George T. Hensley

Glomerular Lesions in the Acquired Immunodeficiency Syndrome

Between January 1982 and December 1983, 75 patients with the acquired immunodeficiency syndrome were identified in our hospitals: 35% used intravenous drugs, 50% had proteinuria in excess of 0.5 g/dL, and 10% were nephrotic. Glomerular changes seen at autopsy in 36 patients included frequent mesangial lesions and deposits associated with mild asymptomatic proteinuria. Focal and segmental glomerular sclerosis was found in 5 patients and 4 of these had the nephrotic syndrome. Whereas reversible episodes of acute renal failure were not uncommon, terminal episodes of acute renal insufficiency occurred in 14 patients. The short survival of these patients may prevent the development of chronic renal failure.

The comparative survivals of alcoholics versus nonalcoholics after distal splenorenal shunt.

Survival after distal splenorenal shunt is appreciably better in nonalcoholic patients than in alcoholics. This increase in survival does not appear to be dependent upon the state of biochemical liver function or the severity of changes in liver histology since these latter were similar for both groups. We suggest that the poorer survival of alcoholics may be related to continuing alcohol toxicity, and that a possible reason for the failure to demonstrate this difference in survival after portacaval shunts may be due to the harmful effects of total portal diversion on the liver.

Interstitial Lung Disease Due to Contamination of Forced Air Systems

Eight patients had hypersensitivity pneumonitis due to contaminated home or office forced-air heating or air-conditioning systems. We studied their clinical and laboratory features, and the results indicated that this disease may occur as an acute or insidious form differing in type and intensity of respiratory and systemic symptoms. Thermophilic actinomycetes contaminatinf the forced air systems were identified as the sensitizing agents in most cases. Precipitating antibodies to the organisms could be shown in the serums of the patients and the antigen identified by immunofluorescent studies in the three lung biopsies examined by this method. Inhalation challenge studies with the cultured organism or other materials obtained from the forced air systems reproduced the clinical syndrome in the four patients tested. Avoidance of the contaminated system, and the use of corticosteroids in more severe cases,seems to be appropriate therapy for patients with this disease.

Frequency and anatomic distribution of lymphadenopathic Kaposi's sarcoma in the acquired immunodeficiency syndrome: An autopsy series

Histologic material from 52 autopsies of persons who had died of the acquired immunodeficiency syndrome (AIDS) were reviewed. The study group included 23 Haitians, 19 homosexual men, five intravenous drug abusers, two hemophiliacs (type A), and three persons at unknown risk. Nineteen of the patients (36.5 per cent) had typical Kaposis sarcoma alone, but 49 (94.2 per cent) had the inflammatory variant of Kaposis sarcoma as well as typical Kaposis sarcoma. Inflammatory Kaposis sarcoma was found in all risk groups studied. In all cases of typical Kaposis sarcoma, histomorphologic transitions of inflammatory Kaposis sarcoma to typical Kaposis sarcoma were observed. Lymph nodes and spleen were the organs most commonly involved by both typical and inflammatory Kaposis sarcoma. The findings indicate that Kaposis sarcoma is more common and has a wider morphologic spectrum in AIDS than is generally appreciated.

Wood-Pulp Workers' Disease: A Hypersensitivity Pneumonitis Caused by Alternaria

Abstract Respiratory disease resulting from prolonged exposure to logs contaminated withAlternariamay be owing to a hypersensitivity reaction. Two patients had heavy and prolonged exposure to this ...

An animal model of hypersensitivity pneumonitis in the rabbit.

This study was devised to produce an animal model of hypersensitivity pneumonitis in order to study both the induction and the elicitation of the disease. Rabbits exposed by aerosol to large quantities of pigeon antigens developed a humoral, but not cellular, immunologic response. Moreover, their lungs were essentially normal histologically. A single i.v. injection of killed BCG in oil permitted the induction of pulmonary cell-medid hypersensitivity to the inhaled antigen, as well as the development of pulmonary lesions which were more severe than that caused by the administration of BCG alone. The humoral immunologic response to the inhaled antigen was not increased after BCG injection. Since many individuals are exposed to the etiologic agents of hypersensitivity pneumonitis for extended periods without developing the disease, these findings in animals suggest that some event may occur to induce cell mediated hypersensitivity in order to initiate the disease process. In addition, we have shown that animals with normal lung histology and circulating complement-fixing antibodies undergo serum complement (CH50) depression after an aerosol challenge with the specific antigen. Animals with circulating, complement-fixing antibodies, and inflamed lungs (BCG-induced failed to undergo a complement depression subsequent to an aerosol challenge with specific antigens. These results re consistent with those seen in symptomatic and asymptomatic pigeon breeders and suggest that antigen distribution through the lung is important in the pathogenesis of hypersensitivity pneumonitis.

MR of Toxoplasma encephalitis : Signal characteristics on T2-weighted images and pathologic correlation

PURPOSE Our goal was to determine if there are any T2-weighted MR signal characteristics of Toxoplasma encephalitis that might be useful in diagnosis and/or in gauging the effectiveness of medical therapy. METHOD We retrospectively analyzed the MR, CT, thallium-201 SPECT brain scans, and medical records of 27 patients with medically proven (26) and biopsy proven (1) Toxoplasma encephalitis, supplemented by autopsy findings in 4 additional patients, 2 of whom had postmortem MR correlation. The neuropathologic literature was also reviewed. RESULTS Among the 27 patients, we discovered three distinct imaging patterns. Ten (37%) patients had predominantly T2-weighted hyperintense lesions and had been on medical therapy an average of 3 days (excluding one outlier). Ten (37%) patients had T2-weighted isointense lesions and had received medical therapy an average of 61 days. Seven (26%) patients had lesions with mixed signal on T2-weighted images and had been on treatment an average of 6 days. Analysis of autopsy material from the four additional patients revealed the presence of organizing abscesses in three and necrotizing encephalitis in one, while the patient who had a brain biopsy demonstrated both types of pathologic lesions. In both cases having postmortem MRI, organizing abscesses appeared isointense to hypointense on T2-weighted images. CONCLUSION There is a definite variation in the appearance of lesions of Toxoplasma encephalitis on T2-weighted images that precludes a definitive diagnosis based on signal characteristics alone. Pathologically, our data suggest that T2-weighted hyperintensity correlates with necrotizing encephalitis and T2-weighted isointensity with organizing abscesses. Furthermore, in patients on medical therapy the T2-weighted MR appearance may be a transition from hyperintensity to isointensity as a function of a positive response to antibiotic treatment, indicating that the signal change might be used to gauge the effectiveness of medical therapy.

Endoscopic Evaluation of Inflammatory Bowel Disease

The colonoscopic examination is not a routine procedure for patients with inflammatory bowel disease; colonoscopy does not supersede the double contrast barium x-ray examination as the diagnostic study of choice. The use of colonoscopy in patients with inflammatory bowel disease must be dictated by the particular clinical situation or nature of the problem and governed by the severity of colitis, the physical condition of the patient and the overall safety of the procedure in each instance. The judicious application of the colonoscopic examination in certain patients with inflammatory bowel disease yields important information concerning the nature, extent, and complications of the colonic inflammatory process, which heretofore has been unavailable for use in diagnosis and management of inflammatory bowel disease.

Esophageal-atrial fistula resulting in systemic "meat and vegetable" emboli.

An 85-year-old demented woman died in the state hospital and her death was investigated by our office, based on allegations of neglect. At autopsy, a feeding catheter was found passed through an esophageal-atrial fistula into the left atrium. Fragments of striated muscle and plant wall (cellulose) embolized to the systemic organs including heart, kidney, and brain. Her dilated esophagus suggests a premortem esophageal motility disorder that contributed to the formation of the fistula. This is the first reported case of an esophageal-atrial fistula in the medical literature.

Chronic Active Hepatitis Treated with 6-Mercaptopurine—Sustained Remission

Excerpt There is general agreement regarding the clinical and pathological features of chronic active hepatitis (1)—lupoid hepatitis (2), plasma cell hepatitis (3), active juvenile cirrhosis (4)—bu...