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Biomedical subjects

H P Dincsoy

Publications and source records attributed to H P Dincsoy.

At least 19 recordsLinked to original sources
PubMed1992

Pasteurella multocida endocarditis.

Human infection with Pasteurella multocida is the leading cause of animal bite wound infection. Life-threatening infection may occur in patients with a variety of underlying disorders and an immunocompromised state. Infective endocarditis with P. multocida is very rare and only a few clinically diagnosed cases have been reported. Described here is an autopsy case of a 61-year-old man with polycystic kidney disease who had P. multocida bacteremia and acute infective endocarditis with multiple bacterial clumps involving bicuspid aortic valve. The organisms were gram negative. Apparently the sepsis with P. multocida was acquired via licking of leg ulcers by his pet dog, establishing an animal-related causal relationship. Because P. multocida is a very common flora of many animals, infection with this organism probably occurs more frequently than is commonly appreciated. High index of suspicion and early diagnosis, especially in immunocompromised patients, are warranted because the disease is potentially life threatening, yet is a readily treatable infection.

Endocarditis, Bacterial↗
PubMed1990

Cytomegaloviral adrenalitis and adrenal insufficiency in AIDS.

In a review of 74 autopsy cases of acquired immune deficiency syndrome (AIDS), the incidence of cytomegalovirus (CMV) infection was found in 50% (37 cases). Of these 37 cases the adrenal glands were affected by CMV in 84%. The authors analyzed the histologic features of 30 of these 37 cases of CMV adrenalitis by grading the CMV inclusions, inflammation and necrosis (CMV score), focal versus diffuse involvement, and the degree of fibrosis (fibrosis score). The clinical data were not significant except for sodium to potassium ratio (Na:K), which was less than 30 in 11 cases. Focal CMV adrenalitis had low CMV and fibrosis scores and Na:K ratio higher than 30, whereas diffuse adrenalitis had high CMV and fibrosis scores and Na:K ratio less than 30. Adrenocorticotropic hormone (ACTH) stimulation tests performed in three patients revealed normal or elevated baseline cortisol levels with a blunted response after stimulation. The authors conclude that the adrenal gland is the most frequently affected organ in AIDS with CMV infection. ACTH tests on a larger number of selected cases of AIDS are needed for further evaluation of functional status of adrenal glands. Selection criteria for the test should include evidence of CMV infection from any site and a low Na:K ratio.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Primary squamous cell carcinoma of the thyroid associated with leukocytosis and hypercalcemia.

Primary squamous cell carcinoma of the thyroid is an extremely rare, aggressive neoplasm with a uniformly poor prognosis. Described herein is a case of a 66-year-old man with primary squamous cell carcinoma of the thyroid associated with hypercalcemia (13 mg/dL [3.24 mmol/L]) and unexplained leukocytosis (28,400/mm3 [28.4 X 10(9)/L]). The histogenesis of squamous cell carcinoma of the thyroid remains controversial. The associated hypercalcemia and leukocytosis most likely represent a form of paraneoplastic syndrome; possible mechanisms will be discussed in the light of recent studies on tumor-derived mediators.

Aged↗
PubMed1986

Ketoconazole-resistant Candida esophagitis in patients with acquired immunodeficiency syndrome.

Although ketoconazole has been shown to be effective in treating esophageal candidiasis in other immunodeficiency states, similar studies have not been reported in patients with acquired immunodeficiency syndrome. Six patients with acquired immunodeficiency syndrome and oral and esophageal candidiasis who had been treated with ketoconazole for more than 2 mo were evaluated with barium esophagram and endoscopy with biopsy and brush cytology. All of the patients had persistent Candida esophagitis. In 2 patients, fungal cultures and sensitivity testing indicated Candida albicans resistant to ketoconazole in vitro. In patients with acquired immunodeficiency syndrome, esophageal candidiasis may not resolve with up to 6 mo of ketoconazole therapy and may require more vigorous antifungal therapy than in patients with other immunodeficiency states.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Effect of chronic ethanol consumption on the pancreas of the hamster.

The purpose of this study was to determine the effect of chronic ethanol consumption on pancreatic morphology and biochemistry in the hamster, with special attention to lipid changes. A control group of Syrian golden hamsters fed a synthetic liquid diet was compared to an ethanol group pair-fed the same diet with ethanol substituted for 35% of the carbohydrate calories. The animals were sacrificed at 7 weeks and 3, 6, 9, and 12 months. After 12 months of ethanol consumption, a significant decrease in pancreatic triglycerides and a significant increase in pancreatic RNA was seen. These changes were associated with a rise in pancreatic weight and protein content in the ethanol group, reversing a six-month decline in these values. This rise in RNA and protein in the ethanol-treated group corresponded with the appearance of large abnormal zymogen granules. Other ultrastructural features such as lipid droplets, mitochondria, and endoplasmic reticulum were not altered by ethanol. Ethanol did increase the water content of the pancreas. Although ethanol had no effect on the fasting levels of insulin or pancreatic polypeptide, the fasting serum gastrin immunoreactivity was significantly lower in the ethanol animals. This study shows that chronic ethanol consumption produces a metabolic change in the hamster by 12 months which is suggestive of increased protein synthesis with a decrease in pancreatic triglycerides and no lipid droplet formation.

Age Factors↗
PubMed1985

Granulomatous involvement of the liver in patients with AIDS.

During a one month period liver biopsy was carried out on eight patients with established acquired immune deficiency syndrome (AIDS) and two suspected of having AIDS to evaluate raised liver enzymes or unexplained fever and weight loss. Each of the 10 patients were found to have hepatic granulomas. Appropriate staining techniques showed acid-fast bacilli in seven of the liver specimens. One specimen contained numerous Cryptococcal organisms. Two biopsies showed granulomas but no organisms. Liver biopsy was found to be a high yield and rapid diagnostic procedure in patients with AIDS. Our results suggest that hepatic mycobacterial infection may be more common in the syndrome than previously recognised and that liver biopsy specimens should be examined routinely for the presence of acid-fast bacilli.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Predicting severity of liver disease: twelve laboratory tests evaluated by multiple regression.

To determine the predictive value of laboratory procedures for severity of liver disease, twelve laboratory tests were evaluated in seventy-two patients with various liver disease and in nine non-liver disease hospitalized cases. A numerical score based on the number and extent of abnormal findings was developed for grading clinical and histological severity. Multiple linear regression, utilizing a forward stepwise selection procedure, was used to find the best combination of laboratory tests for prediction of disease severity. The best predictive model for both clinical and histological severity was found for lecithin cholesterol acyltransferase (LCAT), total plasma cholesterol, alkaline phosphatase and bile acids. Of the routine tests prothrombin time and albumin/globulin were useful if the four-test combination listed above was not used. There was a significant correlation (p less than 0.001) between the clinical and the histological score, confirming validity of clinical scoring. In conclusion, this study shows LCAT to rank as first in predicting severity of liver disease. Cholesterol metabolism appears to be affected by liver disease even more than prothrombin time, albumin and globulins. LCAT and bile acids have a place in routine testing of severity of liver disease.

Adult↗
PubMed1984

Cholesterol ester storage disease and mesenteric lipodystrophy.

Cholesterol ester storage disease is a rare, inherited metabolic disorder of lipid associated with acid cholesteryl ester hydrolase deficiency. Thus far, 15 cases have been reported in the world literature. Reported here is the autopsy study of the oldest patient with this disease. The lipid storage occurred in the forms of birefringent needle-shaped crystals limited to hepatocytes and non-birefringent autofluorescent granules accumulated within the foam cells of the hepatic portal triads, duodenum, and ovaries. The cholesterol content of the liver was 16 times normal, primarily caused by increased cholesterol ester. Only trace cholesteryl ester hydrolase activity was demonstrated in the liver. An additional unique finding in our case was the presence of mesenteric lipodystrophy. Whether these two rare disorders observed in our patient represent unrelated conditions or have an etiologic association remains unknown.

Acid Phosphatase↗
PubMed1982

Severe hyperbilirubinemia and coma in chronic congestive heart failure.

A 64-year-old man developed severe hyperbilirubinemia of predominantly conjugated fraction in 1978, eight years after a myocardial infarction and development of congestive heart failure. In 1975, he was admitted elsewhere for symptoms suggestive of chronic hepatitis, but liver biopsy revealed replacement of hepatocytes by red blood cells which was interpreted as a result of left-sided cardiac failure. In 1978, liver biopsy showed congestive liver disease with cardiac sclerosis. Despite initial improvement, his condition deteriorated, he became encephalopathic, and died in a coma. This case is reported to illustrate that chronic congestive heart failure can present with severe jaundice and terminate in hepatic coma.

Cholestasis↗
PubMed1982

Exercise in rats with liver injury induced by carbon tetrachloride or bile duct obstruction. Blood cholic acid and liver histology.

UNLABELLED: Tolerance of exercise in rats with liver injury was evaluated by the response of plasma cholylglycine (CG) and by liver histology in two experiments with CCl4 hepatocellular damage and in two other experiments with cholestatic liver injury induced by obstruction of the common bile duct. (1) Rats swimming daily for 1 h while exposed to five successive doses of CCl4 and studied at rest, had a trend (P less than 0.06) to higher CG and a higher plasma SGPT (P less than 0.05) than sedentary CCl4 rats. (2) In rats recovering from four successive doses of CCl4 there were no differences between CG curves before, during, and after exercise, except at 48 h of recovery when exercise elevated CG (P less than 0.05). (3) Sixteen days after ligation of the bile duct CG was high but not affected by exercise, 45 days after ligation exercise resulted in further increase of CG (P less than 0.05). (4) When ligation of the bile duct lasted only 24 h, exercise prior to release of the obstruction did not affect CG. Exercise 8 h and 27 h after release of ligation resulted in an increase in CG (P less than 0.05). Return to pre-exercise CG occurred 30 min after exercise. CONCLUSION: CG was a useful indicator of liver injury showing a positive correlation with the CCl4 dose and a negative correlation with recovery from CCl4. Exercise had only mildly adverse effect in hepatotoxic and cholestatic liver injury. CG appeared to respond more sensitively to exercise after release of bile duct obstruction than in CCl4 hepatocellular injury.

Alanine Transaminase↗
PubMed1982

Lipogranulomas in non-fatty human livers. A mineral oil induced environmental disease.

Forty-four cases of lipogranulomas (LG) in non-fatty livers (NFL), consisting of 38 biopsies and six autopsy livers, were studied. LG in NFL have a distinct morphologic characteristic and virtually all are attached to or closely associated with the walls of hepatic venules. The reason for this peculiar location remains unexplained. Our data from lipid histochemistry and analysis of lipid extracts from the livers and foodstuffs by thinlayer chromatography and gas-liquid chromatography indicate that LG in NFL most likely represent a reaction to absorbed saturated hydrocarbons, like mineral oil, used widely in the food industry. The incidence of LG is increasing, as evidenced by a 1.7% incidence in 1952-53 compared with 4.6% in 1978-80. LG seldom present a diagnostic problem provided serial sections are examined. An awareness of the characteristic morphology will prevent an extensive granuloma work-up. They appear to be an incidental finding in liver biopsies, and of no clinical significance at present; however, their long-term implication, if any, must await future observations.

Chromatography, Gas↗
PubMed1982

Budd-Chiari Syndrome and antithrombin III deficiency.

Presented herein is a case report of a 20-year-old woman with a past history of oral contraceptive use who developed Budd-Chiari syndrome. Onset of her illness was abrupt and stormy, simulating fulminant viral hepatitis or toxic hepatic injury. She died within six months of her initial presentation. Although the patient discontinued the use of oral contraceptives two years prior to the initial presentation of the disease, the morphologic features of the venous thrombosis and hepatic damage were indicative of a chronic, ongoing process of longer than six months' duration, thus raising the possibility of a cause-effect relationship between the "pills" and thrombotic process. Of interest was the finding of persistently depressed antithrombin III levels. While a relationship between oral contraceptive usage, antithrombin III deficiency and the Budd-Chiari syndrome is strongly suggested in this case, prospective studies are needed to substantiate this view.

Adult↗
PubMed1982

The significance of giant mitochondria in liver biopsies as observed by light microscopy.

One hundred forty-three liver biopsy specimens were evaluated by light microscopy for giant mitochondria (GM), and were correlated with a variety of histological and clinical parameters. GM were found in 57% of the biopsy specimens. In alcoholic liver diseases, GM are mostly round in shape, are centrilobular in distribution, and frequently coexist with Mallory bodies. The frequency of hepatocytes containing GM in alcoholic liver disease is the highest of all groups. In nonalcoholic liver diseases, GM are round or needle-shaped, distributed randomly or in the periphery of the hepatic lobules, and the frequency of hepatocytes containing GM is less than that in alcoholic liver disease. These features are useful in separating alcoholic from nonalcoholic liver diseases. While GM appear to represent early hepatocellular injury, certain factors appear to influence GM formation in nonalcoholic liver diseases, including high alcohol consumption in both alcoholic and nonalcoholic liver diseases, fatty change, under-nutrition or abnormal nutrition, and upper gastrointestinal tract disorders.

Alcohol Drinking↗
PubMed1982

Haloperidol-induced chronic cholestatic liver disease.

A 15-yr-old patient with chronic cholestatic liver disease associated with haloperidol therapy is presented. Emphasis is placed on the pattern of biochemical abnormalities and on the histologic features observed in the four serial biopsies which demonstrated a pronounced injury to the bile duct epithelium, correlating well with the clinical and biochemical abnormalities. During the early stage of illness, the clinicopathologic features simulated obstructive jaundice, whereas a resemblance to chronic chlorpromazine-induced cholestasis or primary biliary cirrhosislike syndrome was striking as the chronicity developed. Comparison is made of the features in our patient with those in 2 patients with biopsy-documented, acute haloperidol-induced liver disease reported for the first time in 1977. Despite the lack of concrete evidence, both the clinical and morphologic features, and the close temporal relationship between the medication and onset of illness in this patient led to the reasonable inference that haloperidol was responsible for the chronic cholestatic reaction on a hypersensitivity basis.

Adolescent↗
PubMed1981

Circulating Charcot-Leyden crystals in the hypereosinophilic syndrome.

A patient who had malignant melanoma associated with the hypereosinophilic syndrome died of cardiovascular thrombotic lesions. Widespread tissue eosinophilia was accompanied by numerous Charcot-Leyden crystals in the tumor as well as in various organs, including the renal tubules. A unique observation, not previously described, is the finding of Charcot-Leyden crystals in the thrombi and vessels, including the renal glomeruli. While little is known of the significance of Charcot-Leyden crystals, it is speculated that the circulating crystals injure the endothelium and trigger intravascular coagulation, resulting in thrombosis. A search for the crystals in blood and/or urine may be of additional aid in the evaluation of the extent of the thrombotic process. A special staining method is proposed to facilitate recognition of the crystals, since these are virtually not visualized by routine stain. With the use of such a staining method, future observations in other cases of the hypereosinophilic syndrome may elucidate the role of Charcot-Leyden crystals in the pathogenesis of the thrombotic cardiovascular lesions of this syndrome.

Adult↗
PubMed1981

Tuberculosis in pregnancy with fatal congenital infection.

An unusual case of miliary tuberculosis which presented as fever and a tubo-ovarian abscess in a postpartum patient is described. Fatal congenital tuberculosis was also diagnosed in the mother's premature infant. The difficulties encountered in diagnosing the tuberculosis in these patients are summarized, and the need for early recognition and therapy is emphasized. Epidemiologic follow-up of the premature infant's exposed contacts was thorough and revealed no new cases of tuberculosis among the infants or the personnel who were exposed to the infected baby.

Abscess↗