A morphological control for ventricular pathology in man: a morphometric and morphologic assessment of LV myofibres in secundum ASD.

Ethical considerations preclude the biopsy of normal human myocardium. As a consequence, morphological investigations of diseased human heart muscle are hampered by a lack of suitable normal control tissue. The left ventricular (LV) myocardium of patients with isolated secundum atrial septal defect (ASD) is considered to be normal. This study was designed to investigate the possibility that the fine-structure of LV myofibres in hearts with ASD could be used as normal controls for myofibre pathomorphology. Wedge biopsies from the LV of four adults undergoing elective surgery for the repair of ASD were examined by light and electron microscopy. Bivariant myofibre morphometry showed that the LV myocardium of one specimen was 'normal' while three specimens exhibited varying degrees of hypertrophy. There was a correlation between the diameter (FD) and morphology of individual myofibres within and between specimens. In general, myofibres with FD less than 25 microns were similar in fine-structural appearance to those described as morphologically normal in animal models whereas those with FD greater than 25 microns exhibited hypertrophic features that increased in 'severity' with increase in myofibre size. It is proposed that although the LV myocardium in ASD may be mildly hypertrophied, myofibres with FD less than 25 microns are probably normal and may be used as fine-structural controls for myofibre pathomorphology in hearts suspected of disease.

Myocardial ischaemia in constrictive pericarditis--a morphometric and electron microscopical study.

Left ventricular biopsies, taken during pericardiectomy, were morphometrically and morphologically examined to determine the pathology of the myocardium in constrictive pericarditis (CP). To serve as a normal control a similar appraisal was made of tissue from the left ventricle of a patient undergoing atrial septal repair. Morphometrically, mean cross-fibre diameters at the position of the nucleus in atrial septal defect (ASD) and CP hearts were within a range previously reported as normal. In hearts from patients with CP, the range of individual myocardial fibre diameters was extended. Ultrastructurally the myocardium in ASD appeared normal. In CP, myofibres could be divided into two groups: (a) small and morphologically normal; and (b) large and oedematous. Oedematous fibres contained abnormal nuclei and sarcoplasmic organelles and myofibrillar dissolution was a prominent feature in many cells. These pathological features are among those previously used to characterize myofibre ischaemia. In CP, prolonged cardiac compression is thought to predispose the heart to atrophy due to its inability to function properly (disuse atrophy). The results of this study suggest that in CP, myocardial ischaemia is a more important factor in the aetiology of myocardial dysfunction than is atrophy which arises from enforced cardiac disuse.

Characterisation of normal human myocardium by means of morphometric analysis.

A morphometric analysis of ventricular myofibres, in specimens taken at necropsy from ten normal hearts, was performed to determine the distribution of fibre and nuclear diameters and their dependence on sampling position within the heart (group a). To assess the significance of the findings, two control groups of specimens were subjected to the same analysis: b) specimens from the hearts of four patients who had died of African cardiomyopathy; c) biopsies taken from the left ventricles of two hearts undergoing surgical repair of atrial septal defects (ASD), in which the myocardium is considered normal. Although mean values for the left ventricle were 13% greater on average than those for the right, a linear correlation, independent of sampling position, was found between nuclear and fibre diameter. Mean fibre and nuclear diameters for specimens from the normal and ASD control groups followed the same correlation as for individual normal fibres, whereas there was a significant deviation in the case of the cardiomyopathy specimens. The relationship between nuclear and fibre diameters was found to distinguish between normal and pathological specimens more clearly than the mean values of either dimension considered separately. It is suggested that this relationship is a more sensitive criterion of ventricular fibre normality or pathology than the parameters used in previous studies of this nature.

Tracheo-oesophageal fistula from blunt trauma. A case report.

Tracheo-oesophageal fistula is a rare complication of blunt trauma; by 1980 only 35 cases had been recorded. Presentation is usually delayed and the initial trauma severe. Fractures, pneumothorax, haemoptysis and surgical emphysema are not invariable features. Mediastinitis is rare, and surgical management is usually successful. The site of the fistula in the posterior wall of the trachea proximal to the main carina is remarkably constant. The membranous trachea is probably lacerated at the time of injury and the oesophageal wall contused. The contusion progresses to necrosis and a fistula is formed.

An ultrastructural study of the origin and function of basophilic degeneration in human cardiac muscle--cardiac colloid. Type 1.

The myofibres in biopsies obtained from the left ventricle during cardiopulmonary bypass, in patients undergoing surgery for mitral and aortic valve replacement and the correction of atrial septal defect, contained inclusions thought to be type 1 cardiac colloid. Electron microscopy showed this material to be synthesised by and contained within a grossly dilated rough endoplasmic reticulum. The presence of membrane-bound aggregates of non-fibrillar sarcoplasmic organelles within colloid deposits, together with osmiophilic inclusions thought to be related to lipofuscin, both within and moving from this structure, suggest that type 1 cardiac colloid is an autophagic vacuole designed to degrade ageing or redundant sarcoplasmic organelles.

Intrapericardial teratoma: A case report.

Successful removal of an intrapericardial teratoma in an adult, with the adjunct of cardiopulmonary bypass, is described. Unusual features are the rarity of the tumour, the recognition of the tumour in adult life (most are recognized during infancy), and the use of cardiopulmonary bypass as a technical aid because of firm adhesion of the tumour to vital structures.

75Se-sodium selenite as a diagnostic aid in the assessment of peripheral pulmonary opacities.

To establish or exclude the diagnosis of bronchial carcinoma a series of 43 patients with peripheral pulmonary opacities was studied by lung scanning after intravenous injection of 75Se-sodium selenite. A diagnosis was ultimately obtained in all patients. The incidence of both false-positive and false-negative results was high. Selenite was taken up by a range of non-neoplastic processes including inflammatory lesions. The value of the procedure in distinguishing bronchial carcinoma from non-neoplastic conditions of the lung that radiographically mimic carcinoma was not confirmed.

Percutaneous drainage in the treatment of Klebsiella pneumoniae lung abscess.

Seven cases of lung abscess involving Klebsiella pneumoniae with or without other pathogens presented with gross expansion of the involved lobes or segments and severe clinical illness despite medical treatment. Operative management by rib resection and tube drainage was successful in each case, one of which was found to be an infected cryptococcoma. Postoperative bronchograms were made in six cases.