CEREBRO-SPINAL INFARCTION CAUSED BY ATHEROMATOUS EMBOLI

Cholesterol embolization to the abdominal viscera is common, but rare in the central nervous system. Fourteen cases of atheromatous embolization to the central nervous system were morphologically investigated. Among the 800 consecutive autopsy cases, 38 cases had atheromatous emboli in various organs. Cerebro-spinal infarction caused by atheromatous emboli was found in 11 cases. Infarction rate (11/14) was relatively higher than in other organs and 5 of these cases were thought to be due to direct injury to the erosive surface of the aorta; cardiac catheterization (2 cases), intra-aortic baloon pumping (2 cases), and extra-anatomical bypass graft operation (1 case). These 14 patients consisted of elderly patients (70.1 ±6.3 years old) usually associated with hypertension (78.6%) and diabetes mellitus (42.8%). Anatomically, aortic aneurysms were seen in 10 cases (71.4%), in which aortic arch aneurysm was seen in 6 cases. Hence, aortic mechanical procedure is of great importance for denuding atheromatous materials from erosive atherosclerosis to the central nervous system. ACTA PATHOL. JPN. 35 : 789–801, 1985.     

Atheromatous Embolization Report of Two Cases with Unusual Complications

Two cases of spontaneous atheromatous embolization associated with unusual complications are presented. One is an 85-year-old man who developed an acute abdomen and underwent a surgical resection of totally infarcted left-sided colon. Histologically, multiple acute atheromatous emboli were found occluding the serosal and pericolic mesenteric arteries causing transmural necrosis of the involved portion of bowel. The other is an 80-year-old woman who had had a coronary heart disease, hypertension, and renal insufficiency, and terminally developed a rapid deterioration of renal function and melena. Postmortem examination showed a severely, ulcerated, aortic atherosclerosis and widespread, recurrent, atheromatous emboli in many abdominal organs with the resultant severe nephrosclerosis, gastrointestinal mucosal hemorrhagic necrosis, and multiple infarcts in the pancreas and spleen. In addition, there was focal cortical necrosis of the kidenys accompanied with glomerular capillary fibrin thrombi indicating disseminated intravascular coagulation (DIC). These findings seen in the present two cases were briefly discussed in light of the previous pertinent literature.     

Atheromatous embolization. Report of two cases with unusual complications

Two cases of spontaneous atheromatous embolization associated with unusual complications are presented. One is an 85-year-old man who developed an acute abdomen and underwent a surgical resection of totally infarcted left-sided colon. Histologically, multiple acute atheromatous emboli were found occluding the serosal and pericolic mesenteric arteries causing transmural necrosis of the involved portion of bowel. The other is an 80-year-old woman who had had a coronary heart disease, hypertension, and renal insufficiency, and terminally developed a rapid deterioration of renal function and melena. Postmortem examination showed a severely, ulcerated, aortic atherosclerosis and widespread, recurrent, atheromatous emboli in many abdominal organs with the resultant severe nephrosclerosis, gastrointestinal mucosal hemorrhagic necrosis, and multiple infarcts in the pancreas and spleen. In addition, there was focal cortical necrosis of the kidneys accompanied with glomerular capillary fibrin thrombi indicating disseminated intravascular coagulation (DIC). These findings seen in the present two cases were briefly discussed in light of the previous pertinent literature.     

Association of leptomeningeal carcinomatosis in carcinoma of the breast with infiltrating lobular carcinoma. An autopsy study

We analyzed the autopsy records of 261 patients with breast carcinoma, who died at The Institute of Oncology, Ljubljana, Yugoslavia, for the presence of metastases to the central nervous system, particularly for the presence of leptomeningeal carcinomatosis. Metastases to the central nervous system were found in 41 (18.1%) of 226 patients who had metastatic cancer. In 24 cases (10.6%), metastases were seen in brain parenchyma; in 11 cases (4.9%), only dura mater was involved, and in six cases (2.6%), leptomeningeal carcinomatosis was found. All patients with leptomeningeal carcinomatosis showed some symptoms of central nervous system involvement while alive. The patients died between 2 weeks and 2 months after the onset of central nervous system symptoms. Four of six patients with such a complication presented with locally advanced or disseminated carcinoma on the first admission. With regard to histologic findings, three patients had infiltrating lobular carcinoma, two had infiltrating ductal carcinoma, and one had mixed infiltrating lobular and ductal carcinoma, with a metastasizing lobular component. Metastases to the brain parenchyma were found exclusively in infiltrating ductal carcinoma. We stress that infiltrating lobular carcinoma represents a distinctive type of breast cancer with an unusual propensity to disseminate into leptomeninges, as this occurred in almost 14% of all cases of infiltrating lobular carcinoma in our series in contrast to a 1% incidence in cases of infiltrating ductal carcinoma.     

经腹经阴道联合三维超声对11～14孕周胎儿颅内透明层厚度与中枢神经系统畸形的相关性研究

目的探究经腹经阴道联合三维超声对11~14孕周胎儿颅内透明层(IT)厚度与中枢神经系统畸形的相关性。方法将150例IT厚度异常的孕妇(孕11~14周),分为增厚组(63例)、减小组(58例)与消失组(29例),颅内透明层厚度正常的为对照组(60例),均给予经腹经阴道联合三维超声检查胎儿IT厚度与中枢神经系统畸形发生情况。结果增厚组胎儿头臀径与IT值显著比其它组高(P<0.05),消失组中枢神经系统畸形发生率为93.10%,增厚组为79.37%,均比减小组、对照组高(P<0.05),IT厚度与发生中枢神经系统畸形呈正相关(P<0.05)。结论根据胎儿颅内透明层厚度可评估中枢神经系统畸形发生率,值得应用与推广。     

Cryptococcus neoformans var. gattii in the koala (Phascolarctos cinereus): a review of 43 cases of cryptococcosis.

Details of 11 previously reported cases and 32 new cases of cryptococcosis in captive and wild koalas were analysed. Cryptococcus neoformans var. gattii accounted for all 29 cases in which varietal status was determined. No age or sex predisposition was observed. The respiratory tract was the primary focus of disease in 77% of cases. Although the lower respiratory tract was affected most commonly (60% of cases), 30% of cases had upper respiratory tract lesions and 14% had both. Dissemination was common, especially to the central nervous system (37% cases). Local extension to surrounding tissues was a feature of upper respiratory tract disease. Other tissues showing cryptococcal invasion included lymph nodes (19%), gastrointestinal tract (12%), kidneys (12%), spleen (9%) and skin (7%). Only three cases (7%) had no respiratory tract or central nervous system involvement, two cases of primary skin inoculation and one case of primary lymphadenopathy. Late presentation was a likely factor in the high proportion of cases with disseminated disease (40%). The proportion of koala cases with involvement of the central nervous system, lower respiratory tract and skin, parallels what has been reported for immunocompetent people. Cryptococcosis in the koala appears to be an excellent naturally occurring model for examination of the cryptococcal host-parasite relationship in all species.     

Coronary artery embolism with special reference to invasive procedures as the source.

Since 1978, there have been sporadic reports of coronary artery embolism caused by cardiac catheterization, percutaneous transluminal coronary angioplasty, and other invasive procedures. To determine whether coronary artery embolism has increased with the wider application of such procedures, we searched for patients with coronary artery emboli among the autopsy cases with suspected acute myocardial infarction at the National Cardiovascular Center from 1977 to 1990. Of the 28 patients with emboli, 10% of the total autopsy cases of myocardial infarction was confirmed in 18. Infarction was diagnosed clinically in only six of these patients and directly caused the death of 11 of the 18 patients. In contrast to previous reports, where a minority of coronary emboli were caused by instrumentation, 14/28 patients in our series had coronary embolism due to invasive procedures, including eight patients with atheromatous emboli. half of the myocardial infarcts caused by embolism were hemorrhagic. Thus, coronary emboli are not so rare as once thought, and they may increase further with the progress of invasive diagnostic and surgical interventions. The possibility of coronary embolism thus needs to be kept in mind by all clinicians in the cardiovascular fields.     

Intrapulmonary neuroglial heterotopia.

Nonteratomatous intrapulmonary neuroglial heterotopia not associated with birth trauma or frank vascular embolization has been described rarely. This article briefly reviews the literature, and presents two additional cases of intrapulmonary neuroglial heterotopia. We found 14 cases in the literature. Twelve of these cases had central nervous system disruption, where neuroglial elements were in direct contact with amniotic fluid. Several hypotheses have been proposed, including fetal aspiration of detached neural fragments within amniotic fluid, neural crest migration defects, and vascular embolization with implantation. Of our two cases, one represents the first occurrence where central nervous system abnormalities were secondary to mechanical disruption, rather than to a primary neural tube defect. Our second case represents the youngest documented occurrence (17 weeks gestation) of intrapulmonary neuroglial heterotopia. Additionally, immunohistochemical studies were performed on these lesions, the results of which favor their neural origin. We present these findings and suggest they support the aspiration mechanism for neuroglial heterotopia in lung tissue.     

Congenital hydrocephalus--analysis of 49 cases.

The causes of congenital hydrocephalus vary widely and have an important effect in determining the future counseling of affected cases. We analyzed the postmortem findings of 49 autopsies diagnosed as hydrocephalus to find the causes and related conditions. The cases were collected during the last 10 years (1981-1990). The cases consisted of 25 cases associated with various congenital malformations of the central nervous system (CNS), 14 cases of posthemorrhagic hydrocephalus, 4 cases of postinfection hydrocephalus, and 2 cases of hydranencephaly. Four cases were associated with supracerebellar arachnoid cyst (1) and unknown causes (3). Twenty-five cases associated with congenital malformation of the CNS consisted of 10 cases of holotelencephaly, 5 cases of stenosis of the Sylvian aqueduct, 4 cases of agenesis of the corpus callosum, and 3 cases each of Dandy-Walker malformation and Arnold-Chiari malformation. Various malformations of other organs were associated with these cases. Cardiovascular malformations were common, consisting of 11 cases of patent ductus arteriosus (PDA), 7 cases of atrial septal defect (ASD), and 6 cases of patent foramen ovale (PFO). Among the anomalies of the respiratory system, abnormal lobation was commonly associated, as well as hypoplasia of the lung. Gastrointestinal malformations included Meckel's diverticulum, diaphragmatic hernia, mobile intestine, and midline small liver. Cryptorchidism was the most common malformation in the genitourinary system. Holotelencephaly cases showed multiple craniofacial anomalies, as well as other malformations in the central nervous system. Skeletal malformations included polydactyly, simian crease, and flexion deformity. There were no specific constellations of malformations in these different groups of CNS malformations associated with hydrocephalus.     

诱发电位对痴呆和非痴呆型帕金森病与宾斯旺格病的比较研究

目的 :探讨帕金森病 (PD)与宾斯旺格病 (BD)患者的中枢神经通路和认知功能状态。方法 :对无痴呆的PD 2 8例 (PD组 ) ,伴痴呆的PD 2 2例 (DPD组 )及BD组 18例进行①体感诱发电位 (SEP)、②视觉诱发电位 (VEP)、③脑干听觉诱发电位 (BAEP)和④事件相关电位 (ERP)检查。结果 :①SEP :PD组中 5例 (18% )异常 ,DPD组中 8例 (36 % )异常 ,BD组中 11例 (6 1% )异常 ;②VEP :PD组仅 1例 (4% )异常 ,DPD组中 4例 (18% )异常 ,BD组 3例 (17% )异常 ,经统计学处理 ,潜伏期与左右眼差值均无显著差异 ;③BAEP :PD组中 4例 (14% )异常 ,DPD组中 5例异常 (2 3% )异常 ,BD组 4例 (2 2 % )异常 ;④ERP :PD组中 5例异常 (18% ) ,DPD组 9例异常 (41% ) ,BD组 11例异常 (6 1% )。结论 :SEP和ERP阳性率最高 ,其阳性率的顺序为BD >DPD >PD ,提示三组病例的中枢神经系统功能的损害有明显区别。     

BCL-2 in primary central nervous system lymphomas. Immunohistochemistry and molecular biology

BCL-2 is a membrane protein known to be an apoptosis inhibitor. It is the product of the bcl-2 gene located on chromosome 18. Several different tumors show BCL-2 over-expression as result of a translocation or independently from it. More than 85% of follicular lymphomas and a smaller number of diffuse large cell B lymphomas contain t(14;18) (q32;q21). The aim of this study was to investigate the immunohistochemical expression of the BCL-2 protein and to ascertain, by means of traditional PCR (Polimerase Chain Reaction), its possible dependence from t(14;18) (q32;q21) in 9 primary central nervous system lymphomas. Six cases (67%) shoved immunohistochemical BCL-2 over-expression and 3 cases (33%) had t(14;18). Precisely: 2 cases (22%) had immunohistochemical BCL-2 over-expression and t(14;18) (q32;q21); 4 cases (44%) had BCL-2 over-expression without translocation; 1 case (11%) did not show diffuse BCL-2 over-expression in presence of the traslocation; the remaining 2 cases (22%) did not demonstrate BCL-2 over-expression or t(14;18) (q32;q21). In conclusion, our results indicate primary central nervous system lymphomas frequently show BCL-2 over-expression that in some case may be related to t(14;18) (q32;q21). Nevertheless, t(14;18) (q32;q21), as evaluated by traditional PCR, may not correspond to diffuse immunohistochemical BCL-2 positivity.     

The neuropathology of AIDS. UCLA experience and review.

The central nervous system (CNS) has been examined at autopsy in 89 patients who died of the acquired immune deficiency syndrome (AIDS), including 14 patients who died primarily of neurologic complications of the disease. A total of 66 brains (74%) showed significant pathologic abnormalities, with opportunistic infections including cytomegalovirus (14) and cryptococcal (11) infections, progressive multifocal leukoencephalopathy (6), toxoplasmosis (6), and histoplasma microabscesses (1). Incidental Mycobacterium avium-intracellulare infection was found in 4 cases. Simultaneous CNS infection by more than one microorganism was encountered in 5 patients. Subacute (microglial nodule) encephalitis-related to cytomegalovirus infection or possibly brain infection by the causative agent of AIDS was present in 56 cases. Primary CNS lymphoma was noted in 3 patients. Secondary CNS deposits of lymphoma were found in 1 patient, and another patient had lymphomatoid granulomatosis. Vascular complications were not infrequently seen, and included infarcts secondary to vessel occlusion and disseminated intravascular coagulation in 4 patients and intracranial hemorrhage of variable severity in 13. White matter changes included vacuolar myelopathy (3 cases), central pontine myelinolysis (1 case), and foci of calcified, necrotizing leukoencephalopathy in pontocerebellar fibers of the basis pontis (2 cases). These findings highlight the variety of CNS complications in AIDS, some of which are not associated with clinical manifestations. Nevertheless, characterization of all lesions may be important in understanding the neurologic sequelae of AIDS.     

孙氏手术治疗头臂血管严重受损的A型主动脉夹层过程中血液动力学参数的意义

目的:探讨孙氏手术治疗头臂血管严重受损的A型主动脉夹层对血液动力学参数的影响。方法:选取125例头臂血管严重受损的A型主动脉夹层患者,对其行孙氏手术,观察体外循环时间、主动脉阻断时间、低流量选择性脑灌时间以及同期合并手术;并发症及30 d内死亡发生率;手术前后左室舒张末期内径（LVEDD）、心指数（CI）、中心静脉压（CVP）。结果:患者体外循环时间、主动脉阻断时间以及低流量选择性脑灌时间平均分别为（194.32±52.64）、（103.66±33.07）、（23.15±7.29） min,同期合并手术主要有Bentall手术、升主动脉替换、主动脉瓣成形;19例（15.20%）发生并发症,主要有神经系统并发症、多脏器功能不全甚至衰竭、肾功能不全甚至衰竭,8例（6.40%）30 d内死亡,主要死于多脏器功能不全甚至衰竭;与手术前比较,手术后患者LVEDD显著降低,CVP、CI显著升高,差异有统计学意义（P<0.05）。结论:孙氏手术治疗头臂血管严重受损的A型主动脉夹层不仅能够降低并发症发生率和死亡率,而且还能改善血液动力学参数,对临床治疗A型主动脉夹层有积极意义。     

Atheromatous emboli in renal biopsies. An ultrastructural study.

In a series of 755 renal biopsies atheromatous emboli were found in biopsies of 8 men from 49 to 72 years of age. Unexplained recent deterioration of renal function was present in each. This previously unreported incidence of 8/755 biopsies is ascribed to the selection for biopsy of patients with unexplained decrease in renal function. Hypertension was a major feature in 6, hyperlipidemia in 2, a leaking aortic aneurysm in 1, carcinoma of the pancreas in 1, and chronic glomerulonephritis in 1 patient. Toluidine-blue-stained epoxy sections proved to be more effective in recognizing small emboli than paraffin sections. Ultrastructural observation concerned a) early lesions (eg, fresh emboli with endothelial distortion or injury), b) intermediate lesions (eg, histiocytic or giant cell reaction and intimal proliferation), and c) later lesions (eg, extraluminalization of the crystals eventually resulting in inert location in intimal stroma). Osmiophilic deposits on the crystal surfaces were myelin-form in structure and were felt to result from lysosomal action.     

Cholesterol embolism causing bleeding gastric ulcers

Two cases of atheromatous embolism of the small arteries of the stomach are reported. Insofar as has been ascertained, they are the first reported cases in the literature which presented symptoms of severe gastric bleeding and were found to have bleeding gastric ulcers on endoscopy. Both patients were successfully treated surgically, and their ulcers were found to be secondary to small arteriolar occlusions owing the atherosclerotic embolization. Awareness of clinicians as well as pathologists of this phenomenon in elderly males with symptoms of abdominal pain and other upper gastrointestinal symptoms unrelated to the ingestion of food is stressed. Pathophysiology of atherosclerotic emboli is also discussed.     

肾移植后中枢神经系统并发症的临床诊疗

背景：目前国内外关于肾移植后中枢神经系统并发症的研究较少。 目的：探讨肾移植后中枢神经系统并发症的临床诊疗方案。 方法：对河南中医学院第一附属医院2008-01/2010-08收治的277例同种异体肾移植后出现中枢神经系统并发症的15例患者进行回顾性分析。 结果与结论：15例(5.41%)出现中枢神经系统并发症的患者中：弥漫性脑病7例(2.52%),脑血管意外4例(1.44%),癫痫发作3例(1.08%),中枢神经系统感染1例(0.36%)。提示肾移植后中枢神经系统原因较复杂,包括感染、缺氧、代谢、电解质紊乱、移植后排斥反应及免疫抑制剂(钙调蛋白抑制剂)等。     

中枢神经细胞瘤的临床病理特征和预后

目的：探讨中枢神经细胞瘤（CNC）的临床病理特征及其与预后的关系。方法：应用光镜、电镜检查观察了22例CNC的组织病理、超微结构特点,应用免疫组织化学染色观察了突触素、神经元特异性烯醇化酶（NSE）、Leu-7、胶质纤维酸性蛋白（GFAP）、髓磷脂碱性蛋白（MBP）及增殖细胞核抗原（PCNA)董关CNC的表达情况。结果：本组病例年龄4－14岁,平均27．9岁。肿瘤均发生于脑室。随访18例,14例生存8个月至14年11个月;4例死亡,平均生存时间70．7个月。CNC组织学特点,瘤细胞有明显的核周空晕,呈蜂窝状结构,特征性改变为无核纤维岛。细胞异型、核分裂象及灶性坏死罕见。免疫组织化学染色突触素、NSE、Leu-7阳性表达,GFAP7有MBP阴性反应,PCNA极少数细胞阳性。超微结构特点为圆形瘤细胞可见多量细胞突起,突起内含微管、神经分泌颗粒、透明囊泡及溶酶体样结构。结论：常规光镜检查难以鉴别CNC和少突胶质细胞瘤,免疫组织化学和电镜对确诊CNC很重要。CNC一般预后良好。间变性组织学特点与生物学行为之间的关系仍不清楚。     

Penoscrotal transposition and associated anomalies: Report of five new cases and review of the literature

We present the largest single series of cases (n = 5) of penoscrotal transposition (PST) with carefully documented nongenitourinary/anal anomalies, none of which fell into categories of known syndromes, associations, sequences or chromosome disorders. Several unexpected anomalies were observed including coloboma of the iris and retina, hydrocephalus, microcephaly, diaphragmatic hernia, tracheo-esophageal fistula/esophageal atresia and cleft palate. The most frequent anomalies other than PST were renal defects (100%) such as renal agenesis and dysplasia, imperforate anus (60%), central nervous system anomalies (60%) and preaxial upper limb defects (40%). Cardiovascular defects (atrial septal defect, double aortic arch with vascular ring) were noted in only one case. The surviving patients (3/5) had postnatal growth failure and mental retardation. Our 5 PST patients are compared to 16 well-documented cases from the literature. The overall incidence of various extragenital abnormalities were: renal (90%), mental retarardation (60%), imperforate anus (33%), central nervous system (CNS) anomalies (29%), vertebral defects (29%), preaxial limb defects (24%) and congenital heart disease (19%). PST is a rare heterogenous anomaly, the detection of which should warrant careful clinical evaluation to rule out other anomalies, especially of the urinary system, gastrointestinal tract, upper limbs, craniofacial region and central nervous system. PST may be a localized field defect involving the genitourinary system; however, the wide variety of more distant defects noted in our series and the literature would raise doubt about that assumption. The high frequency of growth deficiency and mental retardation has also not been given due respect as accompanying problems associated with PST. © 1995 Wiley-Liss, Inc.     

Factors associated with local invasion in infective endocarditis: a nested case–control study

ObjectiveA substantial proportion of infective endocarditis (IE) cases are complicated by local invasion. The purpose of this study was to identify patient and disease characteristics associated with local invasion in surgically treated IE patients.MethodsThis was a nested case–control study. All episodes of IE for patients admitted to Cleveland Clinic from 1 January 2013 to 30 June 2016 were identified from the Cleveland Clinic IE Registry. Patients ≥18 years of age who underwent surgery for IE were included. Among these, cases were those with local invasion, controls were those without. Local invasion, defined as periannular extension, paravalvular abscess, intracardiac fistula or pseudoaneurysm, was ascertained from the surgical operative note. Associations of selected factors with local invasion were examined in a multivariable logistic regression model.ResultsAmong 511 patients who met inclusion criteria, 215 had local invasion. Mean age was 56 years; 369 were male. Overall 345 (68%) had aortic valve, 228 (45%) mitral valve, and 66 (13%) tricuspid or pulmonic valve involvement. Aortic valve involvement (OR 6.23, 95% CI 3.55–11.44), bioprosthetic valve (OR 3.88, 95% CI 2.36–6.44), significant paravalvular leak (OR 3.80, 95% CI 1.60–9.89), new atrioventricular nodal block (OR 3.77, 95% CI 1.87–7.90), infection with streptococci other than viridans group streptococci (OR 7.54, 95% CI 2.42–24.87) and presence of central nervous system emboli (OR 1.85, 95% CI 1.13–3.04) were associated with local invasion.DiscussionIntracardiac and microorganism factors, but not comorbid conditions, are associated with local invasion in IE.     

Endocarditis-associated brain lesions in slaughter pigs

Left-sided valvular endocarditis (LSVE) is a common finding in slaughter pigs. The lesion is often associated with renal thromboembolism, but information on embolization to other organs is sparse. This study focuses on the presence and type of endocarditis-associated brain lesions (EABLs). The brains of 20 slaughter pigs with spontaneously arising LSVE and 11 controls were examined by sectioning half of a formalin-fixed brain into 4 mm slices for histological examination. The aetiology of the endocarditis was determined by bacteriological and, in some cases, by fluorescence in-situ hybridization examinations. These examinations identified 11 cases of Streptococcus suis, six cases of Erysipelothrix rhusiopathiae, one Streptococcus spp. and two cases that remained aetiologically undetermined. One of the S. suis cases had a dual infection with S. suis in the aortic valve lesions and Streptococcus dysgalactiae subsp. equisimilis in the atrioventricular valve lesions. Renal infarcts were present in eight cases. Focal encephalitis was found in 12 cases, with the number of lesions ranging from one to 11. Most pigs had less than four microscopical lesions. Acute lesions were characterized by focal microabscesses without observable bacteria. Chronic lesions were characterized by astrocytosis and focal accumulation of mononuclear leucocytes. An infarct was observed in one animal. Perivascular inflammation was seen in 14 cases, mostly as two or three lesions, while focal leptomeningitis was found in eight cases. EABLs are therefore common in slaughter pigs with LSVE. The number of lesions per animal is small, which may explain the limited attention paid to this sequela of LSVE. EABLs have rarely been reported in domestic animals and mostly in patients with neurological signs. The frequent occurrence of EABLs in slaughter pigs suggests that this pathology should be investigated in other animal species with LSVE.