Chronic intrauterine meconium aspiration causes fetal lung infarcts, lung rupture, and meconium embolism.

Three neonates with chronic intrauterine meconium aspiration are reported. All had distinctive subpleural plate-infarcts of the lungs caused by meconium-induced vasoconstriction of peripheral preacinar arteries. These vessels showed plexogenic arteriopathy with medionecrosis and obliterative hyaline sclerosis. Organized thrombi and systemic-pulmonary arterial anastomoses were numerous. The infarcts contained inspissated meconium with a granulomatous reaction. In one case, lung rupture occurred, causing meconiumthorax and meconium embolism to hilar lymphatics and lymph nodes; this suggests that particulate meconium may enter the circulation. This fetus had rubella and probable acute twin-twin transfusion following the intrauterine death of the co-twin. The cause of the hypoxia that led to intrauterine passage of meconium in the other cases is unknown. Meconium-stained amniotic fluid was noted in only one case.

Prenatal diagnosis of osteogenesis imperfecta.

The lethal perinatal types (II A-C) of osteogenesis imperfecta are reported to occur in approximately 1:55000 births. We here present three cases in three unrelated families, diagnosed by antenatal ultrasound within one year. A reliable diagnosis of the lethal perinatal type of osteogenesis imperfecta can be made by ultrasound examination during the second trimester, by identification of fractures of the long bones. The compression of the fetal head by the ultrasound probe and the low echogeneity of the cranium, should raise the suspicion of skeletal dysplasia, but is not diagnostic for osteogenesis imperfecta. The diagnosis is confirmed by postmortem examination including radiography and biochemical studies of cultivated fibroblasts from the fetus. Although rare, this lethal condition should be recognized when an ultrasound examination is performed, to prevent unnecessary obstetric intervention. In families with a previously affected fetus, prenatal diagnosis by first trimester transvaginal ultrasound investigation or chorionic villus sampling should be discussed.

Ophthalmomyiasis caused by the reindeer warble fly larva.

Two boys with ophthalmomyiasis caused by the first instar larva of the reindeer warble fly Hypoderma tarandi are reported. Both were 9 years old and came from the coast of northern Norway. One had ophthalmomyiasis interna posterior and one eye had been removed because of progressive pain and blindness. Histological examination showed the remains of a fly larva. The second boy had ophthalmomyiasis externa with a tumour in the upper eyelid, and histological examination showed a warble with a well preserved larva. Identification of the parasite in the histological material was based on the finding of cuticular spines and parts of the cephalopharyngeal skeleton identical with those of the first instar larva of H tarandi.

Holocene timberline fluctuations in jasper national park, alberta.

Pollen, fossil logs, and macrofossils from three high-elevation sites in the Maligne Range, Jasper National Park, Alberta, provide the first detailed record of timberline fluctuations in the Canadian Rockies during the last 8700 years. Timberlines were much higher than at present between 8700 to 5200 years ago but oscillated significantly in elevation, with a major episode of timberline recession punctuating two periods of high timberline between about 6700 to 5900 and about 8700 to 7000 years ago. Since 5200 years ago, regional timberlines have generally receded with perhaps brief reversals, reaching their lowest recorded positions sometime after 500 years ago.

Lateral cervical anomaliew and salivary heterotopia.

It is widely accepted that most lateral cervical fistulas with an external opening in the suprasternal region orginate from second branchial arch remnants. Lateral cervical cysts occur higher in the neck and according to current theories, may develop either from the branchial apparatus or from glandular inclusions in cervical lymph nodes. An histological study revealed salivary tissue in 9 of 24 fistulas, 5 of these representing a congenital cervical salivary sinus, while only one of 17 cysts showed salivary heterotopia. This investigation indicates that salivary tissue may occur more commonly in the lateral neck than is generally realised, and that lateral cervical cystis and fistulas probably differ in their histogenesis.

Chronic serous otitis media in the adult.

Twelve adult patients with serous otitis media have been seen in a five-year-period. Five of seven patients with nasopharyngeal neoplasm have died, and one case of polyarteritis nodosa has also terminated fatally. The remaining four patients had benign pathology in the nasopharynx, including one case of branchial cyst. A group of patients with chronic nasopharyngitis but without otological involvement is also reviewed.

A patient with Cronkhite-Canada syndrome, myxedema and muscle atrophy.

A case of Cronkhite-Canada syndrome is presented. The patient had alopecia, onychodystrophy and gastrointestinal polyposis, mainly in the stomach and duodenum, with transient diarrhea and hypoproteinemia. Marked atrophy and weakness of the shoulder girdle muscles due to myopathy were also present. In addition she had primary hypothyroidism. The outcome of the disease is usually fatal within months, but so far our patient is alive four years after the onset of symptoms. The pathological changes, pathophysiology, symptoms, course and treatment of this rare disorder of unknown etiology are discussed.

Heterotopic cervical salivary glands.

A four-year-old girl presented with bilaterally symmetrical cutaneous orifices situated at the junction of the middle and lower thirds of the sterno-cleido-mastoid muscle. The preoperative diagnosis was lateral cervical, or branchial, sinuses. At operation the sinus tracts were found to extend only 2 cm. deep to the skin surface, and histological examination revealed mixed salivary glands. The literature is reviewed and the differential diagnosis of sinus orifices in the lower, anterior part of the neck is discussed.

Adult coeliac disease. A case with ulceration, dermatitis herpetiformis and reticulosarcoma.

A 64-year-old woman with adult coeliac disease developed recurrent ulceration and perforation of the small intestine, dermatitis herpetiformis and a reticulosarcoma of the small intestine. She died following the third perforation. The possible importance of strict adherence to a gluten-free diet in the hope of preventing these complications in patients with adult coeliac disease is discussed.