Disseminated herpes simplex virus infection in an apparently immunocompetent woman.

A young, previously healthy woman developed bilateral exudative tonsillitis that was associated with severe systemic symptoms. This was followed by evidence of multisystem disease with acute abdominal pain, raised liver enzyme levels, respiratory difficulty, increasing drowsiness and multiple vesicular skin lesions. Herpes simplex virus type-1 was isolated from skin lesions and a throat swab and herpes simplex virus type-1 antigen was detected in a liver biopsy sample. She recovered rapidly without any sequelae after treatment with intravenously administered acyclovir.

Barrett's esophagus: clinical, endoscopic, and histologic spectrum in fifty patients.

The columnar lined (Barrett's) esophagus is an acquired condition resulting from chronic gastroesophageal reflux. The clinical spectrum of 50 consecutive cases of endoscopically consistent, histologically proven Barrett's esophagus was reviewed. The mean age of patients was 65.9 +/- 12.4 (SD) years with only four patients younger than 50 years. The predominant presenting symptoms were dysphagia, heartburn, and regurgitation. At endoscopy, the columnar lined segment extended over 6.5 +/- 3.0 cm of the lower esophagus. Specialised columnar (intestinal) epithelium was the most frequent histological type identified. Radiologic or endoscopic evidence of a hiatal hernia was present in the majority. Complications were present at endoscopy in 38 (76%) patients. Reflux esophagitis (56%) was present at the area of the squamo-columnar junction. Stricture formation (38%) and ulceration (36%) were located either at the squamo-columnar junction or more distally within the columnar epithelium. Two patients (4%) had adenocarcinoma arising in a segment of Barrett's esophagus at presentation. Treatment included physical measures, dilatation, and cimetidine. Bougienage in 20 patients was successful in alleviating dysphagia but multiple treatment sessions were often necessary. Although esophagitis readily resolved with cimetidine therapy, ulceration was generally resistant to medical therapy. Indeed, by two months, healing was achieved in only five of 12 patients. Endoscopic surveillance of 12 patients who received cimetidine (1 g/day) for at least 12 months showed no regression of the metaplastic mucosa.

Early gastric cancer.

Thirty patients with early gastric cancer were studied as part of a consecutive series of 308 gastric cancers, giving a proportion of 9.7%. Twenty-eight of the early gastric cancer patients were symptomatic, pain being the most common symptom. Endoscopy proved more effective than barium studies as a first investigation but the diagnosis rate at first examination was still only 69%. Seven patients with early gastric cancer had lymph node spread at the time of presentation. Five patients eventually died of cancer metastases. There was a high incidence of benign peptic ulceration (50%) and this with lymph node metastasis was an unfavourable prognostic feature. Only four of the 26 patients submitted to standard surgical resections died of cancer. This study supports the concept that early gastric cancer does indeed occur in Western man and the five year survival rate (65%) is much higher than for late gastric cancer (13%). The high incidence of metastasis at the time of presentation may account for the difference between our survival rate for early gastric cancer, and that reported from Japan.

Comparative evaluation of diagnostic cytological features of malignancy in GMA sections, paraffin sections and smears.

A quantitative evaluation of glycol methacrylate (GMA) embedded sections in the cytological assessment of body fluids is reported for the first time. The technique is compared with routine smears, filter preparations and paraffin sections of cell blocks. Diagnostic problems were encountered mainly in the assessment of reactive mesothelial cells and lymphoreticular cells. Diagnostic accuracy was highly dependent on technique of cell preparation, and the GMA sections were a useful supplementary technique in cases where there were difficulties of interpretation. The method offers the advantage of improved sampling by using a concentrated cell block technique and high resolution of cellular detail essential for accurate cytological diagnosis.

Congenital hepatic fibrosis associated with Mallory bodies and copper retention.

New observations are described in a case of congenital hepatic fibrosis. Histochemical stains of liver tissue for copper (rhodanine) and copper associated protein (orcein) were positive and hepatic copper concentration, measured by atomic absorption spectroscopy, was markedly elevated being 550 micrograms/g dry weight (NR less than 30 micrograms/g dry weight). Mallory bodies were observed in several areas in liver sections. These observations have not been previously recorded in congenital hepatic fibrosis. Increased hepatic copper concentration in this case may have contributed to the production of liver damage. Hepatic copper concentration should be specifically measured in other patients with congenital hepatic fibrosis.

Intracellular acidic mucins and their identification in diagnostic cytology.

Exfoliative, abrasive and aspiration cytology were increasingly relied upon for tissue diagnosis of tumours. The established histological stains for the differentiation of mucin and non-mucin-secreting tumours are not ideal for alcohol-fixed cytology smears and a more reliable cytological technique for the preservation and staining of intra-cellular acidic mucins using Alcohol Alcian Blue 8GX is presented.

Severe tubulo-interstitial disease in a renal allograft due to cytomegalovirus infection.

A 34 year old female developed impaired function of her renal allograft 21 months post-transplant. This was associated with lethargy, pyrexia, tenosynovitis, pancytopenia and a colonic ulcer. Severe tubulo-interstitial changes with intranuclear inclusion bodies and intracytoplasmic herpes type viral particles were seen on renal biopsy. There was no evidence of rejection. Cytomegalovirus was cultured from the urine and there was a rise in CMV antibody titer. These findings suggested the renal impairment was due to a direct cytopathic effect of the CMV. Despite treatment with transfer factor and adenine arabinoside, there was progressive loss of graft function.

Liver disease and the e antigen in HBsAg carriers with chronic renal failure.

This study was undertaken to assess the frequency of development and the stages of evolution of chronic liver disease in patients with renal failure who are chronic carriers of hepatitis B surface antigen. Cirrhosis or chronic active hepatitis developed in five of 21 patients and could not be predicted by the initial histological appearance or by HLA-A and B typing but was associated with the e antigen in four of the five patients. However, the antigen was not a consistent indicator of a poor prognosis, as the four other e antigen positive patients did not develop chronic liver disease during the period of the study. Transmission of hepatitis B to spouses occurred in four cases, was fatal in one instance, and was associated with e antigen in three of the four. Determination of e antigen status in renal unit patients who are carriers of hepatitis B surface antigen may be of value to the patient and his home environment.

Alpha1-antitrypsin deficiency--a literature review and a case report of a patient with chronic obstructive airways disease and cirrhosis.

A patient who manifested both pulmonary and hepatic disease associated with alpha1-antitrypsin deficiency is described. The biological function of alpha1-antitrypsin is discussed, as well as the inheritance of deficiency states and the spectrum of disorders which may ensue. Severe deficiency of alpha1-antitrypsin has been linked with pulmonary emphysema in adult life, progressive liver disease in childhood, adult cirrhosis but rarely with both pulmonary and liver disease.