Ebstein's anomaly--an autopsy study of 28 cases.

Twenty eight autopsy specimens of Ebstein's anomaly were studied in order to evaluate the morphologic features of the abnormal tricuspid valve. All cases showed marked dilatation of the original tricuspid annulus, a normally positioned anterior leaflet and variable downward displacement of the posterior and septal leaflets. Sixteen cases showed a very large anterior leaflet. All three leaflets showed dysplastic features and a wide range of anatomic abnormalities in the valve and valve apparatus. A thin walled atrialised right ventricle was present in nine cases. Associated cardiac anomalies were seen in 21 cases, the commonest being an atrial septal defect (17 cases).

Cardiac lesions in non-specific aorto-arteritis. An autopsy study.

Autopsy data of 58 cases (1958-1986) was analysed for cardiac lesions. The cases were divided into 2 groups; paediatric (23) and adult (35). The heart was normal in 8.7% and 20.5% of the above groups respectively. Rest of the cases showed left ventricular hypertrophy with variable dilatation. Obstructive lesion in the aorta and or renal arteries was present in 91.3% of paediatric and 80.0% of adult cases. Congestive cardiac failure was very common in paediatric group (60.8%) and was not seen in absence of obstructive lesion in the aorta or renal arteries. Histologically the aortic lesion was healed in 70% and 50% of paediatric and adult cases. The commonest additional lesion found, was coronary artery involvement in 11 cases (17%). Ostial stenosis was noted in 7 cases, including 2 in paediatric age group. Epicardial coronaries were involved in 4 cases with infarcts in 4. Aortic incompetence was rare (3.4%). Associated rheumatic mitral stenosis was seen in 2 and healed infective endocarditis in one. Histologically apart from the above mentioned lesions the myocardium showed essentially a response to hypertension. Focal lymphocytic infiltration was seen in 2 children and tuberculosis myocarditis in 3 adults. No case of any other type of myocarditics or cardiomyopathy was seen. In conclusion hypertension and coronary artery disease are the main factors responsible for myocardial failure but additional related or unrelated factors were present in 15.0% cases.

Carcinoma of lung with special reference to adenocarcinoma (an autopsy study of 122 cases).

We report morphological observations on 122 autopsied cases of lung carcinoma during the years 1974-1989, with emphasis on 44 cases of adenocarcinoma. Adenocarcinoma was the commonest histological type encountered (36%), confirming the trend reported in Western countries. It was also noted that nearly 50% of cases of adenocarcinoma were in the central zone, which is contrary to reported literature. 92% of small cell carcinoma, 87% of epidermoid carcinoma, 64% of combined carcinomas and 48% of adenocarcinomas were centrally located, while 91% of bronchioloalveolar carcinomas and 88% of large cell carcinoma were located peripherally. Of the 44 cases of adenocarcinoma, 23 were peripheral and 21 were central. In ten out of the 21 cases of central adenocarcinoma the tumour was confined to the bronchial tree without any parenchymal involvement. This type of gross morphology has not been described in adenocarcinoma so far. In the other 11 cases, there was a tumour in the lung parenchyma involving the bronchus. In these cases, it was not possible to decide whether bronchial involvement was primary or secondary, but bronchial obstruction due to a polypoid mass was present in three of these cases.

Elevated levels of IgG specific antimyosin antibodies in acute rheumatic fever (ARF): differential profiles of antibodies to myosin and soluble myocardial antigens in ARF, acute glomerulonephritis and group A streptococcal pharyngitis.

Group A streptococcus is the common etiologic agent associated with group A streptococcal pharyngitis (SAP) and its sequelae: acute rheumatic fever (ARF) and acute glomerulonephritis (AGN). However, hyperresponsiveness to cardiac antigens stemming from the shared antigenic determinants with streptococcal antigens is believed to play a role only in the pathogenesis of ARF. A Profile of IgM and IgG immune responses to soluble myocardial antigen (SMA) and myosin was evaluated in ARF, AGN and SAP. A modified ELISA measuring the area under curve (AUC) for quantitation of antibodies to SMA and rabbit muscle myosin was employed. Proteins in the SMA were resolved by SDS-PAGE. Immune responses to a major protein band of congruent to 205 kD, corresponding to the molecular weight of the heavy chain of cardiac myosin was also evaluated. In the ARF group while a significant elevation of both IgM and IgG anti-SMA antibody levels was observed, only antibodies of IgG isotype were elevated against rabbit muscle myosin and 205 kD protein of human cardiac tissue in comparison with normal controls, AGN and SAP groups. There was a significant positive correlation of antibodies against skeletal muscle myosin with antibodies against 205 kD protein of human cardiac tissue for both IgM and IgG specificities in ARF alone. The incidence of positive sera (values greater than mean + 2SD of control values) for IgM and IgG anti-SMA and antimyosin antibodies was higher in ARF than in AGN and SAP. None of the AGN and SAP sera had elevated levels of antibodies against SMA whereas low incidence of positive sera for antimyosin antibodies was observed in these groups. Although group A streptococcus etiology is associated with ARF, AGN and SAP, differential profiles of immune responses to cardiac antigens is observed in these diseases. Elevated IgG specific response to myosin and 205 kD cardiac protein was demonstrated in ARF and not in other groups with a similar etiology. It may be worthwhile, therefore to explore the possibility of using this as an additional parameter in diagnosis of ARF.

Persistent truncus arteriosus--an autopsy study of 16 cases.

Sixteen specimens of heart with persistent truncus arteriosus were studied to evaluate the anatomic features. Using the Collet and Edwards classification, type I truncus arteriosus was the most frequent (62.5%). Using Van Praagh's classification type A1 was the most common (43.7%). There were two cases which could not be classified according to the Collet and Edwards classification. The truncal valve was tricuspid in 75% of the cases and bicuspid in the remaining 25%. In all 6 cases with interruption of the aorta, the truncal valve was committed to the right ventricle. The ventricular septal defect was subtruncal in all except 1 case. There was variation in the thickness of the posterior limb of the septal band and the ventriculo-infundibular fold. Absence of the ventriculo-infundibular fold in 3 cases led to truncal tricuspid continuity. Right-sided aortic arch and interruption of the aorta were frequently associated arch anomalies.

Association of lung carcinoma and tuberculosis.

Two hundred and twenty one consecutive cases of bronchogenic carcinomas were studied histologically for evidence of associated lesions. Seventy eight lesions were seen in 55 patients (24.8%). The most frequent was tuberculosis, seen in 29 patients. The next in frequency were scars, in 22, emphysema in 12 and thickened pleura in 7. Interstitial fibrosis, chronic bronchitis, lobar pneumonia and bronchiectasis, were other lesions, seen in very few cases. The types of carcinoma, in which associated lesions seen were, undifferentiated carcinoma (76%), adeno-carcinoma (56%), mixed tumor (37%), large cell anaplastic (25%), small cell anaplastic (23.7%) and epidermoid carcinoma in (5.44%). The incidence of tuberculous lesions in autopsies unassociated with tumor is 7%, as compared to 24.8% incidence of association with carcinoma; which is significant. There were seven scar cancers; with origin in tuberculous scars in two. The study indicates necessity of prospective study in this field.

Antibodies to N-acetylglucosamine and heparin in acute and remission phases of rheumatic fever.

The etiology of acute rheumatic fever (ARF) is believed to involve an immunological response to group A streptococcal antigens. Antibodies to group A carbohydrate (A-CHO) have been reported in ARF and rheumatic heart disease patients. As N-acetylglucosamine (GlcNAc) units form the major immunodominant regions in A-CHO antigens, we investigated levels of antibodies to GlcNAc and heparin (with repeated sequences of GlcNAC) in rheumatic fever (RF) patients. Serum samples from 26 acute cases (ARF), 18 remission cases and 17 normal healthy subjects were analyzed for IgG and IgM levels of antibodies to GlcNAc and heparin. High titres of IgG antibodies to heparin and GlcNAc were observed in the ARF group in comparison with controls (p less than 0.0025 and 0.0125 respectively). There was no difference in the levels of IgM antibodies. Remission group demonstrated low titres of IgG to heparin and GlcNAc (p less than 0.01 and 0.0125 respectively) in comparison with ARF group. Heparin antibodies of IgM class was comparatively lower in remission group (p less than 0.005). While the role of these antibodies in different phases of RF needs to be investigated, we conclude that GlcNAc antibodies do not play any role in the pathogenesis of RF or rheumatic heart disease.

Tuberculous pericarditis and the cardiac conduction system.

Nine cases of acute and 8 cases of chronic tuberculous pericarditis were studied for involvement of epicardial structures such as the S-A node, A-V node and large coronary arteries. Extensive caseation was seen in the region of the S-A node in 2 cases of chronic and one case of acute pericarditis. No nodal tissue was identifiable in these cases. In one more case of chronic pericarditis, granuloma with fibrosis was seen in the S-A node. Minor mononuclear infiltration of the S-A node was seen in 2 cases. In the rest of the cases, the S-A node was normal though inflammation was very close to it in 4 cases of acute and all the cases of chronic pericarditis. The A-V node, bundle of His and coronary arteries were normal in these cases.

The bicuspid aortic valve--an autopsy study.

Congenital Bicuspid Aortic Valve is a common congenital anomaly. We studied 48 cases of bicuspid aortic valve seen over a period of 20 years. 18 cases were associated with other congenital anomalies, patent ductus arteriosus being the most frequent. 30 were isolated lesions. The morphology of the cusps and position of raphe were noted. Calcification and infective endocarditis were frequently noted in the isolated forms of Bicuspid Aortic Valve. Coronary arteries were dissected in 32 cases to determine the dominance.

Atresia of the common pulmonary vein.

In our study of 1326 autopsied cases of congenital heart disease, we have encountered 3 cases of atresia of the common pulmonary vein. This is a rare condition of which, to the best part of our knowledge, only 19 cases have been reported so far. Interestingly, two of our cases were associated with isomerism of the right atrial appendages, and one also had a common arterial trunk. The association with isomerism of the right appendages, and with absence of the spleen, has been observed previously but no previous case of which we are aware has had a common arterial trunk. Atresia of the common pulmonary vein is part of the spectrum related to totally anomalous pulmonary venous connexion, a lesion known to be frequently associated with isomerism of the right atrial appendages. Atresia of the common pulmonary vein, however, has not commonly been found with isomerism of the right appendages.

Taussig-Bing complex--a pathologic study of eight cases.

Taussig-Bing Complex, an uncommon anomaly, was found in 8 out of 110 hearts of double outlet right ventricle (7.2%). The mean age at death was 23.5 months with maximum survival upto 10 years. There was only one case of dextrocardia; viscero-atrial and atrio-ventricular concordance was seen in all. Subpulmonary ventricular septal defect (VSD) was restrictive in two cases, in one of whom it was due to spontaneous closing process. Additional VSD was found in 2 cases. The great vessels showed side by side relationship with bilateral conii in 7 cases. In the remaining case there was L malposition with absent subpulmonary conus. Subpulmonary stenosis was noted in 3 cases. Tubular hypoplasia of aorta was seen in 2 cases with subaortic obstruction in one. Mitral valve abnormalities were present in 5 cases of which stenotic lesions were seen in 3. Coronary artery abnormalities were noted in 3 cases.

Single ventricle (morphologic study of 21 cases).

The morphological characters of 21 cases of single ventricle which constituted 1.63% of cases of congenital heart disease were studied. The single ventricular chamber with left ventricular characters was seen in 11 cases. In 8 of these, the great vessels were transposed with aorta arising from outlet chamber (SLL-7:SDD-1). Except in one case where there was common A-V valve, two A-V valve, two A-V valves entered the main chamber with some abnormality of A-V valves in all the cases. Bulbo-ventricular foramen was obstructive in 6 cases with resultant hypoplasia of aorta. Aortic arch anomalies were present in 5 of these. Valvular pulmonary stenosis was present in two. In 3 cases with normally related great vessels (SDS), bulbo-ventricular foramen was obstructive in two with hypoplastic pulmonary artery. Abnormalities of A-V valves were similar to the previous group. The incidence of single right ventricle was high in this series (47%). In half the cases, there was associated asplenia syndrome. This group in general showed common atrium with exception of one case, common A-V canal, both great vessels arising from same outflow with atrophic conal septum. Anomalies of pulmonary veins were common. The subsets observed were ADD-3, ADL-1, AL single trunk-1. In the remaining cases without asplenia, both A-V valves were present though some abnormalities were present in all. Systemic and pulmonary venous anomalies were rare. The subsets observed were SLL-3, SDL-1, SDD-1.(ABSTRACT TRUNCATED AT 250 WORDS)

Congenital aneurysms of the sinus of Valsalva with dissection into the interventricular septum.

Four cases of congenital aneurysm of sinus of Valsalva (CASV) with rupture and dissection into the intraventricular septum are described. Their incidence (26.6%) in 15 consecutive cases of CASV is unusually high. Only one of these showed secondary rupture into the left ventricle. If these aneurysms remain unruptured, their diagnosis during life is difficult as in the case of other unruptured aneurysms of CASV. The occurrence of conduction abnormalities in young patients should be one of the indications, and 2-D echocardiography would help to arrive at a definite diagnosis and aid in the institution of appropriate surgical treatment.

Spectrum of histological lesions in 185 consecutive prostatic specimens.

One hundred and eighty five consecutive prostate specimens were studied. The predominant lesion noted was benign prostatic hyperplasia (B.P.H.) (92.97%). The incidence of carcinoma was low, (7.02%). Conditions which can mimic and should be considered in the differential diagnosis of carcinoma, like basal cell hyperplasia, atypical hyperplasia and atrophy associated hyperplasia were noted in 10, 4 and 3 cases of B.P.H. respectively. None of these cases showed evidence of carcinoma. Corpora amylacea were noted in 38.91% of the cases of B.P.H. and were conspicuously absent in cases of carcinoma. Chronic prostatitis was frequently encountered (58%) and metaplastic changes were seen in 11% of the cases.

Persistence of heart reactive antibodies (HRA) in acute rheumatic fever (ARF) and rheumatic heart disease (RHD) patients.

Heart Reactive Antibodies (HRA) of IgG and IgM classes were investigated in 79 patients in four clinically classified groups. Group I comprised of 16 children with Acute Rheumatic Fever (ARF) and Group II consisted of 15 cases with active Rheumatic Heart Disease (RHD). Twenty seven cases of ARF and RHD in remission and 21 adults with quiescent RHD were included in Groups III and IV respectively. Control groups comprised of 14 normal, healthy, donors and eight Post Streptococcal Acute Glomerular Nephritis (PSAGN) cases. Low levels of HRA of IgG and IgM classes were detected in control groups. The overall incidence of HRA of IgG and IgM classes was 82.28 and 39.24% respectively in the patient group. An increased frequency of HRA-IgM antibodies was observed in Groups I, III and IV (p less than 0.01, 0.001 and 0.025 respectively). All the four groups demonstrated a highly significant increase in incidence of HRA--IgG class (p less than 0.0005). Persistence of high titres of HRA-IgG class in ARF and RHD is reported in the paper.