Prosthetic valve endocarditis: clinicopathologic analysis of 22 necropsy patients with comparison observations in 74 necropsy patients with active infective endocarditis involving natural left-sided cardiac valves

Clinical and morphologic features are described in 22 necropsy patients with endocarditis involving rigid-framed prosthetic valves: aortic in 15 patients and mitral in 7. The interval from valve replacement to onset of symptoms of prosthetic valve endocarditis was less than 2 months in 8 patients and longer than 2 months in 14 patients. The most frequent infecting organism was the Staphylococcus (13 patients). In each of the 22 patients the infection was located behind the site of attachment of the prosthesis to the valve ring, and the infection spread to adjacent structures in 13 patients, 11 of whom had aortic prostheses. Prosthetic detachment causing severe regurgitation occurred in 12 of the 15 patients with an infected aortic valve prosthesis, and in 2 of the 7 with an infected mitral valve prosthesis. Prosthetic obstruction by vegetative material occurred in 5 of 7 patients with prosthetic mitral infection and in only 1 of 15 with prosthetic aortic infection. High degrees of conduction defects developed in seven patients with aortic prosthetic valve endocarditis: complete heart block in five, and complete left bundle branch block in two. Comparison of observations in the 22 patients with prosthetic valve endocarditis with those in 74 patients with active infective endocarditis involving natural left-sided cardiac valves revealed significant (P less than 0.05) differences in the percent with ring abscess, hemodynamic consequences of the endocarditis (valve stenosis), frequency of Staphylococcus as the causative organism and percent with complete heart block or left bundle branch block. No significant differences were observed between the two groups when comparing age, sex, type of underlying valve disease or frequency of organ infarcts of splenomegaly.     

Impact of Streptococcus pneumoniae bacteremia and human immunodeficiency virus type 1 on oral mucosal immunity

To determine whether defects in mucosal immunity were associated with invasive disease caused by a mucosal pathogen, Streptococcus pneumoniae, levels of salivary immunoglobulins and nonspecific immune factors were compared in subjects with human immunodeficiency virus type 1 (HIV-1) infection and in HIV-1-seronegative subjects with and without pneumococcal bacteremia. The IgA2 subclass may be of particular importance because S. pneumoniae produces IgA1 protease, which cleaves IgA1 but not IgA2. Levels (37-56 micrograms/mL) and proportions (11%-17%) of IgA2 were similar among groups. Serotype-specific capsular salivary IgA was present in a minority of patients with acute bacteremia. Levels of lactoferrin were increased with bacteremia. Neither selective mucosal IgA2 deficiency nor impaired nonspecific upper respiratory mucosal responses were associated with invasive pneumococcal disease during HIV-1 infection; thus, other defects in mucosal cellular responses and systemic immunity may predispose HIV-1-infected patients to invasive pneumococcal disease.     

Ultrastructural studies of prepubertal porcine uterine tube epithelium

Ultrastructural details of prepubertal porcine uterine tube (oviduct) were studied in normal, growing gilts and compared with observations reported in other species. Tissues from the ampulla region of uterine tube were taken from 6 prepubertal gilts (106 to 139 days old) to determine cytodifferentiation of ciliated and secretory cells. The epithelium consisted of 2 distinctive cells, the ciliated and the secretory cells. Cilia were observed in the uterine tube of prepubertal gilts; however, degeneration of cilia was not observed in the present study. Most prominent observations were the occurrence of fibrous granules in the apical cytoplasm of ciliated cells. These fibrous granules contained electron-dense material and were present near basal bodies. The most unusual feature was the occurrence of procentrioles around a condensation form. These data indicate that ciliated cells are sensitive to estrogen. Intimate morphologic association between fibrous granules and basal bodies indicate that fibrous granules might provide precursor material for the development of cilia and rootlets. The cytoplasm of the secretory cells contained rough endoplasmic reticulum of tubular form and numerous ribosomes. Evidence for synthesis, storage, and release of secretory granules was not apparent. It is suggested that the secretory cells are not sensitive to the low, circulating concentration of plasma estrogen. The ultrastructure of the stromal cells and lymphatic capillary was described for the 1st time. The uterine tube stromal cells were characterized by prominent nucleus and a few cytoplasmic organelles. The lymphatic capillaries were distinguished by the blood capillaries, their much wider lumen, endothelium with an attenuated cytoplasm, absence of basal lamina, and overlapping and interdigitating intercellular junctions. The fine structure of the porcine uterine tube lymphatic capillary generally resembled that of other mammalian species.     

Dynamics of psychopathologic and neurologic syndrome in severe trauma to the skull and brain

A dynamical clinical psychopathologic and neurologic study of disturbed functions of the nervous system following closed trauma of the skull and brain was conducted on 52 patients. The following three periods could be distinguished: the immediate result of the injury (1 to 2 weeks), recovery (2 weeks to 2 months), and outcome (2 to 3 years after the injury). The clinical forms of the course of psychopathologic and neurologic syndromes in each period were determined.     

The morphological characteristics of the lung lesions in straighteners working with brass-bronze alloys

Morphologic study of lung specimens obtained during diagnostic thoractomy in 6 workers engaged in smelting brass-bronze alloys showed changes typical of exogenous fibrosing alveolitis, namely, terminal bronchiolitis with pseudopolypous growth in the submucous layer, vasculitis (predominantly arteritis) paralleled by secondary recalibration of vessels, arteriolar and venular shunting, and microcirculatory disorders.     

The detector, the command neuron and plastic convergence

The paper deals with the structure of detectors, the function of commanding neurones and the problem of relationship between detectors and commanding neurons. An example of hierarchial organization of detectors is provided by the colour analyser in which a layer of receptors, a layer of opponent neurones and a layer of colour-selective detectors are singled out. The colour detector is selectively sensitive to a certain combination of excitations at the input. If the detector is selectively activated by a certain combination of excitations at the input, the selective activation of the commanding neurone through a pool of motoneurones brings about a reaction at the output, specific in its organization. The reflexogenic zone of the reaction is determined by the detectors which converge on the commanding neurone controlling the given reaction. The plasticity of the reaction results from a plastic convergence of the detectors on the commanding neurone which controls the reaction. This comprises selective switching off the detectors from the commanding neurone (habituation) and connecting the detectors to the commanding neurone (facilitation).