Carotid body hyperplasia in cystic fibrosis and cyanotic heart disease. A combined morphometric, ultrastructural, and biochemical study

A combined morphometric, ultrastructural, and biochemical study was done on carotid bodies (CBs) obtained at autopsy from 213 patients in a pediatric and young adult population. The objective was to determine whether this group had statistically significant differences in sudden infant death syndrome (SIDS, n = 38), cystic fibrosis (CF, n = 30) and cyanotic heart disease (CHD, n = 17), compared with an age-matched control population (n = 128). Average combined weights of CBs in CF and CHD were significantly greater than those of controls in most age intervals (Student t test, P less than 0.05), and computerized planimetry showed an increase in both total surface area and area of "functional" parenchyma. There was diminished chief cell argyrophilia in 72% of CF CBs, and in 8 cases studied ultrastructurally there was moderate to marked depletion of dense-core neurosecretory granules. Most CBs from patients with CHD showed intense cytoplasmic argyrophilia similar to that of controls. Quantitative analysis for tissue catecholamines showed that dopamine was present in greatest concentration in each group of patients but was significantly elevated in CHD. There were no significant differences in morphometry, ultrastructure, or catecholamine content of CBs from SIDS victims, compared with age-related controls. These data add further support to CBs having a chemoreceptor role in humans with compensatory hypertrophy and hyperplasia occurring in most patients with chronic hypoxia due to CF and CHD. There were no significant findings to indicate that CBs play a direct role in the etiopathogenesis of SIDS.

Life-threatening toxic methemoglobinemia induced by prilocaine

Methemoglobinemia is reviewed briefly with particular reference to prilocaine. One case of prilocaine induced toxic methemoglobinemia is presented and discussed to remind the practitioner that although rare, this condition can be life threatening, and should be considered in the differential diagnosis of cyanosis.

[Value of cyanosis and petechiae in strangulation and concurrent severe anemia (author's transl)]

Cyanosis, petechiae, and hemorrhages into the soft tissues and muscles of the neck may be absent after strangulation (throttling) during life, if severe bleeding has happened before. If in severe anemia signs directly or indirectly caused by strangulation have developed, it may be suggested that strangulation occurred during life and persisted for some time.

Retrolental fibroplasia in hypoxic newborn

A premature infant with hypoxia caused by severe cardiac malformations developed stage IB retrolental fibroplasia, which was documented after death. Despite arterial oxygen partial pressures of 91 mm Hg or less the classical histologic changes were observed in the temporal periphery of each eye.

Thrombocythemia as a cause of erythermalgia

Erythermalgia is a distinctive clinical entity characterized by local redness, warmth, and burning pain in the distal portions of the extremities. In this study, erythemalgia was observed in two patients with myeloproliferative disease. A new theory suggesting abnormally rapid platelet aggregation as a cause of erythermalgia was advanced. The following evidence is presented: (1) histologic evidence of thrombi occluding the arterioles and probably composed of platelet aggregates; (2) reversal of the clinical findings with platelet aggregating drugs, such as heparin sodium and acetylsalicyclic acid; (3) disappearance of the erythemalgia with the adequate control of the myeloproliferative disease.

Thrombocythemia as a cause of erythermalgia

Erythermalgia is a distinctive clinical entity characterized by local redness, warmth, and burning pain in the distal portions of the extremities. In this study, erythemalgia was observed in two patients with myeloproliferative disease. A new theory suggesting abnormally rapid platelet aggregation as a cause of erythermalgia was advanced. The following evidence is presented: (1) histologic evidence of thrombi occluding the arterioles and probably composed of platelet aggregates; (2) reversal of the clinical findings with platelet aggregating drugs, such as heparin sodium and acetylsalicyclic acid; (3) disappearance of the erythemalgia with the adequate control of the myeloproliferative disease.

Conjunctival and nailbed biomicroscopy in atrophic ozenatous rhinopathy

On the basis of the hypothesis that vascular pathology is of etiological importance in ozena, the microcirculation of 127 persons, with and without nasal diseases, was investigated by biomicroscopy of the conjunctiva and the nailbed. Ischemia and the pattern described in acrocyanosis were common features found in primary atrophic rhinitis and ozena. There was good correlation between the severity of the vascular pathology and the degree of nasal atrophy.