American journal of clinical pathology
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Am. J. Clin. Pathol. · Jun 1985
Case ReportsHeparin-induced thrombocytopenia and thrombosis: detection and specificity of a platelet-aggregating IgG.
A 46-year-old female who died as a result of thrombocytopenia associated with multiple arterial occlusions and septicemia while on heparin therapy was found to have a platelet-aggregating factor present in several plasma samples and in a sample of serum. This factor was subsequently shown to be an IgG with aggregating properties toward normal platelets that were enhanced by, but not dependent on, the presence of heparin. Further studies showed that heparin was unlikely to have acted as a hapten in initiating the IgG production but that its role was significant in aggravating the ensuing arterial thrombosis. The necessity of substitution of heparin with alternative anticoagulant/antithrombotic therapy to avoid the worst sequelae of this potentially catastrophic syndrome is discussed.
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Am. J. Clin. Pathol. · May 1985
Alterations in plasma-, monocyte-, and lymphocyte-associated fibronectin during cardiopulmonary bypass surgery.
The changes in plasma fibronectin and IgG, and monocyte- and lymphocyte-associated fibronectin were studied in patients undergoing elective cardiopulmonary bypass surgery. A significant fall (P = less than 0.0005) in plasma fibronectin occurred during bypass, resulting largely from hemodilution as assessed by IgG concentrations, but also related to consumption of fibronectin. ⋯ Our studies confirm a reduction in circulating fibronectin in cardiac surgery, with accompanying fall in lymphocyte-associated levels presumed to reflect nonspecific adsorption. In contrast, the increased binding to monocytes may be an important functional aspect requiring further investigation, together with assessment of monocyte-macrophage function, before empiric use of cryoprecipitate therapy in these patients is recommended.
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Vasovasostomy specimens were examined for vascular changes in 50 cases of vasitis nodosa. In five, benign gland- or ductule-like structures were seen invading small veins and, in one, also the small arteries. ⋯ In 12 additional cases, elastosis of arteries and veins was seen without intravascular ductules. These changes suggest that proliferating ductules in vasitis nodosa invade the blood vessels after they have become obliterated by regressive and reparative processes.
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In a retrospective histologic study, 154 vasovasostomy specimens (77 patients) yielded 50 examples of vasitis nodosa. These cases were examined for nerve invasion by proliferating ductules; benign neural invasion was present in four instances, and four additional cases were found on step sectioning the vasovasostomy specimens, totaling eight cases (16%) of the 50 studied. ⋯ The number of glands within individual nerves varied from one to eight. The findings are discussed in the context of benign glandular invasion of nerves in other locations.
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Am. J. Clin. Pathol. · Nov 1984
Case ReportsNecrotizing sarcoid granulomatosis with suppurative features.
Necrotizing sarcoid granulomatosis has become a well-defined entity within the spectrum of disorders classified as pulmonary granulomatosis with angiitis. It is characterized clinically by disease generally restricted to the chest, steroid sensitivity, and a good prognosis. Pathologically, confluent granulomas, vasculitis, and bland necrosis are seen. ⋯ This feature has not been reported previously, and its recognition will allow more cases to be diagnosed correctly. Serum angiotensin converting enzyme (ACE) was not elevated, and ACE could not be demonstrated in tissue from the lung biopsy obtained during recurrence of disease. This further suggests significant differences between this entity and sarcoid.