Pterygium with granuloma faciale-like histologic picture.

PURPOSE: Description of a case with an atypical conjunctival pterygium with an unusual histologic picture suggesting granuloma faciale, a vasculitis-like disease of facial skin with a chronic, indolent course. Discussion of diagnosis and treatment. METHODS: Repeated clinical and histologic observations. RESULTS: A pterygium with an unusual nasosuperior localization was excised and examined microscopically. There was a dense vessel-related inflammatory infiltrate, essentially identical to granuloma faciale. The lesion recurred and, as granuloma faciale is amenable to dapsone (diphenyl sulfone), treatment with 100 mg daily resulted in rapid improvement, whereas reduction of the dose to 50 mg daily resulted in relapse. Reinstitution of the original dose resulted in normalization of the histologic picture. However, a recurrent pterygium developed, which had a quite unspecific histologic picture. CONCLUSION: A disease with a histologic picture essentially identical to granuloma faciale may manifest itself as a pterygium. Treatment with dapsone may be beneficial.

A case of hyperoxaluria. Radiological aspects.

PURPOSE: Oxalosis is an unusual pathological condition with calcium oxalate deposits in soft tissue and bone, recognized as osteosclerosis on radiography. Osteosclerotic bone changes in patients treated with hemodialysis are in most cases due to secondary hyperparathyroidism, but several other diagnoses have to be considered. MATERIAL, METHODS AND RESULTS: We describe the case of a young woman with advanced renal failure treated with hemodialysis since her youth. She had skeletal pain and radiological examination showed: osteosclerosis with sclerotic vertebral bodies; irregular sclerosis and unsharp periostal outline in the tubular bones of the extremities; and acrolysis and calcifications of vascular and soft tissue in the hands. Histological examination showed changes typical of oxalosis. A liver biopsy excluded primary oxalosis type I, and she probably had a secondary oxalosis due to renal failure. This condition (as opposed to primary oxalosis) can be treated with renal transplantation. CONCLUSION: Oxalosis is a rare condition but it should be considered in patients with radiological skeletal changes and chronic renal failure and should not be misinterpreted as renal osteodystrophy. The classification of oxalosis as primary or secondary is important for further treatment.

Salivary gland anlage tumor: cytologic features in a case examined by fine-needle aspiration.

The cytologic features in fine-needle aspirates from a rare benign nasopharyngeal salivary gland anlage tumor in a newborn boy are described and commented on, regarding therapeutically important differential diagnoses.

Imaging in chronic achilles tendinopathy: a comparison of ultrasonography, magnetic resonance imaging and surgical findings in 27 histologically verified cases.

OBJECTIVE: To compare information gained by ultrasonography and magnetic resonance imaging (MRI) in chronic achilles tendinopathy with regard to the nature and severity of the lesion. DESIGN: Imaging of both achilles tendons with ultrasonography and MRI was performed prior to unilateral surgery. Operative findings and histological biopsies together served as a reference. PATIENTS: Twenty-seven patients (22 men, 5 women; mean age 44 years; 21 athletes) suffering from chronic achilles tendinopathy participated in the study. Eighteen patients had unilateral and 9 had bilateral symptoms. RESULTS AND CONCLUSIONS: Surgical findings included 4 partial ruptures, 21 degenerative lesions and 2 macroscopically normal cases. Microscopy revealed tendinosis (degeneration) in all tendon biopsies, including cases with a partial rupture, but only slight changes in the paratendinous tissues (paratenon). Ultrasonography was positive in 21 of 26 and MRI in 26 of 27 cases. Severe intratendinous abnormalities and a sagittal tendon diameter > 10 mm suggested a partial rupture. In tendons with a false negative result histopathological changes were mild and a tendency towards a better clinical outcome was noted in the sonographic cases. Assessment of the paratenon was unreliable with both methods. Ultrasonography and MRI give similar information and may have their greatest potential as prognostic instruments.

Chronic Achilles tendinopathy. A survey of surgical and histopathologic findings.

The surgical findings and the histopathology are reported for 163 patients (134 males, 29 females; mean age, 38 years; range, 13-72 years; 75% athletes) with chronic Achilles tendinopathy. Biopsy specimens from symptomatic (155 cases) and nonsymptomatic (90 cases) parts of the tendon and from the paratenon (97 cases) were obtained. Surgical reports were reviewed and histopathology was evaluated according to a standardized protocol. Eighteen tendons also were analyzed by immunofluorescence for fibrinogen, immunoglobulins, and complement. Degenerative changes (tendinosis) characterized by abnormal fiber structure, focal hypercellularity, and vascular proliferation were noted in 90% of biopsy specimens from symptomatic parts of the tendons and, to a lesser degree, in 20% from nonsymptomatic parts. Fibrinogen could be identified in most lesion biopsy specimens. Partial tendon ruptures were present in 19% of the patients and always occurred in areas afflicted with tendinosis. The paratenon was mostly normal or revealed only slight changes. Increasing age and male gender were associated with more pronounced histopathologic changes. Tendinosis, sometimes complicated by partial rupture, appears to be the major lesion in chronic Achilles tendinopathy; the paratenon is rarely involved. Important features are a lack of inflammatory cells and a poor healing response.

Phenotypic characteristics of mononuclear cells in human ovarian tumors - with special reference to cystic and ascitic fluid.

The occurrence of mononuclear cells and their cell-surface phenotype was studied in cryo- and paraffin sections in 26 untreated ovarian tumors and in normal ovarian tissue. T cells (positive for CD4 or CD8 markers) were sparsely represented in all sections of normal ovarian tissue and benign ovarian tumors, and in most ovarian cancer sections. B cells were found in three malignant tumors, CD57-positive (natural killer) cells in two, and CD25 (interleukin-2 receptor)-positive cells in one. Macrophages occurred sparsely both in normal ovarian tissue and in benign and malignant ovarian tumors. One endometrioid ovarian cancer, however, manifested rich infiltration of T cells (predominantly positive for CD8 marker). Cystic fluid from malignancies manifested higher prostaglandin concentrations and total cell counts than did benign cystic fluid, but sparse lymphocytes as a rule (5-10% of the total cell count). As compared to cystic fluid, ascitic fluid had higher concentrations both of prostaglandins and cells, with up to 25% lymphocytes in connection with malignancies. Immunogenic activity thus would appear to be weak in ovarian cancer. The harvest of tumor-infiltrating lymphocytes (TIL) from cystic fluid in ovarian cancers is moderate, compared to that of tumor-associated lymphocytes (TAL) from corresponding ascitic fluid samples.

Black cartilage after therapy with levodopa and methyldopa.

A study was undertaken of 14 autopsy cases with pigmented rib cartilage. Twelve of these patients had been treated with levodopa because of Parkinson's disease for at least 6 years, and two had been treated with methyldopa because of essential hypertension for 19 years. Thirty-two percent of the autopsy cases of Parkinson's disease during a recent 70-month period demonstrated pigmented rib cartilage. Only one of them also demonstrated pigmentation of intervertebral disks. No abnormal pigmentation was seen in other sites. The pigment was located in the hyaline matrix of rib cartilage and in necrotic chondrocytes. Levodopa was chromatographically demonstrated within the cartilage of patients with Parkinson's disease, but in both pigmented and unpigmented sites. It is speculated that a pigmented drug metabolite is bound preferentially to the matrix of rib cartilage. Dopa pigmentation only occurs in cartilage and differs in several respects from endogenous and exogenous ochronosis. It appears to be harmless but irreversible.

Reversible scleroderma, fasciitis and perimyositis.

A patient with reversible scleroderma, fasciitis (without blood or tissue eosinophilia) and perimyositis is described. This case is of interest because it might be considered as an overlap between progressive systemic sclerosis and eosinophilic fasciitis.

Basal cell carcinoma. An epidemiologic study in a defined population.

BACKGROUND: The incidence of basal cell carcinoma (BCC) in a defined population is unknown. METHODS: The incidence of histologically diagnosed cases of BCC in a defined population of a city in southern Sweden was studied. Four 2-year periods were examined from 1970 to 1986. Cases from 1970 and 1980 were reexamined microscopically. RESULTS: From 1970 to 1986, the age-standardized incidence of BCC was doubled. BCC was equally common in male and female patients. It was possible to trace another BCC in the medical history of 41% of the patients. The risk of development of BCC increased rapidly with age greater than 55 years. Approximately two-thirds of the tumors were found in the head and neck region. There was a possible increase in superficial multicentric tumors on the trunk but otherwise an essentially unchanged pattern in type and distribution. CONCLUSIONS: The age-standardized incidence of histologically diagnosed BCC was doubled from 1970 to 1986. The rapid increase should be taken into consideration when planning allocation of medical resources.

Staphylococcal wound infection in the pig: Part I. Course.

Full-thickness excision wounds infected with Staphylococcus hyicus, a pig pathogen, or Staphylococcus aureus, a human pathogen, were produced in pigs. The inoculated wounds were kept occluded for 2 days and then exposed and biopsied at intervals for 9 to 12 days. The exposed lesions were edematous and exudative. The S. aureus model was experimentally advantageous because the infection remained localized to the wound without systemic infection or signs of discomfort. The S. hyicus infection caused a rash with skin blisters; thus, its use is discouraged. The concentration of S. hyicus in the wound on day 2 was log 8.6 +/- 0.4 CFU/g (mean +/- standard deviation). On day 4 the mean was log 9.2. For S. aureus the values were log 8.0 +/- 0.9 on day 2 and 6.9 on day 4 (p less than 0.05). Of the 50 individual values in the S. aureus series, 45 were above log 5. The inflammatory reaction was more pronounced after the infection with S. hyicus, whereas with S. aureus the fibroblast response came earlier and was more pronounced. The model parallels typical clinical courses of staphylococcal infection.

Non-traumatic brain abscess. Epidemiology, clinical symptoms and therapeutic results.

Two groups of patients with non-traumatic focal intracranial suppurative diseases were studied retrospectively to illustrate epidemiology, clinical symptoms and therapeutic results. The first group consists of 87 patients treated for brain abscess in the Department of Neurosurgery in Lund. During the 36-year period investigated (1947-1982) marked epidemiological changes occurred. Thus otogenic abscesses, constituting 33% of the cases below the age of 30 during the first 12 years of the study, virtually disappeared. During the third 12-year period of this study a marked increase in the number of abscesses was noted. The increase was caused particularly by the number of cryptogenic abscesses amounting to 51% of the material during 1971-1982. The second group of patients consists of all patients with pre- or post-mortem diagnosed brain abscess in the city of Malmö during 1960-1981. Since during this period 85% of all persons who died in this city were subjected to post-mortem examination this material offers a unique possibility of epidemiological studies. The combined study of these two groups of patients lends no support to the view that a real increase in the number of brain abscesses has occurred. We conclude that in patients with cryptogenic brain abscess the clinical symptoms do not usually indicate the presence of an infectious disease. In the majority of these patients a correct diagnosis has presumably not been obtained until the last decade. Furthermore, the investigation confirms the view that a mortality below 10% is nowadays feasible in unselected cases of brain abscess.

A histologic comparison of experimental microarterial end-in-end (sleeve) and end-to-end anastomoses.

Twenty-five microvascular end-in-end and 21 end-to-end anastomoses were performed on the central arteries (diameters 0.8 to 1.2 mm) of rabbit ears. The appearance of longitudinal specimens taken after intervals of 1 to 2 hours and 1, 3, 7, 14, 30, and 90 days was studied microscopically. Between 1 to 2 hours and 14 days, all end-in-end anastamoses showed considerable narrowing of the telescoped segment, and platelets had accumulated at the sleeved vessel end. The vascular walls of the telescoped segment were thickened distally, and the internal elastic laminas were folded in the lingitudinal direction due to contraction. Extensive loss of endothelium was observed both around sutures and distally in the telescoped segments. The stenosis initially noted in telescoped vessels gradually decreased due to atrophy of the medial layers in the double vascular walls. Following the organization of the platelet aggregates, subsequent endothelialization was completed between 7 and 14 days. After 2 weeks, neointimal hyperplasia was frequently found at the sleeved vessel end. In the early postoperative period, platelets covered exposed subendothelial structures and sealed defects in the vessel walls of all end-to-end anastomoses. During the first few postoperative weeks, the medial layers disintegrated and were replaced by increasing fibrosis. Reendothelialization was completed between 7 and 14 days, whereafter gradual intimal hyperplasia became significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Growth and function of human placenta and amnion grafted to nude mice. A preliminary communication.

Normal human placenta and amnion from the 20th week of pregnancy were transplanted into nude mice. The transplants retained the histological and immunohistochemical picture of the original tissue and maintained synthesis of human chorionic gonadotropin (hCG), pregnancy-specific beta 1-glycoprotein (SP1), GnRH and placental proteins PP5, PP11 and PP12 for 5 weeks. This experimental model has a wide potential application for studies on placental protein synthesis and the hormonal influence of human placenta on other simultaneously transplanted human tissues.

Occult bleeding from giant small-bowel diverticula.

Two cases of occult intestinal blood loss due to giant ileal diverticula are described. In one of them, ectopic gastric mucosa was found at microscopic dissection. In the other that was probably originating from a blind loop formation at a previous operation, multiple mucosal erosions, probably due to retained bowel contents, were considered responsible for the blood loss. Though giant diverticula are rare throughout the gastrointestinal tract, and usually cause symptoms other than bleeding, the importance of a careful search for this malformation in children with occult faecal blood loss is stressed.

Predominant B-lymphocyte deficiency in a case with lymph node disease resembling angioimmunoblastic lymphadenopathy.

A case with clinical and histological features resembling angioimmunoblastic lymphadenopathy, but with a very marked decrease in B-lymphocytes instead of T-lymphocytes is presented.

Methacycline hyperpigmentation: a five-year follow-up.

A five-year follow-up is presented of a unique material of patients who acquired a greyish black hyperpigmentation during long-term methacycline therapy for chronic bronchitis. The melanosis disappeared in cases in which tetracycline therapy was discontinued during the observation period but not in those in which doxycycline had been substituted. In two autopsy cases pigment deposits were also found in cartilage and atherosclerotic lesions. Overall clinical and microscopic findings suggest a similarity to the pigmentation occurring in iatrogenic ochronosis.