Phagocytosis of monosodium urate (MSU) crystals by polymorphonuclear leukocytes (PMN) in vitro results in PMN degranulation, phagolysosome membrane dissolution, and cell death (1). Release of cytoplasmic as well as lysosomal enzymes has been reported to occur after in vitro phagocytosis of urate but not calcium pyrophosphate dihydrate (CPPD) crystals (2,3). Wallingford no distinct phagosome membranes around the urate crystals, although in pseudogout (calcium pyrophosphate crystal synovitis) easily demonstrable phagosomes have been described (5,6). These observations have suggested that the phagolysosome rupture seen with urates may not follow calcium pyrophosphate crystal phagocytosis.This report compares the ultrastructural findings after in vitro CPPD and MSU crystal phagocytosis. As judged by electron microscopy, synthetic CPPD crystals do not produce the rapid sequence of membrane lysis and cell death seen with MSU crystals. CPPD crystals, however, were also phagocytized less avidly than MSU. One possible factor in the decreased phagocytosis is the greater size of the CPPD. Grinding of CPPD or MSU to produce smaller crystals improved phagocytosis and may increase the injurious effect of CPPD on the PMN. MATERIALS AND METHODSSynthetic calcium pyrophosphate dihydrate crystals were prepared as described by Tse and Phelps (7). X-ray diffraction showed predominantly calcium pyrophosphate but also suggested slight contamination by material resembling hydroxyapatite. T h e preparation viewed by polarized light included both monodinic and triclinic crystals that appeared similar to those seen in human pseudogout. Crystals averaged 21 p i n length (95% of crystals were 10 to 26 p) and were wider than MSU crystals. A small amount of nonbirefringent globular material was also seen (Figure 1). The same preparation was used for all experiments.

Two patients with hemorrhagic esophagitis secondary to esophageal invasion with herpes simplex virus, type 1, are reported. Microscopic examination of the esophageal mucosa revealed multinucleated cells and intranuclear inclusions which are typical of herpes simplex infection. Herpes virus was cultured from each patient. Thus, hemorrhagic esophagitis due to esophageal invasion by herpes simplex virus may be a more frequent cause of upper-gastrointestinal bleeding than previously recognized.

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Bilateral breast uptake of 99mTc polyphosphate was found in a patient with metastatic adenocarcinoma from the rectum. The metastatic breast lesion showed no radiographic evidence of calcification.