1.

Norepinephrine-Induced Pulmonary Petechiae in the Rat: An Experimental Model with

Potential Implications for Sudden Infant Death Syndrome

Henry F. Krous,Andrew C. Catron &Jay P. Farber

Pages 115-122 | Received 22 Nov 1982, Accepted 05 Jan 1983, Published online: 09 Jul 2009

Cite this article https://doi.org/10.3109/15513818409041193Abstract

Autonomic nervous system abnormalities have been implicated in infants dying of or considered at high
risk of sudden infant death syndrome (SZDS). In a rat model, norepinephrine (0.02 mg/kg) caused
systemic hypertension and numerous pulmonary petechiae, the latter a common finding in SIDS.
Petechiae were not seen below the diaphragm. The animals were killed by tracheal occlusion 5 min after
the intravenous administration of norepinephrine. The number of pulmonary petechiae was greatly
reduced by alpha-adrenergic blockade (phentolamine) and dopaminergic blockade (haloperidol) but not
by beta-adrenergic blockade (timolol). A significantly greater reduction of peak mean systemic arterial
pressure occurred after alpha-adrenergic blockade than with other blocking agents. It is conceivable that
hypoxia-induced endogenous catecholamine release contributes to the pathogenesis of pulmonary
petechiae found at necropsy of SZDS victims.

Based on the above result of the experiment in healthy rats, death of mice begins because of
tracheal occlusion secondary to broncho constriction as natural autonomic response of the body to
hypoxia-induced norepinephrine administration. The effect was systemic hypertension and decreased
pulmonary perfusion as shown by petechia of lung tissues, which is also observed during necropsy of
healthy infants who died of SIDS found sleeping face down on its tummy. These catecholaminergic
changes may be caused by chronic hypoxia or ischemia, and also may underlie alterations in respiratory
and cardiovascular control in sleep.

Reference

Catecholamine neurons alteration in the brainstem of sudden infant death syndrome victims T Obonai 1,
M Yasuhara, T Nakamura, S Takashima PMID: 9445505 DOI: 10.1542/peds.101.2.285 doi:
10.1542/peds.101.2.285.
 2. Lung Perforation by Chest Tubes in the Neonate

Geoffrey A. Machin

Pages 103-114 | Received 05 Mar 1982, Accepted 20 Jan 1983, Published online: 09 Jul 2009

Cite this article https://doi.org/10.3109/15513818409041192

Abstract

In 272 consecutive neonatal autopsies in one institution, 70 patients had had intercostal drainage tubes
inserted to treat air leak secondary to pulmonary disease. In 9 of these cases, one or more chest tubes
penetrated lung parenchyma. The majority of these occurred in infants less than 36 weeks’ gestation
with hyaline membrane disease and its sequelae. Laceration of lung parenchyma most commonly
occurred when tubes were inserted on the left side at 5 days or later and when multiple tubes were
inserted.

Based on the 227 neonatal autopsies study of Machin (2009), 70 of the neonates undergone
intercostal drainage tube to treat air leaks. According to Yadav; Lee; and Kamity (2023), neonatal
respiratory distress syndrome is a frequent cause of increased morbidity and mortality in neonates
within hours after birth, but often immediately after delivery. RDS occurs from a deficiency of surfactant,
due to either inadequate surfactant production, or surfactant inactivation in the context of immature
lungs. Acute complications may occur along the course of short- and long-term treatment. Positive
pressure ventilation or invasive chest tube drainage may lacerate the lung pharenchyma causing air-leak
syndromes such as pneumothorax, pneumomediastinum, and pulmonary interstitial emphysema.
Understanding the pathophysiology, clinical presentation, diagnosis, prevention, and management of
this condition is vital to decreasing morbidity and mortality among premature infants.

Cross Reference
Sudeep Yadav; Brian Lee; Ranjith Kamity 2023. Neonatal Respiratory Distress Syndrome
https://www.ncbi.nlm.nih.gov/books/NBK560779/

3. Cytomegalovirus Infection of the Bowel in Infancy: Pathogenetic and Diagnostic Significance

James E. Dimmick &Kevin E. Bove

Pages 95-102 | Accepted 01 Sep 1983, Published online: 09 Jul 2009

Cite this article https://doi.org/10.3109/15513818409041191

Abstract

Three infants had cytomegalovirus (CMV) infection of the bowel. Infected enteric ganglion cells were
found in two, one of whom had hypoganglionosis and colonic dysmotility. The third infant had classic
short segment Hirschsprung's disease and colitis with CMV inclusions in vascular endothelium, a
situation wherein viral transformed cells may have led to misinterpretation of the diagnostic biopsy.
Gastrointestinal signs and symptoms have rarely been reported in association with cytomegalovirus
(CMV) infection in young infants. However, in 1981 clear pathologic evidence was presented implicating
this virus as a cause of hypoganglionosis and bowel dysmotility. This finding was reported by Ann M.
Kosloske, et al. (1988) in four infants with CMV infection, in whom gastrointestinal dysfunction was the
reason for emergency abdominal operation. Since the association was made retrospectively, they were
unable to demonstrate hypoganglionosis, but their experience emphasizes the need to include CMV
intestinal infection in the differential diagnosis of the acute surgical abdomen in young infants, who may
have other diseases such as case of Hirschsprung's disease and colitis from the findings of James E.
Dimmick &Kevin E. Bove 2009.

Cross Reference

Acute abdominal emergencies associated with cytomegalovirus infection in the young infant
Ann M. Kosloske,corresponding author1 Patrick F. Jewell,1 Alfred L. Florman,1 and Edith T. Umland1
Pediatr Surg Int. 1988; 3(1): 43–46. doi: 10.1007/BF00177079
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7088330/

4. Arnold-Chiari Malformation: Report of a Case with Contamination of Ventricular and

Subarachnoid Spaces by Amniotic Sac Contents

Dimitris P. Agamanolis,Marvin S. Platt &John H. Vollman

Pages 89-94 | Accepted 15 Feb 1983, Published online: 09 Jul 2009

Cite this article https://doi.org/10.3109/15513818409041190

Abstract

An infant with the Arnold-Chiari malformation had a lumbosacral amniotic-central nervous system fistula
that allowed massive amounts of squamous cells and lanugo hair to enter the ventricular and
subarachnoid spaces causing blockage, gliosis, and fibrosis. This rare complication can be diagnosed by
cytologic examination of cerebrospinal fluid and should be considered in the prognosis of Arnold-Chiari
malformation and selection of cases for treatment.

The exact cause of Chiari malformations is not known, but often the cavity near the base of the skull
(posterior fossa) is narrow and abnormally small in relation to the size of the cerebellum, which this
portion of the skull encloses. Researchers believe that in some cases the small posterior fossa may cause
the developing brain, specifically the cerebellum and the brainstem, to be pushed downward. Part of the
cerebellum (known as the cerebellar tonsils) may protrude (herniate) through the foramen magnum,
which is the normal opening found in the occipital bone at the base of the skull. The tonsils may thus
interfere with the flow of cerebrospinal fluid (CSF) to and from the skull and spinal canal, potentially
leading to accumulation of cerebral spinal fluid in the subarachnoid spaces of the brain and spine. In
relation to the findings of Agamanolis, Platt and Vollman (2014), another form of malformation shows a
lumbosacral amniotic-central nervous system fistula that allowed massive amounts of squamous cells
and lanugo hair to enter the ventricular and subarachnoid spaces causing blockage, gliosis, and fibrosis
with specific signs and symptoms, requiring a specific type surgical and medical treatment.

Cross Reference Chiari Malformations https://rarediseases.org/rare-diseases/chiari-malformations/

5. Pathology of Suspected Acquired Immune Deficiency Syndrome in Children: A Study of Eight Cases

V. V. Joshi,J. M. Oleske,A. B. Minnefor,R. Singh,T. Bokhari &R. H. Rapkin

Pages 71-87 | Received 13 Apr 1983, Accepted 01 Aug 1983, Published online: 09 Jul 2009

Cite this article https://doi.org/10.3109/15513818409041189

Abstract

Biopsy and/or autopsy material from lymphoreticular and other organs was studied in 8 children with
suspected acquired immune deficiency syndrome (AIDS). One or both parents of each of these children
had one or more of the recognized risk factors for AIDS, such as intravenous drug abuse, prostitution,
Haitian origin. The following histologic patterns were noted in the lymph nodes: (1) follicular hyperplasia
with normocellular paracortex, (2) follicular hyperplasia with depletion of paracortex, and (3) atrophy of
follicles with depletion of paracortex. Lymphoid interstitial pneumonitis (LIP), a previously unreported
lesion in AIDS, was present in 4 cases. It is suggested that the pulmonary lymphoid lesion may be part of
a more generalized lymphoid hyperplasia involving B cells. The gross and microscopic features of the
thymus, available in 2 of the 8 cases, indicated that the immunologic defect in these children was not of
congenital type. Pathologic findings can be helpful in the diagnosis of the syndrome when correlated
with clinical and immunologic features of suspected cases and of the pulmonary lesion. The latter is of
importance in deciding the type of therapy to be given for the pulmonary disease process.

Cross Reference

Vijay V Joshi Pathology of Acquired Immunodeficiency Syndrome (AIDS) in Children

The Keio Journal of Medicine 1996 Volume 45 Issue 4 Pages 306-312
https://doi.org/10.2302/kjm.45.306

Acquired Immunodeficiency Syndrome (AIDS) was first described to occur in children in 1983. With
experience of increasing number of cases of AIDS, pathologic lesions in various organs and tissues such
as lungs, brain, G.I. tract, heart, blood vessels, lymph nodes, spleen, bone marrow, etc. became evident
in autopsy and biopsy specimens. In recent years the emphasis of pathologic study is on the reactive and
neoplastic proliferative disorders. These disorders include nodal and extranodal lymphoproliferative
lesions (such as myoepithelial sialadenitis, malignant lymphomas, etc) In terms of pulmonary lymphoid
lesion, it specifically identified a more generalized lymphoid hyperplasia involving B cells. The gross and
microscopic features of the thymus, available in 2 of the 8 in the above cases, indicate that the
immunologic defect in these children was not hereditary or congenital in nature, which is significant in
the type of therapeutic intervention specific for the pulmonary disease category.
 6. Germinoma of the Pineal Body with Syncytiotrophoblastic Giant Cells

Ricardo Drut &Marta Celina Jones

Pages 65-70 | Received 20 Sep 1982, Accepted 28 Dec 1982, Published online: 09 Jul 2009

Cite this article https://doi.org/10.3109/15513818409041188

Abstract

Almost all types of germ cell tumors are known to occur in the third ventricle-pineal region. In this paper
we report the case of a 16—year-old boy having a particular subtype of germinoma of the pineal body in
which scattered syncytiotrophoblastic cells positive for human chorionic gonadotropin were found.This
tumor is considered the central nervous system counterpart of seminoma with syncytiotrophoblastic
giant cells and dysgerminoma with syncytiotrophoblastic giant cells.

Cross reference

Danielle Betz; Kathleen Fane 2023. Human Chorionic Gonadotropin. National Library Medicine
https://www.ncbi.nlm.nih.gov/books/NBK532950/

In relation to the cause of third ventricle -pineal region tumor in a 16 year old boy, syncytiotrophoblastic
cells were identified that is positive for human chorionic gonadotropin (hCG). hCG is a chemical hormone
created by trophoblast tissue, tissue typically found in early embryos and which will eventually be part of
the placenta. According to Betz and Fane (2023), measuring hCG levels can be helpful in identifying a
normal pregnancy, pathologic pregnancy, and can also be useful following an aborted pregnancy. There
is also a benefit in measuring hCG in a variety of cancers including choriocarcinoma and extra-uterine
malignancies.

7. Scanning Electron Microscopic Study of the Airways in Normal Children and in Patients with
Cystic Fibrosis and Other Lung Diseases

David L. Simel,J. Pat Mastin,Philip C. Pratt,Charles L. Wisseman,John D. Shelburne,Alexander Spock &

show all

Pages 47-64 | Received 22 Sep 1982, Accepted 15 Nov 1982, Published online: 09 Jul 2009

Cite this article https://doi.org/10.3109/15513818409041187

Abstract

Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) were used to examine
pulmonary tissue from 9 patients with cystic fibrosis (CF), 12 patients with diseases other than CF, and
from two surgically resected specimens with no known airways disease. A region of the human airways,
the transition zone, was observed between the end of the terminal bronchiole and the type II alveolar
cell lining of the respiratory bronchioles. This region was lined predominantly by nonciliated bronchiolar
(NCB) cells. Patients with CF exhibited indistinct transition zones, epidermoid metaplasia, large dilated
bronchial gland, copious surface mucus, alveolar destruction, and unusual microvilli; no single lesion
specific for cystic fibrosis was identified.

Cross reference

Sandhya Pruthi 2024. Cystic Fibrosis. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/cystic-

fibrosis/symptoms-causes/syc-20353700

Cystic fibrosis (CF) is an inherited disorder that causes severe damage to the lungs, digestive system and
other organs in the body. CF affects the cells that produce mucus, sweat and digestive juices. These
secreted fluids are normally thin and slippery. But in people with CF, a defective gene causes the
secretions to become sticky and thick. Instead of acting as lubricants, the secretions plug up tubes, ducts
and passageways, especially in the lungs and pancreas. In relation to the findings indicated by Scanning
Electron Microscopic Study of the Airways in Normal Children and in Patients with Cystic Fibrosis, CF
exhibited indistinct transition zones, epidermoid metaplasia, large dilated bronchial gland, copious
surface mucus, alveolar destruction, and unusual microvilli that are diagnostic indicators of Cystic
Fibrosis compared with the normal tissue microscopy among non CF samples.

8.Acetylcholinesterase Histochemistry and the Diagnosis of Hirschsprung's Disease: A 31/2—Year

Experience

Paul E. Wakely &A. James McAdams

Pages 35-46 | Received 16 Jun 1982, Accepted 01 Aug 1982, Published online: 09 Jul 2009

Cite this article https://doi.org/10.3109/15513818409041186

Abstract

Using a modification of the histochemical acetylcholinesterase (ACE) reaction of Karnovsky and Roots,
154 suction rectal biopsies performed during the clinical investigation for Hirschsprung's disease were
examined and compared to simultaneously obtained paraffin-embedded, hematoxylin-eosin (H&'E)-
stained tissue. Serial paraffin sections were adequate to identify normal ganglia or to raise suspicion of
Hirschsprung disease at initial biopsy in 129 of 154 (83%) cases. Interpretation of the ACE-stained tissue
correlated exactly with this interpretation in 123 instances; 6 cases had uninterpretable ACE frozen
sections. From this group of adequate paraffin sections, 18 patients with aganglionic megacolon were
identified with the ACE preparation, relying primarily on a pattern of unusually thick and numerous
nerve fibers within the muscularis mucosa.

Cross reference

Lusine Ambartsumyan, Caitlin Smith, and Raj P Kapur Diagnosis of Hirschsprung Disease

First published online December 2, 2019

https://doi.org/10.1177/1093526619892351

https://journals.sagepub.com/doi/10.1177/1093526619892351
A variety of diagnostic tests including contrast enema and anorectal manometry are used as diagnostic
screens, but similar to the above procedures presented in the study of Wakely & McAdams (2009),
diagnosis ultimately rests upon histopathological evaluation of a rectal biopsy. For the experienced
pathologist, conventional hematoxylin-and-eosin-stained sections often suffice to exclude HSCR or
establish the diagnosis.
Ancillary diagnostic tests such as acetylcholinesterase histochemistry or calretinin
immunohistochemistry are considered as complementary and extremely helpful in some cases. Twenty-
five paraffin-embedded specimens were deemed uninterpretable because of absent or insufficient
submucosa or because of location. The ACE-stained section, however, correctly predicted the presence
or absence of ganglia in 23 of these additional cases where the diagnosis could subsequently be
confirmed either by repeat biopsy or repeated clinical follow-up examination of the patient.
Using the ACE method alone, initial biopsy in 146 of 154 specimens obtained a
diagnosis equivalent to (95%). However, this percentage was increased to 99% (152 of 154 specimens) if
both ACE and paraffin sections were utilized. Moreover, recognition of the normal and abnormal
patterns of nerve fiber staining in ACE preparations permits reliable, decisive interpretation of rectal
suction biopsies in the evaluation of Hirschsprung's disease.

9.Lipid-Laden Macrophages in Tracheal Aspirates of Newborn Infants Receiving Intravenous Lipid

Infusions: A Cytologic Study

Aida L. Recalde,Bruce G. Nickerson,Maria Vegas,Charles B. Scott,Benjamin H. Landing &David Warburton

Pages 25-34 | Received 05 Apr 1982, Accepted 14 May 1982, Published online: 09 Jul 2009

Cite this article https://doi.org/10.3109/15513818409041185

Abstract

Seventy-four neonates with respiratory distress syndrome had cytologic study of tracheal aspirates.
Thirteen, all of whom were receiving intravenous lipid and nothing orally had abundant macrophages
with foamy cytoplasm, positive for intracytoplasmic lipid by Sudan black stain, in the tracheal aspiration
specimens. Cytologic surveillance of tracheal aspiration specimens may be a useful method of
monitoring infants receiving intravenous lipid infusions.

Cross Reference

Lipid-laden macrophages in the tracheal aspirate of ventilated neonates receiving Intralipid®: A pilot
study†

Andrzej Kajetanowicz MD, Dora Stinson MD, FRCPC, Krista S. Laybolt RT, Lothar Resch MD, FRCPC

First published: 23 July 1999 https://doi.org/10.1002/(SICI)1099-0496(199908)28:2<101::AID-

PPUL5>3.0.CO;2-GCitations: 18

† Presented in part at the Annual Meeting of the Canadian Paediatric Society, Saskatoon, June 23, 1996.
Lipid-laden macrophages (LLM) in tracheal aspirates are reported to be pathognomonic findings in exo-
and endogenous lipoid pneumonia in adults that could possibly associated with aspiration. A pilot study
was carried out to evaluate the effect of lipid infusion on the LLM index of the tracheal aspirates from
ventilated neonates. LLM indices increased during the first week after birth; the average LLM index then
continued in the same range, but with a wide distribution of individual values. The mean LLM index from
infants receiving an IV lipid infusion during days 4–7 was 87.9 (SD = 44.8) and was significantly higher
compared to 58.7 (SD = 40.8) in infants receiving no IV lipid (P < 0.003). In many instances, tracheal
aspirates from infants with and without IV lipid infusion yielded many LLM index values >100. Therefore,
these observations invalidate the use of the LLM index >100 as proof of aspiration pneumonia in this
group of infants that may have caused by other risk factors. Pediatr Pulmonol. 1999; 28:101–108. ©
1999 Wiley-Liss, Inc.

10.Tubulointerstitial Renal Diseases of Children: Pathologic Features and Pathogenetic Mechanisms in

Fanconi's Familial Nephronophthisis, Antitubular Basement Membrane Antibody Disease, and
Medullary Cyst Disease

Leszek Huczynski &Benjamin H. Landing

Pages 1-24 | Received 26 Aug 1982, Accepted 01 Mar 1983, Published online: 09 Jul 2009

Cite this article https://doi.org/10.3109/15513818409041184

Abstract

The renal lesions of 15 children with tubulointerstitial diseases (TID), originally diagnosed as Fanconi's
familial nephronophthisis (FFN), medullary cyst disease (MCD), or antitubular basement membrane
(TBM) antibody disease were studied by light, electron, and immunoflauorescence microscopy and by
peroxidase-anti-peroxidase stain for IgG. Kidneys originally considered in all three categories showed
similar pathologic findings, with periglomerular fibrosis, interstitial fibrosis and infiltration, TBM
thickening, and glomerulopathy. The data suggest that MCD and FFN are not synonyms, but that FFN can
lead to medullary cystic disease, as can other tubulointerstitial diseases. Anti-TBM disease appears to be
a more frequent cause of TID than is usually recognized. Glomerular involvement in TID may be due to
deposition of anti-TBM antibody/TBM antigen complexes.

Cross Reference

Tubulointerstitial nephritis

Published: November 1992

Volume 6, pages 572–586, (1992)

Cite this article: https://link.springer.com/article/10.1007/BF00866512

Tubulointerstitial nephritis (TIN) as what Helczynski & Landing (2009) describes is a wide range of
pathological processes that can cause the progression of other renal etiologies. In fact, clinical studies
proves that TIN frequently manifests the pathological onset of glomerulonephritis, and similar
complications such as obstructive uropathy, reflux nephropathy and cystic diseases, although it may also
present as a primary disease process associated with infection, drug use or other immunologically
mediated disease. Recent clinical and laboratory research has increased knowledge of tubulointerstitial
structure, physiological function and tubulointerstitial response to injury. Thus, above facts conclude that
acute and chronic tubulointerstitial diseases differ from other kidney disorders and recognized as the
pathogenesis of other kidney diseases.