Clinical Pathological Diagnosis Research Articles

Predominant infiltration of rejecting human renal allografts with T cells expressing CD8 and CD45RO.

Subsets of T cells have been identified by the expression of different isoforms of CD45. Some T cells expressing CD45RA (gp220) have been characterized as "naive" in their response to antigens including alloantigens, whereas T cells expressing CD45RO (gp180) have been characterized as "memory" T cells. To examine the potential association between kidney allograft rejection and infiltration with these subsets, immunohistologic labeling of serial frozen sections from 17 nonrejecting and 18 rejecting kidney transplant biopsies was performed. Biopsies were selected on the basis of unambiguous clinical pathological diagnosis, no antirejection therapy within 1 month before biopsy, and enough tissue available for immunohistologic labeling. Sections were labeled for CD3, CD4, CD8, CD45RA, and CD45RO, and slides were evaluated in a masked manner. The numbers of cells were counted in 10 (400x) high power fields (HPF) in each section. The medians of average cell counts were significantly higher in the rejecting compared with nonrejecting group for CD3+, CD4+, CD8+, CD45RA+, and CD45RO+ T cells in both diffuse and aggregate patterns of infiltration. However, the numbers of infiltrating cells per HPF in rejecting grafts were most striking for CD8+ and CD45RO+ cells: 16/18 rejecting vs. 1/17 nonrejecting cases had more than 5 CD8+ cells/HPF. Likewise, 17/18 rejecting vs. 1/17 nonrejecting cases had more than 5 CD45RO+ cells/HPF. In both cases, the difference was most striking for cells infiltrating in a diffuse versus aggregate pattern. Significantly higher CD45RO+ to CD45RA+ ratios were observed in rejecting versus nonrejecting groups, both in the diffuse and aggregate patterns. Within the rejecting cases, the CD45RO+ to RA+ ratio was significantly higher in diffuse versus aggregate patterns of infiltration (P < 0.0002). These results indicate that a significant increase in CD8+, CD45RO+, and the ratio of CD45RO+ to CD45RA+ T cells in a diffuse pattern of infiltration is most characteristic of clinical renal allograft rejection.

DETECTION OF IMMUNOGLOBULIN HEAVY CHAIN AND T CELL RECEPTOR GENE REARRANGEMENT IN LYMPH NODE ASPIRETS WITH PCR: DIAGNOSTIC SIGNIFICANCES FOR LYMPHOPROLIFERATIVE DISORDERS

Lymph node aspirets of 17 cases with enlarged superficial or visceral lymph nodes were detected for immunoglobulin heavy chain gene rearrangement (IgHRA) and T cell receptor gene rearrangement (TCRγRA) by polymerase chain reaction (PCR) . Combining with clinical data, pathologic diagnosis and immunophenotypy, we analysed the results as follows: 5 cases of nonlymphoid cancers and 3 cases of reactive lymphadenopathy did not present two kinds of clone gene rearrengement. 5 out of 7 cases of NHL showed clone gene rearrangements (IgH 3 cases, TCRγ2 cases) , two kinds of monoclonal band (100~120bp for IgHRA and 170~230bp for TCRγRA) were observed after electrophoresis of amplified DNA products. One case whose clinical situation accorded with features of lymphoma was diagnosed as granulomatous lymphadenitis by pathologist, but after gene rearrangement, clone TCRγRA was detected and a correct diagnosis as NHL was made. The significances of detecting two kinds of gene rearrangement for diagnosis and limitation in lymphoproliferative disorders were discussed. Key words: PCR; lymphnode biopsy needle aspirets; lymphoproliferative disorders

Arthroscopic approach and anatomy of the shoulder

Shoulder arthroscopy has established an invaluable role in the clinical diagnosis and treatment of glenohumeral and subacromial pathology. To be competent in this technique a surgeon must have a firm understanding of both surface and arthroscopic anatomy, as well as a systematic, reproducible examination technique. This article will cover these areas.

Extrapericardial tamponade with herniated omentum after transhiatal esophagectomy

An unusual complication following transhiatal esophagectomy for lower esophageal carcinoma is reported in which extrapericardial tamponade and profound shock occurred secondary to a herniated section of omentum in the immediate postoperative period. The two-dimensional echocardiogram was nondiagnostic, but the diagnosis was confirmed during reexploration of the abdomen. Anatomic and pathophysiologic considerations of this unusual but life-threatening complication are discussed. The literature suggests that computed tomography is the study of choice to confirm the clinical diagnosis of pericardial pathology, and this case report is yet another example to support routine closure of the esophageal aperture.

Field Strength in Neuro-MR Imaging

A study was undertaken comparing neurological magnetic resonance imaging at high (1.5 T) and mid (0.5 T) field strengths. Twenty-eight patients (20 head and 8 spine) from our routine case load volunteered to undergo two consecutive and identical MR studies on the two systems. The two MR systems were built by the same manufacturer and were equipped with essentially identical hardware and software. Individual patient studies were performed consecutively in adjacent MR suites, and pulse sequence parameters were replicated exactly at the two field strengths. One exception to this rule was that the second echo of the long TR sequence in the head was acquired with a narrow receiver bandwidth on the 0.5 T system. The resulting axial double echo long repetition time (TR) and sagittal short TR head images and sagittal short and double echo long TR spine images were graded by two blinded observers (senior staff neuroradiologists) on two levels. First, the images were graded for image quality, i.e., conspicuousness of artifacts and clarity in depiction of normal and pathologic anatomy. Second, diagnostic accuracy of MR was assessed relative to the clinical-pathologic diagnosis in each case. The image quality of the 1.5 T system was rated superior in both the head and spine for most specific items assessed. This observer preference for 1.5 T images did not, however, translate into greater diagnostic accuracy for the 1.5 T system in the head. Although the 1.5 T system did have a slight advantage in diagnostic accuracy in the spine, a significant difference was not found.

Automated enzyme immunoassay for lutropin with the Abbott IMx analyzer.

An automated enzyme immunoassay for human lutropin for use with the Abbott IMx analyzer is described. The assay provides results in approximately 40 min with a sensitivity of 0.25 int. units of LH per liter for up to 23 serum or plasma samples. Cross-reactivity with follitropin (2000 int. units/L) and thyrotropin (2 int. units/L) was negligible; it was 0.016% with human choriogonadotropin (1 X 10(6) int. units/L). There was no interference by high concentrations of bilirubin (0.5 g/L), hemoglobin (7.50 g/L), or triglycerides (13.5 g/L). Intra-, inter-, and total assay CVs were less than or equal to 3.75%, less than or equal to 7.1%, and less than or equal to 7.94%, respectively. Values obtained with the IMx correlated well (r = 0.98, n = 194) with values obtained with Diagnostic Products' LH Double Antibody RIA, and Serono's LH MAIAclone assay. This assay should be useful for small to medium-size laboratories involved in the clinical diagnosis of reproductive pathology.

Early and late neuropathological changes in perinatal white matter damage.

Our material presents two patterns of white matter lesions in the brain of newborns dying with the clinical diagnosis of intrauterine or perinatal pathology: (1) classical periventricular ischemic infarction resulting in coagulative necrosis and (2) diffuse periventricular colliquative necrosis, in some cases involving the center of the cerebral convolutions. The majority of cases did not survive the first month of life. The cases with longer survival (up to six years) presented clinically with the syndrome of bilateral spastic cerebral palsy. Neuropathological examination showed dilation of the lateral ventricles, small cavities, and diffuse glial scars, not only in the periventricular white matter but also involving the axis of cerebral convolutions, as opposed to the relative sparing of cerebral cortex and other brain structures. These changes could be considered as evident or putative forms of a distinct type of perinatal brain damage.

An Introduction to the Treatment and Examination of the Spine by Combined Movements

Summary To date hands-on examination and treatment techniques have been the most accurate way of understanding the musculoskeletal workings of the spine, and the likely clinical diagnosis of pathology seen there. The underlying biomechanics are an integrated complex of physiology, biochemistry and anatomy, at each of the spinal levels, typified on examination by a characteristic pattern of movement in the three classic planes, ie sagittal, frontal and horizontal. With normal activity, combined movements among all three planes of movement also occur, depending on the structure and function between motion segment levels, up and down the spine. Changes in these ‘normal’ patterns occur when abnormal pathology is present, typified by the signs and symptoms expressed. The most important of these are the altered physiological and accessory movements demonstrated by the ‘regularity’ or ‘irregularity’ of movement patterns, for any given pathology. Regularity or irregularity of the combined movement pattern depends on the relationship between the primary movement and the overall abnormal pattern. This may be interpreted as an I or H configuration for ease of notation. The primary movement is that direction of movement, in one of the three planes, which is the most symptomatic. Depending on the area of symptoms and assuming that the symptoms do not cross the midline, ‘regularity’ may be expressed as a regular stretch or compression pattern. The outcome of the treatment and its expediency can be greatly influenced by accurate assessment of this movement relationship, between the normal and pathological state and thus by the correct choice of the combined movement technique; which can be performed as a physiological technique, an accessory technique, or both together. It also gives a greater appreciation of the likely causative structure at fault, from its anatomical location in the motion segment. This can be seen from the superimposed I or H pattern. This may aid in a clearer prediction of treatment results and prognosis. Undoubtedly this form of examination and treatment progresses the former maze of techniques and examination procedures into a much clearer guide for treatment when dealing with the conservative management of spinal pathology. It also allows some greater insight into the ways of forming and understanding a clinical diagnosis with such often difficult conditions, and is an essential progression of manipulation in the treatment and understanding of such spinal conditions.

Tumors of the small intestine with little or no malignant predisposition: a review of the literature and report of 56 cases.

Benign small bowel tumors are rare. If those with malignant potential are excluded, a small group of truly benign lesions remains. Fifty-six cases of these small bowel tumors were analyzed for clinical data, pathologic diagnosis, number, size, location, and radiologic appearance. Lesions included lipoma, myoepithelial hamartoma, Peutz-Jeghers hamartoma, neurogenic tumors (including gangliocytic paraganglioma), Brunner's gland abnormalities, and inflammatory fibroid polyp. Location, number, and radiographic morphology can be helpful in reaching a more specific diagnosis. Age of patient and size of tumor may be helpful in the differential diagnosis; however, sex of the patient and clinical symptoms are not.

Linear Array Multiple Transducer Ultrasonic Examination of the Eye

Dynamic ultrasonic imaging adds a time dimension to the clinical diagnosis of ocular pathology. A recent development in this area of ophthalmic sonography has been the introduction of an electronically scanned, multiple transducer system that provides improved real-time imaging of ocular tissue motion. This paper discusses clinical observations made in a variety of ophthalmic conditions with a high speed, linear array ultrasound system and discusses briefly the apparatus and special examination techniques needed to make these observations. Clinical subjects include vitreo-retinal adhesions: the clear cortical vitreous network; vitreous hemorrhage, opacities and membranes; shallow, fixed, and mobile retinal detachments; blood vessels within ocular tumors and the evaluation of intraocular foreign bodies.

Cerebrovascular and degenerative changes in the brain; a study of 233 Japanese 50 or more years of age.

A neuropathologic study, chiefly cerebrovascular lesions and degenerative changes, was conducted on the brains of 233 subjects 50 years of age and over among 557 autopsy cases of RERF-ABCC Hiroshima in 1972-1974. There were some discrepancies between the principal clinical diagnosis and principal pathologic diagnosis in cerebrovascular disease. For cerebral hemorrhage, 8.6% were accounted for in the clinical diagnosis of the entire subjects while only 2.1% were accounted for in the pathologic diagnosis of the same subject. The degenerative changes in the central nervous system have been increasing with age and these changes were seen more in the females than in the males. Intracerebral arteriosclerosis of a moderate extension or more existed in 36.5% of the subjects and the frequency of this disease increased with age. the frequency of cerebral infarct increased with age. The location of the infarcts was most often seen in the basal ganglia and cortex of cerebrum, the size of the cortical infarct was within 0.5 cm in diameter and multiple. The vascular lesions or degenerative changes were seen in about 74% of the brains of 50 years and over.

A NEW TAXONOMY OF ADMINISTRATIVE PROCESS

The state of contemporary theory in administration is contentious. This is most evident in the subset of educational administration where controversy rages as evidenced in the Griffiths‐Greenfield debate and its variations. To some extent this argument can be understood through tendencies which Whitehead described as simplemindedness and muddleheadedness but at a more elementary and fundamental level the divergences of opinion can be traced to defects in conceptual mapping. One of these has to do with the taxonomy of administrative process. The article offers a brief listing and critique of attempts at process analysis and then suggests a version (P3M3) which would avoid errors of logical typing and which would allow for a more sophisticated and logically accurate treatment of the terrain. This postulates a non‐rigid and elisible sequence from philosophy through planning, politics, mobilization, and management to monitoring and evaluative feedback. Such a sequence is consistent with conventional wisdom on the politics‐administration and administration‐management distinctions but it affords the possibility for some clinical diagnosis of organizational pathology and for the re‐interpretation of administrative practice. In particular, the article draws attention to the match between the taxonomy and cognitive, value, and reality correlates. Cognitive correlates are based on the work of deBono while value and reality correlates are based on the work of the writer. An important implication of the logic is the peculiar significance of the “synapse” or connection between the fields of administration and management. Leadership would appear to be a function which occurs in mid‐cycle rather than in the Platonic or orthodox view which places it at the initiation of cyclic process.

Histopathological pattern of endometrial samples in abnormal uterine bleeding

Background: Histological characteristics of endometrial biopsy material as assessed by light microscopy remain the diagnostic standard for the clinical diagnosis of endometrial pathology. Management of abnormal uterine bleeding is not complete without tissue diagnosis. The aim of the study was to find out the histopathological pattern of the endometrium in abnormal uterine bleeding. Materials and Methods: Endometrial biopsy specimens received from Jan 2007 to Nov 2010 were studied retrospectively in the Department of Histopathology, Helping Hands Community Hospital, Kathmandu. The specimens were routinely processed and the hematoxyllin and eosin stained slides were studied. Results: A total of 300 specimens were analyzed. In the group of patients less than 40 years of age, 73 (50%) were normal, 34(23%) had abnormal physiologic changes and 13 (9%) had pregnancy related complications and benign changes. In the age group between 40 – 55 years, abnormal physiological changes, benign conditions and normal physiological changes were 45 (32%), 41 (29%) and 37 (26%) respectively. In the age group &gt; 55 years, there were 3(21%) malignant and 3(21%) benign conditions. There were 5(36%) unsatisfactory samples in this age group. Conclusion: It is important to know the histological pattern of the endometrium in abnormal uterine bleeding in different age groups since it will help in the management of the cases. In this study endometrial hyperplasias were seen in 55 cases (18.8%). The importance of studying the histological pattern of endometrium in abnormal uterine bleeding in different age group is to help in correctly managing the cases. Keywords: Endometrium; Simple hyperplasia; Complex hyperplasia; Endometritis; Endometrial Carcinoma. DOI: 10.3126/jpn.v1i1.4443 Journal of Pathology of Nepal (2011) Vol.1, 13-16

The roentgen diagnosis of retractile mesenteritis.

Retractile mesenteritis is a rare disease of unknown etiology characterized by fibro-fatty thickening and chronic inflammation of small bowel mesentery. A case is reported in which the correct preoperative diagnosis was made.The nosologic problems posed by this peculiar lesion are briefly considered as well as the essential clinical features, pathology, and roentgen diagnosis.

Die Infektionen durch das Herpes Simplex-Virus

This is the second in a projected series of monographs on infectious diseases and their causative agents. The eventual completed series is intended by the editors to resemble and, it is hoped, to fill the place formerly occupied by the “Handbuch der pathogenen Mikro-Organismen” of Kolle and V. Wasserman almost indispensable to workers in this field thirty and forty years ago. The author has thoroughly covered and brought up to date what is known regarding the great variety of clinical manifestations, the epidemiology, immunology, pathogenesis, pathology, cytology and laboratory diagnosis of herpes simplex virus infection. The newly acquired knowledge regarding the morphology, architecture, physico-chemical properties as well as the behavior of the virus in tissue culture is more than adequately treated for the general reader. There is good discussion on general methods of treatment as well as the recently introduced virus-static substances.

Ossifying fibroma — Maxilla

1. A case report of ossifying fibroma with the detailed clinical history, operative notes, and pre and post operative diagnosis of the Pathology of this tumor is reported. 2. A critical review of the literature has been made with the discussion on the terminology of these benign ossifying tumors of the Jaws has been noted.

Breast Masses

One cancer detection clinic has found that less than 60% of cooperative patients with clinically benign breast masses who are reported to their physicians with a recommendation for biopsy actually undergo this procedure, and then often as late as 12 months after clinical diagnosis. 1 Furthermore, at least 10% of patients with an apparently benign breast mass who are later found to have cancer receive inappropriate, nonsurgical treatment from the first physician they consult. 2 These studies indicate a prevailing belief on the part of many physicians that they can somehow distinguish without surgical biopsy between benign and malignant tumors of the breast. This paper reports the experience of the surgical service of the University Hospitals of Cleveland in the preoperative clinical versus postoperative pathological diagnosis of benign and malignant breast masses and demonstrates the inaccuracy of clinical diagnosis alone by surgeons as well. Methods The operating room records of