J. N. Cox

Aspergillus endocarditis and myocarditis in a patient with the acquired immunodeficiency syndrome (AIDS) : a review of the literature

We report the post-mortem findings of the case of a 31-year-old male who, through sexual contacts with a female drug addict, was found to be HIV-positive and developed the acquired immunodeficiency syndrome (AIDS) 2 years later. He was treated for various opportunistic infections over the next 7 years when he presented with cardiac abnormalities and multiple cerebral lesions which were responsible for his death. The results revealedAspergillus fumigatus endocarditis and myocarditis with mycotic thromboembolic extension to the brain, spleen, kidney and pancreas. We review the literature ofAspergillus infection in patients with AIDS and more specifically cardiac involvement with this pathogen.

Aorto-coronary by-pass with autogenous saphenous vein grafts: Histopathological aspects

The histological modifications in 8 cases of autologous aorto-coronary saphenous vein grafts were studied. In the early stages, these showed intimal thickening and medial hypertrophy, particularly affecting the middle circular layer. The intimal thickening progressed, and the media later became largely replaced by dense fibrous tissue. No aneurysmal dilatations were observed, but in 3 cases the grafts were thrombosed. The pathogenesis of these changes is discussed.

A lymphoproliferative syndrome, “cutaneous dystrophy” and combined immune deficiency with lack of helper T-cell factor

Abstract The case of an 18-month-old boy, born of consanguineous parents, presented at the age of 4 months with fever, widespread lymphadenopathy, hepatosplenomegaly, and thick skin folds with eczematous lesions, is documented. Thymic shadow was not visualized. Extreme T lymphocytosis and eosinophilia were important features. It was possible to demonstrate by immunohistochemistry and ultrastructural studies of the lymph nodes that the hyperplasia was due principally to a benign proliferation of immature cells of T-cell lineage in the paracortical zone. There was a combined immunodeficiency with absence of serum IgG and IgA as well as an abrogated lymphocytic response. The latter was restaured in vitro through interleukin 2 (TCGF). In addition the childs lymphocytes spontaneously suppressed allogeneic cell responses, were deficient for 5-nucleotidase and showed T-cell-subset imbalance. During the 14 months of his illness there was persistent failure to thrive, frequent bouts of fever, and finally diarrhea leading to extreme cachexia and death due to bronchopneumonia.

Morphological changes in human myocardium during permanent pacing

We have reviewed 74 cases of patients with permanent pacing, using different types of pacing leads in order to determine what morphological changes are produced by this therapy. Macroscopic examination of the heart was performed and slides at the implantation site reviewed when available. Severe chronic inflammation, scarring and a myocardial response were the prominent findings. From a strictly morphological aspect, the initial trauma at implantation time, the chronic foreign body reaction and myocardial response to chronic trauma, are both much less significant in endovenous than in epimyocardial pacing.

Teratoma of the heart

The clinical manifestations and pathological features of an extremely rare cardiac tumour, a mature (benign) teratoma, in a 6 year-old girl are described. These are compared with those reported in the literature.

Epithelial liver hamartoma, systemic arterial hypertension and renin hypersecretion.

The case of a 14-year old girl presenting with headaches, severe progressive hypertension and high plasma renin levels, in whom a voluminous epithelial liver hamartoma or adenoma was discovered at surgery is documented. The morphological characteristics of the hamartomatous abnormality are described and evidences are put forward which would suggest that the liver lesion might have been the site of the abnormal renin production which was responsible for the systemic arterial hypertension.

Necrotizing Tracheobronchitis: A complication of high frequency jet ventilation

The tracheal and bronchial lesions observed are described in seven patients, presenting with respiratory distress syndrome and receiving both conventional and high frequency jet ventilation for various periods. The histological findings are related to the duration of the exposure as well as the number of pulsations administered to the tracheobronchial tree. Severe damage to the mucosa leading to acute tracheobronchitis, hyperplasia and hypersecretion of the mucosal glands may explain some of the clinical symptoms observed, especially the upper respiratory obstruction. Care should be taken to limit these changes which may lead to various degrees of stenosis in survivors receiving this mode of therapy.

Liver schistosomiasis and primary biliary cirrhosis

The case of a patient suffering from liver schistosomiasis diagnosed by liver biopsies is presented. There were also lesions in the liver suggestive of non-suppurative destructive cholangitis and the serum-immunological studies strengthened the diagnosis of primary biliary cirrhosis. The eo-existence of these two affections and their possible interrelationship are discussed. The authors further discussed some clinical, biochemical, immunological and pathological aspects of these two conditions and evoked the eventuality of an auto-immune type of hepatic affection triggered by the presence of the schistosome eggs.

Hamartoma of the stomach in childhood

The clinical symptoms, x-ray appearances, and anatomical description of a large gastric hamartoma in an 8-year-old girl are presented. The literature of this condition in childhood is reviewed. The differentiation between true genuine hamartomas of the gastric wall and heterotopic (ectopic)tissues is stressed.

Fatal necrotizing angiitis after sulfadimethoxine therapy presenting as anaphylactoid purpura

A fatal case of diffuse systemic necrotizing angiitis is described in a 14 year old boy presenting with Schönlein-Henoch purpura and developing renal failure. It is proposed that a long-acting sulfonamide (sulfamidethoxine) caused the disease, thus serving to reinforce previously published warnings against the indiscriminate use of long-acting sulfonamides.