A case of pulmonary veno-occlusive disease in infancy.

A 1-year-old girl who had failure to thrive died suddenly of pulmonary veno-occlusive disease. In this case, the vascular disorder was due to nonthrombotic obstruction of only the postcapillary venules. This unusual pattern of involvement and the absence of thrombi, new or old, suggests that the pathogenesis of pulmonary veno-occlusive disease may involve mechanisms other than thrombosis.

Cytologic evaluation of pulmonary effluent in neonates with respiratory distress syndrome and bronchopulmonary dysplasia.

Tracheobronchial effluent from 108 infants with respiratory distress syndrome (RDS) was classified cytologically in relationship to the duration of endotracheal intubation and mechanical ventilation with supplemental oxygen. Three cytologic classes emerged: class I (1 to 4 days), associated with exfoliation of cohesive and organized sheets of tracheobronchial cells, class II (4 to 10 days), during which regeneration of tracheobronchial cells was prominent and reactive cells were present, and class III (after 10 days), during which squamous metaplasia, chronic inflammation and regeneration were characteristic. An influx of polymorphonuclear neutrophilic leukocytes and macrophages was typical of classes II and III. In 70% of the cases, the identification of class III changes enabled the diagnosis of bronchopulmonary dysplasia (BPD) to be made earlier than by radiography alone. This classification of tracheobronchial cytology should be of benefit in the identification and treatment of infants with bronchopulmonary dysplasia. It may also offer a more direct means for evaluating new therapy to prevent or modify this disorder.

Newborn tracheal aspirate cytology: classification during respiratory distress syndrome and bronchopulmonary dysplasia.

Cytopathologic examinations of tracheobronchial aspirates from 108 infants sampled during mechanical ventilation demonstrated a well-defined progression of cytologic changes in bronchial cells that could be divided into three classes. Seventy percent of infants with respiratory distress syndrome who developed bronchopulmonary dysplasia had pulmonary effluent cytology designated Class III; no infants with RDS but without BPD had these cytologic findings. Additionally, a temporal progression of events involving polymorphonuclear leukocyte and macrophage populations occurred in the absence of infection; these events were associated with duration of assisted ventilation and oxygen exposure. The technique described provides a useful way to monitor the progression of lung injury and repair and offers a cytologic method to predict and diagnose the development of bronchopulmonary dysplasia.

Legionnaires' disease in a patient with systemic lupus erythematosus.

A young woman with systemic lupus erythematosus developed a rapidly fatal pneumonia from which no visible or culturable organisms were found. Subsequent stains disclosed typical findings of Legionnaires' disease. A cutaneous portal of entry was suspected and a fulminant lung abscess developed, neither of which has been previously reported in Legionnaires' disease.

Metastatic malignant melanoma transplanted via a renal homograft: a case report.

A case of transplantation of a malignant melanoma via a cadaver renal homograft is presented. The recipient developed a widespread malignancy ninteen months after renal transplantation. At autopsy the tumor was diagnosed as a malignant melanoma. Autopsy of the donor had previously revealed a spindle cell malignancy in the spleen. It is postulated that the splenic tumor in the donor represents a spindle cell variant of malignant melanoma, and hence this malignancy was inadvertently transferred to the recipient via the renal homograft.

Systemic amyloidosis in cystic fibrosis.

We report two siblings with cystic fibrosis and systemic amyloidosis. The major clinical problem in both cases was recurrent respiratory infection with pulmonary fibrosis and bronchiectasis prior to death at ages 20 and 22 years. Findings from postmortem examinations disclosed diffuse amyloidosis. In addition, amyloid infiltration developed in both patients, with enlargement of the thyroid gland, and one required thyroidectomy. An autopsy review of 17 additional cases of cystic fibrosis failed to disclose any other instances of systemic amyloidosis.

Dissection of the aorta complicating intra-aortic balloon counterpulsation.

A 61-year-old man with recent myocardial infarction complicated by a ventricular aneurysm and recurrent ventricular tachycardia underwent intra-aortic balloon counterpulsation prior to angiography and left ventricular aneurysmectomy. A dissecting aneurysm of the descending aorta adjacent to the position of the balloon catheter was found at autopsy. No intimal tear or cystic medial degeneration of the aorta was present to account for the dissection. The authors suggest that lateral and shearing forces generated by inflation of the balloon could result in dissection of the aorta.