Pulmonary edema localized in the right upper lobe accompanying mitral regurgitation

Focal patterns of pulmonary edema are confusing and often mistaken for the more common causes of focal lung disease, pneumonia, infarction, or aspiration. The authors report four cases of right upper lobe edema secondary to mitral regurgitation. The pathogenesis believed to be responsible for this condition is the vector of blood flow from the left ventricle to left atrium, which may be targeted at the right superior pulmonary vein, locally accentuating the forces for edema formation in the right upper lobe. Pulmonary edema accompanying mitral regurgitation should be suspected whenever right upper lobe consolidation develops in a patient with known or suspected mitral valve disease. The presence of interstitial edema in the remainder of the lungs can help in the differentiation of this condition from pneumonia and other disorders.     

Air in the minor fissure: a sign of right-sided pneumothorax

Pneumothorax in the critically ill patient may be difficult to detect when the air does not rise to the apex of the thorax. Several radiographic signs have been previously described to help recognize this condition. Air in the minor fissure, a previously unreported radiographic finding, is an additional sign of right-sided pneumothorax.     

Small lymphocytic lymphoma: a clinicopathologic analysis of 268 cases

We analyzed specimens from 268 patients with small lymphocytic lymphoma (SL) to identify prognostic factors significant for survival. These patients were staged and treated according to the protocols of the Cancer and Leukemia Group B, Eastern Cooperative Oncology Group, Southeastern Cancer Study Group, and the Southwest Oncology Group. Univariate analysis showed that a large-cell grade greater than I, WBC greater than 10,000/microL, hemoglobin (Hgb) less than 11 g/dL, age greater than or equal to 55 years, and failure to respond to treatment were all poor prognostic factors. Multivariate analysis showed that large-cell grade, age, degree of capsular invasion, and symptom type were independently associated with survival. Separate analyses of cases with and without leukocytosis indicated differences in survival. In patients without leukocytosis, age, presence or absence of anemia, and treatment response were significant prognostic variables; in patients with leukocytosis, large-cell grade, presence or absence of anemia, symptom type, and treatment response were significantly related to survival. Multivariate analysis showed that age was the only significant independent prognostic variable in patients without leukocytosis; in patients with leukocytosis, symptom type, large-cell grade, and bone marrow involvement were independently associated with survival. We conclude that several parameters, both clinical and pathologic, should be assessed at the initial diagnosis of SL to predict prognosis better.     

Preservation of somatostatin secretion in cystic fibrosis patients with diabetes

Immunohistochemical studies of pancreatic tissue from patients with cystic fibrosis associated with diabetes mellitus (CFDM) show increased numbers of somatostatin secreting delta cells. To look for a possible functional correlate to this finding basal and arginine stimulated plasma somatostatin and serum C peptide concentrations in eight insulin treated patients with cystic fibrosis and eight normal male controls were measured. Mean basal somatostatin concentrations were not different in the two groups. Mean peak somatostatin concentrations were significantly higher in the group with CFDM: 11.60 pmol/l v 7.14 pmol/l in controls. Mean peak C peptide concentrations were significantly lower in the group with cystic fibrosis: 0.89 nmol/l v 4.27 nmol/l in controls. This observation provides a physiological correlate to the pathological finding of increased somatostatin content in pancreatic tissue from patients with CFDM. Selective preservation of somatostatin secretion in patients with cystic fibrosis may further complicate pancreatic endocrine insufficiencies through paracrine inhibition of insulin and glucagon secretion.     

Immunocompetent cells in oral candidiasis of HIV-infected patients: an immunohistochemical and electron microscopical study

OBJECTIVE: The purpose of this study was to elucidate the pathogenesis of oral candidiasis, a common cause of discomfort and social impairment among HIV-infected individuals.
STUDY DESIGN, MATERIALS AND METHODS: The oral mucosal immune system cells were analysed by immunohistochemistry and electron microscopy in biopsies from five erythematous and four pseudomem-branous candidiasis cases and were compared with those from seven HIV-positive and 10 HIV-negative controls without candidiasis.
RESULTS: The superficial lamina propria and basal epithelial layer was populated by CD1a⁺ Langerhans cells with infiltration of CD8⁺ lymphocyteS. Within the submu-cosa are CD36⁺ dendritic macrophages and lymphocytes, although CD4⁺ subsets were absent from the infiltrate. The expression of human leukocyte antigen system, DR locus (HLA-DR) and leukocyte specific adhesion molecules was low in erythematous, yet more marked in pseudomembranous candidiasiS. In the pseudomembra-nous form, CD14⁺ leukocytes were found in the basal epithelial layer. Langerhans cells were significantly more numerous and were richer in dendrites and Birbeck granules in erythematous than in pseudomembranous can-didiasis.
CONCLUSIONS: Candidiasis is associated with alterations in the number and differentiation of lymphocytes and dendritic cells, being more severe in the pseudo-membranous than erythematous form. We propose that these alterations play a role in the pathogenesis and evolution of the disease.     

Seminal megavesicles with adult polycystic kidney disease

Adult polycystic kidney disease has been found in association with pathological dilatation of the seminal vesicles in six patients. These men appeared normal on clinical examination, but had azoospermia or severe oligozoospermia. They were investigated by scrotal exploration with vasography, renal and transrectal ultrasound scans (TRUS), and percutaneous puncture of the seminal vesicles in one case, before and after resection of the ejaculatory ducts. This revealed that the gross dilatation of the seminal vesicles was not caused by obstruction, but appeared to be due to atonicity (megavesicles). These ultrasonic appearances, when described previously, were incorrectly thought to be due to seminal vesicle cysts.