Necrosis In Association Research Articles

Breast cancer with associated granulomatous axillary lymphadenitis: A diagnostic and clinical dilemma in regions with high prevalence of tuberculosis

Intratumoral granulomas and granulomas in lymph nodes draining breast carcinomas have been reported previously. However, in regions like Pakistan, where the incidence of tuberculosis (TB) is high, it is sometimes difficult to distinguish between TB and a non-specific granulomatous response especially if there is an association with focal necrosis. We present a series of cases of invasive breast carcinoma with an associated granulomatous reaction in lymph nodes with or without necrosis, which were further analyzed for a possible coexisting tuberculosis using special stains and PCR-based assays for the identification of Mycobacterium tuberculosis. Twenty-two cases were examined using ZN stain for AFB and PAS stain for fungal organisms. Nested PCR assays for M. tuberculosis DNA were performed on formalin-fixed, paraffin-embedded tissue. In all the cases, ZN stain for AFB and PAS stain for fungus were negative. M. tuberculosis DNA was detected in 11 (50%) out of the 22 cases. Six of 12 cases which had granulomas in association with necrosis were positive for MTB-DNA, while 5 of 10 cases without necrosis were also positive for MTB-DNA. It is concluded that the presence of granulomas with or without necrosis in association with malignancies should be further evaluated, particularly in regions with a high prevalence of tuberculosis, for the possibility of coexistent tuberculosis, as this may alter the postoperative management of the patient. PCR-based assays are recommended for the diagnosis of TB in cases where ZN is unhelpful for demonstrating AFB or no tissue is submitted for microbiological studies.

High Thyroglobulin (Tg) Concentrations in Fatal Traumatic Brain Injuries

It is well known that under physiological conditions, the Tg molecule is the substrate for the hormones triiodothyronine and thyroxine. Its function outside the thyroid gland is unknown. Under certain pathologic conditions, an increase in Tg concentrations in the blood can occur, a phenomenon that is used in the clinical diagnosis of certain thyroid disorders. However, fatal traumatic brain injuries (TBI) can also produce a raised Tg concentration in blood. In such cases, mean (n=151) Tg concentrations of 405.8+/-353.3 ng/mL have been observed, with the values in 57% of these cases exceeding 200 ng/mL. Since it was possible to rule out specifically any thyroid disorders in these cases, the raised values may be explained by the effect of TSH in the spectrum of the "hypothalamic-pituitary-thyroid axis." This assumption has been substantiated by immunohistochemical tests for TSH and Tg. Compared with the controls (sudden unnatural deaths: Tg 23.3+/-27.6 ng/mL), the raised Tg values in the TBI cases were usually accompanied by a reduction in the intensity of immunohistochemical reactions relating to TSH and Tg. The hypophysis showed evidence of significant damage with morphologic changes such as edema, hemorrhages, and focal necrosis in association with reduced TSH levels.

Acute pancreatic necrosis in association with diverticula of the intestine

Acute pancreatic necrosis in association with diverticula of the intestine

Multiple Aseptic Pulmonary Nodules With Central Necrosis in Association With Pyoderma Gangrenosum

Pulmonary manifestations of pyoderma gangrenosum are relatively rare. We report the case of a 45-year-old patient with multiple pulmonary nodules with central necrosis as assessed by CT scan. The patient had a 4-year history of pyoderma gangrenosum with only minor skin manifestations. A CT-guided, fine-needle biopsy of the lung revealed a nonspecific, inflammatory, aseptic necrotic process, which was comparable to the skin biopsy of one pyoderma lesion. Following the initiation of oral prednisolone therapy, a rapid resolution of the pulmonary nodules occurred. We conclude that pulmonary nodules represent a rare pulmonary manifestation of pyoderma gangrenosum.

Small bowel necrosis in association with early postoperative enteral feeding after pancreatic resection

A 70-year-old man underwent a pancreatoduodenectomy for carcinoma of the distal common bile duct. A needle catheter jejunostomy was inserted as an adjunctive procedure, and enteral feeding was begun on the first postoperative day. On the seventh postoperative day, the patient had crampy abdominal pain, progressive distension, and tenderness with metabolic acidosis and leukocytosis. During an emergency laparotomy, intestinal full thickness necrosis was found involving the small bowel beginning at the jejunostomy tube insertion site and continuing for approximately 50 cm distally.

Necrosis in 84 Ovarian Carcinomas

Carcinomas metastatic to the ovary are often difficult to distinguish from primary ovarian carcinomas. Adenocarcinoma of the colon may simulate both primary endometrioid and mucinous ovarian tumors. The histologic finding of "dirty" necrosis in association with a "garland" or cribriform pattern has been suggested as a useful feature in distinguishing metastatic colonic carcinomas from primary endometrioid ovarian carcinomas. This study was performed to determine the use of "dirty" necrosis in distinguishing primary ovarian carcinoma from metastatic colonic carcinoma by studying 71 of the former and 10 of the latter. At least focal dirty necrosis was found in 68% of primary ovarian epithelial cancers, including 92% of the endometrioid subtype, and in 100% of the metastatic colonic carcinomas. A subgroup of cases was evaluated immunohistochemically using cytokeratin (CK) 7, CK 20 and carcinoembryonic antigen (CEA). The phenotype of CK 7 +/CK 20-/CEA-was present in 92% of primary ovarian carcinomas studied, whereas, 90% of metastatic colonic carcinomas were CK 7-/CK 20 +/CEA+. The finding of dirty necrosis is not specific for metastatic colonic cancer, and differential cytokeratin immunostaining is a useful adjunct in this differential diagnosis.

Endovascular aortounifemoral grafts and femorofemoral bypass for bilateral limb-threatening ischemia.

Although axillobifemoral bypass procedures have a lower mortality rate than aortobifemoral bypass procedures, they are limited by decreased patency, moderate hemodynamic improvement, and the need for general anesthesia. This report describes an alternative approach to bilateral aortoiliac occlusive disease using unilateral endovascular aortofemoral bypass procedures in combination with standard femorofemoral reconstructions. Seven patients who had bilateral critical ischemia and tissue necrosis in association with severe comorbid medical illnesses underwent implantation of unilateral aortofemoral endovascular grafts, which were inserted into predilated, recanalized iliac arteries. The proximal end of the endovascular graft was fixed to the distal aorta or common iliac artery with a Palmaz stent. The distal end of the graft was suture-anastomosed to the ipsilateral patent outflow vessel, and a femorofemoral bypass procedure was then performed. All endovascular grafts were successfully inserted through five occluded and two diffusely stenotic iliac arteries under either local (1), epidural (5), or general anesthesia (1). The mean thigh pulse volume recording amplitudes increased from 9 +/- 3 mm to 30 +/- 7 mm and from 6 +/- 2 mm to 26 +/- 4 mm ipsilateral and contralateral to the aortofemoral graft insertion, respectively. In all cases the symptoms completely resolved. Procedural complications were limited to one local wound hematoma. No graft thromboses occurred during follow-up to 28 months (mean, 17 months). Endovascular iliac grafts in combination with standard femorofemoral bypass grafts may be an effective alternative to axillobifemoral bypass in high-risk patients who have diffuse aortoiliac occlusive disease, particularly when bilateral axillary-subclavian disease is present.

Proximal cutaneous necrosis in association with chronic renal failure

Proximal cutaneous necrosis in association with chronic renal failure

Proximal cutaneous necrosis in association with chronic renal failure

We report two patients with renal failure who developed painful symmetrical ulceration over the proximal thighs and abdominal wall. Histological examination of the ulcerated areas revealed intravascular calcification. This phenomenon has been termed calciphylaxis and is a rare complication of renal failure. The pathogenesis is poorly understood. However, abnormalities of calcium/phosphate metabolism and of coagulation are important.

A Single Endotoxin Challenge Induces Delayed Myocardial Protection against Infarction

Sublethal endotoxemia attenuates cardiac functional injury from global ischemia but it is unknown whether endotoxemia can protect myocardium against infarction. Furthermore, increases in myocardial catalase and heat shock protein (HSP) following endotoxemia have been associated with cardiac ischemic protection. We therefore hypothesized that a 72-hr pretreatment with endotoxin (ETX) would reduce myocardial tissue necrosis in association with augmented catalase activity and stress protein expression. Rabbits were treated with normal saline or lipopolysaccharide (Salmonella typhimurium) at 10, 5, and 1 μg/kg doses. Three days after saline or ETX injection they were subjected to 45 min of coronary artery occlusion followed by 3 hr of reperfusion. Area of necrosis (tetrazolium staining) was normalized to anatomic risk zone size (Evans blue staining). Catalase activity was measured by a standard assay and HSP 72 was assessed by immunohistochemistry. During regional ischemia and reperfusion there were no differences in heart rate or mean arterial blood pressure between groups. ETX treated rabbits had the same risk zone size as controls. Infarct size was reduced in the ETX treated rabbits at the 10 and 5 μg/kg doses compared with control rabbits (17.5 ± 1.5% and 22.2 ± 3.1% vs 45.3 ± 2.5%;P< 0.05) but no protective effect was observed at the 1.0 μg/kg dose (38.0 ± 4.6%;P> 0.05 vs control). Catalase activity was not different between control and ETX (5 μg/kg) treated groups (997.8 ± 59.1 U/g vs 1099.6 ± 69.3 U/g myocardium;P> 0.05) but endotoxin induced expression of myocardial HSP 72. We conclude that a single challenge with endotoxin can induce delayed myocardial protection against infarctionin vivo.This delayed cardioprotective response involves enhanced stress protein expression without changes in myocellular catalase activity.

Acquired functional protein s deficiency, cerebral venous thrombosis, and coumarin skin necrosis in association with antiphospholipid syndrome: report of two cases

We report for the first time an association among lupus anticoagulant, coumarin skin necrosis, and cerebral venous thrombosis. We found that serum concentrations of free functional protein S were markedly depleted because of excessive binding of protein S to C4b binding protein in two patients at the time they experienced these unusual thromboses

Extensive bone marrow necrosis in patients with cancer and tumor necrosis factor activity in plasma

Tumor necrosis factor (TNF), a macrophage secretory protein produced by peripheral blood monocytes from patients with cancer, has been shown to possess cytotoxicity toward tumor cells in vitro. TNF in the blood of individuals with cancer is usually not detectable except with extremely sensitive radioimmunoassay or enzyme-linked immunosorbent assay (ELISA) methods. We have encountered two patients with the rare syndrome of extensive bone marrow necrosis in association with cancer. The first patient presented with marrow failure secondary to necrosis and was found to have adenocarcinoma in thoracic lymph nodes, lung, and marrow lymphatics at autopsy. Plasma tested at two dilutions (1:200 and 1:2,000) contained TNF at a concentration of 8.3 ng/ml, or 80 U/ml by a cytotoxicity assay using LM cells. The presence of TNF was confirmed with immunoblotting. The second patient had a poorly differentiated lymphoid tumor involving bone marrow, pancytopenia, and marrow necrosis. The plasma cytotoxicity assay indicated the presence of 0.7 ng/ml or 7 U/ml TNF. TNF was not detectable in plasma from six other patients with untreated cancer involving bone or bone marrow using either of our methods. The levels of TNF in the two patients with marrow necrosis were greater than those previously measured by others in patients with cancer but were comparable to those noted in patients with lethal sepsis. Since large doses of TNF have been shown to cause organ necrosis in animals, the data presented here are consistent with TNF involvement in mediating the observed marrow necrosis in our patients.

Visceral brown fat necrosis in postperinatal mortality.

Fat necrosis was present in 22 of 400 cases of consecutive postperinatal mortalities investigated to assess the presence and pattern of deep fat necrosis. In just over 50% of the cases of fat necrosis the cause of death was categorised as sudden infant death syndrome, which also showed more severe degrees of necrosis. The mechanism of necrosis may be vascular hypoperfusion, possibly related to shock, and brown adipose tissue, on account of its high metabolic activity and rich capillary plexus, may be particularly vulnerable to infarction. The occurrence of fat necrosis in association with other causes of death did not provide any definite clue as to the nature of the alleged shock.

Osseous Lesions and Pancreatitis

Fat necrosis in association with pancreatic disease is usually limited to the pancreas and adjacent tissues. In some instances, however, widely disseminated fat necrosis occurs and metastatic foci may be observed in the mediastinum, pericardium, and subpleural tissues, 1 subcutaneous tissues, 2 periarticular tissues, 3 and bone marrow. 4 Scarpelli 4 demonstrated foci of fat necrosis in the bone marrow in 7 of 67 autopsied cases of acute hemorrhagic pancreatitis and in two of six dogs dying in experimentally induced hemorrhagic pancreatitis. In all cases, medullary fat necrosis occurred in association with widespread abdominal or extraabdominal fat necrosis. Metastatic fat necrosis has also been described in patients with carcinoma of the pancreas, 5 chronic pancreatitis, 6 and traumatic pancreatitis. 5,7,8 See also the article by Neuer et al in this issue (p 738). In children, trauma to the abdomen is the most common cause of acute pancreatitis. 9 Medullary fat

Nasal necrosis; a complication of nasotracheal intubation

Two cases of nasal necrosis in association with nasotracheal intubation are presented. This complication is probably preventable if the site of the contact between tube and nose is inspected twice daily, and the tube removed at the first sign of severe erythema, and secondly by preventing sharp angulation between tube and nose.

Nasal Necrosis: A Complication of Nasotracheal Intubation

Two cases of nasal necrosis in association with nasotracheal intubation are presented. This complication is probably preventable if the site of the contact between tube and nose is inspected twice daily, and the tube removed at the first sign of severe erythema, and secondly by preventing sharp angulation between tube and nose.

Comparative Penetration and Development of Meloidogyne Naasi in Wheat and Oat Roots

Direct observations of root penetration by Meloidogyne naasi larvae into 'Pawnee' wheat and 'Wintok' oats were made using micro-observation chambers. Effects of inoculum density, exposure time, and temperature on larval penetration and nematode development were investigated in wheat and oats. The maximum number of larvae penetrated the wheat and oat roots at the 2000 level of inoculum density, but the maximum percent penetration was at the 500 level for wheat and at the 200 level for oats. In both wheat and oats an ascending trend in larval penetration was more discernible during the first 96 hours than during 96 to 192 hours. Maximum penetration occurred at 25°C in both wheat and oat roots. Cell necrosis in association with larvae was common in oats. Three times as many larvae matured and laid eggs in wheat as in oat roots. Analysis of hostparasite relationships suggests that 'Pawnee' wheat is highly susceptible, and 'Wintok' oats tolerant or moderately resistant to M. naasi.

Renal and pulmonary alterations induced in rats by a single injection of monocrotaline.

SummaryA single subcutaneous injection of monocrotaline produced various grades of pulmonary arterial injury including necrotizing arteritis in rats. The arterial lesions were presumed to be sequelae of long standing pulmonary hypertension as manifested by right ventricular hypertrophy. It was noted that monocrotaline could also produce a renal hemosiderosis, as well as glomerular necrosis in association with hyaline thrombosis in the glomerular capillaries and afferent arterioles.

Subcutaneous Fat Necrosis Associated with Pancreatitis and Portal Cirrhosis

Summary 1.A case of subcutaneous fat necrosis in association with pancreatitis, portal cirrhosis and cholelithiasis, is reported. 2.The extreme rarity of this condition is commented upon. It is possible that subcutaneous fat necrosis is another cutaneous manifestation of pancreatic disease, such as livedo reticularis and the Grey-Turner sign, which might be noted more frequently if a more thorough search were made.