Recurrent myocardial infarction with patent coronary arteries.

Two separate episodes of severe chest pain occurred several years apart in a 25-year-old male patient with typical clinical findings of acute myocardial infarction with each episode. Cardiac catheterization following the second infarction confirmed the presence of myocardial dysfunction with apical akinesis and dyskinesis. Both coronary arteries were radiologically patent; however, there was evidence of probable recanalization of the right coronary artery.

Myocardial infarction in sickle cell disease.

Gross and microscopic findings consistent with acute (three patients) and healed (four patients) myocardial infarction were found in seven (9.7%) of 72 consecutive hearts from patients with sickle cell disease studied after autopsy between 1950 and 1982. Gross obstructive and atherosclerotic lesions were absent in all seven patients, while microthrombi were present in the arterioles of infarcted tissue in two patients.

Pathological spectrum of liver diseases in sickle cell disease.

Most pathologic studies of liver disease in sickle cell anemia and its variants were performed retrospectively on autopsy specimens, and, because of the prominent histologic features of intrasinusoidal sickling and Kupffer cell erythrophagocytosis, hepatic dysfunction was attributed to the intrahepatic sickling of erythrocytes in this hemoglobinopathy. We compared the liver histology from 19 patients who had liver biopsies to the autopsy specimens from 32 patients who succumbed to the complications of the hemoglobinopathy. In the former, nine patients had histological evidence of viral hepatitis.

Liver involvement in sickle cell disease.

In an effort to clarify the features of hepatic dysfunction in sickle cell disease, we obtained serial tests of liver function in 100 consecutive patients with sickle cell anemia and in 30 consecutive patients with hemoglobinopathy SC during a five-year period. There were 32 patients with chronic abnormalities in tests of liver function. These abnormal tests were explained by a variety of lesions in 30 cases, and the liver disease remained unexplained in only 2 patients who declined liver biopsy.

Carcinoma of the pancreas and periampullary structures. Pattern of metastasis at autopsy.

We studied the pattern of metastasis at autopsy in 158 patients with carcinoma of the pancreas and in 29 patients with carcinoma of the periampullary structures. The three most commonly involved organs were the abdominal lymph nodes, liver, and lung. Other organs and sites were involved in less than 25% of the cases.

Immunopathologic and clinical studies in pulmonary hypertension associated with systemic lupus erythematosus.

PH is an uncommon manifestation of SLE. The symptoms of PH develop within a few years after the onset of the multisystem disease. The most common presenting complaints of SLE patients with PH are dyspnea on exertion, chest pain, nonproductive cough, edema, and fatigue or weakness.

Acute myocardial infarction in sickle cell anemia.

Typical acute myocardial infarction in a well-documented case of sickle cell disease, to our knowledge, has not been reported. A patient with hemoglobin SS proved by electrophoresis with typical clinical manifestation and diagnostic ECG changes died suddenly. Autopsy findings were confirmatory, but no atherogenic lesions were present.

Sclerosing hepatic carcinoma: relationship to hypercalcemia.

A series of 30 patients is reported whose primary hepatic tumors had a distinctive histologic pattern that we have called "sclerosing hepatic carcinoma" (SHC). Sixty-nine percent of those tested had hypercalcemia and low levels of serum phosphate. As comparison, 38 control patients who had either classical peripheral cholangiocarcinoma or typical hepatocellular carcinoma were studied.

An autopsy survey of clinical and anatomic diagnoses associated with alcoholism.

Alcoholism, a major cause of hospitalization and death in the United States, has been associated with multiple organ system dysfunctions. A systematic search by computer was made of the diagnoses in 35,579 autopsies performed from 1949 to 1972 at the Los Angeles County-University of Southern California Medical Center. Alcoholic and control cases (total, 8,186) were matched by age, sex, race, and appropriate date of death.

Selective immunodeficiency and malignant lymphoma of the central nervous system. Possible relationship to the Epstein-Barr virus.

This report presents the findings of a study of a 17-year-old male with a selective immunodeficiency to the Epstein-Barr virus, who died of a malignant lymphoma following clinical infectious mononucleosis. Autopsy findings and immunohistochemical techniques demonstrated a malignant lymphoma with B-lymphocyte characteristics which primarily involved the central nervous system (CNS). The relationship of the Epstein-Barr virus to lymphoproliferation is discussed.

Cholelithiasis: a frequent complication of artificial heart valve replacement.

The results of this investigation reveal that 39 per cent of patients in a study group of 46 patients with heart valve prostheses had gallstones if they survived 18 months or longer following valve replacement. In contrast, the prevalence of gallstones in a general population of autopsied rheumatic heart disease patients, including those who had been operated for severe valvular heart disease and had not survived for more than one month, was only 12 per cent. These findings suggest that gallstones are a frequent late complication of heart valve replacement.

Metastatic cystosarcoma phyllodes. A report of 2 cases presenting with neurological symptoms.

Two cases of cystosarcoma phyllodes of the breast are presented with central nervous system (CNS) metastases appearing several years after mastectomy for the primary lesion. Unusual features in these cases include the widespread metastases themselves, neurologic symptomatology and CNS involvement, metastases into a uterine leiomyoma and into an area of hepatic adenomatous hyperplasia, and glomus-like structures in one of the primaries with similar structures resembling glomus cells in metastases. The distant metastases were of stromal cells only and frequently surrounded epithelial cells to isolate the indigenous glandular structures.

The changing incidence of association of hepatitis B with hepatocellular carcinoma in California.

Two hundred seventy-nine patients who died of hepatocellular carcinoma were autopsied at Los Angeles County--USC Medical Center and the John Wesley--USC Liver Unit from 1949 through 1974, and tissues from 168 of these cases were available for staining for hepatitis B surface antigen (HBSAg). Twenty-one per cent of the livers had stainable HBSAg. There were prominent increases both in total numbers of hepatic cancers and in the percentages that were HBSAg-positive beginning about 1970, but the numbers of hepatocellular carcinomas arising in noncirrhotic livers also increased.

Disseminated toxoplasmosis with brain involvement in a renal allograft recipient.

A 47-year-old male with renal failure received a renal transplant which subsequently was rejected. After removal of the transplant the patient went into a catabolic state, and developed fever and hematochezia. The patient became septic, developed respiratory involvement.