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A 47 year old male patient had extensive verrucous lesions on the right upper limb for 33 years. One of the lesions-4eveloped ulceration which had not healed for6 years. A clinical diagnosis of chromoblastomycosis was confirmed histopathologically and mycologically, Cladosporium cladosporioides being the organism cultured. Combined treatment with amphotericin B and 5fluorouracil gave good response with most lesions resolving. A few verrucous plaques and the ulcer persisted. Biopsy from the ulcer revealed a low - grade squamous cell carcinoma which was treated with excision and grafting. A year later, the patient developed metastasis in the axillary lymph nodes which also showed fungal granuloma at the time of biopsy. The axilla was irradiated with 4500 rads and three courses of bleomycin injections were given. However, he died 10 months later following a massive bleed from an axillary vessel.

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Systemic fungal infections were identified in 13 of 1468 necropsies of infants dying in the 1st year of life in a south Indian hospital. Candidiasis was present in 11 infants, most often as pneumonia or enteritis. Spread to other organs occurred in four cases. Intestinal candidiasis was associated with zygomycosis of the intestine in one infant and with aspergillosis of the lungs and intestine in another. One case of aspergillosis of the myocardium and one of gastric zygomycosis were also diagnosed. Septicaemia, broad spectrum antibiotic therapy, surgery and congenital abnormalities, including immune deficiencies, were important predisposing factors.

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This report describes 16 cases of candidiasis, seven of aspergillosis, four of mucormycosis, two of cryptococcosis and one of nocardiosis in which the kidney was involved. Characteristic patterns of renal tissue injury were seen in each of these infections. Candida and nocardia caused microabscesses in the cortex and medulla. Tissue destruction was minimal with candidiasis and when present was confined to the papillary tips and produced only mild impairment of renal function. Aspergillus and mucor invaded blood vessels resulting in thrombosis and extensive necrosis of cortical and medullary tissue and most patients had clinical and biochemical evidence of renal disease. Cryptococcosis caused no tissue reaction or clinically evident renal disease in the two immunosuppressed patients studied.

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Angiodysplasia of the intestine was diagnosed by selective visceral angiography in ten of 30 patients from India with unexplained recurrent hemorrhage of the gastrointestinal tract. In contrast with the reports from the western literature, most of the instances involved the small intestine and occurred in the third decade of life.

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Electron microscopic examination of cardiac tissue from seven patients with tropical endomyocardial fibrosis showed the endocardium to be replaced by maturing granulation tissue containing haphazardly arranged collagen bundles, smooth muscle cells, blood vessels and degranulated mast cells. Mature collagen was present on the luminal aspect of the granulation tissue. Myofibres showed mitochondrial swelling, lamella bodies, focal myocytoplasmic clearing and collapsed intercalated discs. Small calibre blood vessels exhibited endothelial swelling, areas of basement membrane duplication and collections of neutrophilic and eosinophilic leucocytes. Eosinophils showed alteration in granule morphology. These changes are similar to the lesions reported in endomyocardial disease with eosinophilia.

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Electron and, or light microscopic examination of paraffin embedded renal tissue obtained from necropsies on eleven patients with obliterative cardiomyopathy showed a variety of abnormalities. Glomerular lesions present in patients with endomyocardial fibrosis included capillary wall thickening, basement membrane duplication, mesangial expansion and interposition, intraluminal fibrin and dense subendothelial deposits. These changes, some of which have been reported earlier in patients with Loffler's endocarditis, probably result from deposition and organisation of immune complexes.

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Out of 709 consecutive patients with isolated secundum atrial septal defect, the pulmonary artery systolic pressure was greater than 50 mm Hg in 118 patients (17%). Pulmonary hypertension was present in 13% of patients under 10 years and in 14% aged 11 to 20 years. The Eisenmenger reaction was present in 9% of the 709 patients. The frequency of the Eisenmenger reaction was high in young patients and was not significantly different in patients in the first and second decades as compared to older patients. None of our patients with pulmonary hypertension resided at high altitude. The high frequency of pulmonary hypertension in our young patients cannot be satisfactorily explained. Autopsy studies suggest that in some, pulmonary hypertension is due to the persistence of the fetal pulmonary vascular pattern.

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Os autores apresentam resultados de uma serie de 91 pacientes com hipertensao pulmonar primaria observada em area tropical.Havia predominancia de doentes do sexo masculino, ao contrario do constatado em regioes nao tropicais. Praticamente, todos os pacientes apresentavam dispneia de esforco. Alteracoes eletrocardiograficas com aumento de voltagem de onda R em V1 tinham forte correlacao positiva com o nivel de pressao arterial pulmonar. Alteracoes da conducao de estimulo eletrico eram pouco frequentes. Era destacada em 90% dos casos o aumento de tamanho das arterias pulmonares, apreciado sob o aspecto radiologico.Pressao arterial pulmonar sistolica superior a 90 mmHg foi registrada em cerca de 70% dos doentes, sendo que em cerca de 49% ela superava o nivel sistemico. De um total de 58 pacientes seguidos, 34 morreram dentro de um periodo medio de 20 meses.Nao se podem determinar as razoes para o maior grau de severidade observado nesta serie, sendo possivel a participacao de um fator etnico

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A case of Werner syndrome is reported. The patient was prematurely old, had skin atrophy, characteristic posterior subcapsular cataracts and prepubertal primary hypogonadism. Additional ocular features compatible with premature ageing included presbyopia, arcus seniles and diminished tear flow. Diabetes mellitus, poliosis, baldness and beak-like nose were not present.

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Primary malignant tumours of the mediastinum are difficult clinical problems in thoracic surgery from both diagnostic and therapeutic points of view. Three cases of malignant seminoma of the mediastinum have been documented, thus bringing the total number of cases reported in the literature to 78. A case of metastasis to the subcutaneous tissue in malignant thymoma has been documented. Because of the multiple-cell types of these tumours and their ill-defined extent due to involvement of adjacent structures, surgery is often difficult. Radiotherapy along with chemotherapy has a definit place in their management, either as a primary treatment in inoperable cases or as a supplement to surgery if the condition is operable.

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