Fat necrosis in surveillance biopsies of heart transplants.

Fat necrosis was observed in surveillance biopsies of five patients following heart transplant. This reaction is poorly documented in the literature, but in personal communication, some pathologists working in the field have had experience with it. Four of the cases developed two to six days after transplantation, but in the fifth case, fat necrosis developed ten months after transplantation. Autopsy study of one case showed extensive severe fat necrosis involving both donor and recipient tissues. The cause is not known, and the changes are independent of rejection. However, the fat necrosis can be found within the interstitial tissues of the myocardium and subendocardium and may be mistaken for rejection if lymphocytes and polymorphs are part of the inflammatory response. The only clinical finding thought to be related to the fat necrosis was the development of transient complete heart block in a patient in whom the International Society for Heart and Lung Transplantation (ISHLT) standardised rejection grading was never greater than IA.

Postmortem identification by means of a recovered intraocular lens.

Formal legal identification of the decomposed remains of an edentulous woman was facilitated by the postmortem recovery of an intraocular lens implant. The dimensions and dioptric power of this prosthetic lens were identical with those recorded by her ophthalmologist at the time of cataract surgery 2 years previously. On the basis of this and other circumstantial evidence, legal identification was accepted by the Coroner.

Pathology review of sudden and unexpected death in aboriginal and non-aboriginal infants.

Previous research showed that the sudden infant death syndrome (SIDS) rate for Aboriginal infants significantly increased during the 1980s in Western Australia (WA) and raised the possibility of a diagnostic transfer of Aboriginal infant deaths from other causes to SIDS over this period. Here, therefore we review the pathology of SIDS and other sudden and unexpected deaths in infancy (SUDI) for Aboriginal and non-Aboriginal infants in WA between 1980 and 1988. The aim was to investigate whether there had been differences in the diagnosis and/or classification of SIDS according to whether the infants were Aboriginal or non-Aboriginal. The study population comprised: (1) all Aboriginal cases of SIDS and other SUDI between 1980 and 1988, and (2) corresponding random samples of non-Aboriginal cases. A two-stage process was employed for the review. First, histology slides were reviewed for each case where the aboriginality of the infant was Aboriginal and the original cause of death were unknown to the pathologists. Second, all paper records (i.e. death scene investigations, laboratory tests and medical reports) except for the original cause of death information were reviewed by the pathologists. The results showed that there was excellent agreement between the final review diagnosis and the original diagnosis for both Aboriginal and non-Aboriginal SUDI. Thus, there was no evidence for a diagnostic shift among Aboriginal infant deaths and the review supported the observed increase in the SIDS rate for Aboriginal infants.

Death by hanging in Western Australia.

We present a review of the circumstances and medical findings of 280 fatalities due to hanging in Western Australia (WA) during the 5 yr period 1988-1992. Two hundred and forty one (241) of the cases were examined prospectively; the completed Coroner's files of a further 39 cases, from rural WA, were examined retrospectively. Most of the 280 deaths were in males (88%), and most were in the age range of 15-35 yrs (56%). Seven cases occurred in children aged 15 or less. There was one homicide, 14 cases thought to be accidental, and 261 suicides; in 4 cases the manner of death could not be determined. In one-third of the cases there was a medical history of a psychiatric condition. The majority occurred in or around the decedent's home (71%). The most commonly used ligature was a rope (59%). Alcohol was the most commonly detected drug following post mortem analysis (30%). In WA then, there is one hanging death every 6.5 days, the majority being suicides, in men of young adult age, typically occurring in or around the home.

Autoerotic deaths: four cases.

We describe the circumstances and post mortem medical findings of 4 unusual fatalities where death occurred during autoerotic practice. Three cases occurred in young to middle-aged men--hanging, electrocution and inhalation of a zucchini. The manner of death in each was accidental. The fourth case was an elderly man who died of ischemic heart disease, apparently whilst masturbating with a vacuum cleaner and a hair dryer.

Cycling fatalities in Western Australia.

OBJECTIVE: To present a review of the circumstances of 64 cycling fatalities in Western Australia (WA) during the nine-year period 1984-1992, and the major injuries sustained by the cyclists. DATA SOURCES: The number of deaths was ascertained from lists maintained by the WA Police Department, Forensic Pathology Division of the Health Department and the Coroner's office. Individual case files held by the Coroner's office and Forensic Pathology Division were then examined for details of the circumstances of each incident, epidemiological data, and medical and toxicological findings. DATA SYNTHESIS: Most of the 64 fatalities (59%) occurred in children or young adults less than 20 years of age. Most fatal injuries (54%) were to the head alone. Forty-seven of the deaths involved collision with a motor car. Alcohol was demonstrated in the blood of five of the 30 cases in which analysis of blood alcohol level was performed. On average, 7.8 cyclists died annually in WA before the introduction of legislation for the compulsory wearing of safety helmets while cycling. In the 12-month period following this legislation, there was only one cycling death. CONCLUSIONS: Most cycling deaths occur in children, primarily from head injury resulting from impact with a motor car. The enactment of legislation for the compulsory wearing of cycling helmets has been associated with a fall in cyclist fatalities.

Splenectomy during primary maximal cytoreductive surgery for epithelial ovarian cancer.

Six patients with epithelial ovarian cancer underwent splenectomy as part of their extensive primary cytoreductive surgical management at the Johannesburg University Hospital. These patients represented 7.6% (6 of 79) of advanced-disease patients (stages III and IV) followed during the study period. Five splenectomies were performed because of metastatic disease confirmed on microscopy. One of these showed parenchymal involvement and represented only the third case in the world literature. The remaining patient required splenectomy for capsular avulsion injury and resultant bleeding. Late thrombotic complications occurred in 4 of 6 (67%) patients, resulting in death of one patient from massive pulmonary embolism 20 days after surgery. Three patients (50%) currently have no evidence of disease 14, 25, and 32 months after surgery. The remaining 2 patients died of recurrent disease 19 and 58 months following primary operation. This, the largest reported series in the English literature, indicates that splenectomy, albeit potentially hazardous, is justified when it permits optimal cytoreductive surgery.

Involvement of the appendix in ovarian epithelial cancer--an update.

Appendicectomy was performed at the time of primary definitive surgery in 60 of 102 patients with epithelial ovarian cancer at Johannesburg Hospital over a 9-year period (January 1979-December 1987). Metastases were present in 37 of the 46 (80.4%) appendices removed from patients with advanced disease (stage III or IV) and in only 1 of the 14 patients (7.1%) with early disease. Metastases were not limited to serosal implants and included vascular and lymphatic space involvement, chronic obliterative appendicitis and almost complete replacement of the appendix by adenocarcinoma. The role of appendicectomy in the surgical management of epithelial ovarian cancer is discussed.

Adenocarcinoma from endometriosis causing urinary tract obstruction in a patient on oestrogen replacement therapy after hysterectomy. A case report.

A patient on oestrogen replacement therapy after hysterectomy developed endometriosis and adenocarcinoma. The involvement of the urinary tract and theories on the pathogenesis of endometriosis and adenocarcinoma in relation to oestrogen replacement therapy are discussed.

Non-gynaecological metastases to the vulva and vagina.

A retrospective study of 1513 vulval and vaginal biopsy specimens was undertaken to determine the frequency of non-gynaecological metastases to the vulva and the vagina; 7 cases were found. These were reviewed and an attempt was made to determine the mode of spread.

Cervical endometriosis: facilitated diagnosis by fine needle aspiration cytologic testing.

Regarded as infrequent, endometriosis of the cervix probably occurs more commonly than is generally realized. The lesion's apparent rarity may be ascribed to limited awareness of the clinical appearance, combined with technical difficulty in obtaining suitable biopsy material for confirmation. A consequence of previous cervical trauma, endometriosis of the cervix can be expected to increase in incidence with more widespread use of invasive cervical procedures. Clinical recognition and tissue confirmation thus become essential. This paper refocuses attention on cervical endometriosis by documenting the clinical, colposcopic, and histopathologic findings in 16 cases seen at a single colposcopy clinic over a 6-month period. Diagnosis in these patients was facilitated and improved by fine needle aspiration cytologic testing. This technique, not previously used for documentation of endometriosis in this location, is outlined in detail, together with a full description and illustration of the cytologic features.

Tick-bite fever in pregnancy. A case report.

Despite the frequency of tick-bite fever in southern Africa and its doubtless occurrence in pregnancy, this report documents the first case in a pregnant woman. Consequently, the natural history of tick-bite fever in pregnancy and concomitant placental involvement must be regarded as conjectural. Accordingly a register has been opened by the Department of Obstetrics and Gynaecology, University of the Witwatersrand, for recording similar cases. At this stage of our knowledge, erythromycin 500 mg 6-hourly until 3-5 days after defervescence is the therapy of choice for such patients.

Epithelial ovarian tumours of low malignant potential.

The available literature and the management of epithelial tumours of low malignant potential (LMP) is reviewed. The criteria for a diagnosis of LMP at the University of the Witwatersrand are delineated in detail. Based on the records in the Ovarian Tumour Registry of this University, experience with 29 such tumours over 4 years is presented. Of these, 14 (48.3%) were of the serous variety, 12 were mucinous (41.4%), and 2 (6.9%) were mucinous-serous, the remaining 1 (3.4%) being endometrioid. LMP tumours accounted for 12.9% of proliferating epithelial ovarian tumours in black patients compared with 16.9% in white patients. Pelviperitoneal cytological washings for detection of malignant cells in patients with LMP tumours is mandatory.

Fine-needle aspiration of a ureteric stricture used to diagnose persistent cervical carcinoma. A case report.

Fine-needle aspiration of a ureteric obstruction diagnosed persistent disease in a 65-year-old woman who 2 years previously had had a Wertheim hysterectomy and postoperative irradiation for a stage lb cervical carcinoma.

Renal adenocarcinoma presenting with bilateral metastases to Bartholin's glands: primary diagnosis by aspiration cytology.

The first recorded case of renal adenocarcinoma presenting with bilateral metastases to the Bartholin's glands is presented. Primary diagnosis of the metastatic deposits was made by fine-needle aspiration cytology with subsequent localization of the unsuspected renal primary. The value of fine-needle aspiration in the identification of inapparent primary tumors is discussed and cytological findings are described in detail.

Endometriosis of the rectovaginal septum. Diagnosis by fine needle aspiration cytology.

The cytologic picture seen in two cases of rectovaginal endometriosis diagnosed by fine needle aspiration (FNA) cytology is presented in detail. The cell pattern differed considerably from that previously described in fluid specimens and more closely resembled the exfoliation observed in direct endometrial samples. No previous report appears to exist on the diagnosis of rectovaginal endometriosis by FNA.

Cytologic detection of cervical granuloma inguinale.

Two cases of granuloma inguinale detected cytologically on routine Papanicolaou-stained cervical smears are presented; the cytologic and histologic features are described in detail, and the electron microscopic appearances are shown. The suitability of the Papanicolaou stain in the detection of granuloma inguinale is discussed, with emphasis on possible differential diagnoses to be considered. It is concluded that a definitive diagnosis of granuloma inguinale can be made on routine Papanicolaou-stained smears showing the following spectrum of changes: intact capillaries indicative of epithelial and stromal ulceration; a marked inflammatory cell infiltrate consisting predominantly of neutrophils; epithelioid histiocytes representing granuloma formation; and Donovan bodies located in characteristic single or multiple intracytoplasmic vacuoles within large histiocytes. Recognition of this cytologic picture may enable early diagnosis, even in nonendemic areas, of a potentially disfiguring venereal disease.

Human papillomavirus infection related to oesophageal carcinoma in black South Africans. A preliminary study.

Oesophageal specimens derived from 70 patients with established invasive squamous cell carcinoma of the oesophagus were histologically reviewed with special reference to the morphological manifestations of human papillomavirus (HPV) infection. Epithelial changes fulfilling the criteria for HPV infection were noted in 23 cases (33%). The presence of HPV antigens was demonstrated by immunohistochemical staining in 7 of these 23 cases. Although acceptable for routine diagnostic purposes, histological typing and immunoperoxidase staining methods are not entirely conclusive of HPV infection. Electron microscopy for detection of viral particles and a molecular hybridization technique have to be used for absolute confirmation and viral subtyping. The results of this pilot study will be used for prospective studies to determine the role of HPV infection in the aetiology of oesophageal carcinoma.