The frequency of diagnosed and treated organ-confined renal cell carcinoma is increasing. The prognosis of this group of tumours is difficult to predict. The main purpose of this study was to examine the prognostic significance of microvascular invasion, tumour size and nuclear grade in a complete cohort of 76 consecutive patients with organ-confined clear cell renal cell carcinoma treated with radical nephrectomy. Patient ages ranged from 39 to 88 years (mean 66 years). Median follow-up was 10.2 years (range 0.1-19.4 years). The tumours were graded according to Fuhrman. Representative histological sections were stained for CD31, which decorates endothelial cells, in order to assess microvascular invasion (MVI). In univariate analysis, microvascular invasion (p < 0.01), tumour size (TS) (p=0.01), TNM stage (p=0.01) and Fuhrman nuclear grade (p=0.02) were significant predictors of cancer-specific survival. Multivariate analysis, adjusted for age, revealed that microvascular invasion, tumour size and nuclear grade were independent covariates. According to our findings microvascular invasion is a strong independent prognostic predictor, and including this in the histopathology report should be considered together with nuclear grade and tumour size.

Background: Pouchitis is a common and troublesome condition in patients operated on with ileal-pouch-anal-anastomosis (IPAA). A disturbed mucosal perfusion in the pouch has been suggested as a possible cause. Laser Doppler flowmetry (LDF) has been used successfully to measure gastric and colonic mucosal perfusion in humans. In a previous study, we demonstrated a reduced mucosal perfusion in the distal part of the pouch, during probiotic intervention, examined by LDF measurement. The aim of the present study was to confirm our previous results in a much larger material, and to compare the results of LDF measurements and inflammatory activity in ulcerative colitis (UC) patients with those in familial adenomatous polyposis (FAP) patients. Methods: Five hundred millilitres of a fermented milk product (Cultura), containing live lactobacilli (La-5) and bifidobacteria (Bb-12), was given daily for 4 weeks to 41 UC and 10 patients with FAP, operated on with IPAA. Mucosal perfusion was measured with LDF and the degree of inflammation was examined at predefined levels of the distal bowel by histology and faecal calprotectin measurements both before and after intervention. We also evaluated the applicability of a Pouchitis Disease Activity Index (PDAI). Results: The LDF measurements were reproducible in the pelvic pouch at each of the predefined levels, but did not change during intervention. Mucosal perfusion was significantly reduced in the distal compared to the proximal part of the pouch in the UC group ( P < 0.05). The perfusion levels were higher in the FAP patients compared to the UC patients at all predefined levels ( P < 0.05). Calprotectin levels and histological score did not change significantly after intervention in any of the groups. The calprotectin level was significantly lower in the FAP compared to the UC group both before and after intervention. The PDAI decreased in both groups from a level considered diagnostic for pouchitis to a level considered as not active pouchitis. The decrease was significant for the UC patients. Conclusions: The results did not demonstrate an effect of probiotics on histology, although a significant effect on the PDAI was achieved, which concurs with the previously reported effect on symptoms and endoscopic score. The significantly reduced blood flow in the UC group compared to the FAP group, operated on with the same procedure, and the significantly increased calprotectin levels in the UC group, are original findings. Both findings may be related to an increased risk for pouchitis among UC patients. The lack of effect of intervention on mucosal perfusion does not exclude a role for reduced circulation as a cause of pouchitis based on the reduced LDF measurements in the distal part of the pouch.

This study concerns harmful effects of systemic administered parenteral nutrition in Wistar rats. A standard complete parenteral nutrition (CPN) regimen, its main components (Vamin-N®, Intralipid® 20% and Glucose 50%) and different doses of these substrates were investigated. All animals receiving Vamin and Intralipid died within 30 and 45 days respectively. All animals except for those receiving glucose showed a tendency to increased weight of liver, spleen and lungs compared to the controls. Microscopical examination revealed epithelioid cell granulomas in liver, spleen and lungs in animals given Vamin and Intralipid, in addition to vasculitis with thrombus formation in the lungs. Osmiophilic fat droplets were found in the pulmonary capillaries in all animals receiving Intralipid, but not in rats receiving Vamin. Most microscopical findings were dose dependent, indicating that the organ changes in liver, spleen and lungs and cause of death may be due to the nutritive substrates themselves.

Silica deposition and characteristic nodular silicotic lesions of the bone marrow, virtually unknown features of silicosis, are described in a case of severe lung silicosis with silicotic granulomas of the liver and spleen. Scanning electron microscopy and X-ray microanalysis confirmed the presence of quartz and feld-spars. The bone marrow lesions included inconspicuous accumulations of silica-containing macrophages, free silica, slight lymphocyte and plasma cell infiltration, and reticulin fibre formation; and development of slightly larger partly fibrous silicotic nodules, comparable to those of the lung, liver, and spleen. Silicosis must therefore be considered in the differential diagnosis of bone marrow granulomas.

A fatal case of infusion of a (at emulsion (Intralipid®) into the pericardium is reported. Perforation of the anterior wall of the right ventricle of the heart by a central venous catheter had occurred 3 days after insertion via the basilic vein. Local myocardial inflammation and necrosis along the puncture wound through the myocardium was a feature. The incident underlines the necessity for prompt assurance of correct positioning of central venous catheters. It is emphasized that effective treatment is possible if one is aware of some important features of the condition. Immediate diagnosis is mandatory.

Vertebral bone infarcts in two fatal cases of staphylococcic endocarditis are reported. It is suggested that they were embolic in nature, and that ischemia could be a reason for bone pain in infective endocarditis.

A case of disseminated malignant melanoma with generalized melanosis of the skin and other tissues, melanuria, melanoptysis, and a dark brown blood serum is reported. The reticuloendothelial system contained large amounts of melanin pigment. Lysis of degenerating pigment‐loaded melanoma cells in peripheral blood vessels seemed to be of considerable importance in the pigmentation of tissues. Focal pigmentation of capillary endothelium and perivascular deposition of melanin pigment in macrophages and, occasionally, in other cells, was noted. Single cell metastases contributed to melanin pigmentation of most organs, but were not found in sections of the skin. Melanoptysis (black sputum) was due to diffuse melanoma cell infiltration of the lungs, with secondary pigment deposition in macrophages and in bronchial epithelial cells. In this case the ‘glomerular melanoma cell emboli’ recorded by previous authors consisted of melanin pigment and cell debris. Focal damage of glomeruli affected by pigment emboli is described allowing access of melanoma cell debris (including melanin pigment granules) into glomerular tubules.

A case of aortic rupture in a 30-year-old women with a rare skin disease, elastosis perforans serpiginosa, is presented. Skin lesions are characterized by marked elastic tissue changes. Multiple large arteries and the distal part of the aorta were thinwalled also with aneurysm-like dilatations. Focal fibroelastosis and degenerative changes were present in the vessel walls. The changes in the aorta made the surgical treatment difficult.

ABSTRACT. The clinical and pathological findings in two neonates with the malformation of the great vein of Galen are given. They both reported with serious neonatal heart failure suggesting congenital heart disease. In one of them cardiac catheterization revealed a foetal pattern of circulation causing cyanosis. A bruit and in one of them a thrill over the skull gave the clinical diagnosis of an intracranial arteriovenous aneurysm. They died 48 and 144 hours after birth in spite of medical treatment. The outlook for patients having malformation of the great vein of Galen and suffering neonatal heart failure treated conservatively, seems hopeless.

A patient with acute ischaemia of the abdominal organs after coeliac- and superior mesenteric artery occlusion is reported. Following vascular reconstruction and resection of gangrenous colon and ileum the main early postoperative problem was hepatic failure. A grave malabsorption syndrome developed necessitating periodic i.v. hyperalimentation. The patient showed no improvement of intestinal function and died 5 months postoperatively from peritonitis.

A case is presented of elastosis perforans serpiginosa (EPS) with unilateral dermal lesions, widespread arterial lesions with aortic rupture, and elastosis of the endocardium and bronchiolar walls. Other chronic skin disorders with lesions resembling EPS are discussed; and the arterial lesions compared with some arterial diseases. The findings support a concept of the disease as a focal affection of elastic tissue, not only in the skin, but also in arteries and other organs.

A 13-year-old girl with no previously known predisposing disease developed phycomycosis involving the left lung, pleura and shoulder, the left side of the neck, the left thigh, the kidneys and the brain. Prolonged amphotericin B therapy resulted in clinical improvement, but the disease was wide-spread when the patient died 5 months after debut of symptoms from a subarachnoid haemorrhage due to fungal destruction of the basilar artery. During hospitalization, a marked reduction in the bactericidal activity of circulating neutrophil granulocytes was repeatedly demonstrated and the endotoxin stimulated nitroblu tetrazolium test was negative. Together with the demonstration of granuloma formation and the accumulation of lipid-laden histiocytes in the spleen, lymph nodes, bone marrow and the thymus, these findings indicate that the patient had a less severe form of chronic granulomatous disease.

A case of post-operative perforation of the gallbladder with massive intraperitoneal haemorrhage is presented. The clinical picture was complicated by urinary infection and bleeding from an acute gastric erosion. It is suggested that the antibiotic treatment given for his urinary infection may have altered the clinical course of his cholecystitis, allowing a silent perforation to take place and present in the form of an atraumatic liver rupture.

ABSTRACT: Vesterhus, P., Eide, J. Frtftand, S. S., Haneberg, B, and Jacobsen, K. B. (Department of Paediatrics and Department of Pathology, the Gade Institute, University of Bergen, Bergen, and Institute of Immunology and Rheumatology, Rikshospitalet University Hospital, Oslo, Norway). Maldescent of the thymus in a hypoparathyroid infant with pharyngeal pouch syndrome. Acta Paediatr Scand, 64:555, 1975.–The clinical and pathological findings in a 6‐month‐old boy with III‐IV pharyngeal pouch syndrome are reported. The infant had multiple congenital anomalies including absence of the parathyroid glands, maldescent of the thymus, aberrant right subclavian artery and dysfunction of the glossopharyngeal nerve. Because of persistence of the thymus in the cervical area, a thymic shadow was not found on roentgenographic examination of the anterior mediastinum. The weight and histology of the thymus were normal, as were studies of humoral and cellular immunity.