Pseudomembranous tracheobronchitis caused by Aspergillus.

Four immunosuppressed patients with a rapidly evolving, febrile, respiratory distress syndrome were found at autopsy to have Aspergillus pseudomembranes of their lower tracheobronchial tree. Steroids, neutropenia, broad spectrum antibiotic use, and alcoholism appear to be predisposing risk factors. Bronchoscopy may reveal the pathology but antemortem diagnosis is difficult because of the low yield of sputum cultures and fulminant nature of the disease.

A management informatics rotation for pathology residents.

A formal, core, two-month rotation incorporating management concepts and computer usage has been instituted for residents in clinical pathology at Rush Medical Center. In this rotation, emphasis is placed on the pathologist's role as a laboratory director and decision maker and in the necessary computer skills and managerial background that must be acquired to make this role most effective. Specific behavioral goals and objectives were formulated for this rotation. The goals served as a guideline for the resident while involving each resident in the decision making process and in problem solving in day-to-day laboratory activities. The resident was encouraged to become familiar with the laboratory computer system, its operation, access, and reporting. Computer fundamentals were taught in instances where there was little or no prior computer experience. Management activities in which the resident was involved dealt with affirmative action, position searches, hiring and firing, laboratory accreditation, licensure laws, and decision making. This paper describes the rotation in detail and discusses each objective while incorporating both the resident's and laboratory director's perspectives.

Giant cell arteritis of the breast. A unique syndrome.

A 58-year-old woman had a unilateral, solitary breast lesion determined by biopsy to be due to giant cell arteritis. Clinical, laboratory, and pathological findings in this patient and in other patients reviewed from the literature revealed that characteristically patients with giant cell arteritis of the breast have (1) tender unilateral or bilateral nodules at times mimicking breast carcinoma; (2) significant constitutional symptoms of anorexia, weight loss, myalgias, fever, and arthralgias; (3) marked elevation of the erythrocyte sedimentation rate; (4) normal or mildly decreased hemoglobin values and normal or slightly elevated leukocyte counts; (5) normal temporal artery biopsy findings; (6) rare organ involvement; and (7) rapid improvement after prednisone therapy or frequent spontaneous resolution. This mode of presentation suggests features of a unique syndrome since many patients had no systemic involvement, require no treatment at all, and had a self-limited clinical course.

The detection and interpretation of urinary eosinophils.

We determined the clinical diagnosis for 183 patients who had urine samples examined for the presence of eosinophils. Urine samples were examined with both Hansel's stain and Wright's stain. A total of 11% of these patients had eosinophils detected in the urine. A variety of clinical conditions were associated with eosinophiluria. Urinary tract infection and acute interstitial nephritis were most common, each accounting for 25% of the total patients with eosinophiluria. Eosinophiluria proved to be a good predictor of acute interstitial nephritis. Hansel's stain was superior to Wright's stain in detecting eosinophils in urine. In particular, Hansel's stain increased the sensitivity of eosinophiluria for acute interstitial nephritis (63% vs 25%) as well as its positive predictive value (50% vs 25%).

Disseminated penicilliosis in a patient with acquired immunodeficiency syndrome.

We describe a case of disseminated penicilliosis in a patient with the acquired immunodeficiency syndrome. Penicillium marneffei was cultured from the blood, bone marrow, sputum, stool, and skin; the yeast forms were demonstrated in skin and bone marrow biopsy specimens. To our knowledge, this is the first reported case of disseminated penicilliosis described in a patient with the acquired immunodeficiency syndrome. The differential diagnosis with Histoplasma capsulatum is reviewed.

Pisse prophecy: a brief history of urinalysis.

This article has reviewed a few of the major historic aspects of urine examination from ancient times to the twentieth century. It is a most fascinating history for it mirrored that of the history of medicine itself. The recognition of the importance of urine in diagnosis was made over 6000 years ago by several of the earliest civilizations, and a few of their clay tablets have been found that give us some insight into their observations and conclusions. However, the progress in analysis and its clinical significance was often slow and frequently littered with charlatanism. Visual inspection alone, and prognostication therefrom, was shown to be inadequate as a single means of diagnosis, and over 600 years ago Paracelsus, as well as others, began to reject ancient dogma and searched for new approaches to the analysis of urine by using chemical distillation techniques. Progress in anatomy and physiology, coupled with the understanding of organ function, provided a fertile field for the investigation of the composition of the urine and associating its chemical constituents with specific disease states. The advent of the microscope caused scientists to examine all body fluids, especially the urine, and to record their observations as an aid to diagnosis--the beginnings of medical microscopy. This century has also seen remarkable advances in the field of urinalysis: dipstick testing, the application of modern chemical and microscopic techniques to constituent analysis, automation, and, most recently, monoclonal antibody and recombinant gene technology to enhance and improve urine examination. In short, urinalysis, the first of all laboratory tests, began as and still remains a most valuable and highly important means of diagnosis in clinical medicine.

Quality assurance in urinalysis.

Instituting a Quality Assurance program in urinalysis is an important step in achieving accurate and reproducible results. This article has explored the various components of such a program for routine urine examination and included a discussion, along with "how to" recommendations, of such topics as specimen collection and handling, dipstick chemical analysis, sediment evaluation, and reporting. Properly collected fresh urine samples should be analyzed promptly, preferably without refrigeration. Each step of the urinalysis procedure should be carefully controlled and standards applied to assure optimal results. Reports should include clinically useful pertinent data organized in convenient, readable fashion.

The clinical significance of eosinophiluria.

Eosinophils are normally absent from the urine. Their presence has been associated with a variety of clinical conditions affecting the kidney or urinary tract. The authors examined the clinical significance and eosinophils, in particular, for acute interstitial nephritis.

Herpes simplex viral hepatitis in adults: two case reports and review of the literature.

Herpes simplex viral (HSV) hepatitis is uncommon in adults. Two new cases are reported herein; a literature review revealed an additional 33 patients. Ages ranged from 13 to 87 years; the mean age was 32.6 years, and the median was 28 years. HSV hepatitis usually occurs as part of disseminated HSV infection and is characterized by fulminant hepatic necrosis with serum transaminase levels frequently elevated 100- to 1,000-fold. Disseminated intravascular coagulation was present in 90% of the cases. Outcome was poor; 86% of the patients died. Eighty-six percent of the patients had an underlying condition associated with impaired host defenses. Renal transplantation (26%), steroid use other than in renal transplant patients (26%), and pregnancy (23%) were the most frequent underlying conditions. Early recognition and prompt initiation of antiviral therapy may offer a chance for improved survival rates.

Tuberculous esophagitis with erosion into aortic aneurysm.

An 87-year-old woman with a known atherosclerotic thoracic aneurysm died suddenly from a massive esophageal hemorrhage. Prior to death, tuberculous esophagitis was diagnosed by biopsy. At autopsy, a fistulous tract was found extending from the esophagus to the aortic aneurysm; this fistula proved to be the site of fatal hemorrhage. The tract was surrounded by a granulomatous inflammatory reaction, in which acid-fast bacilli were found. To our knowledge, this is the first reported case of tuberculous esophagitis extending to an aortic aneurysm resulting in hemorrhage and death.

Hyaline casts in the urine: mechanism of formation and morphologic transformations.

Hyaline urinary casts have been examined primarily by scanning electron microscopy. Their appearance and their transformation with time are described. From this data, the mechanism of their formation and evolution has been deduced. These results permit more accurate identification and assessment of the types of urinary casts present and their significance.

Identification and composition of types of granular urinary casts.

Granular urinary casts were analyzed by scanning electron microscopy and histochemistry. Three types were identified. They appear to have distinctly different origins and significance. Their clinical associations remain to be defined. One type can be misidentified by bright field microscopy. Bacterial casts also can be misidentified as granular casts unless the sediment is examined carefully.

Paramesonephric papillary serous cystadenocarcinoma: a case report with scanning electron microscopy.

A case report of a malignant tumor, presumably paramesonephric in origin, is presented. Although uncommon, malignancies of the cystic structures of the broad ligament have been reported. The embryologic derivations and histologic feature of these tumors--mesonephric, mesothelial and paramesonephric--have been describe extensively, but no primary lesion has been evaluated previously by scanning electron microscopy. A prior laparotomy and biopsy with a diagnosis of a malignant papillary growth, probably paramesonephric, stimulated the examination of fresh tissue by an ETEC Autoscan scanning electron microscope at subsequent definitive, ablative surgery. Although features of cellular dysplasia were noted, there were no specific, unique characteristics of this neoplasm. Since all reported cases have been premenopausal, a hormonal interaction is questioned.

A specific urinary cast in acute pyelonephritis.

A specific type of urinary cast has been demonstrated in the urine of patients who have acute pyelonephritis. This cast is characterized by the presence of bacteria in its matrix and appears to be specific for and diagnostic of pyelonephritis. It is easily demonstrated by routine urinalysis.

Unsuitability of electron microscopic examination of urinary sediment for the diagnosis of amyloidosis.

Several recent reports suggest that amyloidosis can be diagnosed by ultrastructural identification of fibrillar proteins in the urinary sediment. However, the authors routinely identified similar fibrils in the urinary sediments of all patients with a wide variety of renal diseases who were producing urinary casts, as well as in those of stressed healthy individuals. They therefore conclude that electron microscopic examination of the urinary sediment alone has little value in the diagnosis of amyloidosis when unaccompanied by chemical or immunologic tests.