Cavitation of mesenteric lymph nodes: a rare complication of coeliac disease, associated with a poor outcome.

Five cases are presented, all of which showed peculiar cavitation of mesenteric lymph nodes. Clinically, three presented with abdominal symptoms, a mass or obstruction, warranting laparotomy. Two patients showed cavitating mesenteric lymph nodes at autopsy. Lymph nodes were enlarged with central, partly cystic degeneration; milky fluid exuded from the cut surface. In each case, investigation showed intestinal villous atrophy and splenic atrophy; coeliac disease was confirmed by response to gluten withdrawal. Three patients died, two from cachexia and the other from pneumonia; the other two are alive and well one year and six years after presentation. Review of the literature shows 12 previously reported cases, with a mortality of about 50%. The diagnosis is made by the histopathologist, alerting appropriate treatment. The pathogenesis is unknown.

Electron microscopic identification of aberrant melanosomes using a combined dopa/Warthin-Starry technique.

A method combining the DOPA and Warthin-Starry techniques is described in order to positively establish the nature of pleomorphic granules observed in the cytoplasm of cells of putative amelanotic melanoma. The technique identifies these granules as aberrant melanosomes by discretely depositing electron dense silver on suitably prepared sections of DOPA-treated tissue blocks.

A sequential study of hepatic structural damage following the intravenous injection of Corynebacterium parvum.

Sequential histological and fine structural changes were studied in liver from 4.5 min to 21 days after a single intravenous injection of Corynebacterium parvum in the rat. A previously unreported effect of the micro-organism, the formation of eosinophilic inclusion bodies within hepatocytes, was observed between 15 min and 24 h of injection. These structures were most common in periportal hepatocytes at 2 h. The structural, enzyme- and immunohistochemical features of these bodies suggest that they represent a consequence of sub-lethal cell injury, affecting the endoplasmic reticulum or Golgi apparatus; resolution occurred within 24 h. The ingestion of C. parvum by phagocytes and the deposition of fibrin within sinusoids preceded the development of acute and chronic parenchymal and portal tract inflammation, leading to self-limiting granulomatous hepatitis. Lethal cell injury was represented by the presence of single-cell and confluent hepatocyte necrosis. Intravenous C. parvum causes sublethal and lethal hepatocyte damage, seen as the formation of cytoplasmic bodies and hepatocyte necrosis, respectively. Disseminated intravascular coagulation may mediate these changes via local hypoxia. This model could prove useful in the study of granulomatous hepatitis and in the evaluation of anti-inflammatory agents.

Malignant melanoma in Scotland 1979-1983.

1318 cases of primary malignant melanoma of the skin first presenting in Scotland in the years 1979-83 and registered with the Scottish Melanoma Group are described. The annual age-adjusted incidence rate is 4.75 per 100 000 for females and 2.77 per 100 000 for males. Incidence rose by an annual average of 2.5% over the five-year period. The female: male ratio was 2:1, and 48.5% of all cases were of the superficial spreading histogenetic variety. Five-year survival rates for the patients registered in 1979 confirm the prognostic value of the tumour-thickness (Breslow) measurement. They were 93% for patients with tumours less than 1.5 mm thick (39% of patients), 67% for those with tumours 1.5-3.49 mm thick (30%), and 37% for those with tumours thicker than 3.5 mm (31%). This study shows that methods for early recognition of thin tumours should be encouraged.

Bullous skin eruption associated with carbamazepine overdosage.

A patient who developed a bullous skin eruption associated with carbamazepine overdosage is described. The authors believe this previously unreported phenomenon to be of clinical importance. Carbamazepine should be considered in the differential diagnosis of drug-induced coma with associated bullous lesions.

The activity of lysyl oxidase in experimental hepatic fibrosis.

Hepatic collagen synthesis was studied during progressive fibrosis induced by carbon tetrachloride in male Sprague-Dawley rats by determination of lysyl oxidase activity, hydroxyproline levels and morphological assessment. The activity of lysyl oxidase was increased significantly when fibrosis became apparent histologically.

Cytoplasmic vacuolation of peripheral blood cells in acute alcoholism.

Cytoplasmic vacuolation of peripheral blood leucocytes is reported in three patients with acute alcoholism. Apparently this is the first report of vacuolation of peripheral blood leucocytes associated with acute alcoholism. Apart from any direct cytotoxic effect of alcohol the metabolic acidosis and hypoglycaemia associated with acute alcoholic poisoning may be important factors in the pathogenesis of the morphological changes.

Hepatic prolyl hydroxylase activity in human liver disease.

The activity of prolyl hydroxylase was measured in liver tissue obtained from a small series of patients with a variety of liver disease. Enzyme levels were marginally elevated in patients with fatty liver and viral hepatitis, conditions not normally associated with progressive fibrosis. In some patients with alcoholic hepatitis and in all patients with cirrhosis and chronic active hepatitis, there was a marked increase in enzyme activity. Patients with conditions characterised by high liver prolyl hydroxylase levels showed histological evidence of extensive hepatic fibrosis and also significant increases in the serum values of glutamate dehydrogenase and gamma-glutamyl-transpeptidase. Prolyl hydroxylase activity was not detected in serum.

Peroxidase activity in non-parenchymal cells isolated from rat liver: a cytochemical study.

The cytochemical demonstration of endogenous peroxidase activity has been used as a marker for the Kupffer cells present in a heterogeneous population of non-parenchymal cells isolated from normal rat liver by perfusion and enzymatic digestion. Peroxidase activity was present in the cytoplasm of a greater proportion of cells than were activities of acid phosphatase and non-specific esterase. The value of endogeneous peroxidase as a marker for the Kupffer cell is discussed.

Infection of mouse liver by human adenovirus type 5.

CBA mice, inoculated intravenously with large doses of adenovirus type 5, showed raised levels of serum aspartate aminotransferase (SAAT; EC 2.6.I.I) and died within a few days from histologically demonstrable hepatic necrosis. After inoculation of I LD50, virus was rapidly taken up by the tissues where infectivity then declined greatly. Organ titres then increased about 100-fold by 48 h p.i. but, in the liver, which showed intranuclear inclusion bodies, and by electron microscopy, scattered intranuclear and intracytoplasmic adenovirions, the increase was 10000- to 100000-fold. P antigen was detected by single radial diffusion in liver extracts, and by immunofluorescence in 80% of liver cells at 36 h p.i. Hexon, penton base and fibre antigens appeared later and in fewer cells. The maximum amount of hexon, of demonstrable type 5 specificity, was shown by radioimmunoassay to be equivalent to up to 5 x 1011 whole adenovirions/g liver. It is concluded that human adenovirus type 5 undergoes an abortive but lytic infection in most liver cells but that replication may proceed to completion in a few.

Dysfibrinogenaemia and liver cell growth.

From the evidence presented, it is proposed that 'dysfibrinogenaemia' represents the production of normal fetal fibrinogen by rapidly proliferating liver cells in both regenerating and neoplastic tissue. Prolongation of the reptilase clotting time, which was formerly believed to reflect dysfibrinogenaemia, may be rather the result of hepatocytic death.

Cholestasis in acute alcoholic liver disease.

10 of a series of 108 patients with alcoholic liver disease presented with cholestasis associated with non-cirrhotic alcoholic liver disease and without evidence of extrahepatic biliary obstruction. In 7 patients liver histology and the associated conditions presenting as cholestasis were heterogeneous. However, in 3 patients who had been drinking excessively before cholestatic jaundice developed, cholestasis was a major feature of liver histology. The term acute alcoholic cholestasis is suggested for this apparently distinct syndrome of cholestatic jaundice in the absence of hepatitis.

Alpha 1-antitrypsin deficiency and infantile liver disease.

Infantile liver disease with deficiency of serum alpha1-antitrypsin is illustrated by a description of the clinical, biochemical, and pathological findings in two affected families. The simplicity of the diagnostic tests is emphasized. Review of 61 biopsies of liver from children and adolescents provided a further 3 cases. It is prudent to exclude this metabolic defect in children with a history of "neonatal hepatitis".

Hepatic prolyl hydroxylase activity in experimental cirrhosis.

Hepatic collagen synthesis was studied during progressive fibrosis induced by carbon tetrachloride in male Sprague-Dawley rats by determination of prolyl hydroxylase activity and hydrocyproline levels along with morphological assessment of fibrosis. Cirrhosis was present after approximately 4 weeks treatment. Prolyl hydroxylase activity was increased significantly before fibrosis was apparent histologically or by hydroxyproline levels. The significance of this finding is discussed.