Hepatoid carcinoma of the lung with production of alpha-fetoprotein and abnormal prothrombin: an autopsy case report

Alpha-fetoprotein (AFP) is a useful tumor marker for the diagnosis of hepatic and testicular tumors. Several cases of AFP-producing lung cancer have been reported. We present here a patient with AFP-producing primary lung carcinoma, which showed high values of serum AFP (100,000 ng/mL). The concanavalin A nonbinding fraction rate of AFP was 15%. Gross and microscopic features of the lung carcinoma bore a striking resemblance to those of hepatocellular carcinoma. According to the histologic classification of lung tumor, this case was large cell carcinoma with prominent hepatoid differentiation. Immunohistochemically, we detected AFP in the cytoplasm of the neoplastic cells. We also detected another useful tumor marker for the diagnosis of hepatocellular carcinoma, i.e., des-gamma-carboxy prothrombin (protein induced by vitamin K absence or the absence of antagonist-II [PIVKA-II]), in serum using an enzyme immunoassay and in tumor cells by immunohistochemical analysis.     

Three sibs with mild variety of osteopetrosis

We report three sibs with mild autosomal recessive variety of osteopetrosis. The prominent clinical features were short stature, malocclusion of teeth, hepatosplenomegaly and a typical facial appearance. The only atypical features were microcephaly, a normal upper segment to lower segment ratio and a normal arm span.     

A case of successful resection of pulmonary arteriovenous fistula with a high shunt ratio

We report on a 25-year-old cyanotic man who was diagnosed as having a pulmonary arteriovenous fistula. His chief complaint had been shortness of breath since childhood. Polycythemia (Hb 21.4 g/dl) was detected during a health checkup at his company. A chest X-ray showed an abnormal mass in the left lung. Blood gas analysis showed severe hypoxia with PaO2 of 38.6 mmHg at room air. Angio-CT showed a large aneurysmal lesion at S6 of the left lung with a large feeding artery and vein. Oxygen saturation was 75.2% in the radial artery and 62.5% in the right atrium. The right-to-left shunt ratio was therefore calculated as 62%. The aneurysmal lesion was resected by segmentectomy of the left S6 following division of A6 and V6. After a successful operation, the patient no longer had shortness of breath or cyanosis and blood gas analysis showed PaO2 as 84.3 mmHg at room air. Pulmonary angiography showed no residual shunt lesion.     

A case of mosaic trisomy 2 diagnosed at amniocentesis in an abnormal fetus and confirmed in multiple fetal tissues

A female renal transplant recipient had intractable femoral neuralgia due to a large calcified disk herniation. She then developed an anterior epidural hematoma above the herniation, from T12 to L2, in the absence of clotting disorders. Spontaneous resorption of the hematoma occurred. The femoral neuralgia resolved after surgical treatment of the herniation. The location of the hematoma suggests that the calcified disk may have torn the fragilized epidural venous network.     

Reconstruction of an abnormal hepatic vein in a donor liver: a case report

In the era of worldwide organ shortage for liver transplantation, every effort must be made to use all potentially available livers. In this case report, we present a liver graft with abnormal left hepatic vein draining directly to the right atrium of the donor heart, which was discovered during back table preparation of a liver graft. The vein was reconstructed and the subsequent liver transplantation was successful. Five years after the transplantation, no signs of complications have emerged.     

Balanced reciprocal translocation mosaicism associated with an abnormal phenotype

Balanced reciprocal translocation mosaicism is rarely reported in humans. Only two previous cases have been associated with an abnormal phenotype. We report on a third case of apparently balanced reciprocal translocation mosaicism associated with an abnormal phenotype, largely different from those reported previously. Since low levels of mosaicism may not be detected in routine cytogenetic analyses, balanced reciprocal translocation mosaicism may be associated with an abnormal phenotype more often than has been recognized to date.     

A case of male pseudohermaphroditism associated with elevated LH, normal FSH and low testosterone possibly due to the secretion of an abnormal LH molecule

A 27 year old female is described who had 46,XY chromosome complement, ambiguous external genitalia with elevated LH, slightly above normal FSH and low testosterone. Her plasma testosterone level increased 15-20 fold after HCG stimulation (5000 IU X 3). then returned to prestimulation level 3 months later. This was possibly due to the secretion of an abnormal LH molecule which is immunoreactive but biologically inactive in the human.     

Granulocytic sarcoma. A case with an unusual location

A 58-year-old male was admitted to our hospital with a preliminary diagnosis of bacterial endocarditis. After admission, echocardiography indicated the presence of vegetation-like tissues on both the left coronary cusp and the anterior mitral leaflet, although retrograde aortography two months earlier hadn't indicated an abnormal finding on the aortic cusp. The vegetation-like tissues had gradually enlarged despite the administration of antibiotics at another hospital, and aortic and mitral regurgitation had become severe. We decided to perform replacements of the aortic and mitral valves on the day of admission. During the operation, the aortic valve was found not to have vegetation, but an aneurysmal pouch on the left coronary cusp. It was supposed that either bacterial endocarditis or catheter injury had made a part of the aortic cusp weak and intolerant of diastolic pressure gradient, and as a result, the weakened part of the cusp progressively dilated into the left ventricle forming an aneurysmal pouch. To our knowledge, there have been only two previous reports of an aneurysmal pouch on the aortic cusp documented in the literature.     

Bilateral total hip prosthesis in osteopetrosis. Apropos of a case. Review of the literature

BACKGROUND: After our first known patient with vancomycin-resistant enterococci (VRE) infection was admitted in 1993, we observed a gradual increase in infections and colonization caused by this organism. Thus we initiated a prospective study to quantitate the incidence of VRE infection versus colonization, to identify risk factors for VRE, and to define the natural history of VRE colonization among our patients. METHODS: Stool/rectal cultures were performed for patients admitted to the intensive care units at the time of admission and weekly thereafter. Patients found to be carrying VRE were followed with cultures every 2 weeks, and this protocol was continued after transfer to the medical-surgical wards. A surveillance form was initiated on each VRE patient and included demographics, underlying diseases, and risk factors. Environmental cultures in the intensive care units were randomly performed. Patients with positive cultures were isolated. RESULTS: During a 27-month period, 210 patients were found to be colonized or infected with VRE. Ages ranged from 35 to 97 years; the mean age was 65 years. Fourteen percent (29 of 210) of the patients were VRE positive on admission. Nosocomial colonization or infection occurred at an average of 28 days after admission. Seventeen percent (25 of 216) of patients cleared VRE during their hospital stay; 19% (40 of 210) developed 47 infections. One third of infections involved the urinary tract. Liver transplantation, chemotherapy, and total parenteral nutrition were each associated with infection. CONCLUSION: Routine measures as advocated by the Centers for Disease Control and Prevention were not effective in controlling VRE in our patient population.     

Rupture of an abnormal pulmonary artery with a flow-directed pulmonary artery catheter

Most authors believe that biliary pancreatitis rarely progresses to chronic pancreatitis. Here, we present a case of an 18-yr-old white male with a history of gallstone pancreatitis and pancreatic pseudocyst resulting in radiographic and pathologic evidence of pancreatic calcification over a 16-mo period.     

A human T cell line with an abnormal trisomy 2 karyotype established by coculture of peripheral lymphocytes with an HTLV-II-infected simian leukocyte cell line

A new human T cell line with a chromosomal abnormality (47,XY,+2), designated AS-IIA, was established by coculturing peripheral blood leukocytes of a healthy adult male with a lethally irradiated human T lymphotropic virus type II (HTLV-II)-infected simian leukocyte cell line (Si-IIA). A polymerase chain reaction method showed that this interleukin-2 (IL-2)-dependent cell line possessed the HTLV-II provirus genome; the cells also reacted with HTLV-II-positive human sera, anti-HTLV-I/II p24, and anti-HTLV-II gp46 antibodies. AS-IIA cells expressed the suppressor/cytotoxic T cell markers CD3+, CD4-, CD8+, CD25+, and HLA-DR+, with later conversion to CD8-. These cells showed better proliferation than other human HTLV-II-infected cell lines with normal karyotypes, but were not transplantable into severe combined immunodeficiency mice. Virus production from AS-IIA was confirmed not only by electron microscopic examination, which revealed mature and immature type C virus particles, but also by the capacity of the line to immortalize human T cells. These results suggest that HTLV-II shows broad tropism for T cells including CD4+ or CD8+, and that not only Si-IIA, but also AS-IIA, are good sources of HTLV-II. The authors of the present study believe that AS-IIA may be a useful human T cell line for the investigation of HTLV-II in comparison with HTLV-I.     

A case of intrahepatic stones with an anomalous intrahepatic portal venous system

A 64-year-old woman who had undergone surgery for gallstones twice was admitted with epigastric pain and fever. Ultrasonography revealed gallstones in the dilated left lateral intrahepatic bile ducts. Abdominal computed tomography disclosed atrophy of the left lateral segment and the right lobe of the liver, and hypertrophy of the left medial segment and the caudate lobe. Percutaneous transhepatic cholangiography demonstrated that the stones were localized in the left lateral intrahepatic bile ducts, and that the choledochoduodenostomy previously established was patent. Percutaneous transhepatic portography revealed that the left portal vein was absent and the left medial segment was supplied by the right portal vein. Left lateral hepatic segmentectomy and release of the choledochoduodenostomy were performed. Postoperative recovery was good, and the patient is now well without any complaint. This report discusses the surgical treatment for intrahepatic stones under very complicated conditions and the relationship between intrahepatic stones and anomalous portal venous system.     

Follow-up study of a case of generalized ceroidlipofuscinosis of childhood with special reference to the finding of an abnormal serum lecithin fatty acid pattern

In quest of a more precise and stringent diagnosis for a case of generalized ceroidlipofuscinosis the patient was reexamined and additional laboratory tests were performed. For the third time myeloperoxidase activity was normal. On two separate occasions the serum lecithin fatty acid pattern was found to be abnormal and to resemble closely the pattern reported to be characteristic of polyunsaturated fatty acid lipidosis. The tau fraction was measured on one occasion and found to be normally present. Head circumference was confirmed to be normal. Pigmentary retinal changes were observed by fundoscopic examination. The child had prominent epileptic activity in form of myoclonic jerks. The case does not fit exactly into the picture reported recently for children with polyunsaturated fatty acid lipidosis. Doubt is voiced that these children have other than an infantile type of generalized ceroidlipofuscinosis. Thus, for the time being we regard ours as a case of generalized ceroidlipofuscinosis of infantile onset with an abnormal serum lecithin fatty acid composition. Furthermore, it seems to us that the infantile form, in the same manner and to the same extent as the late infantile and juvenile forms, does not constitute an entirely homogeneous group within the ceroidlipofuscinoses.     

The ultrasonic diagnosis of an early abnormal pregnancy

During the period of January 1993 to February 1994, 70 pregnant women had an ultrasonic diagnosis of abnormal pregnancy. 111 ultrasound examinations were made--mean 1.6 of each woman. The ultrasonic diagnosis up to 70 women was: missed abortion--35 women (50%), blighted ovum--30 women (42.9%), other diagnosis--5 women (7.1%). Histological examination of material was made with 64 women (91.4%). Comparing the ultrasonic diagnosis to histological results, authors do not recommend a final diagnosis before eight gestation week.     

A report of an intrathoracic case of hibernoma

The paper describes the synthesis of 6-[4-alkylpiperazinyl-1)phenylamino]-1,2,5-thiadiazolo[3,4-h ]quinolines where methyl (Drug G-1574) and ethyl (Drug G-1569) are alkyls. The two agents are as effective as mebendazole against the larval stage of Echinococcus multilocularis infection. Drug G-1574 has been demonstrated to ensure 100% recovery of spontaneously Hymenolepis nana-infected albino mice given doses 2.5-5 times lower than the effective dose of phenasal (niclosamide).     

Evaluation of cardiac STATus CK-MB/myoglobin device for rapidly ruling out acute myocardial infarction

The Cardiac STATus CK-MB/Myoglobin device is highly sensitive and has a high negative predictive value within 3 hours of patient presentation. The device may play a role in the re-triage of patients from the CCU to less intensive settings, resulting in a net cost savings.