[Successful surgical management of spontaneous multiple free ileum perforation caused by regional enteritis (Crohn disease)]. / Spontán, szabad, multiplex, többszakaszos ileumperforatiót okozó regionalis enteritis (morbus Crohn) sikerrel operált esete.

Spontaneous free perforation of the small intestine is a rare early (first) complication of the Crohn's disease. Case reports have not exceeded the hundred. The authors report the case history of a 40 years old male patient who was successfully operated on double, multiple free perforation of ileum as first sign of the Crohn's disease. First the suture of the perforated small bowel and second the resection of reperforated ileum was carried out. The base on the macroscopic and microscopic appearance of the resected bowel, the diagnosis was supposed by pathologists too. Presented paper based on the very rare clinical finding.

Value of mortality data and necropsy records in monitoring morbidity in a population.

STUDY OBJECTIVE: The aim was to compare the value of four sources of data in assessing morbidity in a population: (1) data from a screening programme including follow up records, (2) death certifications by attending physicians, (3) death certifications by doctor-coroners, and (4) necropsy reports. DESIGN: The study was a cohort analysis of health and mortality in a sample of agricultural workers first examined in 1964-66 when they were aged 60 years or older. Follow up examinations enabled morbidity assessment to be made and ICD diagnostic categories to be compared with data available on persons in the cohort who had died. SETTING: Hajdúszoboszló, a small town in eastern Hungary. PARTICIPANTS: 1412 persons (96.1% of those aged greater than or equal to 60 years) were examined in 1964-6. Those still alive and available in 1989 were examined again. Necropsy records were available for 144 persons from the cohort in 1989 and were extensively reviewed in comparison with data available from other sources. MEASUREMENTS AND MAIN RESULTS: Comparison of causes of death established at necropsy showed marked differences from those registered by attending physicians and doctor-coroners, deviations ranging from -91.6% to +74.8%; 19.4% of underlying causes of death occurred exclusively in the necropsy group. Major divergencies in diagnostic classification occurred in the three data sources, particularly for diseases of the circulatory system, where hypertensive renal disease, old myocardial infarction, acute cerebrovascular disease, and venous thrombosis were rarely documented by physicians/coroners. When necropsy data were used the number of diagnostic categories increased strikingly over the other sources of information. Necropsy records revealed quantitatively similar information on morbidity to follow up examination though there were qualitative differences, necropsy being less likely to document diagnoses of endocrine disorders, mental and neurological diseases, digestive disorders, and musculosketal disorders. CONCLUSIONS: Necropsy records contain much valuable material not available from other sources, exceeding by ninefold the amount of information reported at present. A way should be found to make use of this large data pool.

Do adrenal metastases from lung cancer develop by lymphogenous or hematogenous route?

In order to analyse the possible mode and pathways of adrenal metastases from lung cancer, the frequency of adrenal metastases ipsilateral and contralateral to the site of the primary cancer was investigated based on autopsied lung cancer cases. In 405 of 1,607 such cases, adrenal metastases could be found: on both sides, 234; ipsilateral only, 105; contralateral only, 66 cases. In the early stages of tumor progression, a striking difference can be seen between the two sides. Ipsilateral metastases were of significantly higher incidence in early metastatic tumor stages, but later, in cases having six or more involved organs, the ipsilateral/contralateral quotient reaches 1. It is postulated that in the early stages adrenal metastases from lung cancer probably develop mainly by lymphogenous, but later mainly by hematogenous routes.

[Histologic classification of lung cancers and reproducibility of diagnoses based on 10 years' autopsy material]. / Tüdörákok szövettani osztályozása és a diagnózisok reprodukálhatósága 10 év boncolási anyaga alapján.

Reviewing autopsy records of a ten-year period in the Department of Pathology of Szolnok County Hospital 1607 lung cancer cases were detected, in 1213 of which histological reexamination could be performed. The reproducibility of main histological groups was 73.4%, highest of all in small cell lung cancer. The cause of the relatively low reproducibility rate can be first of all the considerably changeable histological appearance and the frequency of transitional forms between terminally differentiated tumor types. One must not even leave lower diagnostic accuracy of frozen sections out of consideration, the basic method of first diagnosis. The light microscopic heterogeneity and transitional histological forms have been analysed in this article.

Cytophotometric investigations on a chronic tubular nephropathy simulating preneoplastic condition.

Cytophotometric investigations were performed on the atypical renal tubular epithelium of a young man who died of renal failure, possibly due to chronic lead exposure. The aim of this analysis was to determine whether nuclear atypia indicates incipient malignancy or is a type of so-called "benign atypias". DNA histogram, showing euploid polyploidy supports the latter view and the dysplastic epithelial lesion is not even considered to be a preneoplastic condition.

Cytophotometric investigations on atypical epithelial cells of the human seminal vesicle.

Normal seminal vesicles were studied histologically in 80, and by Feulgen's cytophotometric method in 10 autopsied cases (males, 44-82 years of age). In every case large, hyperchromatic nuclei were found. By cytophotometry euploid polyploid atypia was also shown in every case, which is characteristic of benign hormonal dysplasia.

Bizarre leiomyoma of the prostate.

Obstruction of the urethra, caused by a prostatic tumour necessitated prostatectomy in a 49-yr-old man. Histology revealed a moderately cellular and vascular tumour with marked cellular atypia. After a follow-up for three years, the results of both the clinical investigations and prostatic needle biopsy were negative. Thus the original opinion of malignant prostatic mesenchymal tumour was revised, resulting in the diagnosis of bizarre leiomyoma. Subsequently the smooth muscle cell origin and the benign nature of the tumour were demonstrated by electron microscopy and Feulgen-cytophotometry, respectively. This is the first prostatic bizarre leiomyoma in which malignancy was excluded by demonstrating euploid polyploidy. This case also calls the attention to the need of more sophisticated methods in everyday diagnostic pathology.