Histology Course Research Articles

The natural history of nonalcoholic fatty liver disease: a clinical histopathological study

Objectives We aimed to define nonalcoholic steatohepatitis (NASH) histopathological change over time and to correlate changes with clinical characteristics. Methods We retrieved nonalcoholic fatty liver cases from our histopathology database covering 1985 to 2001. We also identified patients in clinic with NASH on biopsy >1 yr prior. All patients were evaluated and clinical data obtained in clinic. Those patients qualifying for NASH therapeutic trials underwent liver biopsy pretreatment. One pathologist (S.T.) read all slides using a NASH grading and staging system. Results A total of 22 patients had repeat biopsies a mean of 5.7 yr (range 1.4–15.7 yr) after the first biopsy. Nine were women, nine had diabetes, 11 had hypertension, and 14 had hyperlipidemia. Mean body mass index was 33.8 kg/m 2 (range 26.5–48.6 yr). Mean age was 50.6 yr (range 33–64 yr). Ten patients (45%) had fibrosis stage 1 or 2, and two patients (9%) had bridging fibrosis or cirrhosis (stage 3 or 4) on first biopsy. Seven (32%) had increases in fibrosis score. Four patients (18%) had decreases in fibrosis score. The percentage of patients with stage 3 or 4 increased from 9% to 18%. In two patients the disease progressed rapidly (fibrosis scores from 1 to 3 in 1.4 yr and from 2 to 4 in 2.6 yr). Only serum AST at last biopsy correlated with histological change, being higher in those with disease progression. Three patients progressed from steatosis to steatohepatitis with fibrosis. Conclusions NASH has a variable histological course. However, one third of patients have fibrosis progression, and one third of these have rapid progression to advanced fibrosis. Histological progression correlated with higher serum AST but no other clinical factors. Steatosis alone may progress to NASH with fibrosis.

Histological course of recurrent hepatitis C after liver transplantation

Histological course of recurrent hepatitis C after liver transplantation

Enhancing the Dental Histology Curriculum Using Computer Technology

The predominant difference between the histology offered to dental students and that taken by other health care professionals is the emphasis placed on the oral tissues. The oral histology component of the dental curriculum is commonly handled in one of three ways, all delivering far more detailed information than the often less than one hour that a typical medical histology course spends on the oral cavity and its component tissues. Overall, three general curricular styles can be defined: 1) dental histology is taught by medical or dental faculty as a separate course, the oral histology component being a separate course taught by either faculty group; 2) medical and dental students take histology together in a single class with the oral histology component taught separately by faculty from either college; and 3) both basic and oral histology is taught within a single semester, the format used at the University of Kentucky College of Dentistry. The oral histology topics are similar in all of the course formats, regardless of whether they occur as a stand-alone course or are merged with basic histology. The main portion of this paper will describe a self-study, non-microscope-based laboratory experience designed to complement this fused topic course. Self-study labs using digital media are becoming more popular across both medical and dental histology curricula, specifically with the oral histology component where the histological skills for preparing these tissues are rapidly disappearing from many schools. This paper describes a typical syllabus for a fused course, outlining the topics for basic and oral histology, and demonstrates how the laboratory portion has been enhanced using digital technology.

Diagnosis of inflammatory pseudotumor of the liver

Inflammatory pseudotumor (IPT) is a rare benign tumor of unknown origin, it has the appearance of a malignant tumor but has a benign histology and clinical course. Therefore, we studied five patients with IPT of the liver to determine what examination can aid in its diagnosis. Five cases of inflammatory pseudotumor of the liver were analyzed. All patients were examined by echography, computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiography (ERC) and angiography to diagnose the liver tumor. In all patients echography and CT scan showed a similar appearance while MRI showed a variable pattern. In two patients ERC showed a stenotic image of intra-hepatic bile ducts. In the angiographic study, the arterial phase in three patients showed a hypervascular tumor and in one patient, a hypovascular tumor. Vascular abnormality was presented in one patient. Similarly, portography in four patients showed some abnormality. We performed ultrasonography-guided percutaneous needle biopsy in two patients in order to diagnose IPT. Histological examinations of two patients were consistent with IPT. The other three patients underwent surgical treatment for a cholangiocellular carcinoma or abscess. It is difficult to diagnose IPT of the liver exclusively with an image examination. Ultrasonography-guided percutaneous liver biopsy should be performed in order to diagnose IPT by histology.

AAA award winners

AAA award winners

Innovative testing method for an integrated radiology-histology curriculum.

A module of radiology instruction was incorporated into an existing histology course for first-year medical students (n = 177). An innovative testing methodology for assessing the instructional effectiveness of the integrated radiology-histology module was developed and tested. Test items were designed to measure the students' ability to integrate the two disciplines successfully. Radiologic and histologic images were displayed at each of seven stations, to which the content of the images either were or were not related. The seven stations were incorporated into three traditional histology laboratory examinations. For purposes of data analysis, each test was divided into three components, including histology alone, histology in combination, and radiology in combination. Testing lengths were equated using the Spearman-Brown statistical adjustment. Analysis of the test results showed the reliability coefficients to be comparable to the traditional testing methods used previously in the course. Correct responses were similar in all three sections, ranging between 85 to 97%. This methodology thus appears to be an effective means of testing an integrated curriculum.

Regeneration of the semitendinosus tendon after its use in anterior cruciate ligament reconstruction: a histologic study of three cases.

We describe the histologic course of regenerated tissue simulating the semitendinosus tendon in three patients after anterior cruciate ligament reconstruction with doubled semitendinosus and gracilis tendons. Specimens were retrieved during revision surgery for removal of tibial hardware at 6, 24, and 27 months, respectively. Resisted flexion during physical examination in all patients revealed a "string" on the posteromedial aspect of the knee that was quite evident, suggesting the presence of a regenerated semitendinosus tendon. At surgery, a well-defined fibrous band was identified about 3 cm proximal and medial to the pes anserinus, reproducing the pathway of the native semitendinosus tendon. In the specimen retrieved 6 months postoperatively, a prominent fibroblastic proliferation was observed together with a few vessels surrounded by fibrous tissue; only a few bundles of well-oriented collagen fibers were present, together with scattered rows of spindle-shaped cells. In both of the specimens retrieved 2 years postoperatively, all of the central, thicker portion of each specimen was occupied by well-oriented tendon-like fibers together with uniformly distributed spindle-shaped cells that had the appearance of mature tenocytes arranged in orderly rows. These findings help us to understand the progression of the healing process at the harvest site and the nature of the regenerated semitendinosus tendon, which has previously been investigated only by studies of clinical and functional outcomes and by imaging studies.

The relationship between premedical coursework in gross anatomy and histology and medical school performance in gross anatomy and histology.

Many premedical students enroll in courses whose content will be encountered again during their medical education. Presumably, students believe this practice will lead to improved academic performance in corresponding medical school courses. Therefore, this study was undertaken to determine whether a premedical gross anatomy and/or histology course resulted in increased performance in corresponding medical school courses. A second aim of the study was to examine whether the type of premedical gross anatomy and/or histology course differentially affected medical school performance. A survey that assessed premedical gross anatomy and histology coursework was administered to 440 first-year medical students. The results from this survey showed that students with premedical gross anatomy (n = 236) and/or histology (n = 109) earned significantly more points in the corresponding medical school course than students without the premedical coursework (P < 0.05). Analysis of premedical course types revealed that students who took a gross anatomy course with prosected specimens (n = 35) earned significantly more points that those students without premedical gross anatomy coursework (P < 0.05). The results from this study suggest: 1) premedical gross anatomy and/or histology coursework improves academic performance in corresponding medical school courses, and 2) a premedical gross anatomy course with prosected specimens, a specific type of undergraduate course, significantly improves academic performance in medical gross anatomy.

Using web-based animations to teach histology.

We have been experimenting with the use of animations to teach histology as part of an interactive multimedia program we are developing to replace the traditional lecture/laboratory-based histology course in our medical and dental curricula. This program, called HistoQuest, uses animations to illustrate basic histologic principles, explain dynamic processes, integrate histologic structure with physiological function, and assist students in forming mental models with which to organize and integrate new information into their learning. With this article, we first briefly discuss the theory of mental modeling, principles of visual presentation, and how mental modeling and visual presentation can be integrated to create effective animations. We then discuss the major Web-based animation technologies that are currently available and their suitability for different visual styles and navigational structures. Finally, we describe the process we use to produce animations for our program. The approach described in this study can be used by other developers to create animations for delivery over the Internet for the teaching of histology.

Laboratory instruction in histology at the University at Buffalo: recent replacement of microscope exercises with computer applications.

Histology is a morphologic science in which the structure of the cells, tissues, and organs of the body are examined with a microscope. In the laboratory courses in histology at the School of Medicine of the University at Buffalo, histologic specimens had been used since the late 19th century to teach the principles of cell, tissue, and organ structure. Students also had to learn how to analyze or "read" slides with a microscope. Learning histology in this way, i.e., by direct examination of actual specimens, is time consuming and viewed by some as unnecessary. As a result of recent curricular reform at the School of Medicine that reduced contact time in histology, half of all laboratory exercises that would have been performed with a microscope were performed instead with interactive computer applications. By replacing some microscope exercises with more efficient computer applications, the histology course accommodated curricular change by both reducing contact time and continuing to offer valuable microscope laboratories for most of the organ systems of the body. To provide a basis for comparing traditional microscope exercises with computer-assisted instruction in histology, the nature of the laboratory experience between 1846 and 1998 is briefly reviewed. The instructional strategy behind the use of computers is presented, along with the nature of the computer applications and the means by which the computer applications were incorporated into the school's laboratory course in histology.

Wheater's Functional Histology: A Text and Colour Atlas

4th ed, by Barbara Young and John W. Heath, 424 pp, with illus, Philadelphia, Pa, Churchill Livingstone, 2000.The fourth edition of Wheater's Functional Histology: A Text and Colour Atlas is a well-written and well-illustrated documentation of the basic aspects of histology.The photomicrographs included in the chapters are excellent. Both the electron micrographs and the light micrographs are very clear and well labeled. Figure legends are extensive and provide more than adequate descriptions of the figures. In addition, the diagrams are markedly improved from the previous version of this atlas. While the photographs alone would have made this atlas one of the best available, the inclusion of diagrams boosts it to the top-notch level.The text that accompanies the micrographs is quite readable. It provides a basic overview of the organelles, tissues, and organ systems. Although the text is not extensive enough to provide all of the necessary written material for a graduate or medical histology course, it likely would be adequate for undergraduate students. In addition, the book could serve as a refresher for those who have previously taken the course and want to review the material.The inclusion of the CD-ROM is an added bonus for both faculty and students. It enables the instructors to readily utilize the images in the book in lectures and review sessions. In addition, students can select and rearrange the diagrams and photomicrographs to review specific sections of the material. Thus, the CD-ROM can be a benefit to both instructors and students.Overall, the fourth edition of Wheater's Functional Histology: A Text and Colour Atlas is an excellent atlas for medical and graduate histology courses.

Web pages: an effective method of providing CAI resource material in histology

Increased student numbers and the recognition that computer skills are essential for medical students led to the introduction of computer-aided instruction (CAI) resource material as an integral part of the second-year histology course at the University of Natal (South Africa) Medical School. Several copies of a commercial software package (compact disc–CD) covering the entire course were available. During the course of the year, using the physical and human resources available, the first in-house software package ('The Integumentary System') was generated in MS Word and saved as a series of linked html documents. The package could be accessed simultaneously by all students via the local area network (LAN). As part of an extensive evaluation of the introduction of CAI in histology, student comments and criticisms of the commercial and in-house package were canvassed. The response regarding the in-house software was encouraging, with students perceiving that it met their educational needs, preferring it to the commercial package. This report describes the ease with which this software can be developed, using limited resources and available skills, while providing students with valuable learning opportunities.

Do No Harm—A Comparison of the Effects of On-Line Vs. Traditional Delivery Media on a Science Course

This paper presents the results of a study designed to examine the effects of distance delivery on student performance and classroom interactions in an upper level science (Histology) course. Outcomes were assessed by comparing performance on content pre- and posttests for students enrolled in on-campus and on-line sections of the same course. Interactions were classified according to initiator, topic, and Bloom's taxonomy level for content interactions. The resulting patterns were analyzed to compare behaviors in different settings. It was found that although the groups were indistinguishable in content knowledge at the outset of the study, by the end of the semester, students in the on-line group significantly out-performed their peers in the on-campus section. The on-line settings had a greater proportion of high-level interactions (according to Bloom's taxonomy) than the on-campus setting.

Chronic recurrent multifocal osteomyelitis

The aim of this paper is to give a detailed description of the so-called "chronic recurrent multifocal osteomyelitis" (CRMO). The clinical, radiological and histopathological results of an analysis of 29 cases (15 children/adolescents and 14 adults) are presented and correlated to current data from the literature. We could delinate the following points: 1. CRMO is a systemic aseptic inflammation of the bone marrow (Osteitis), it can occur polytopically and association with pustulous dermatologic symptoms is possible. 2. It is not a rare disease 3. Osteomyelitis is probably "reactive" and a plasma-cell sclerotic process with ist own characteristic histologic three-phase course. 4. We could observe 5 specific types of localization which can be documented by X-ray or bone scan. 5. Accompanying arthritis os often present, especially "sympathetic coxitis". 6. The use of drugs in treatment of CRMO (i.e. azithromycin, calcitonin, and bisphosphonates) is discussed. In conclusion we want to point out, that 1. 99mTC bone scan should always be performed when there is suspicion for CRMO to reveal the pattern of affection, 2. the rheumatologist and dermatologist should be contacted, 3. operation is normally not necessary for treatment of the mostly self-limitin disease, and 4. the term "SAPHO syndrome" should be avoided, further differentiation of the diagnosis is necessary.

The influence of cytomegalovirus viraemia on the outcome of recurrent hepatitis C after liver transplantation.

Several interrelated host and hepatitis C virus (HCV) associated factors have been proposed to explain the variable outcomes in HCV recurrence. Recent evidence suggests that cytomegalovirus (CMV) infection not only is co-factor in progression of HCV recurrence but may precipitate allograft rejection. We investigated whether short-term CMV viremia influences HCV recurrence, the number and grade of acute rejection episodes, and the histological course of HCV recurrence during the first year after orthotopic liver transplantation (OLT) for HCV-related cirrhosis. A cohort of 39 patients transplanted for cirrhosis HCV-related was analyzed. Patients were evaluated twice weekly for CMV infection by a blood polymerase chain reaction (PCR) assay. Triple therapy with cyclosporine or tacrolimus, azathioprine and prednisolone was the initial immunosuppressive regimen. Preemptive treatment with ganciclovir was started when two consecutive PCRs for CMV were positive. Liver biopsies were performed on day 7 after OLT or when indicated. A 3-day IV 1 g methilprednisolone was given to patients with moderate or severe rejection. Ishak's score was used to grade inflammation and to stage fibrosis. Neither CMV viremia nor CMV disease after OLT for HCV-related cirrhosis adversely influenced the incidence and grade of acute rejection episodes nor the histological outcome of post transplant HCV recurrence, during the first year after liver transplantation. CMV viremia as detected by PCR does not affect the progression of HCV recurrence in liver grafts.

Hinweis auf endometriale Gewebsatypien durch Endometriumzellen im Zervixabstrich: Effekte der Hormonsubstitution - Predictive Value of Endometrial Cells in Cervical Smears Reflecting Endometrial Pathology: Effects of Hormonal Replacement Therapy -

Objective: The presence of endometrial cells in cervical Pap smears can reflect endocrine anomalies or endometrial pathology. Endometrial shedding due to endocrine anomalies is rare in postmenopausal women without hormone replacement therapy. We aimed to evaluate the predictive value of endometrial shedding for endometrial pathology in postmenopausal women with and without hormone replacement therapy. Methods: We reviewed the results of 75 099 cytologic cervical smears obtained between 1985 and 1994. We analyzed the histologic findings and clinical course of patients with asynchronous (>12th day of the cycle) or postmenopausal shedding of endometrial cells according to menopausal status. Results: A total of 968 cases with adequate follow-up were analyzed. 85 patients had cytology suggestive of endometrial adenocarcinoma. 80 of these patients were found to have cancer and 4 had atypical endometrial hyperplasia. Of the 883 patients with asynchronous shedding of endometrial cells without cytologic features of malignancy, histology showed adenocarcinoma or atypical hyperplasia in 31 (7.8%) of 397 premenopausal women, 19 (15%) of 130 postmenopausal women with hormone replacement, and 96 (27%) of 356 postmenopausal women without hormone replacement therapy. The difference between postmenopausal patients with or without hormone replacement is significant (p < 0.006). Conclusion: In postmenopausal women the predictive value of endometrial cells in cervical smears reflecting endometrial pathology is strongly influenced by hormone replacement therapy.

Refractory celiac disease (RCD): Histology, T-cell clonality and clinical course

Refractory celiac disease (RCD): Histology, T-cell clonality and clinical course

Dual or Single Hepatitis B and C Virus Infections in Childhood Cancer Survivors: Long-Term Follow-Up and Effect of Interferon Treatment

We conducted a long-term prospective study of 89 cancer survivor children who had acquired hepatitis B virus (HBV) and/or hepatitis C virus (HCV) during treatment for neoplasia, the aim being to evaluate the natural history of the diseases and the effect of interferon (IFN) treatment. Patients were followed up for a median period of 13 years (range, 8 to 20); 46 were infected by HBV, 11 by HCV, and 32 coinfected by HBV and HCV. A spontaneous clearance of hepatitis B surface antigen (HBsAg) occurred more frequently in coinfected patients (19%) than in the HBV-infected (2%; P = .004), with an annual seroconversion rate of 2.1% and 0.2%, respectively (P= .008). Loss of hepatitis Be antigen (HBeAg) occurred in 44% of coinfected and in 28% of HBV-infected patients. Clearance of serum HCV-RNA was observed in 34% and 9%, respectively, of coinfected and HCV-infected patients. Seventeen HBV-infected, 4 HCV-infected, and 16 coinfected patients received -IFN treatment. In the HBV group, 6 patients (35%) cleared serum HBV DNA and seroconverted to anti-HBe; in the HCV-group, none cleared HCV-RNA. In the coinfected group, 1 patient cleared both HBV DNA and HCV-RNA, 6 patients cleared serum HCV-RNA alone, and 1 only HBV DNA and HBeAg. Overall, the diseases showed a mild histological course with no evidence of liver cirrhosis. A reciprocal interference on viral replication between HBV and HCV may occur in coinfected patients. Treatment seems to be effective for selected cases and is justified in view of the uncertain prognosis of the disease in these patients.

Dual or Single Hepatitis B and C Virus Infections in Childhood Cancer Survivors: Long-Term Follow-Up and Effect of Interferon Treatment

AbstractWe conducted a long-term prospective study of 89 cancer survivor children who had acquired hepatitis B virus (HBV) and/or hepatitis C virus (HCV) during treatment for neoplasia, the aim being to evaluate the natural history of the diseases and the effect of interferon (IFN) treatment. Patients were followed up for a median period of 13 years (range, 8 to 20); 46 were infected by HBV, 11 by HCV, and 32 coinfected by HBV and HCV. A spontaneous clearance of hepatitis B surface antigen (HBsAg) occurred more frequently in coinfected patients (19%) than in the HBV-infected (2%; P = .004), with an annual seroconversion rate of 2.1% and 0.2%, respectively (P= .008). Loss of hepatitis Be antigen (HBeAg) occurred in 44% of coinfected and in 28% of HBV-infected patients. Clearance of serum HCV-RNA was observed in 34% and 9%, respectively, of coinfected and HCV-infected patients. Seventeen HBV-infected, 4 HCV-infected, and 16 coinfected patients received α-IFN treatment. In the HBV group, 6 patients (35%) cleared serum HBV DNA and seroconverted to anti-HBe; in the HCV-group, none cleared HCV-RNA. In the coinfected group, 1 patient cleared both HBV DNA and HCV-RNA, 6 patients cleared serum HCV-RNA alone, and 1 only HBV DNA and HBeAg. Overall, the diseases showed a mild histological course with no evidence of liver cirrhosis. A reciprocal interference on viral replication between HBV and HCV may occur in coinfected patients. Treatment seems to be effective for selected cases and is justified in view of the uncertain prognosis of the disease in these patients.

Students' attitudes towards computer testing in a basic science course.

The introduction of computerized testing offers several advantages for test administration, however, little research has examined students' attitudes toward computerized testing. This paper, reports the attitudes of 202 students in a first year cell biology and histology course toward computerized testing and its influence on their study habits over a three year period. Multiple choice and image-based extra credit examinations and summative image-based examinations have been successfully administered in the course. The results indicate that students readily accept computer exams and that their study habits were influenced in a positive manner by the computer administered extra-credit examinations. Our results provide further evidence that medical students like the use of computer administered examinations and that the examinations may actually accentuate the learning experience.