficult, and intervention may be inappropriate because of diametrically opposite treatments. Our experience with three cases and the necropsy findings in two of them demonstrate that postbypass thrombocytopenic coagulopathy may be a clinical and pathologic spectrum of consumptive coagulopathy, with heparin as the major premorbid factor. This report further emphasizes the need for vigilance in assessing certain patients preoperatively to lessen the high risk of morbidity and mortality associated with this syndrome.

Measurement of left ventricular mass in hypertrophic cardiomyopathy using MRI: comparison with echocardiography.

Left ventricular mass (LVM) is an important consideration in the management of cardiac hypertrophy associated with hypertrophic cardiomyopathy (HCM), systemic hypertension, and other diseases. A brief MRI cardiac imaging procedure used to monitor regression of LVM during treatment would be beneficial in management of these patients, since echocardiograms cannot be obtained in all patients and since the volume of a hypertrophic heart can straightforwardly be assessed from a series of tomographic slices. The present study was designed to evaluate a brief cardiac MRI procedure for measurement of LVM in HCM and compare it to echocardiography. MRI images acquired in a simulated transverse body plane were used to evaluate the mass of the left ventricle in 6 ex vivo human hearts obtained at autopsy. The estimates of LVM by MRI in the ex-vivo hearts were within 8% of the actual LVM. MRI images were acquired to evaluate LVM in 5 normal subjects and 12 patients diagnosed with HCM. Echocardiography was accomplished on 4 of the normal subjects and 10 of the patients having HCM. There were no significant differences in LVM by MRI and echocardiographic techniques in normal subjects. Transverse MRI images acquired on normal subjects demonstrated that estimates of LVM are reproducible when repeated over 3-w to 3-mo intervals. Images selected for analysis represented the heart in an early diastolic phase. MRI and echocardiographic techniques demonstrated significant differences in LVM in HCM patients. Estimates of LVM in normal subjects and patients diagnosed with HCM were normalized for body weight. The LVM estimates for HCM patients were very significantly different than normal subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrasound diagnosis of a twin gestation with concordant body stalk anomaly. A case report.

Concordant body stalk anomaly in an 18-week twin gestation was diagnosed by ultrasound and confirmed by pathologic examination after elective termination of pregnancy. The ultrasonographic presentation of this rare anomaly and its embryogenesis are discussed.

Bypass circuits as the source of thromboemboli during extracorporeal membrane oxygenation.

To determine the presence and extent of thrombus formation in the apparatus used for extracorporeal membrane oxygenation we studied various portions of the polyvinylchloride circuit from five infants who received extracorporeal membrane oxygenation for 70 to 330 hours. All infants had right-sided cannulation. Sections were cut from the circuit at the time of decannulation and subjected to light and scanning electron microscopy. The site that contained the most thrombus formation was the membrane oxygenator bypass circuit, which is subjected to repeated periods of unclamping and clamping to direct blood flow through the membrane oxygenator. Autopsy results from nonsurvivors showed evidence of pulmonary and renal infarcts, a left frontal lobe infarct, a thromboembolus of the left external and internal carotid arteries, and thrombi in the lungs, kidney, brain, and coronary arteries. One survivor had computed tomographic evidence of infarction of the left middle cerebral artery distribution. We suggest that the areas of the extracorporeal membrane oxygenation circuit subjected to repeated changes in flow dynamics may be the source of microemboli.

A comparative study of PAS-phosphotungstic acid-Diamine Supra Blue FGL and immunological reactions for type I collagen.

Immunohistochemical techniques proved valuable in histological studies of various types of collagens. However drawbacks include non-specific reactions of antibodies, masking of antigens, and the high cost of antibodies. This study was undertaken to ascertain the specificity of the PAS-phosphotungstic acid-Diamine Supra Blue FGL (PAS-PTA-DSB-FGL) reaction for type I collagen, differentiating it from other collagens. Duplicate series of methacarn-fixed sections of various tissues were treated with the PAS-PTA-DSB FGL reaction and the peroxidase-antiperoxidase (PAP) technique for type I collagen and the staining patterns were compared. Fibers binding the blue dye were found only at sites reacting with antibodies against type I collagen. These observations indicate that the PAS-PTA-DSB FGL procedure is suitable for visualization of type I collagen, e.g. in screening of large series of sections and in the practice of surgical and autopsy pathology.