Abstract During 3 months, nine patients with a marrow transplant hospitalized in a leukemia research center and six donor-members of their families developed acute hepatitis. Serum glutamic-oxalace...

Pulmonary alveolar proteinosis is a disorder of unknown origin that occurs rarely after lung transplantation. We identified a patient with pulmonary alveolar proteinosis 66 days after undergoing single lung transplantation for idiopathic pulmonary fibrosis. We based the diagnosis on the presence of amorphous clumps or globules of acellular and finely granular material in bronchoalveolar lavage fluid (BALF). This material persisted for an 18.5-month period and was present in 9 of 14 lavage specimens. However, despite its presence in the native lung at autopsy, the material was seen in only 1 of 14 transbronchial lung biopsy specimens. Although uncommon, pulmonary alveolar proteinosis can be diagnosed readily in BALF by its distinctive cytopathologic features and should be considered in the differential diagnosis of pulmonary disease in lung transplant recipients.

BACKGROUND:The reliability of cytologic criteria to classify nonproliferative breast lesions (NPBL) is still debated. Sampling error and heterogeneity of breast lesions complicates the histologic correlation of fine-needle aspiration results further.METHODS:To provide optimal cytohistologic correlation, two smears (one that was stained with hematoxylin and eosin and one that was stained with Diff-Quik [American Scientific Products, McGraw Park, IL]) were prepared from specific tissue sections from breast biopsies without mass lesions. The 42 cases classified as NPBL histologically were included in the current study. The cytologic features of the smears were evaluated.RESULTS:Cellularity ranged from low (40% of cases) to moderate (50% of cases) to high (7% of cases). The cells were arranged in small clusters in 79% of cases, were mixed with large sheets in 17% of cases, and were in large sheets in 2% of cases. Intact lobules were noted in 31%. The configuration of the epithelial groups was complex in 62% of cases. Myoepithelial cells in the background and within the epithelial groups were noted in all the specimens. The percentage of single epithelial cells was < 10 in 38% of cases, 10-20 in 41%, and 20-30 in 19%. Mild nuclear enlargement and overlap, micronucleoli, and mild chromatin clumping were noted in a significant number of cases.CONCLUSIONS:NPBL have been found to have a wide spectrum of cytologic appearances. At one end of the spectrum, smears are cellular with up to 30% single cells and large sheets in a complex configuration and exhibit nuclear enlargement and overlap and prominent nucleoli, features that overlap with those described in proliferative breast lesions.

Recommendations for Handling Specimens from Patients with Confirmed or Suspected Creutzfeldt-Jakob Disease Get access John A. Bryan John A. Bryan Search for other works by this author on: Oxford Academic PubMed Google Scholar Laboratory Medicine, Volume 15, Issue 1, 1 January 1984, Pages 50–51, https://doi.org/10.1093/labmed/15.1.50 Published: 01 January 1984

Herpesvirus and Candida albicans are each well-known pathogens associated with esophagitis, and concomitant infections by both agents are occasionally observed. The case of a 58-year-old man who had been treated for carcinoma of the tonsil and died of confluent bronchopneumonia is presented. Autopsy revealed an esophagitis in which cytologic changes of viral infection were seen in the intact esophageal epithelium along with pseudomycelia of Candida albicans within the ulcer bed. In addition, ultrastructural study showed dual infection by Candida and herpesvirus within individual esophageal epithelial cells at the ulcer edge, a unique demonstration of coexistent intracellular infection.

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Hepatitis A and hepatitis B are distinguished clinically by differences in onset and serologically by the presence of hepatitis A antigen or of any one of at least three hepatitis B antigens on the virus particle. At present, hepatitis non-A, non-B can be diagnosed only by exclusion of the other two types. Clinically it resembles hepatitis B. Hepatitis A is most often contracted through the fecal-oral route, and preschool children are at particular risk. Hepatitis B usually is transmitted by parenteral inoculation of virus-containing material. Transmission is now known to occur venereally as well. Since all blood donors now are screened for hepatitis B surface antigen, the cases of transfusion-associated hepatitis that do occur are caused mainly by non-A, non-B virus(es).

Journal Article Hemodialysis-Associated Hepatitis in the United States, 1974 Get access David R. Snydman, David R. Snydman Viral Diseases Division Bureau of Epidemiology, Atlanta, Georgia Please address requests for reprints to Dr. David R. Snydman, Viral Diseases Division, Bureau of Epidemiology, Center for Disease Control, Atlanta, Georgia 30333. Search for other works by this author on: Oxford Academic PubMed Google Scholar Dennis Bregman, Dennis Bregman Viral Diseases Division Bureau of Epidemiology, Atlanta, Georgia Search for other works by this author on: Oxford Academic PubMed Google Scholar John A. Bryan John A. Bryan Viral Diseases Division Bureau of Epidemiology, Atlanta, Georgia Search for other works by this author on: Oxford Academic PubMed Google Scholar The Journal of Infectious Diseases, Volume 135, Issue 4, April 1977, Pages 687–691, https://doi.org/10.1093/infdis/135.4.687 Published: 01 April 1977

Morbidity and surveillance data on viral hepatitis cases in the United States since 1970 has revealed plateauing of case rate, continued failure to observe seasonal variation, more general geographic distribution of cases, and persistence, although at progressively lower levels, of highest rates in males 15-29 years of age. Based on results of HBS Ag testing, as much as 24 per cent of hepatitis B may be misdiagnosed by physicians and from 18 to 46 per cent of reported cases can be classified hepatitis B, thus suggesting that hepatitis B may account for up to one-half the recognized viral hepatitis in this country. HBS Ag-negative hepatitis still seems commonly acquired through close personal contact; hepatitis B patients 15-29 years of age also commonly have personal contact association. Parenteral drug abuse and transfusion of blood and blood products continue to play a role in dissemination of hepatitis B, but hepatitis B seems to account for only about one half of all reported transfusion-associated hepatitis. Case fatality rates for reported cases appear to increase with age but are not higher for HBS Ab positive patients than for negative patients.

Eleven of 40 patients in a hemodialysis unit had clinical or biochemical evidence of hepatitis during a five-week period. The clinical disease was mild, being limited solely to dialysis patients. Epidemiologic investigation indicated that the incubation period was between 17 and 35 days and that 10 of 11 patients had been exposed to a single venous-pressure monitor before onset. Dried blood and evidence of blood reflux up the venous-pressure gauge suggested that cross-contamination of the blood of successive patients probably resulted in transmission of disease. No association with the hepatitis B surface antigen or anti-hepatitis B antibody was demonstrated, but 10 of the 11 patients with elevated transaminase levels had evidence of recent exposure, to Epstein-Barr virus as manifested either by Ox-cell hemolysin titers or rises in titers to viral capsid antigen.

In 1972, 73 cases of viral hepatitis (VH) were recognized in Bermuda. This representedthe most cases in any year since 1968 when 166 cases were reported. Cases in 1972 were randomly distributed both geographically and chronologically. The incidence of hepatitis was greater among individuals 15–29 years of age than among those ≤ 14 years. While the majority of illnesses are believed to have been due to hepatitis-A virus (HAV) infection, some hepatitis-B virus (HBV) disease was also recognized. Twenty-three ill individuals were examined for presence of the hepatitis-B antigen (HBAg), and 4 were positive. No common source or single exposure appeared responsible for the increase in cases in 1972; rather, the illnesses resulted from a number of different factors including (a) person-to-person transmission during close personal contact in households, (b) sharing of needles and/or close intimate contact with parenteral drug abusers, and (c) occupational exposures.

To the Editor.— A reply to a recent question (229:579, 1974) was an informative discussion of attempts to find absolute methods of inactivating the viruses of hepatitis A and B by heat sterilization or use of germicidal solutions. Heating (boiling, dry heating, or autoclaving) is the treatment of choice for sterilizing instruments and any other objects that can be conveniently so handled. The importance of thorough cleansing of instruments, containers, surfaces, etc, to remove adherent material before treatment with the disinfectant was also emphasized. Hypochlorite solutions were not included in the discussion of chemical disinfectants. My purpose is to stress that hypochlorite solutions are also in general use—and appropriately so—as disinfectants in hemodialysis units, laboratories, and blood banks, where there is a need for inactivation of the agents of viral hepatitis. 1,2 Activity against viruses occurs presumably because of the free chlorine available in these solutions. Hypochlorite solutions containing 5,000

Between Sept 14, 1968, and May 1, 1969, twelve employees of the Children's Hospital Medical Center (CHMC), Boston, contracted viral hepatitis, type B (hepatitis B). Ten had been contacts of an 11-year-old patient with aplastic anemia who had received multiple transfusions and who harbored the hepatitis-B antigen (HBAg). Serum from seven of the 12 ill employees was tested for HBAg; only one was positive, but in most instances serum was obtained late in the convalescent period or following recovery. Investigation showed that, because of an associated hemorrhagic diathesis, the 11-year-old patient was most likely the source of infection. This outbreak demonstrates how hepatitis B can be transmitted via a nonparenteral route and illustrates the occupational hazard to medical personnel involved in this seemingly innocuous and routine exposure.

1.1. Amylase is found in all tissues analyzed of the cottonmouth water moccasin (Agkistrodon piscivorus).2.2. The highest levels were noted in the pancreas, the venom gland and the serum, but these levels were low compared with those of the white rat.3.3. The amylase of these tissues were not inhibited by goat antisera to hog pancreatic amylase whic did inhibite mammalian amylase.