Cryptococcosis in tree shrews (Tupaia tana and Tupaia minor) and elephant shrews (Macroscelides proboscides).

Fungal infections due to Cryptococcus neoformans occurred in seven short-eared elephant shrews (Macroscelides proboscides), six large tree shrews (Tupaia tana), and five lesser tree shrews (Tupaia minor) at the National Zoological Park during a 30-mo period in 1991-1993. Clinical signs were absent or included weight loss, shivering, dyspnea, and/or neurologic disease. Definitive antemortem diagnostic techniques included tracheal lavage and serum cryptococcal antigen latex agglutination titers. Thirteen cases were diagnosed solely by postmortem examination. The source of infection for these animals was uncertain, but C. neoformans is commonly found in soil and other organic material. Two lesser tree shrews and one large tree shrew received antifungal therapy and converted to a negative serum cryptococcal antigen titer.

Immunoglobulin therapy for autoimmune thrombocytopenia purpura during pregnancy. A report of two cases.

High-dose, intravenous immunoglobulin therapy may be effective in elevating low platelet counts in nonpregnant patients with autoimmune thrombocytopenia purpura (ATP). We used immunoglobulin successfully on two pregnant women with ATP who had been refractory to high-dose corticosteroid therapy. The 5-day infusions were started at 12 and 29 weeks' gestation, and the subsequent uncomplicated vaginal deliveries occurred after the shortest reported interval (8 days) and longest (28 weeks) following a single immunoglobulin infusion. A splenectomy was avoided, and no adverse maternal or neonatal effects were apparent.

Coexistent benign teratomas of the omentum and ovary. A case report.

A patient had two cystic teratomas, one involving the left ovary and the other parasitic and attached to the omentum in the upper right quadrant of the abdomen.

Autopsy findings in patients with uterine sarcoma.

Autopsy findings were reviewed in 22 patients treated for uterine sarcoma at the University of Michigan Hospitals. Included are 11 mixed mesodermal tumors, 6 endometrial stromal sarcomas, and 5 leiomyosarcomas. Only one patient died with disease limited to the pelvis. Forty-five percent of the patients died with disease limited to the pelvis and abdomen. The most common site of the disease above the diaphragm was the lung. Lymph nodes were involved in 59% of our patients. There were no obvious differences in the patterns of spread between the tumor types.

Prognostic features of sarcomas and mixed tumors of the endometrium.

A retrospective study of 103 patients with endometrial sarcomas treated at the University of Michigan Hospital includes 47 mixed homologous tumors, 32 mixed heterologous tumors, 21 pure homologous sarcomas (endometrial stromal sarcoma), and three pure heterologous sarcomas (rhabdomyosarcomas). Clinical characteristics appeared similar among the four patient groups. Fourteen percent of the patients had received previous pelvic irradiation. Twenty-nine percent of the patients with a clinical stage I or II tumor had extrauterine disease discovered at surgery. Extent of the tumor at the time of surgery strongly correlated with outcome, and only two patients with extrauterine disease were long-term survivors. Life table survival probability at five years was 58% with surgical stage I, 33% with surgical stage II, 13% with surgical stage III, 0 with surgical stage IV, and 5% in patients referred with recurrence. Risk factors predicting treatment failure were analyzed separately in surgical stages I and II using Cox model analysis. There was no difference in risk for treatment failure between pure endometrial stromal sarcoma, mixed homologous sarcoma, or mixed heterologous sarcoma. The strongest factor correlating with a poor outcome was deep myometrial invasion (P less than .001). An adverse trend was detected in those patients with previous pelvic irradiation, with advancing patient age, and with increasing uterine size, although these differences did not reach statistical significance. Neither the presence of heterologous tumor elements nor cervical involvement were found to be adverse prognostic factors.