Apparent hypoxic changes in pulmonary arterioles and small arteries in infancy.

The pulmonary arterioles and small arteries were studied and their musculature and its nuclei were quantified in 90 neonates, infants, and young children who had suffered from a variety of clinical and hypoxic conditions immediately before death. Among the 90 cases investigated in this study, 30 were of sudden infant death syndrome (SIDS). No evidence was found to support the view that cases of SIDS are subjected to chronic hypoxia before death as significantly more medial muscle tissue in the pulmonary arterioles and small arteries was found in the chronic hypoxic group compared to the SIDS, non-hypoxic, and acute hypoxic groups. Furthermore, there was no statistically significant difference in the amount of medial muscle tissue of the pulmonary vessels as between the SIDS, non-hypoxic, and acute hypoxic groups. With other signs of acute hypoxia found at the necropsy of SIDS, the results of this study could be considered to support the view that cases of SIDS succumb as a result of an acute episode of hypoxia, or possibly repeated short-duration episodes of acute hypoxia which do not produce pulmonary vascular changes.     

Comparison of in situ DNA hybridization (ISH) and immunocytochemistry for diagnosis of herpes simplex virus (HSV) encephalitis in tissue

Summary Formol-fixed and paraffin-embedded brain tissue of 33 cases of human necrotizing encephalitis was investigated for Herpes simplex virus (HSV) by immunocytochemistry with a polyclonal antiserum, and by in situ hybridization (ISH) with a biotinylated cDNA probe. HSV antigens (VA) were found in various types of cells in the cytoplasm, cellular processes and nuclei. Labelling by ISH was mostly restricted to nuclei and intranuclear inclusions but otherwise matched the distribution of VA. Eighteen of 25 acute cases had HSV antigen detectable by immunocytochemistry, and 18 of the acute cases contained HSV DNA detectable by our ISH technique. However, results differed somewhat between the techniques: three brains negative for VA showed hybridization, and other 3 VA-positive cases remained negative by ISH. Thus 21 brains with acute necrotizing encephalitis were labelled with one or both techniques. In 8 cases with a subacute course (duration of disease was longer than 1 month), HSV antigens were never detectable although 4 brains showed hybridization. All brains labelled by one or both techniques contained nuclear inclusions bodies. Only one case, of subacute course, with inclusion bodies remained unlabelled. Brain tissue of 11 controls, including cytomegalic inclusion body disease, was never labelled.These results demonstrate that immunocytochemistry and ISH are techniques of comparable sensitivity (72%) for detection of HSV in paraffin sections of acute necrotizing encephalitis brains; their combined use enhanced sensitivity, in our hands, to 84%. In cases with a disease course longer than one month, ISH seems to be the method of choice to demonstrate HSV in situ.Supported by the Medical-Scientific Fund of the Lord Mayor of the Federal Capital of Vienna, Austria     

Neurovirulence of murine coronavirus JHM temperature-sensitive mutants in rats.

The murine coronavirus strain JHM is highly neurotropic in rats and has a marked tendency to cause demyelinating central nervous system diseases after intracerebral inoculation. The clinical diseases observed range from an acute encephalomyelitis occurring within 2 weeks postinfection to a subacute demyelinating encephalomyelitis developing several weeks or months postinfection. Uncloned wild-type virus induced both acute and subacute diseases, whereas cloned JHM virus grown in tissue culture caused only acute disease without the pronounced lesions of primary demyelination. In contrast, temperature-sensitive mutants selected from that clone were capable of inducing subacute demyelinating encephalomyelitis after prolonged incubation times. Viruses recovered from diseased animals were still temperature sensitive. Inoculation of temperature-sensitive mutants into suckling rats (age, 10 to 15 days) produced high rates of subacute demyelinating diseases running a more chronic course; these diseases often were not fatal. Those rats which did not show clinical signs frequently revealed inflammatory demyelinating lesions. These findings indicate that the rate and type of clinical disease are dependent on the neurovirulence of the virus mutant used for inoculation and the age of the animals at the time of infection.     

Prognostic implications of cytology in acute leukemia in the adult: The case for subacute leukemia

One hundred sixty-nine cases of acute leukemia in adults have been prospectively classified on the basis of the original peripheral blood smear and bone marrow into two subclasses of acute lymphatic leukemia (acute lymphocytic leukemia and subacute lymphocytic leukemia) and five subclasses of acute nonlymphocytic leukemia (acute myelogenous leukemia, subacute myelogenous leukemia, acute myelomonocytic leukemia, erythroleukemia, and acute promyelocytic leukemia). A number od differences in presenting symptoms and physical findings were found among the various subclasses of acute leukemia. Most significant, however, was the marked difference in median survival between patients with acute lymphocytic leukemia (10 months) and subacute lymphocytic leukemia (16.5 months; p=0.01) and acute myelogenous leukemia (2 months) and subacute myelogenous leukemia (6 months; p0.01). The division on the basis of morphology of the acute leukemias into acute and subacute forms has important prognostic significance in terms of survival and perhaps also in terms of response to therapy.     

Cytogenetic effects of two antimonial antibilharzial drugs: Tartar emetic and bilharcid

The effects of tartar emetic and bilharcid, two antimonial antibilharzial drugs, on the chromosomes of laboratory rats are studied. The drugs were administered intraperitoneally in three doses—clinical, intermediate, and maximum tolerated — both acutely (6, 24, and 48 hours) and subacutely. The two drugs produced the same types of chromosomal aberrations with tartar emetic, inducing a higher rate of incidence. No significant differences in the number of cells with chromosomal aberrations were generally observed among the 6, 24, and 48 hours of the acute treatment with both tartar emetic and bilharcid. The dose-response relationship was examined for both the acute and the subacute treatments. Whereas the acute treatment of tartar emetic showed a dose-dependent linear increase in the number of cells with chromosomal aberrations, the subacute treatment of tartar emetic and the acute and subacute treatments of bilharcid displayed their maximum effects at an intermediate dose.     

Parameter in fulminant hepatitis

Serum complement hemolytic activities (CH 50) and plasma prothrombin time (PTT) of patients with fulminant hepatitis (FH, 11 cases of acute type and 11 cases of subacute type), severe acute hepatitis (AH-S, 9 cases) and typical acute hepatitis (AH-T, 20 cases) were examined. AH-S was diagnosed as AH patients with PTT under 40% and without hepatic coma. Survival rates were 100% in AH-S, 45.5% (5/11) in acute type of FH and 9.1% (1/11) in subacute type of FH. The mean levels of CH 50 on their admission were 42.6 U/ml in AH-T, 28.8 U/ml in AH-S and 13.1 U/ml in FH. CH50 levels in acute hepatitis decreased in parallel to the severity of the disease and correlated with PTT (r = 0.809). In many cases of FH and almost all cases of AH-S, CH50 levels changed more slowly than those of PTT. The patients with AH-S and subacute type of FH showed a prolonged PTT and the normal levels of CH 50 in their acute phase. These results indicate that CH50 and PTT could be useful markers differentiating subacute type from acute type of fulminant hepatitis.     

以症状为基础的程序化治疗方案对亚急性、慢性咳嗽的临床有效性研究

目的 探讨以临床症状为基础的程序化治疗方案对亚急性、慢性咳嗽患者的有效性。方法 将56例亚急性、慢性咳嗽患者随机分为试验组和对照组各28例。试验组采用以临床指南制定《以症状为基础的亚急性、慢性程序化治疗方案评估表》进行临床症状评估后,针对指向病因进行治疗,对照组给予经验治疗,以“咳嗽症状积分表”对两组患者的临床疗效进行评估,比较两组咳嗽症状评分、临床有效性评价、安全性评价。结果 治疗后,试验组夜间和全日咳嗽症状积分中位数均低于对照组（P＜0.05）。治疗2周后,试验组有效率为89.29%,高于对照组的52.17%,差异有统计学意义（P＜0.05）。结论 以症状为基础程序化治疗对于亚急性、慢性咳嗽的临床疗效优于简单的经验性治疗。     

Stromal vessels of invasive ductal mammary gland carcinoma]

With the use of antibodies against factor VIII, vascular bed (number, surface and caliber of vessels) was studied in 64 cases of invasive ductal carcinoma and in normal breast tissue. The trend to a decrease of the vessels number with growing size of the tumor and emergence of lymph node metastases was observed. No difference was found in the development of vascular bed depending on the degree of malignancy, clinical course, tumor or normal breast tissue.     

广州市6例克雅氏病病例特征分析

目的探讨克雅氏病（CJD）的临床表现,提高对该病的诊治能力。方法收集广州市报告的CJD患者共6例,均行磁共振成像（MRI）和脑电图检查,14-3-3蛋白及PRNP基因检测。结果多为急性亚急性起病,首发症状以进行性痴呆（2例）和椎体外系症状（2例）为主。病例均无痴呆类疾病家族史和手术、脑垂体生长激素使用史。MRI检查显示,无特异性异常信号。脑电图检查结果,均出现弥漫性慢波,4例出现特征性的周期性三相波。3例14-3-3蛋白阳性,而PRNP基因序列分析均为无突变型。1例进行脑组织活检,蛋白酶K抗性朊蛋白（PK抗性PrP）阳性。结论 CJD早期临床表现不典型,脑脊液14-3-3蛋白检测和持续动态的脑电图检查可能是CJD早期诊断的特异性方法。     

多发性肌炎和皮肌炎33例肌电图与血清肌酶在病程中的演变

目的：探讨多发性肌炎和皮肌炎起病不同时间的肌电图与肌酶的演变规律。方法：对33例多发性肌炎和皮肌炎病人做了53例次肌电图与肌酶检测，根据起病肜式、病程分组分析检测结果。结果：多发性肌炎和皮肌炎患者的肌酸磷酸肌酶升高程度在急、亚急性起病者与慢性起病者之间的差异具有统计学意义(P(0．05)；肌电图在急性、亚急性起病者多表现为肌源性损害与神经源性损害并存．而在慢性起病者则多表现为单纯肌源性损害。结论：肌电图和肌酶能够较客观地反映肌肉炎性病变的急剧程度，埘疾病的临床转归具有一定的预示意义。     

肝衰竭肝脏的组织病理学变化及其干细胞活化情况

目的探讨肝移植病例中重型肝炎肝衰竭的病理组织学变化与其肝脏干细胞活化状态的关系。方法收集肝移植病例中重型肝炎肝衰竭33例,以相应供肝组织作为正常对照,以免疫组织化学EnVision法检测肝组织中c-kit、Ki-67、HBsAg及HBcAg表达情况,并选择10例c-kit明显阳性病例进行了甲苯胺蓝组织化学染色做为对比染色,分析肝衰竭病例肝脏病理组织学、病毒抗原表达、有无人工肝治疗史,c—kit阳性肝脏干细胞活化数量。结果33例中男性25例,女性8例,年龄分布为21～64岁。符合急性肝衰竭6例,其中2例与乙型肝炎病毒感染有关,3例为药物中毒所致,1例为急性妊娠脂肪肝;亚急性肝衰竭5例,均为乙型肝炎病毒感染所致;慢性急性发作性肝衰竭22例,均为乙型肝炎病毒感染所致。肝移植手术前有人工肝治疗史13例。肝脏活化的干细胞被c-kit单克隆抗体所标记,但不能被甲苯胺蓝染料染色。正常供肝内无或偶见c-kit阳性细胞;急性肝衰竭组c-kit阳性细胞为3．50±2．66（0～8）个／mm^2。;亚急性肝衰竭组为11．47±8．85（3～30）个／mm^2;慢性急性发作性重型肝炎组为15．50±10．95（5～45）个／mm^2,各组之间c-kit阳性细胞数差异有统计学意义。有无人工肝治疗史对c-kit阳性细胞计数无明显影响。供体肝脏组织Ki-67染色阴性,而肝衰竭病例在汇管区或旁汇管区可以检测到数量不等的Ki-67阳性细胞,但并不与c-kil阳性前体细胞呈平行关系。结论急性肝衰竭时肝细胞大片坏死但内源性干细胞活化不足是预后差的原因之一。而病程迁延较长的亚急性或慢性肝衰竭,肝脏干细胞活化水平逐渐升高,提示积极治疗肝衰竭使其设法渡过急性期,可以不同程度调动肝脏自身再生重建机制。     

单一庚型肝炎病毒感染的临床和病理与免疫组化的相关性探讨

目的 探讨单由庚型肝炎病毒（ＨＧＶ）感染对肝脏的致病性。方法 用酶联免疫吸附法检测３６例血清抗－ＨＧＶ，用ＨＧＶ的ＮＳ５片段单克隆抗体（ＭｃＡｂ）对２０例临床和病理确诊为单一庚型肝炎者行肝组织免疫组化，其中急性肝炎１０例，慢性肝炎７例，亚急性重型肝炎１例，慢性重型肝炎２例。结果 ①临床表现：急性肝炎呈急性起病，表现为发热、乏力、恶心、厌油等症状，个别有呕吐现象；慢性肝炎起病缓慢，症状轻；重型肝炎呈急性起病，有高度乏力、严重消化道症状，重者发生肝昏迷。②ＡＬＴ和ＡＳＴ改变：急性肝炎和重型肝炎呈中度升高，慢性肝炎呈轻度升高，重型肝炎可出现“酶胆分离”现象。③肝组织的病理损害：急性肝炎以肝细胞肿胀和汇管区炎症细胞浸润为主。慢性肝炎以肝细胞肿胀、小叶内碎屑样或灶状坏死、汇管区轻度炎症细胞浸润和／或纤维组织轻度增生为主。     

Comparative evaluation of clinical, cytological and cell culture methods of candida vulvovaginitis diagnosis]

98 patients with Candida vulvovaginitis (CVV) were examined clinically, cytologically and culturally. Three clinical forms of CVV were distinguished: acute and subacute (26 and 23 patients, respectively)--before treatment, and remission (49 patients)--after treatment. The clinical diagnosis of CVV before the treatment was confirmed cytologically and/or in cultures (87.7%), in remission cytologically (4%), by cultures (20 patients). Candida in the phase of budding and pseudomycelium were prevalent in acute CVV (84.4%). In a subacute form Candida occurred in 30.3%, while in the remaining cases blastospores were observed. Significant correlation between the intensity of Candida colonies growth and phase of development on the mucous membrane was not found. Compared to the cultural method, the cytological technique is more cost effective, faster and simpler.     

Morphology of infectious endocarditis affecting bioprostheses of the cardiac valves

Four varieties of infectious endocarditis were identified after cardiac valve bioprostheses: early acute, early subacute, late acute, and late subacute forms. Any of these forms may be of bacterial, fungal, or mixed (bacterial and fungal) origin. In the early forms, the infection was of exogenous origin, with a predominance of Gram-positive organisms, whereas in the late forms it was endogenous with a preponderance of Gram-negative flora. The hallmarks of fungal thromboendocarditis were an early massive thrombosis of the bioprosthesis, multiple thromboembolism, and an absence of cellular reaction in the cuspal tissue. In the subacute bacterial endocarditis, progressive dysfunction of the bioprosthesis resulting from calcination of bacteria-containing cusps and thrombi was noted.     

Subacute sclerosing panencephalitis in the hamster. Ultrastructure of the acute disease in newborns and weanlings.

Acute subacute sclerosing panencephalitis has been investigated in both newborn and weanling hamsters intracerebrally inoculated with a human subacute sclerosing panencephalitis isolate (HBS) adapted to grow in hamster central nervous system (CNS) tissue. Newborn animals developed a disease which was fatal in approximately 1 week whereas most weanlings showed signs of an acute disease after day 8, from which a significant number recovered. Ultrastructurally, the human subacute sclerosing panencephalitis isolate (HBS) replicated rapidly in the CNS of newborn hamsters in the absence of an immune response. Giant cells developed from neurons and some demyelination was evident, most probably due to oligodendrocytic damage. Virus replication involved the proliferation of both typical measles virions and morphologically defective particles. Intracytoplasmic viral nucleocapsids were seen, but none were found within nuclei during the acute disease in newborns. Weanling hamsters developed a demonstrable immune response approximately 6 days after inoculation. Virions were seen and the majority appeared morphologically defective, lacking the associated nucleocapsids beneath the viral envelope. Abundant intranuclear, as well as intracytoplasmic, viral inclusions were seen. The results are of significance in the examination of myxoviruses (a group frequently linked to a number of chronic diseases of the CNS), in terms of viral replication in the CNS, in the response of different CNS cell types to infection, and in the influence of age and immune status upon the course of CNS disease.     

Isolation and some serological and epidemiological data on the viruses recovered from patients with subacute thyroiditis de Quervain

Virological and serological methods were used in examination of 28 patients suffering from subacute thyroiditis de Quervain. Attempts to isolate a presumed viral agent from 8 patients were performed by inoculation of serum, urine, and aspiration biopsies of thyroid glands taken at different stages of the illness, into tissue cultures of different types of human and animal cells. Recovery of a cytopathic viral agent on cells of a rabbit lung continnuous line was successful in 5 cases. Serological cross reactions exist between the isolated viruses and patient serum but not with serum of healthy people. Cases with the acquired illness and positive antibodies against the isolated viruses who had been in close and prolonged contact with patients suffering from subacute thyroiditis de Quervain were also investigated.We wish to thank Mrs. E. Schinglerová for her very competent technical assistance.     

Coagulative myocytolysis and its outcome in homicide victims. Reflexions on its relative psychologic meaning

This research has been justified by the recent acquisitions about the pathogenic role that stress may play on myocardium, not only through the involvement of coronary vessels, but even through an action directed on the muscle fibres, which results in a coagulative myocytolysis with consequent fibrosis. The Author intended to verify the incidence of the above said cardiopathy, evaluating it with respect to the suprarenal glands changes, in the victims for homicide, mostly belonging to the criminal subculture of the province of Reggio Calabria. The choice of such a casuitic is based on the fact that the suprarenal glands study, carried out by the same Author on the above said victims since 1958 till today, has allowed to point out, excluding the cases of people accidentally involved in the crime (the so-called "innocent victims", typical morphological changes including all degrees of stress (acute, subacute or chronic), with the prevalence of those typical changes occurring in subacute or chronic forms, chiefly in the medullar gland. The research was carried out on the casuistic from two periods: 1st group: 1958-1975 (61 cases, 53 males, aged 10 to 73, mostly killed with fire-arms); 2nd group: November 1989-October 1990 (52 cases, almost exclusively males, aged 17 to 66, 51 of which killed with fire-arms, and one with a knife). The results are the following: 1) In the first group: a) 32 cases showed the presence of myocardial fibrosis striae, for the most part very thin, wavy and parallel to the myocytes; b) all the cases showed a hypercontracted aspect of the myocytes; c) 10 cases, belonging to the 32 cases with fibrosis, showed signs of acute myocytolysis; d) 13 cases showed mild signs of intimal fibrosis in the coronary arteries; e) 48 cases showed signs of subacute or chronic functional hyperactivity of the suprarenal glands, either in the medullar or in the cortical gland, often with signs of acute superstimulation; f) 12 cases showed exclusively signs of acute stimulation of the same glands; g) one case (innocent victim), showed suprarenal glands of normal aspect.(ABSTRACT TRUNCATED AT 400 WORDS)     

Predisposing Factors Associated With Chronic and Recurrent Rhinosinusitis in Childhood

Purpose

There is currently no information regarding predisposing factors for chronic and recurrent rhinosinusitis (RS), although these are considered to be multifactorial in origin, and allergic diseases contribute to their pathogenesis. We evaluated the predisposing factors that may be associated with chronic and recurrent RS.

Methods

In this prospective study, we examined patients with RS younger than 13 years of age, diagnosed with RS at six tertiary referral hospitals in Korea between October and December, 2006. Demographic and clinical data related to RS were recorded and analyzed.

Results

In total, 296 patients were recruited. Acute RS was the most frequent type: 56.4% of the patients had acute RS. The prevalences of other types of RS, in descending order, were chronic RS (18.9%), subacute RS (13.2%), and recurrent RS (11.5%). Factors associated with recurrent RS were similar to those of chronic RS. Patients with chronic and recurrent RS were significantly older than those with acute and subacute RS. The prevalences of allergic rhinitis, atopy, and asthma were significantly higher in patients with chronic and recurrent RS than those with acute and subacute RS.

Conclusions

An association between atopy and chronic/recurrent RS, compared to acute and subacute RS, suggests a possible causal link.     

PATHOLOGICAL STUDY ON GOLD IMPREGNATION OF FAT-STORING CELLS IN HUMAN LIVER

Examination of 51 human liver specimens with the modified Kupffer's gold impregnation method confirmed the presence and distribution of fat-storing cells in various kinds of diseased livers such as fatty liver, acute centro-lobular necrosis, subacute massive necrosis and cirrhosis as well as in liver cell carcinoma. In normal liver, gold-reactive fat-storing cells were distributed in the central area or difisely in lobules. In the liver with marked fatty change and obstructive jaundice, presence of fat-storing cells was able to be clarified by this method. In cases of acute hepatocellular necrosis, the necrotic areas contained a large number of fat-storing cells in contrast to adjacent areas. In cases of subacute massive hepatic necrosis and cirrhosis, the areas with abundant newly formed collagen fibers (type III collagen) contained many gold-reactive fat-storing cells. In the septa consisting of dense type I collagen flbers, by contraries, fat-storing cells were hardly visible. The features suggested that fat-storing cells are closely related to intralobular fibrogenesis. In one case of liver cell carcinoma, there were many gold-reactive fat-storing cells in tumor tissue.     

Administration of hematopoietic cytokines increases the expression of anti-inflammatory cytokine (IL-10) mRNA in the subacute phase after stroke

We investigated the effect of the subcutaneous administration of hematopoietic cytokines, granulocyte colony-stimulating factor (G-CSF)+stem cell factor (SCF), on mRNA expression of tissue cytokines in the acute or subacute phase after focal ischemia in male C57 BL/6J mice. The expression of IL-10 mRNA was elevated at 4-14 days after occlusion when cytokines were given in the acute phase (days 1-10). The expression of IL-10 mRNA was markedly elevated at 14 days after occlusion, then remained high until 28 days when cytokines were given in the subacute phase (days 11-20). However, there were no significant changes in IL-6, TGF-beta1, TNF, G-CSF, SCF and iNOS expression following either acute- or subacute-phase treatment. Further, hematopoietic cytokine treatment in the subacute phase, but not in the acute phase, reduced ED1-positive microglia/macrophages in the infarcted brain. Our recent study showed that the subacute-phase treatment is effective for functional recovery, enhancing generation of neuronal cells from both bone-marrow-derived and neural stem/progenitor cells. Taken together, these results suggest that cytokine treatment in the subacute phase may provide a favorable microenvironment for neurogenesis after ischemic stroke through the up-regulation of IL-10.