Evolving concepts of infection by Pneumocystis carinii.
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Biomedical subjects
Publications and source records attributed to J C Watts.
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Two patients developed fever, cholestasis, and neutropenia following chemotherapy for acute leukemia. Computed tomographic scans of the liver were nondiagnostic, but peritoneoscopy in each case showed diffuse studding of the liver surface with white plaques. Microbiological cultures of the biopsy specimens were negative, but direct immunofluorescence stains of deparaffinized sections of the biopsies confirmed candidiasis. Follow-up laparoscopy in 1 patient after 2 mo of treatment with amphotericin B showed development of diffuse perihepatic adhesions. Peritoneoscopy is valuable in the diagnosis and management of focal hepatic candidiasis, and an etiologic diagnosis can be provided by immunohistology when microbiological culture of the biopsy specimen is negative or unavailable.
Typical yeast-phase cells of Blastomyces dermatitidis have a characteristic appearance in tissue sections. Fungal morphologic variation occurs infrequently in the lesions of blastomycosis, yet it can complicate the differential diagnosis, particularly if fresh tissue is not available for microbiologic culture. The authors report a case of pulmonary blastomycosis, confirmed by culture and direct immunofluorescence, in which some of the yeast-like cells were abnormally large. These giant yeast-like cells exceeded the size range accepted for the tissue forms of B. dermatitidis; therefore, coccidioidomycosis was considered initially in the differential diagnosis. Otherwise characteristic morphologic features of these cells, in particular multinucleation and the production of broad-based blastoconidia, helped resolve the differential diagnosis. The diagnosis can be confirmed by direct immunofluorescence or microbiologic culture.
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Nephrogenic adenoma is an uncommon metaplastic lesion of the lower urinary tract that usually is associated with antecedent inflammation or surgical procedures. We report 10 new cases, 8 of which followed renal transplantation and 1 of which followed partial cystectomy for squamous cell carcinoma of the bladder. No predisposing factors could be identified in 1 patient. The nephrogenic adenomas, all of which were located in the bladder, were treated by either biopsy with fulguration or transurethral resection. The lesion recurred locally in 1 patient.
We have developed a new indirect immunofluorescence procedure for identifying Trypanosoma cruzi amastigotes in sections of Formalin-fixed, paraffin-embedded tissue pretreated with a 0.25% trypsin solution to enhance immunofluorescence. In sections of human and mouse myocardia infected with T. cruzi and stained by this procedure, both intact amastigotes and phagocytosed amorphous antigen were intensely fluorescent and easily detected; nonspecific background fluorescence was absent or minimal. No staining occurred in similarly treated sections of Formalin-fixed, paraffin-embedded tissue that contained Histoplasma capsulatum var. capsulatum, Toxoplasma gondii, or Leishmania donovani to control specificity. Because pathology laboratories usually receive Formalin-fixed tissues for evaluation, this rapid and reliable procedure can be used to extend the diagnostic capability of conventional histopathology.
Practical constraints make it difficult to build large-aperture echo-planar magnetic resonance (MR) imagers. The implementation of a pediatric imager and its performance are described. Spatial resolution and signal-to-noise levels comparable to those of 1982 state-of-the-art MR imagers have been achieved in imaging times of 0.05-0.15 seconds. T1 and T2 information are obtainable in the echo-planar mode. A major issue is that of chemical-shift displacements.
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Patients with disseminated cryptococcosis infrequently present with cutaneous involvement. Skin lesions, when present, are usually multiple and polymorphous in appearance. Cellulitis caused by Cryptococcus neoformans is rare, and necrotizing vasculitis associated with cryptococcal vascular invasion has not to our knowledge been reported. We report here a case of disseminated cryptococcosis in a renal transplant recipient who had cellulitis and necrotizing vasculitis and in whom a diagnostic skin biopsy allowed for early therapy with cure and salvage of the renal allograft.
Section thickness in two-dimensional Fourier transform (FT) imaging is dependent on gradient strength and the shape of the radio-frequency pulses used to excite the nuclei. By manipulation of these parameters, it is possible to obtain 2.5-mm-thick sections in contiguous, multisection imaging. Because this method is efficient in imaging with long repetition times (TR), it effectively complements three-dimensional FT thin-section imaging techniques, which require imaging with short TRs. Fifteen double-echo, contiguous images of 0.9 X 0.9 X 2.5-mm resolution were obtained in 17.1 minutes for a TR of 2 seconds.
Conjugation can be used to synthesize half of the data acquired during a conventional two-dimensional Fourier transform imaging procedure, thus reducing imaging time by nearly half. The images acquired by this process have the same object contrast and spatial resolution as conventional images do, but with a 40% reduction in the signal-to-noise ratio (S/N). Conjugation can be used to advantage in magnetic resonance imaging units in which S/N levels are higher than needed to permit imaging with a single acquisition of each projection.
Mucinous carcinoid tumor of the vermiform appendix, an uncommon variant of appendiceal carcinoid, may present clinically with ovarian metastases. We studied a tumor by immunohistochemistry and electron microscopy and reviewed eight similar cases from the literature. The primary and metastatic tumors in our case were composed of mucin-producing cells and small argyrophilic cells arranged in cords and acini. Tumor cells in both primary and metastatic sites exhibited identical patterns of immunoreactivity for epithelial antigens (epithelial membrane antigen, carcinoembryonic antigen) and neuroendocrine antigens (serotonin, vasoactive intestinal polypeptide, adrenocorticotropic hormone). Ultrastructurally, the cells contained either mucin vacuoles or dense-core neurosecretory granules; rare individual cells contained both types of inclusions. When bilateral solid mucinous ovarian tumors are discovered at laparotomy, diagnostic appendectomy is indicated if no obvious extraovarian primary tumor can be found.
The authors describe spheric to ovoid chlamydoconidia and mucoraceous hyphae in tissues from four patients, two with cutaneous and two with pulmonary zygomycosis. The diagnosis in each case was confirmed by immunofluorescence staining and the presence of characteristic hyphae in tissue. It is important that these conidia be recognized, because they can easily be mistaken for other fungi, nematode ova, or other microorganisms in tissue sections, thereby resulting in the potential for misdiagnosis.
Differences in magnetic resonance (MR) imaging signal-to-noise (S/N) performance between saddle-shaped and solenoidal coils have been postulated. Each coil shape is tied to a particular magnetic field configuration, so that they are not typically interchangeable except in special situations. The solenoidal coil is predicted to have a two- to three-fold advantage over the saddle-shaped coil. Simple basic arguments raise a dispute with this assertion. Experiments show that both coils produce essentially equivalent S/N levels.
Spin-echo magnetic resonance (MR) imaging detects a variety of pathologic states with great sensitivity. A technique for producing multiple spin-echo images in multisection operation is presented. This method of intensity-image acquisition is compared with retrospective intensity-image synthesis from routine data sets. Both yield long echo time (TE) images with similar image contrast and comparable and often increased diagnostic utility. Technical and clinical considerations are addressed, including signal-to-noise levels, flow effects, and patient throughput.
With change in the imaging technique and magnetic field strength used in magnetic resonance imaging, wide variations in the delineation of pathologic features occur. Using imaging data from patients with known pathologic conditions, we evaluated the intensity images in spin-echo and inversion-recovery imaging at varying repetition times, echo times, and inversion times over broad ranges and changing magnetic field strengths. Differences in conspicuity and the apparent size of the lesions are important to consider in diagnosing and evaluating pathologic conditions, especially when different imagers and techniques are employed.