Arrhythmias in idiopathic dilated cardiomyopathy. A preliminary study

Idiopathic dilated cardiomyopathy is second to valvular heart disease as a cause of congestive heart failure in blacks in southern Africa. The disease has a deteriorating clinical course with high mortality. More than half these deaths are sudden and have been related to arrhythmias. In a preliminary study of 20 black patients in congestive heart failure caused by dilated cardiomyopathy, 24-hour ambulatory ECG monitoring was used to assess the prevalence, type and clinical significance of arrhythmias. Eighteen of the 20 patients (90%) had arrhythmias. Supraventricular arrhythmias were detected in 17 (85% of the total), and 18 (90%) had complex ventricular arrhythmias. Eleven (55%) had non-sustained ventricular tachycardia (VT). There was no correlation between complex ventricular arrhythmia and clinical features, resting ECG, chest radiograph or echocardiographic data. Over a 3-year period 13 patients died (65%), half these deaths being unexpected. All 13 had complex ventricular arrhythmias, and those who died suddenly had non-sustained VT. This small prospective study shows that ventricular arrhythmias are common in dilated cardiomyopathy in blacks and are frequently complex and dangerous. Sudden death is common and is more than likely to be related to VT in the presence of an already poorly functioning left ventricle.     

Primary biphasic lymphoplasmacytic lymphoma of the lung. A mucosa-associated lymphoid tissue lymphoma with compartmentalization of plasma cells in the lung and lymph nodes.

A primary mucosa-associated lymphoid tissue lymphoma of the lung in a 27-year-old man was found. The tumor was composed mainly of centrocyte-like cells and plasma cells. These two components were demarcated sharply from each other, resulting in a zoning or biphasic pattern. This characteristic pattern also was present in the involved regional lymph nodes. Monoclonality of tumor cells was shown immunohistochemically and by in situ hybridization techniques. This article also highlights the use of in situ hybridization in detecting light chain mRNA in paraffin sections.     

Incidence and review of sessile serrated polyp reporting in a district general hospital in the UK

The aim of this 4-year audit was to establish whether sessile serrated polyps/adenomas (SSP/A) were diagnosed in a district general hospital in the UK. The study also explored whether SSP/A in the right colon were misdiagnosed as hyperplastic polyps. A retrospective search of the computer records from 2009 to 2012 inclusive for all lesions diagnosed and coded as SSP/A and/or hyperplastic polyps proximal to the splenic flexure was undertaken. All slides were reviewed and a diagnosis of SSP/A made using the criteria recently suggested by the American College of Gastroenterology. Over the study period, no cases of SSP/A were made. On review of all hyperplastic polyps proximal to the splenic flexure, 13/31 in 2009, 17/40 in 2010, 19/48 in 2011 and 16/48 in 2012 were re-classified as SSP/A. The most likely reason for the under-diagnosis of SSP/A is lack of awareness of the lesion both clinically and by pathologists. Adequate biopsies and deeper sections are important to help make the diagnosis of SSP/A. This study shows that SSP/A are reasonably frequently encountered in non-specialist practice settings and that both clinicians and pathologist in this setting need to be aware of its existence.     

Liver blood flow during cardiac surgery

OBJECTIVE: Impairment of liver blood flow and, therefore, potentially liver function, has important short-term consequences because of the liver's key metabolic importance and role in drug metabolism. The objective of this study was to quantify the effect of cardiac surgery on liver blood flow from before the induction of anaesthesia to 24 hours postoperatively. METHOD: Ten patients with no history of liver impairment, moderate or good left ventricular function, and undergoing routine hypothermic coronary artery bypass graft surgery, were entered into the study. Liver blood flow was determined by the clearance of indocyanine green (ICG), expressed as a percentage disappearance rate (PDR). RESULTS: The mean baseline percentage disappearence rate (PDR) of indocyanine green (ICG) was 19.84 +/- 4.47%/min. This increased marginally to 20.42 +/- 6.67%/min following the induction of anaesthesia, but after 15 min of cardiopulmonary bypass, the PDR fell to 13.51 +/- 3.69%/min; this was significantly lower than all other PDRs measured throughout the study. Prior to extubation, the PDR increased again to 20.01 +/- 3.72%/ min, and this level was maintained at 12 hours (PDR 20.32 +/- 3.53%min) and 24 hours (PDR 20.51 +/- 2.27%/min). CONCLUSION: The induction of anaesthesia and positive pressure ventilation do not affect liver blood flow. Cardiopulmonary bypass at 30 degrees C is associated with a significant reduction in liver blood flow, which returns to normal within 4-6 hours of surgery and remains normal for up to 24 hours after surgery.     

CD31 (JC70) expression in plasma cells: an immunohistochemical analysis of reactive and neoplastic plasma cells.

AIMS: To investigate the immunohistochemical expression of CD31 (JC70) in normal and neoplastic plasma cells. METHODS: Plasma cells in bone marrow biopsies and extramedullary locations were examined. All extramedullary biopsies were formalin fixed and paraffin embedded. The bone marrow biopsies were fixed in formal acetic acid and embedded in paraffin wax. Twenty multiple myelomas (12 bone marrow and eight extramedullary deposits), 10 extramedullary plasmacytomas, and 30 biopsies with reactive plasma cells (10 bone marrow, 20 extramedullary biopsies) were stained with anti-CD31 (JC70) using the streptavidin-biotin detection system with diaminobenzidine as a chromogen. Antigen retrieval in bone marrow biopsies was achieved by pressure cooking. In all other biopsies, antigen retrieval was achieved by microwave pretreatment. RESULTS: All 20 extramedullary cases with reactive plasma cells showed intense membrane staining. Focal staining was detected in reactive plasma cells in bone marrow biopsies. Five of 10 plasmacytomas showed membrane staining. None of the cases of multiple myeloma, either medullary or extramedullary, showed any immunoreactivity for CD31. CONCLUSIONS: CD31, a member of the immunoglobulin supergene family of cell adhesion molecules, is strongly expressed in extramedullary reactive plasma cells, focally in bone marrow reactive plasma cells, and occasionally in extramedullary plasmacytomas.