[Ultrastructure of endocardial lesions in the carcinoid syndrome (author's transl)]. / Ultrastruktur der endokardveränderungen beim carcinoidsyndrom.

In a 67-year-old female patient with metastasising carcinoid of the small intestine there were right-sided endocardial plaques characteristic of the carcinoid syndrome. Ultrastructurally, the lesions showed proliferation of smooth muscle cells and myofibroblasts, which were surrounded by basement-membrane-like material and occasionally showed intercellular connections of the macula adhaerens type. The ground substance consisted of acid mucopolysaccharides, normal collagen fibrils, and microfibrils. The endocardial plaques in the carcinoid syndrome differ morphologically from other endocardial lesions by the lack of amorphous elastin. The formation of plaques and its relation to the endocrine activity of the carcinoid tumors is discussed, and pertinent literature is reviewed.

The incidence of congenital adrenal hyperplasia in Switzerland--a survey of patients born in 1960 to 1974.

The incidence of congenital adrenal hyperplasia (CAH) in Switzerland was calucated for patients born in 1960 to 1974. Information was obtained by means of questionnaires sent to all Pediatric Hospitals and Institutes of Pathology in Switzerland. The number of patients and the incidences of the different enzyme defects were: all cases 110 (1:13785 livebirths), 21-hydroxylase 98 (1:15472), 11 beta-hydroxylase 5 (1:303260), 3 beta-dehydrogenase 3 (1:505433). The incidence of females--which is 1:12098 for all cases and 1:13924 for 21-hydroxylase deficiency--presumably appropximates more exactly the real incidence, because of incomplete diagnosis in the male. Salt loss was observed in two thirds of patients with 21-hydroxylase deficiency. A more reliable estimate of the incidence of CAH could be obtained by neonatal screening programs with measurement of serum-17-hydroxyprogesterone.

[Hypochlorhydria in acute gastritis (author's transl)]. / Hypochlorhydrie bei akuter Gastritis.

After swallowing a non-sterilised pH electrode a 25-year-old medical student developed an influenza-like illness followed by hypo- and achlorhydria for several weeks, acute leukocyte-gastrititis, and epithelial defects of the antrum. This possibly represents an infectious disease which can be transmitted by contaminated electrodes or probes.

Esophageal histology in gastroesophageal reflux. Morphometric findings in suction biopsies.

Esophageal suction biopsies were taken in 24 subjects with proven gastroesophageal reflux, 12 subjects with suspected reflux, and 20 healthy controls. Sixty-two percent of the patients with proven reflux, 33% of the patients with suspected reflux, and 10% of the control subjects had neutrophilic and/or eosinophilic granulocytes in the lamina propria. Lymphocytes, plasma cell, and basophilic granulocytes were shown to be constituents of the normal esophageal mucosa. All epithelial dimensions showed marked individual variations in reflux patients and controls. The relative length of stromal papillae as expressed in percent of total epithelial thickness showed a linear correlation with relative basal cell thickness and an indirect linear correlation with epithelial thickness. Elongation of stromal papillae in proven reflux could only be demonstrated by arbitrary retrospective stratification of the data. Hyperplasia of the basal zone and thinning of the epithelium were not observed in the reflux patients. It is concluded that granulocytic infiltrates and not epithelial alterations are the most prominent histological finding in gastroesophageal reflux.

[Paraneoplastic eosinophilic leukemoid with eosinophilic parietal thromboendocarditis in malignant melanoma]. / Paraneoplastisches eosinophiles Leukämoid mit Thromboendocarditis parietalis eosinophilica bei malignem Melanom.

A case of an eosinophilic leukemoid reaction associated with metastasizing malignant melanoma and thrombotic eosinophilic parietal endocarditis in a 58-year-old white male is reported. No similar cases were found in the literature. The leukemoid reaction with leukocytosis of up to 102 300 white cells per microliter , 65% of which were eosinophils, was observed during the last two months of life of the patient, who died of multiple metastasis of malignant melanoma. The primary malignant melanoma had been excised four years before death. The parietal endocarditis was localized on the posterior wall of the left ventricle and was found incidentally at autopsy. The association of leukemoid eosinophilic reaction with consecutive eosinophilic thrombotic parietal endocarditis is believed to be part of a paraneoplastic syndrome. 63 published cases of paraneoplastic eosinophilic leukemoid reaction and 6 published cases of malignant tumor with eosinophilia and additional parietal endocarditis were found. The pathogenesis of these conditions is discussed.

Phlegmonous gastritis diagnosed by endoscopic snare biopsy.

A case of phlegmonous gastritis, diagnosed for the first time without laparotomy and with spontaneous recovery, is described. The only procedure allowing nonsurgical diagnosis of this disease is endoscopic snare ("jumbo") biopsy of the giant folds in the diseased parts of the stomach. Snare biopsy includes submucosal tissue which is the main site of histological changes in phlegmonous gastritis.

[The ossification of the ear cartilage in Addison's disease]. / Die Ohrknorpelverknöcherung beim Morbus Addison

Stiffening and tenderness of the helix of the ear, with radiologically demonstrable calcific deposits, has been reported in various conditions such as frostbite, and also in Addison's disease. To a total of 14 clinical observations with only 4 well documented cases, a first autopsy report of the disorder in a case of tuberculosus Addison's disease is added. It is shown that the elastic cartilage of the pinna, of the epiglottis and of the trachea undergoes ossification without preceding dystrophic or metastatic calcification. The ossification has been observed only in males with longstanding Addison's disease treated exclusively with mineralocorticoids over a long period. The possible pathogenetic mechanisms are discussed. An important factor seems to be the long-standing glucocorticoid deficiency.