Diffuse interlobular septal thickening in a coal miner.

Diffuse interlobular septal thickening (DIST) is an abnormality seen on high-resolution CT (HRCT) scanning of the thorax. While DIST may be present to variable extents in a number of lung conditions, it is uncommon as a predominant finding except in a few entities. This report features an ex-coal miner, thought to have coal workers' pneumoconiosis (CWP), in whom the HRCT scan showed no evidence of CWP and instead showed DIST. The patient's condition progressed incessantly towards death from severe secondary pulmonary hypertension. The case links fatal pulmonary hypertension to DIST, a pattern not previously described in coal workers.

Halving of body weight: a case of an ovarian mucinous cystadenoma.

Benign, mucinous cystadenomatas account for 15% all ovarian neoplasms and of these, giant variants occur rarely. Ovarian masses, particularly mucinous cystadenomas, are among the largest tumours known. Surgery is the treatment of choice for a large mucinous cystadenoma. In this report we present an interesting case of an ovarian mucinous cystadenoma weighing 40 kg. Surgical treatment was successful and the patient adjusted well to her postoperative body image.

Allelotype analysis of oesophageal adenocarcinoma: loss of heterozygosity occurs at multiple sites.

Deletions of tumour-suppressor genes can be detected by loss of heterozygosity (LOH) studies, which were performed on 23 cases of adenocarcinoma of the oesophagus, using 120 microsatellite primers covering all non-acrocentric autosomal chromosome arms. The chromosomal arms most frequently demonstrating LOH were 3p (64% of tumours), 5q (45%), 9p (52%), 11p (61%), 13q (50%), 17p (96%), 17q (55%) and 18q (70%). LOH on 3p, 9p, 13q, 17p and 18q occurred mainly within the loci of the VHL, CDKN2, Rb, TP53 and DCC tumour-suppressor genes respectively. LOH on 5q occurred at the sites of the MSH3 mismatch repair gene and the APC tumour-suppressor gene. 11p15.5 and 17q25-qter represented areas of greatest LOH on chromosomes 11p and 17q, and are putative sites of novel tumour-suppressor genes. LOH on 9p was significantly associated with LOH on 5q, and tumours demonstrating LOH at both the CDKN2 (9p21) and MSH3 (5q11-q12) genes had a significantly higher fractional allele loss than those retaining heterozygosity at these sites. Six of nine carcinomas displaying microsatellite alterations also demonstrated LOH at CDKN2, which may be associated with widespread genomic instability. Overall, there are nine sites of LOH associated with oesophageal adenocarcinoma.

Solitary fibrous tumour arising in the nasal cavity: report of a case.

The nasal and the paranasal sinuses are a rare site for solitary fibrous tumours. There have been no previously reported cases in the English literature, with eight cases in the world literature (Witkin and Rosai, 1991; Zuckerberg et al., 1991). We present a case of a solitary fibrous tumour arising in the nasal cavity and review the previous reports.

Do women with idiopathic sensory urgency have early interstitial cystitis?

Interstitial cystitis is rarely considered as a cause of urinary symptoms in referrals to gynaecology clinics. Recent concepts in the diagnosis of this condition mean that it is emerging as a much more common entity, with both early and late forms of the disease being described. Mast cell density in the detrusor muscle has been reported to be useful as a disease marker to substantiate the diagnosis of interstitial cystitis where no classical diagnostic features exist. We assessed mast cell counts in bladder biopsies from 27 women with idiopathic sensory urgency and 10 control patients about to undergo a colposuspension procedure for pure genuine stress incontinence; 30% of the study group had a clear increase in the detrusor muscle mast cell population (detrusor mastocytosis). No control patient showed such an increase. Early interstitial cystitis should be considered as a possible cause of lower urinary tract symptoms in patients with apparently idiopathic sensory urgency.

Pulmonary endocrine cells in chronic bronchitis and emphysema.

A rôle for pulmonary endocrine cells has been suggested in the response of the lungs to hypoxia, the control of the pulmonary vasculature and inflammatory pulmonary disease. Since hypoxia, inflammation and vascular remodelling are all central to the pathology of chronic bronchitis and emphysema, we have studied these cells in the lungs of subjects with this condition. In comparison with lungs of matched controls, there was a modest uniform increase in endocrine cells containing gastrin-releasing peptide, possibly associated with vascular remodelling, and a marked increase in cells containing calcitonin, which was particularly seen in consolidated lobes and possibly related to inflammation.

Pulmonary endocrine cells in chronic bronchitis and emphysema.

Pulmonary endocrine cells have been studied according to their immunoreactivity for neuron-specific enolase, gastrin-releasing peptide (GRP), calcitonin, leucine-enkephalin, and serotonin in the lungs of subjects with chronic bronchitis and emphysema. The overall population was significantly greater in comparison with matched controls. The change was most marked in lobes affected by pneumonic consolidation, and did not affect equally the sub-populations of cells as identified by their content of peptide; the difference was much greater for calcitonin-containing cells than for those immunoreactive for GRP. This change may be the basis of the hypercalcitoninaemia and hypercalcitoninuria which have been reported in patients with inflammatory pulmonary disease.

Neuroendocrine cell populations in normal human lungs: a quantitative study.

Pulmonary neuroendocrine cells, identified by their positive immunochemical reaction for neurone specific enolase, were readily demonstrable and uniformly distributed in 15 pairs of normal adult human lungs. About 65% contained gastrin releasing peptide and nearly all the rest contained calcitonin. Leucine-enkephalin was not found. Serotonin containing cells were few, and cells immunoreactive for adrenocorticotrophin and antidiuretic hormone were absent. About one in 10 cells was argyrophilic, and costorage of peptides was not seen.

Immunochemistry and electron microscopy of head and neck rhabdomyoma.

Rhabdomyomas are rare benign tumours originating in skeletal or cardiac muscle. Extracardiac tumours are usually situated in the head and neck. Four cases are presented, three arising in the larynx and the other in the cervical region. All four cases were studied by light and electron microscopy, and in three immunohistochemical staining for myoglobin, desmin, and vimentin was carried out to study the diagnostic features of the lesions and their histogenesis.

Temporal study of metabolic change when poorly controlled noninsulin-dependent diabetics change from low to high carbohydrate and fiber diet.

Thirteen poorly controlled noninsulin-dependent diabetic subjects ingested in succession over 5.5 wk their usual low-carbohydrate, low-fiber diet (LCF) for 3 d, a high-carbohydrate, high-fiber diet (HCF) for 3 wk, and the LCF diet again for 2 wk. All diets were designed to be individually isoenergetic. Fasting plasma glucose fell significantly during the HCF diet and then rose significantly during the last LCF diet. Dietary change rather than hospitalization had its full effect by 18 d. Urinary glucose excretion rose transiently on the HCF diet before also falling significantly. Similarly, pancreatic immunoreactive glucagon (IRG) fell significantly on the HCF diet and increased significantly on the LCF diet. No significant differences were observed in plasma insulin, serum free fatty acids, or monocyte insulin binding activity between the two diets. Reduction in circulating IRG may in part explain the lower fasting (or basal) plasma glucose observed on HCF diets.

Pulmonary endocrine cells immunoreactive for calcitonin in the lungs of fetal and neonatal rats.

Previous studies have shown that the size of the population of bronchopulmonary endocrine (Feyrter) cells appears to be greatest in fetal and neonatal life. This has led to the logical assumption that these cells are important during this period and undergo a subsequent decline in number thereafter. In this study endocrine cells containing calcitonin or a closely related cross reacting peptide have been demonstrated in the lungs of fetal and neonatal rats by immunoenzyme histochemistry. They appear first about three days before birth and their number, expressed as immunoreactive cells per cm2 of histological section, remains relatively constant for up to three weeks after birth. It has been shown previously in this department that endocrine cells immunoreactive for calcitonin are present in the lungs of the normal adult rat. Their number in these adult animals is closely similar to the numbers of cells in the lungs of the developing animals of the present study. It is suggested that, at least in the rat, bronchopulmonary endocrine cells immunoreactive for calcitonin have a role that is not confined merely to the period of transition from fetal to neonatal life.

Quantitative study of endocrine cells immunoreactive for calcitonin in the normal adult human lung.

There was no significant variation in the numbers of bronchopulmonary endocrine cells immunoreactive for calcitonin in five pairs of adult human lungs either from case to case or between groups of anatomically equivalent lobes. This was the case whether their numbers were expressed in relation to epithelial length or to the total number of epithelial cells. The mean (SD) values for the frequency of occurrence of these cells in all 25 lobes studied were 4.3 (1.9) per 10 cm of epithelial length or 1.70 (0.78) per 10 000 epithelial cells. Most immunoreactive cells were single and situated in the airways; only three neuroepithelial bodies were observed, and no cells were present in the parenchyma examined. This study provides further evidence that the functional character of these cells may not be confined to early life.

Widespread distribution of bronchopulmonary endocrine cells immunoreactive for calcitonin in the lung of the normal adult rat.

The nature and distribution of bronchopulmonary endocrine cells immunoreactive for calcitonin was studied in normal adult Wistar albino rats by immunoenzyme histochemistry with the peroxidase-antiperoxidase technique. A widespread distribution of both solitary endocrine cells and neuroepithelial bodies immunoreactive for calcitonin was found. Many, but not all, were also immunoreactive for neurone specific enolase. Although both classes of cells were present in airways and parenchyma, most of the solitary cells were found in alveolar ducts and alveoli whereas most of the neuroepithelial bodies were located in bronchi and bronchioles. Bronchopulmonary endocrine cells are generally regarded as being sparse in the adult rat. It is suggested that this may be a consequence of the use of inadequate methods in attempting to identify them. So far as is known, this is the first time that calcitonin has been demonstrated by immunohistochemical methods in the lungs of rats.

Quantitation of pulmonary megakaryocytes and fibrin thrombi in patients dying from burns.

Pulmonary megakaryocytes and fibrin microthrombi were counted in lung sections from 22 patients dying from extensive burns. There was a significant correlation between numbers of megakaryocytes and fibrin microthrombi, supporting a relationship between disseminated intravascular coagulation (DIC) and numbers of pulmonary megakaryocytes. No correlation was found between antemortem platelet counts and either fibrin microthrombi or megakaryocytes. Possible explanations for this are forwarded and the nature of pulmonary megakaryocytes discussed.