are endemic in modern Egypt, and S. hematobium infection has been reported in other Egyptian remains. There was evidence of early cirrhosis of the liver and congestive splenomegaly, possibly with terminal rupture. Schistosoma ova were found in the liver (Fig. 1), which suggests that the cirrhosis was secondary to hepatic schistosomiasis. Although S. mansoni is the commonest cause of this condition, S. hematobium may give the same histologic picture in the liver.
The calcified ova in the kidney and the presence of erythrocytes in the bladder indicate involvement of the urinary system with S. hematobium. (Schistosomiasis remains a chronic debilitating disease in Egypt; there is no sign of adaptation between man and parasite in this geographic area.) An incidental finding, present in all ancient remains, is pulmonary anthracosis,1 which is secondary to environmental pollution by cooking and heating fires, and by oil lamps in small
quarters. It is also possible that Nakht had pulmonary silicosis due to continual inhalation of dust and sand while working near or at a stone quarry or workshop. We thank Ann M. Dowd, MT (ASCP) for technical assistance. References 1. COCKBURN A, BARRACO RA, REYMAN TA, et al: Autopsy of an Egyptian mummy. Science
187: 1155, 1975
6. Trichinella spiralis cyst U. DE BoNI,* PH D. M.M. LENCZNER,f MD; JOHN W. SCOTT, MD
Material from an intercostal space was placed in a 1:1 water-glycerin solution for 24 hours, then in 10% formalin for 24 hours. Subsequently it was embedded in paraffin, and sections 10 ,.tm thick were cut and stained with 0.1% aqueous toluidine blue. *Department of physiology, University of Toronto ITropical disease expert, Toronto General Hospital Reprint requests to: Dr. John W. Scott, Department of physiology, University of Toronto, Toronto, Ont. M5S IAl
With rehydration the skin surface macerated and details were not distinct. The muscle fibres were well defined and blood vessels could be identified. Near the subcutaneous border of the intercostal muscle we found a small cyst, just visible to the naked eye, having the appearance of a parasite. At first we considered it to be Cysticercus cellulosae (the larval form of Taenia solium) but these cysts are about 5 mm in diameter and much larger than the
muscle fibres. The cyst was too small to be that of Trichinella spiralis, but was appropriate in size when compared with the muscle fibres; shrinkage during drying could be the explanation. Trichinella infection, like cysticercosis, is due to the eating of inadequately cooked pork. Nakht's diet probably contained little meat, yet his association with a funerary temple may have given him access to more meat than the average working-class Egyptian enjoyed.E
7. Electron microscopy of mummified tissue PATRICK D. HORNE,* RT; PETER K. LEWIN,f MD *B.ting Institute, department of pathology, Toronto General Hospital tDepartments of pediatrics and pathology, Hospital for Sick Children, Toronto
Reprint requests to: Dr. Peter K. Lewin, Department of pathology, Hospital for Sick Children, 555 University Ave., Toronto, Ont. M5G 1X8
Tissue samples were taken from the sole of the right foot of Nakht (ROM I) and rehydrated in buffered 10%
.CM
.r
*
.'
4
w
FIG. 1-Epithelial cell from basal layer of epidermis of Nakht (ROM 1): CM = cell membrane; DN = disintegrated nucleus, TF tonofilaments (uranyl acetate; x30 000, reduced 28%). 472
CMA JOURNAL/SEPTEMBER 3, 1977/VOL. 117
FIG. 2-Egg of Taenia sp.: arrows indicate hookiets (uranyl acetate; xiS 800, reduced 40%).
AIdactazid. Summary of prescribing information: Pharmacology: Spironolactone effects diuresis by blocking through competitive inhibition, the sodium and water retaining and potassium excreting effects of aldosterone on the distal renal tubule. Hydrochlorothiazide promotes excretion of sodium and water primarily by inhibiting their reabsorption by the cortical diluting segment of the renal tubule. Thus the components of Aldactazide have different and complementary modes of action. In addition, spironolactone minimizes potassium loss characteristically induced by hydrochlorothiazide, thereby reducing the possible serious consequences of potassium depletion. Indications: The treatment of essential hypertension; the edema and ascites of congestive heart failure, cirrhosis of the liver, the nephrotic syndrome and idiopathic edema.
FIG. 3-Enlargement of segmental embryophore (uranyl acetate; x32 500).
*
K FIG. 4-Enlargement of booklet from egg of Taenia sp. (uranyl acetate; x32 500).
formalin. Dry, dust-like intestinal contents were spun in normal saline; the button of material obtained was rehydrated in Sandison's modification of Ruffer's solution (5% sodium carbonate [aqueous], two parts; 96% ethyl alcohol, three parts; and 1% formalin, five parts). Sections were fixed with phosphate-buffered 2% glutaraldehyde and 1% osmium tetroxide, embedded in epoxy and stained for contrast with uranyl acetate. The epidermis was well preserved and cellular components were easily recognized (Fig. 1). The intestinal tract contained several ova of Taenia spp; the ultrastructure of the striated embryophore of an egg (Figs. 2 and 3) with its hooklets (Fig. 4) was demonstrated in great detail. An erythrocyte found in the intestinal contents was photographed with a scanning electron microscope (Fig. 5). These observations confirm the earlier observation that Egyptian mummified material contains preserved cells with recognizable cytoplasmic organelles.1 Reference 1. LEWIN PK: The ultrastructure of mummified skin cells. Can Med Assoc 1 98: lOll, 1968
Contraindications: Acute renal insufficiency; rapidly progressing impairment of renal function; anuria; hyperkalemia; patients known to be sensitive to Ihiazides or other sulfonamide-derived drugs; patients with severe or progressive liver disease at the discretion of the physician; nursing mothers; sensitivity to spironolactone. Warnings: Concurrent potassium supplementation is not indicated unless a glucocorticoid is also given. Aldactazide should not be used in conjunction with other potassium conserving agents. Precautions: The most potentially serious electrolyte disturbance is hyperkalemia which is more likely to occur in severely ill patients. If hyperkalemia occurs, discontinue Aldactazide. Hypokalemia may develop. Use cautiously in patients with sodium depletion. Check for signs of fluid or electrolyte imbalance. The most frequent electrolyte disturbance encountered is dilutional hyponatremia. Rarely a true low-salt syndrome may develop. Decrease dosage before diuresis is complete to avoid dehydration. Thiazide diuretics may precipitate hepatic coma. Use with caution in patients subjected to regional or general anesthesia. Discontinue 48 hours prior to elective surgery as both hydrochlorothiazide and spironolactone reduce vascular responsiveness to norepinephrine. Orthostatic hypotension may occur. Thiazides may increase responsiveness to tubocurarine. Pathological changes in the parathyroid glands have been observed. Consider the possibilities of sensitivity reactions in patients with a history of allergy or asthma as well as exacerbation of systemic lupus erythematosus. Thiazides may cause elevation of BUN. Aldactazide may potentiate the effect of other antihypertensives especially the ganglionic blocking agents. The dosage of such drugs should be reduced at least 50% when Aldactazide is added to the regimen. Spironolactone interferes with the assay of plasma cortisol but not the Ertel method. ASA may interfere with the action of spironolactone. Use with caution in patients with hyperuricemia or history of gout. Insulin requirements may be increased, decreased or unchanged in diabetics. Hyperglycemia and glycosuria may be manifested in latent diabetics. Use with caution in women of childbearing age and weigh benefits against the possible hazards to the fetus. Adverse Effects: Nausea or other gastrointestinal disturbances, gynecomastia or mild androgenic manifestations have been reported in some patients. Other side effects including those of hydrochlorothiazide occur less frequently. Overdose: Symptoms of Overdosage; Acute overdosage may be manifested by drowsiness, mental confusion, maculopapular or erythematous rash, nausea, vomiting, dizziness or diarrhea. Rare instances of hypokalemia, hyponatremia, hyperkalemia or hepatic coma may occur. Thrombocytopenic purpura and granulocytopenia have occurred with thiazide therapy. No specific antidote. Treat fluid depletion and electrolyte imbalances as indicated. Dosage: In essential hypertension, a daily dosage of 2 to 4 tables, in divided doses, will be adequate for most patients, provided the treatment is continued for 2 weeks or longer. Dosage may range from 2 to 8 tablets daily. Dosage should be adjusted according to the response of the patient. In endematous states, a daily dosage of 2 to 4 tablets, in divided doses, will be adequate for most patients but may range from 2 to 8 tablets daily. Dosage should be adjusted according to the response of the patient.
V
FIG. 5-Erythrocyte found in intestinal contents, photographed with scanning electron microscope (uranyl acetate; x6500, reduced 13%).
Supply: Each round, ivory-coloured tablet contains, spironolactone, 25 mg and hydrochlorothiazide, 25 mg. Available in bottles of 100, 1,000 and 2,500 tablets. Complete prescribing information available on request
A.
Searle Pharmaceuticals Oakville, Ontario L6H iMS
CMA JOURNAL/SEPTEMBER 3, 1977/VOL. 117 473
The calcified ova in the kidney and the presence of erythrocytes in the bladder indicate involvement of the urinary system with S. hematobium. (Schistosomiasis remains a chronic debilitating disease in Egypt; there is no sign of adaptation between man and parasite in this geographic area.) An incidental finding, present in all ancient remains, is pulmonary anthracosis,1 which is secondary to environmental pollution by cooking and heating fires, and by oil lamps in small
quarters. It is also possible that Nakht had pulmonary silicosis due to continual inhalation of dust and sand while working near or at a stone quarry or workshop. We thank Ann M. Dowd, MT (ASCP) for technical assistance. References 1. COCKBURN A, BARRACO RA, REYMAN TA, et al: Autopsy of an Egyptian mummy. Science
187: 1155, 1975
6. Trichinella spiralis cyst U. DE BoNI,* PH D. M.M. LENCZNER,f MD; JOHN W. SCOTT, MD
Material from an intercostal space was placed in a 1:1 water-glycerin solution for 24 hours, then in 10% formalin for 24 hours. Subsequently it was embedded in paraffin, and sections 10 ,.tm thick were cut and stained with 0.1% aqueous toluidine blue. *Department of physiology, University of Toronto ITropical disease expert, Toronto General Hospital Reprint requests to: Dr. John W. Scott, Department of physiology, University of Toronto, Toronto, Ont. M5S IAl
With rehydration the skin surface macerated and details were not distinct. The muscle fibres were well defined and blood vessels could be identified. Near the subcutaneous border of the intercostal muscle we found a small cyst, just visible to the naked eye, having the appearance of a parasite. At first we considered it to be Cysticercus cellulosae (the larval form of Taenia solium) but these cysts are about 5 mm in diameter and much larger than the
muscle fibres. The cyst was too small to be that of Trichinella spiralis, but was appropriate in size when compared with the muscle fibres; shrinkage during drying could be the explanation. Trichinella infection, like cysticercosis, is due to the eating of inadequately cooked pork. Nakht's diet probably contained little meat, yet his association with a funerary temple may have given him access to more meat than the average working-class Egyptian enjoyed.E
7. Electron microscopy of mummified tissue PATRICK D. HORNE,* RT; PETER K. LEWIN,f MD *B.ting Institute, department of pathology, Toronto General Hospital tDepartments of pediatrics and pathology, Hospital for Sick Children, Toronto
Reprint requests to: Dr. Peter K. Lewin, Department of pathology, Hospital for Sick Children, 555 University Ave., Toronto, Ont. M5G 1X8
Tissue samples were taken from the sole of the right foot of Nakht (ROM I) and rehydrated in buffered 10%
.CM
.r
*
.'
4
w
FIG. 1-Epithelial cell from basal layer of epidermis of Nakht (ROM 1): CM = cell membrane; DN = disintegrated nucleus, TF tonofilaments (uranyl acetate; x30 000, reduced 28%). 472
CMA JOURNAL/SEPTEMBER 3, 1977/VOL. 117
FIG. 2-Egg of Taenia sp.: arrows indicate hookiets (uranyl acetate; xiS 800, reduced 40%).
AIdactazid. Summary of prescribing information: Pharmacology: Spironolactone effects diuresis by blocking through competitive inhibition, the sodium and water retaining and potassium excreting effects of aldosterone on the distal renal tubule. Hydrochlorothiazide promotes excretion of sodium and water primarily by inhibiting their reabsorption by the cortical diluting segment of the renal tubule. Thus the components of Aldactazide have different and complementary modes of action. In addition, spironolactone minimizes potassium loss characteristically induced by hydrochlorothiazide, thereby reducing the possible serious consequences of potassium depletion. Indications: The treatment of essential hypertension; the edema and ascites of congestive heart failure, cirrhosis of the liver, the nephrotic syndrome and idiopathic edema.
FIG. 3-Enlargement of segmental embryophore (uranyl acetate; x32 500).
*
K FIG. 4-Enlargement of booklet from egg of Taenia sp. (uranyl acetate; x32 500).
formalin. Dry, dust-like intestinal contents were spun in normal saline; the button of material obtained was rehydrated in Sandison's modification of Ruffer's solution (5% sodium carbonate [aqueous], two parts; 96% ethyl alcohol, three parts; and 1% formalin, five parts). Sections were fixed with phosphate-buffered 2% glutaraldehyde and 1% osmium tetroxide, embedded in epoxy and stained for contrast with uranyl acetate. The epidermis was well preserved and cellular components were easily recognized (Fig. 1). The intestinal tract contained several ova of Taenia spp; the ultrastructure of the striated embryophore of an egg (Figs. 2 and 3) with its hooklets (Fig. 4) was demonstrated in great detail. An erythrocyte found in the intestinal contents was photographed with a scanning electron microscope (Fig. 5). These observations confirm the earlier observation that Egyptian mummified material contains preserved cells with recognizable cytoplasmic organelles.1 Reference 1. LEWIN PK: The ultrastructure of mummified skin cells. Can Med Assoc 1 98: lOll, 1968
Contraindications: Acute renal insufficiency; rapidly progressing impairment of renal function; anuria; hyperkalemia; patients known to be sensitive to Ihiazides or other sulfonamide-derived drugs; patients with severe or progressive liver disease at the discretion of the physician; nursing mothers; sensitivity to spironolactone. Warnings: Concurrent potassium supplementation is not indicated unless a glucocorticoid is also given. Aldactazide should not be used in conjunction with other potassium conserving agents. Precautions: The most potentially serious electrolyte disturbance is hyperkalemia which is more likely to occur in severely ill patients. If hyperkalemia occurs, discontinue Aldactazide. Hypokalemia may develop. Use cautiously in patients with sodium depletion. Check for signs of fluid or electrolyte imbalance. The most frequent electrolyte disturbance encountered is dilutional hyponatremia. Rarely a true low-salt syndrome may develop. Decrease dosage before diuresis is complete to avoid dehydration. Thiazide diuretics may precipitate hepatic coma. Use with caution in patients subjected to regional or general anesthesia. Discontinue 48 hours prior to elective surgery as both hydrochlorothiazide and spironolactone reduce vascular responsiveness to norepinephrine. Orthostatic hypotension may occur. Thiazides may increase responsiveness to tubocurarine. Pathological changes in the parathyroid glands have been observed. Consider the possibilities of sensitivity reactions in patients with a history of allergy or asthma as well as exacerbation of systemic lupus erythematosus. Thiazides may cause elevation of BUN. Aldactazide may potentiate the effect of other antihypertensives especially the ganglionic blocking agents. The dosage of such drugs should be reduced at least 50% when Aldactazide is added to the regimen. Spironolactone interferes with the assay of plasma cortisol but not the Ertel method. ASA may interfere with the action of spironolactone. Use with caution in patients with hyperuricemia or history of gout. Insulin requirements may be increased, decreased or unchanged in diabetics. Hyperglycemia and glycosuria may be manifested in latent diabetics. Use with caution in women of childbearing age and weigh benefits against the possible hazards to the fetus. Adverse Effects: Nausea or other gastrointestinal disturbances, gynecomastia or mild androgenic manifestations have been reported in some patients. Other side effects including those of hydrochlorothiazide occur less frequently. Overdose: Symptoms of Overdosage; Acute overdosage may be manifested by drowsiness, mental confusion, maculopapular or erythematous rash, nausea, vomiting, dizziness or diarrhea. Rare instances of hypokalemia, hyponatremia, hyperkalemia or hepatic coma may occur. Thrombocytopenic purpura and granulocytopenia have occurred with thiazide therapy. No specific antidote. Treat fluid depletion and electrolyte imbalances as indicated. Dosage: In essential hypertension, a daily dosage of 2 to 4 tables, in divided doses, will be adequate for most patients, provided the treatment is continued for 2 weeks or longer. Dosage may range from 2 to 8 tablets daily. Dosage should be adjusted according to the response of the patient. In endematous states, a daily dosage of 2 to 4 tablets, in divided doses, will be adequate for most patients but may range from 2 to 8 tablets daily. Dosage should be adjusted according to the response of the patient.
V
FIG. 5-Erythrocyte found in intestinal contents, photographed with scanning electron microscope (uranyl acetate; x6500, reduced 13%).
Supply: Each round, ivory-coloured tablet contains, spironolactone, 25 mg and hydrochlorothiazide, 25 mg. Available in bottles of 100, 1,000 and 2,500 tablets. Complete prescribing information available on request
A.
Searle Pharmaceuticals Oakville, Ontario L6H iMS
CMA JOURNAL/SEPTEMBER 3, 1977/VOL. 117 473
