Fine needle aspiration diagnosis of lymphangiomyomatosis. A case report.

BACKGROUND: Lymphangiomyomatosis is a rare disease of females, usually of reproductive age. There is a proliferation of lymphatic smooth muscle in mediastinal, retroperitoneal and often pulmonary lymphatics and lymph nodes. CASE: A 45-year-old female presented with a right pleural effusion and increasing retroperitoneal adenopathy with palpable left inguinal adenopathy. Three months previously she had undergone a right salpingo-oophrectomy for an ovarian fibroma with concomitant left ovarian wedge biopsy, myomectomy for leiomyomas and partial omentectomy. Three years previously, at age 42, she had experienced two transient episodes of chylous pleural effusion with no sequelae. She underwent computed tomography-guided fine needle aspiration of a 4-cm inguinal lymph node to rule out lymphoma. CONCLUSION: Fine needle aspiration of lymphangiomyomatosis yields distinctive cytologic morphology. This characteristic morphology, in combination with the appropriate history, permits a minimally invasive, timely and in this particular case, entirely unexpected diagnosis.

Streptobacillus moniliformis infection in Swiss white mice.

An epizootic of disease attributed to infection with Streptobacillus moniliformis occurred in a colony of Swiss white mice. The mortality rate among the 180 breeding females in the 6 affected pens was 100%, and most of the sucking young died from starvation. Acute septicemia, subacute septicemia, and polyarthritis were the 3 forms of disease observed. Clinically, septicemic mice either were found dead or were depressed and hunched for 1-2 days prior to death. About a half of these mice had brown skin crusts overlying the mammae. Pathologic findings in cases of acute septicemia were few; in mice with subacute septicemia, there was acute, multifocal, suppurative, embolic interstitial nephritis, and the arthritic form was characterized by many subcutaneous and periarticular abscesses. Severe, acute, diffuse neutrophilic dermatitis was responsible for the brown skin crusts. The S. moniliformis isolate conformed morphologically and physiologically to classical descriptions of the organism. The infection may have gained entry to the colony via wild rats.

High prevalence of cobalamin deficiency in elderly outpatients.

OBJECTIVE: To measure the prevalence of cobalamin (vitamin B12) deficiency in geriatric outpatients as documented by both low serum cobalamin levels and elevations of serum methylmalonic acid and homocysteine and to determine the response to cobalamin treatment. DESIGN: Prospective study screening elderly subjects for cobalamin deficiency using radiodilution cobalamin assays as well as stable isotope dilution gas chromatography-mass spectrometry methylmalonic acid and homocysteine assays. In patients with serum cobalamin levels < or = 300 pg/mL, the response to cobalamin treatment in the group with levels of methylmalonic acid and/or homocysteine > 3 standard deviations (SD) above the mean for normals was compared with that of those without such elevations. SETTING: Outpatient geriatric clinics at the VA Medical Center and University Health Sciences Center, Denver, CO. PATIENTS: One-hundred and fifty-two consecutive outpatients, ages 65 to 99, were screened. Twenty-nine subjects with serum cobalamin levels < or = 300 pg/mL were prospectively evaluated and treated with cobalamin. MAIN OUTCOME MEASURES: Cobalamin, methylmalonic acid, homocysteine, complete blood counts, neurologic examination, and neuropsychological testing. RESULTS: The prevalence of cobalamin deficiency as defined by a serum cobalamin level < or = 300 pg/mL and levels of serum methylmalonic acid and/or homocysteine elevated to > 3 SD was 14.5% of the screened outpatients. A similar proportion of patients with low normal serum cobalamin levels (between 201 and 300 pg/mL) demonstrated elevated metabolites > 3 SD (56%) compared with patients with low serum cobalamin levels (< or = 200 pg/mL) (62%). Cobalamin therapy caused a marked fall or complete correction of the elevated methylmalonic acid and homocysteine levels in each patient who was treated prospectively. Results for complete blood count, lactate dehydrogenase, bilirubin, baseline neurologic score, and baseline neuropsychologic scores did not differ in the group of patients with elevated metabolites compared with those with normal metabolites. The mean red cell volume fell significantly in the patients with elevated metabolites after 6 months of cobalamin treatment. One patient with elevated metabolites had marked improvement in his neurologic abnormalities after 6 months of cobalamin treatment. CONCLUSION: There was a high (14.5%) prevalence of cobalamin deficiency as demonstrated by elevations in serum methylmalonic acid and homocysteine in addition to low or low normal serum cobalamin levels in elderly outpatients. The serum cobalamin level was insensitive for screening since similar numbers of patients with low normal serum cobalamin levels of 201-300 pg/mL compared with patients with low cobalamin levels (< or = 200 pg/mL) had markedly elevated metabolites which fell with cobalamin treatment. Additional studies will be required to define the full clinical benefit from treatment with Cbl in elderly subjects.

Yersinia species isolated from sheep with enterocolitis.

In 40 submissions to the Regional Veterinary Laboratory (RVL) Wagga Wagga from sheep in southern New South Wales from 1981 to 1989, 53 isolates of Yersinia sp were recovered from 45 sheep in 37 flocks. Of 53 isolates, 26 were identified as Y. pseudotuberculosis, 20 as Y. enterocolitica, 5 as Y. intermedia and 2 as Y. frederiksenii. Twelve isolates of Y. pseudotuberculosis tested in the slide agglutination test all belonged to serotype III. The 20 Y. enterocolitica isolates were categorised biochemically as biotype 5 strains and, of 6 isolates serotyped, all belonged to serogroup 2,3. Outbreaks of yersiniosis were most common in late winter and early spring and affected flocks often had experienced a change in husbandry. Infection with Yersinia sp was associated with diarrhoea, illthrift and mortality. At necropsy, congestion and occasionally thickening of the intestinal mucosa were observed in affected sheep. Gastrointestinal nematodiasis and coccidiosis often were concurrent findings. The characteristic histological lesion in sheep infected with Y. pseudotuberculosis was acute segmental suppurative erosive enterocolitis. There were no lesions consistently associated with Y. enterocolitica, Y. intermedia or Y. frederiksenii.

Introduction of late gestational teratogenesis in rat lung by hypervitaminosis A.

Long-Evans black-hooded rats treated via stomach tube with 160,000 USP units of retinyl acetate (vitamin A) in 0.5 ml Mazola corn oil on gestational days 15--19 deliver normal-sized litters with significantly decreased viability. Vitamin A is known to effect the differentiation and to stimulate the growth of epithelial cells. Additionally, lung epithelia undergo marked morphologic and physiologic changes late in gestation. Thus the effects of hypervitaminosis A on developing lung constitute an excellent system for the study of teratogenesis late in gestation. Non-hilar, right lower-lobe sections of lungs from the vehicle control and experimental groups, compared via quantitative light microscopy, revealed no significant difference in gross overall histologic appearance on any given day, either in the total number of airways present in the volume of lung sectioned or in the percent area of any individual airway occupied by cells or by lumen. The only significant difference was in the number of cells per square micrometer in that region of an airway occupied by cells. Additionally, there was a significant difference between the control and experimental mitotic indices on gestational days 18 and 19. Thus in the experimental group the number of cells lining the developing airways increases, while the absolute thickness of this cellular layer remains constant. Transmission electron microscopy (TEM) fails to reveal any morphologic differences between control and treated type II pneumatocytes. The increased number of respiratory cells in what otherwise appears to be normal lung may create a diffusion-perfusion imbalance or other difficulties contributing to the heightened neonatal mortality resulting from teratogen exposure late in gestation.

The composition of tuberous sclerosis grey matter.

The chemical analysis of grey matter from a tuberous sclerosis subject indicated the presence of two different types of grey matter based on two distinctly different ganglioside concentrations. Both samples had gangliosides of reduced concentration with an abnormal composition compared to normal grey matter as evidenced from their thin-layer chromatography profiles. Analyses of the glycoprotein fraction from both samples revealed increased glycoprotein content, particularly in total carbohydrate. This observation was consistent with previous studies of angiofibromas and angiomyolipomas.

Ca++ regulation in caffeine-derived microplasmodia of Physarum polycephalum.

Caffeine-derived microplasmodia possess a Ca++-sequestering system which can initiate motility. The experiments presented here suggest that this system is membranous and nonmitochondrial in nature. Therefore, it is proposed that the shuttle streaming in the plasmodium is controlled by the localized release and uptake of free Ca++ from an intracellular storage system analogous to the sarcoplasmic reticulum.