Diagnosis and management of malignant perirenal schwannoma.

Malignant retroperitoneal schwannoma is an extremely rare tumor, with only six cases previously reported occurring in the perirenal space. We herein report the seventh case. A 50-year-old woman presented with an abdominal mass suggestive of renal cell carcinoma by standard preoperative evaluation. The tumor required surgical exploration and pathologic evaluation for diagnosis. The final histologic diagnosis was made with the aid of electron microscopy and immunohistochemical staining with antibodies for S-100 protein.

The role for regional autopsy centers in the evaluation of covered deaths. Survey of opinions of US and Canadian chairs of pathology and major health insurers in the United States.

OBJECTIVE: To evaluate the advantages and disadvantages of, as well as the attitudes of health care professionals and insurers toward, the development of regional autopsy services. DESIGN: Survey of 150 medical school departments of pathology in the United States and Canada and 12 representative major health insurers in the United States. RESULTS: Of the 25 respondents from the pathology departments, most were in favor of regionalization of autopsy services, if properly underwritten. Of the five respondents from the health insurers, most were disinterested in the autopsy as a measure of outcome and unwilling to provide support. CONCLUSIONS: Health care is being regionalized around networks of insurers rather than hospitals. The networks are defined by a mixture of hospitals, physician groups, and other health care professionals. Within networks, the goal is to subscribe groups of patients, covered lives, for all medical needs from primary to complex care. As the economic risk of caring for patients is shifted to physicians, the incentive to provide service at the lowest possible cost grows, as does the need to assure that medical mismanagement does not occur. To provide quality care at affordable costs, it is necessary that outcomes, including deaths, be professionally evaluated. The present system of death investigation involves hospital colleagues and is potentially biased. Regional autopsy centers that provide timely expert information should be part of the health care system. Medical schools are potential sites for regional autopsy programs because they have the personnel needed to conduct appropriate death-related studies. Most schools are affiliated programmatically and economically with surrounding hospitals and physicians in a manner in which outcomes, costs, and quality of clinical service are of common interest.

Benign fibrous testicular pseudotumors in children.

Benign fibrous pseudotumors of the testicular tunics are rare in children. We report 2 cases of benign fibrous pseudotumors that were managed with gonad sparing surgery. We discuss the etiology, evaluation and treatment of benign fibrous pseudotumors of the testis.

Recurrent massive upper gastrointestinal hemorrhage due to Strongyloides stercoralis infection.

A 29-yr-old black male immigrant from Africa presented with recurrent life-threatening upper gastrointestinal bleeding due to massive duodenal infection by Strongyloides stercoralis. The diagnosis was missed by repeated examinations of fresh stool specimens for ova and parasites and by an initial esophagogastroduodenoscopy. The diagnosis was made by pathologic examination of a duodenal biopsy and of a duodenal aspirate obtained at a second esophagogastroduodenoscopy. This has been previously reported as a cause of massive upper gastrointestinal hemorrhage in four cases. Patients with obscure gastrointestinal bleeding who have travelled or lived in an endemic area should have a duodenal aspiration performed at esophagogastroduodenoscopy.

The cytology of vaginal, cervical and endometrial smears obtained at the time of embryo transfer during in vitro fertilization.

Seventy-four women enrolled in an in vitro fertilization (IVF) program had cytologic smears of the vagina, cervix and endometrium obtained at the time of embryo transfer (ET). Of these, 68 vaginal, 46 cervical and 25 endometrial smears were available for cytologic examination. Of the 68 vaginal smears, 4% showed a proliferative pattern, 40% were early secretory and 56% were advanced secretory. The 46 cervical smears demonstrated a delayed hormonal effect, with 70% showing a proliferative pattern, 23% early secretory and 7% advanced secretory cytology. Endometrial cells were obtained only when the Jones catheter, which has a side opening, was used. Twenty-two patients had both vaginal smears and suitable endometrial smears. Of these, 8 of the 9 patients with early secretory vaginal cytology had secretory endometrium while 10 of the 12 patients with mid-secretory vaginal cytology had secretory endometrium. The value of endometrial cytology in predicting conception following IVF-ET is unknown. It seems, however, that a good correlation exists between endometrial and vaginal cytology and that the latter may be of value as an additional, noninvasive tool for the evaluation of endometrial development.

Light and electron microscopic studies of an antibiotic bonded vascular graft.

Polytetrafluoroethylene grafts were bonded to oxacillin with the cationic surfactant, benzalkonium chloride. Grafts were placed in the canine aorta and harvested six and twelve weeks after implantation. Light and scanning and transmission electron microscopy were performed in all specimens. No histological differences could be demonstrated between control and antibiotic bonded grafts. Significant antibacterial activity was demonstrated at the time of graft implantation. However, none remained six and twelve weeks later.

Prevention of vascular prosthetic infection by a benzalkonium-oxacillin bonded polytetrafluoroethylene graft.

Polytetrafluoroethylene grafts were bonded to oxacillin using benzalkonium chloride. Grafts were then placed in the infrarenal aorta of dogs and contaminated with Staphylococcus aureus. At death or sacrifice, bonded grafts were significantly superior to that for controls in the absence of bacteria histologically, negative cultures, patency and survival. Histologic evaluation of grafts by light and electron microscopy demonstrated normal healing and neointima formation of bonded grafts. The future role of antibiotic bonding in the prevention of vascular prosthetic infections is discussed.