Pinworms and postmenopausal bleeding.

The human pinworm Enterobius vermicularis is normally found within the human gastrointestinal tract. Pregnant females migrate out of their host's anus at night to lay their eggs perianally. As a consequence of this nocturnal migration some worms find their way into adjacent orifices, most commonly the female genitourinary tract, producing irritative symptoms such as vulvovaginitis. A case of pinworm infestation of the uterus presented as postmenopausal bleeding.

Massive aneurysm of the right coronary artery causing sudden death.

Coronary artery aneurysms due to atherosclerosis are increasingly recognised during angiography yet the natural history of these abnormalities has not yet been defined. Only rarely has massive dilatation been observed, usually presenting following death. We report a case of sudden death due to rupture of a massive right coronary artery aneurysm measuring 10 x 5 cm. Diagnosis was made at post-mortem.

Coronary anatomy in patients with various manifestations of three vessel coronary artery disease.

The histology of coronary arteries was compared in patients with rest and effort angina. The arteries came from six patients with three vessel disease who died within four weeks of arteriography and ambulatory ST segment monitoring. Sections of all macroscopically visible arteries were taken every 5 mm and examined histologically. Episodes of ST segment depression had occurred on exertion in two patients, during exertion and rest (nocturnal) in two, and two patients had had no episodes of ST segment depression during ambulatory monitoring. Concentric (29%) or eccentric (62%) intimal thickening due to atheroma or fibroelastic tissue was found in 91% of sections. All but two normal intimal sections (1%) were found to be diseased in patients with ambulatory ST segment changes. Eccentric lesions with medial smooth muscle preservation in areas without intimal thickening, where further luminal narrowing could occur due to increases in smooth muscle tone, were found in 15% of sections. But these areas were not found in the proximal 3.5 cm of any of the major coronary arteries of the two patients with rest and effort ischaemia. Spasm could not have caused total occlusion in any of these arteries because the lumen was splinted by the lesion. There was no difference in mean luminal narrowing between patients with exertional and rest ischaemia and exertional ischaemia only (mean 74%), but mean luminal narrowing was lower in patients with no ambulatory episodes of ST segment change (39%). Thus medial smooth muscle spasm was unlikely to have caused occlusion in patients with ambulatory ST segment changes, although it could have altered lumen diameter. There are no histological differences in the coronary arteries of patients with rest or effort induced myocardial ischaemia.

Comparison of the haematoxylin basic fuchsin picric acid method and the fluorescence of haematoxylin and eosin stained sections for the identification of early myocardial infarction.

A retrospective study has been carried out on the necropsy material from 30 patients who have died after a clinically diagnosed myocardial infarction. This study has been undertaken to compare the reliability of the fluorescence of infarcted myocardium when stained by haematoxylin and eosin and an adjacent section stained by the haematoxylin basic fuchsin picric acid (HBFP) method to detect early ischaemia. The results showed that the fluorescence technique is reliable, reproducible and coincides with the findings obtained by HBFP stain.

The floppy mitral valve. Study on pathogenesis.

The pathogenesis of the floppy valve syndrome is not fully solved. An almost invariable histological finding is the great accumulation of mucinous material in the valve leaflets and constitutes the basis of the valvular theory of the syndrome. The presence of a mucinous layer in normal valves-- the zona spongiosa--is not well recognised. To establish the normal range of the extent of this zone, 50 excised mitral valves from patients aged 2 to 89 years and who died as a result of road traffic accidents or non-cardiac causes have been analysed by measuring the thickness of the zone in relation to the valve thickness. A range of 0 to 60 per cent was found and this was not influenced by age. The findings were compared with 50 patients clinically diagnosed as suffering from the floppy valve syndrome. A value of over 60 per cent (range 62 to 94%) was found in 43 patients. The increase in the extent of the mucinous material was considered to be a secondary change in the thickened fibrosa which normally accompanies the floppy valve syndrome. Measurements of zona spongiosa falling within the normal range were found in seven patients. The clinical features, complications, and accompanying conditions have also been analysed. Chordal rupture had occurred in 20 patients, infective endocarditis in three, and calcification was found in four valves. In four patients the aortic valve was also involved and accompanying aortic root dilatation in an additional patient. It is suggested that these patients should not be included in the group of Marfan's forme fruste, nor in the typical floppy mitral valve syndrome. Apart from the valvular theory, the myocardial theory in the pathogenesis of the syndrome has been discussed and the components ensuring normal mitral valve function have been reviewed. It is concluded that an inherent, prominent zona spongiosa predisposes to the floppy valve syndrome, particularly if any one of the components of normal valve function is abnormal.