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Biomedical subjects

H J Manz

Publications and source records attributed to H J Manz.

At least 19 recordsLinked to original sources

Type-specific identification of herpes simplex and varicella-zoster virus antigen in autopsy tissues.

To identify antigens of herpes simplex virus (HSV) types 1 and 2 and varicella-zoster virus (VZV) in human tissue, polyclonal antisera and an immunoperoxidase method were used to examine formalin-fixed, paraffin-embedded tissues from autopsy cases and experimentally infected animals. These antisera readily distinguished between HSV and VZV antigen, with no evident cross-reactivity. Antiser ato HSV-1 and HSV-2 were more strongly reactive with antigen of the homologous virus than with that of heterologous virus. This difference in immunoreactivity was used to discriminate between HSV-1 and HSV-2 antigens in experimentally infected animal tissues containing HSV antigens of known type and, by extrapolation, to distinguish between these antigens in human autopsy tissues. Thus, with appropriate antisera and tissue controls, HSV-1, HSV-2, and VZV can be identified in paraffin sections.

Adult

Bilateral orbital involvement in fatal giant cell polymyositis.

The case of a young woman with giant cell polymyositis is described. She had bilateral, severe, midly painful proptosis and ophthalmoplegia. Extensive pharyngeal, laryngeal, and cardiac muscle involvement occurred 18 months later coincident with fatal cardiac arrhythmia. At autopsy, extensive muscle necrosis and giant cells were noted in extraocular, pharyngeal, laryngeal, and cardiac muscle with only minimal involvement of other striated muscles.

Adult

Disk fragment migration.

This report analyzes the most frequently observed migration paths of disk fragments in 47 patients who had extruded or sequestered disks. Observations are based principally on magnetic resonance (MR) images. When disk fragments moved in a superior (42%) or inferior (40%) direction from the donor disk, the displaced disk components were most frequently (94%) dislodged into the right or left half of the anterior epidural space (AES) and rarely straddled the midline. To explain this phenomenon, the authors investigated the anatomy of the AES by dissecting four cadaver specimens and reviewing 300 MR images of the spine. They conclude that the migrating path of a disk fragment is determined by the anatomy of the AES, a fairly well-defined space delimited posteriorly by the posterior longitudinal ligament and by membranes laterally attached to it. It consists of two compartments separated by a sagitally aligned septum. During migration, sequestered disk fragments usually stay in these compartments.

Cervical Vertebrae

Rapid isolation of OmpF porin-LPS complexes suitable for structure-function studies.

A gentle and rapid isolation procedure is described yielding fractions containing better than 95% pure OmpF porin of Escherichia coli BE with different amounts of bound lipopolysaccharide (LPS). The procedure employs continuous free-flow electrophoresis (FFE) in the presence of detergent above its critical micelle concentration. Total yields of around 45% were typically obtained when porin-enriched membrane extracts were processed. By use of analytical ultracentrifugation a molecular mass of 114,000 and a sedimentation coefficient S20,w of 5.0 S were determined for porin trimers containing approximately 1 mol of tightly bound LPS. This porin readily formed 3D crystals suitable for high-resolution X-ray diffraction analysis. Three other porin-LPS isoforms isolated by FFE revealed molecular masses of 120,000, 124,000, and 151,000, suggesting that, in addition to the tightly bound LPS, 1, 2, and 8 mol of loosely bound LPS were present per mole of porin trimer. Each of the four different isoforms was suitable for reconstitution into highly ordered protein-lipid membrane arrays. The membrane crystals obtained with the 151-kDa isoform exhibited a unit cell polymorphism similar to that previously reported.

Bacterial Outer Membrane Proteins

Neurogenic fibrosarcoma following radiation therapy for seminoma.

We report a case of radiation-induced neurogenic fibrosarcoma that developed in a patient who received radiation therapy for seminoma. The sarcoma developed within the irradiated field after a latency period of nineteen years. Although the occurrence of a secondary neoplasm is unusual, this possibility should be included in the differential diagnosis of patients who present with tumor growth after a long interval following radiation therapy.

Adult

Malassezia furfur--disseminated infection in premature infants.

Three infants, born prematurely, died after clinical illnesses of 67, 65, and 60 days from infection by Malassezia furfur. Each infant had been nourished with lipid emulsions delivered through deep-line catheters. The infections, all discovered at autopsy, were characterized by massive involvement of lungs. Two of the three had endocardial vegetations containing M. furfur; all three had lesions in liver, kidney, and spleen, and two had lesions in adrenal, pancreas, and colon. In addition, one of the infants had acute meningoencephalitis caused by M. furfur. In some of the distant organs, yeast cells of M. furfur were growing in the lumina of small vessels, filling the lumina, but causing no vasculitis or infarction. In addition to these benign collections of yeasts within vessels, there were acute inflammatory lesions as well. These were consolidation, vasculitis, granulomatous inflammation, septic thrombosis, and septic infarction of lung and foci of necrosis and inflammation in kidney and liver. Two previously reported autopsies described neonates with lesions in lung and heart. The authors' three cases for which autopsies were performed had lesions in lung and heart too but, in addition, had dissemination with acute lesions in kidney and liver. Finally, one patient had a severe meningoencephalitis caused by M. furfur.

Fat Emulsions, Intravenous

MR imaging of neurocysticercosis.

Twenty-six patients with neurocysticercosis were studied with MR imaging to correlate their clinical presentation with the location and appearance of their neurocysticercosis lesions. Intraventricular cysts were present in 14 patients (54%), parenchymal cysts were present in 18 (69%), and intraventricular together with parenchymal cysts were present in six (23%). Intraventricular cysts were detected by mass effect, ventricular obstruction, detection of a cyst rim, and/or CSF flow void adjacent to the cyst. The intensity of most intraventricular and parenchymal cysts presumed to be viable was similar to that of CSF on both T1- and T2-weighted sequences. Cysts presumed to be degenerated had increased signal intensity on T1-weighted images, probably resulting from increased protein content. Pericystic high signal intensity surrounding lesions of various ages was seen on both proton-density- and T2-weighted images and represents gliosis, edema, and inflammation. Patients with parenchymal cysts had symptoms of seizures, while those with intraventricular cysts generally had symptoms related to obstructive hydrocephalus. Aqueductal stenosis, seen in 10 patients (38%), was possibly due to ependymal inflammation or adhesions caused by prior ventricular infection by neurocysticercosis. One patient with the racemose form of neurocysticercosis demonstrated abundant cyst wall proliferation resulting in obstructive hydrocephalus. In six patients scanned 1-6 months after oral praziquantel therapy, there was no change in the MR appearance of intraventricular cysts, while some parenchymal cysts showed evidence of degeneration. We found MR to be useful in detecting the cysts of neurocysticercosis and the accompanying signs of cyst degeneration and pericystic inflammation. MR was inferior to CT in the detection of parenchymal calcifications.

Adolescent

Amniotic band syndrome. Report of two cases and review of the literature.

The amniotic band syndrome, a complex collection of asymmetric congenital anomalies, is almost certainly an underdiagnosed entity. No two cases are exactly alike. Two cases are reported, each of which exhibits craniofacial, visceral, body wall, and limb anomalies, the common types of defects seen in this syndrome. The literature is reviewed, and the most commonly accepted theory of pathogenesis is discussed in juxtaposition to another major theory. The importance of recognizing this syndrome is stressed, since it very rarely recurs in families.

Abnormalities, Multiple

Cutaneous malignant melanoma in survivors of heritable retinoblastoma.

Six survivors of bilateral retinoblastoma developed cutaneous malignant melanoma 20 to 51 years (average, 31 years) after initial therapy for the ocular tumor. Five patients received radiation therapy to the orbital area. In two patients the cutaneous malignant melanoma developed in the field of irradiation. Two patients developed multiple cutaneous melanomas and are thought to have the dysplastic nevus syndrome. At this writing two patients are alive and well after wide resection of their skin tumors. A review of the literature suggests that cutaneous malignant melanoma accounts for about 7% of second malignant neoplasms in survivors of heritable retinoblastoma.

Adult

Central spinal cord injury: magnetic resonance imaging confirmation and operative considerations.

A case of central cervical spinal cord injury, confirmed by magnetic resonance imaging (MRI) and treated by myelotomy, is presented. After recovering well from his central cord syndrome and walking with assistance, the patient developed a rapidly progressive myelopathy beginning 2 months after injury. His main injury localized clinically to the C8, T1 level; but central cord abnormalities were identified 3 months after injury at the C6 level by MRI: a high signal intensity on the proton density sequence and a low-signal intensity on the T1-weighted sequence. At operation 41/2 months after his injury and 1 month after complete paraplegia, a myelotomy at C6 failed to reveal any cavity (syrinx) but instead disclosed only intense gliosis inside a slightly atrophic spinal cord. Rapid clinical improvement ensued. Secondary syringomyelia may be an endstage condition after spinal cord insults that trigger a progressive, pathophysiological reaction leading to central cord necrosis. In selected cases, myelotomy may interrupt this MRI-identified, nosogenic process before cavitation has occurred.

Adult

Intraparenchymal hemorrhage in preterm neonates: a broadening spectrum.

Among 800 neonates screened for cerebral bleeding, perinatal sonography identified 35 preterm neonates with intraparenchymal hemorrhage (IPH). The observed IPHs were categorized in five general groups: classical grade-IV hemorrhage (16 patients), grade-IV hemorrhage with coexisting but anatomically separate hemorrhages (four patients), grade-IV hemorrhage with later development of secondary parenchymal hemorrhages at distant sites (five patients), hemorrhagic periventricular leukomalacia (four patients), and parenchymal hemorrhage unrelated to grade-IV hemorrhages (six patients). Thirty IPHs had concurrent germinal matrix hemorrhages, but in only 16 patients did the IPH represent an extension of the subependymal hematoma and therefore qualify as pure grade-IV hemorrhage according to the most popular classification. The high concurrence of periventricular leukomalacia (80-100% in most groups) and germinal-matrix-remote IPHs supports the concept that most IPHs in preterm neonates represent secondary hemorrhages into ischemic brain tissue.

Brain

An unusual case of central nervous system vasculitis.

A patient with CNS vasculitis limited to small vessels is described. Initial spinal cord involvement with paraparesis was followed by multifocal cerebral and cerebellar involvement, depicted by magnetic resonance imaging (MRI). She also had recurrent cerebral bleeding. A diagnosis of vasculitis was made by cerebral biopsy. Immunosuppressive therapy resulted in clinical improvement and resolution of the MRI abnormalities.

Biopsy

Cytomegalovirus encephalitis associated with episodic neurologic deficits and OKT-8+ pleocytosis.

After 3 days of symptoms suggesting a viral illness, a 35-year-old man experienced three episodes of aphasia, right-sided sensory symptoms, and bifrontal headache. Each lasted several hours. CSF examination revealed a moderate lymphocytosis consisting of 80% OKT-8+ cells. Serum anti-cytomegalovirus (anti-CMV) antibody titer was elevated at 1:1,024 and subsequently fell to 1:64. Episodic symptoms recurred 5 months later, at which time the anti-CMV titer peaked at 1:8,192. A trial of inhaled oxygen aborted two episodes after several minutes each.

Adult

Lymphocytic adenohypophysitis causing pituitary mass.

Lymphocytic infiltration of the anterior pituitary is a rare complication of pregnancy, which has been reported in 18 cases. Symptoms begin in the last trimester or soon after delivery. Radiologically, an expanding mass in the sella may result in suprasellar extension. We studied a case in which there was CT evidence of a pituitary mass 2 weeks postpartum, and biopsy confirmed the diagnosis.

Adult