Wide Variety Of Pathological Conditions Research Articles

Measurement of vitamin E in serum and plasma by high performance liquid chromatography with electrochemical detection.

A deficiency of vitamin E has been associated with a wide variety of pathological conditions, many of them involving neonates. Previously published methods for the quantitation of vitamin E require large sample volumes as well as extensive extraction and concentration procedures. The present work describes a method for the quantitation of vitamin E in small volumes (less than or equal to 50 microliters) of serum or plasma without the need for extraction or concentration of the sample. With further optimization, even smaller volumes (less than or equal to 10 microliters) can be employed. Sample preparation consisted of precipitation of plasma proteins with absolute ethanol. After centrifugation, a small volume (10 to 50 microliters) of the supernatant was injected directly onto the high performance liquid chromatography (HPLC) column. A dual channel electrochemical detector was used for quantitation of the vitamin E. Pooled serum or plasma was used to determine within-day (8.43 +/- 0.19 mg/L) and between-day (8.49 +/- 0.34 mg/L) precision. Analytical recovery of added vitamin E (4-16 mg/L) averaged 102 +/- 7.0%. No interfering peaks were observed. Linearity was demonstrated over 0.5 to 800 ng. Vitamin E acetate is not detected by this method. HPLC with electrochemical detection is a highly sensitive and specific method for the quantitation of vitamin E in plasma or serum. This procedure is rapid and simple, and can be performed with very small sample volumes.

Oxygen radicals in the adult respiratory distress syndrome, in myocardial ischemia and reperfusion injury, and in cerebral vascular damage.

Recent work suggests that oxygen radicals may be important mediators of damage in a wide variety of pathologic conditions. In this review we consider the evidence supporting the participation of oxygen radicals in the adult respiratory distress syndrome, in ischemia reperfusion injury in the myocardium, and in cerebral vascular injury in acute hypertension and traumatic brain injury. In the adult respiratory distress syndrome there is active sequestration of polymorphonuclear neutrophils in the pulmonary vascular system. There is evidence that activation of these neutrophils results in the production of oxygen radicals which injure the capillary membrane and increase permeability, leading to progressive hypoxia and decreased lung compliance which are hallmarks of the syndrome. In acute arterial hypertension or experimental brain injury oxygen radicals are important mediators of vascular damage. The metabolism of arachidonic acid is the source of oxygen free radical production in these conditions. In myocardial ischemia and reperfusion injury, the ischemic myocyte is "primed" for free radical production. With reperfusion and reintroduction of molecular oxygen there is a burst of oxygen radical production resulting in extensive tissue destruction. Myocardial ischemia--reperfusion injury shares in common with the other two syndromes activation of the arachidonic acid cascade and acute inflammation. Thus it would appear that the generation of toxic oxygen species may represent a final common pathway of tissue destruction in several pathophysiologic states.

The pulmonary circulation: The radiology of adaptation

In this George Simon Lecture, I have tried to present a simplistic yet philosophical approach to the physiological processes of adaptation of circulatory and respiratory function in response to pathophysiological challenge. The objective of the body is to achieve a normal ventilation-perfusion ratio of 1 in order to optimise blood-gas exchange in a wide variety of pathological conditions. It is all a question of the right ingredients (oxygen in atmospheric air and reduced haemoglobin in desaturated blood), in the right copious amounts (100 ml/s), in the right proportion (1:1) and in the right place (alveolar capillary membrane). In order to demonstrate the above concepts, a variety of well known conditions, congenital and acquired, have been discussed in the developing infant lung and the adult mature lung; some primarily cardiovascular, others primarily respiratory; some conditions resulting in permanent and others resulting in temporary and reversible major readjustments of the blood supply to the lung. The emphasis has been to illustrate that simple, unsophisticated radiological techniques may provide a substantial amount of valuable information concerning the remarkable capacity of the pulmonary circulation to adapt to varying physiological or pathological demands in order to conserve our precious respiratory resources. George Simon, like all good doctors, had a tremendous respect for the ability of the body to respond to these challenges. He always emphasised the important basic principles rather than fine minutiae. It is hoped that this lecture in his honour follows these principles which he preached so well.

Ultrasonographic anatomy of the caudate lobe.

The caudate lobe, like the other segments and lobes of the liver, can be defined anatomically as well as pathologically utilizing gray-scale ultrasonography. It is anatomically distinct from the left and right lobes as it has its own portal veins, hepatic arteries, hepatic veins, and bile ducts. Sonographically the limits of the caudate lobe can be defined using readily identifiable vascular landmarks such as the proximal left portal vein anteriorly, the inferior vena cava posteriorly, and the main portal vein inferiorly A wide variety of pathologic conditions that affect the caudate lobe, including cirrhosis, infection, and neoplastic lesions, can be demonstrated by ultrasonography.

Arterioportal communications: observations and hypotheses concerning transsinusoidal and transvasal types.

Arterioportal shunting is observed angiographically in a wide variety of pathologic conditions. The route of flow has classically been considered to be via the hepatic sinusoids (transsinusoidal). This route occurs in cases of cirrhosis or the Budd-Chiari syndrome, and results in retrograde hepatofugal flow in portal branches. More recently, a transvasal route has been recognized angiographically, in which portal flow often remains hepatopetal. The transvasal route occurs in cases of hepatocellular carcinoma, metastases, shock, hepatic arterial obstruction, and many other conditions. Histologic confirmation of this route has been sought for many years, with other partial success. Nevertheless, angiographic evidence, as presented here, is sufficiently compelling to justify description of this pathway and its significance. Arterioportal flow may also occur via a post-traumatic fistula (disruption of adjacent portions of hepatic artery and portal vein), and via benign tumor vessels in hemangioma or hemangioendothelioma.

Surgical Anatomy and Technique of Radical Neck Dissection

Understanding the relationship of one part to another enables the surgeon to carry out with safety the most radical procedure of this anatomic region–the radical neck dissection–and all of the lesser procedures for a wide variety of pathologic conditions.

Fine morphology of regressing human mesonephric nephrons

The changes which characterize the involution of human mesonephric nephrons have been studied by means of light and electron microscopy. The most salient glomerular changes appear to be modifications of the mesangial cells and other components of the capillary wall, resulting in progressive reduction and eventual obliteration of the vascular bed of the glomerulus; tubular changes are essentially characterized by severe epithelial cell degeneration and the presence of pleomorphic luminal casts. The possible mechanisms responsible for the regression of the human mesonephros are discussed together with an evaluation of the analogies between the glomerular and tubular changes accompanying the regression of mesonephric nephrons and those occurring in the nephrons of the definitive (metanephric) kidney in a wide variety of pathologic conditions.

B-scan ultrasonography in ophthalmology.

Ninety-two patients with various ocular and retro-orbital abnormalities have had orbital B-scanning carried out using the Nuclear Enterprises Diasonograph 4102. Using the 5 MHz transducer and a simple direct water bath, satisfactory results have been obtained in a wide variety of pathological conditions in the lens, vitreous and retroorbital structures. Several illustrations are shown which demonstrate that standard ultrasonic equipment can be used successfully for ophthalmic investigation.

Nature and biological activities of degradation products of fibrinogen and fibrin.

The recognition of the importance of fibrinogen proteolysis in a wide variety of pathological conditions ranging from disseminated intravascular coagulation to local fibrin deposition in renal diseases has led to numerous studies of the nature of the fibrinogen degradation products (FDP). This review will deal pri­ marily with the biological and clinical aspects of the problem. Details of the chem­ ical and physical characterization may be obtained elsewhere (1-6).

Postoperative hoarseness

There is a great variety of etiologic factors giving rise to postoperative hoarseness. Injury may have arisen during the act of intubation, from the endotracheal tube during the operation, from the endotracheal tube during the postoperative course, from complicating bronchopneumonia, or from injury to the recurrent laryngeal nerve during neck or thorax operations. A wide variety of pathologic conditions result from these injuries to the larynx resulting in postoperative hoarseness. The specific type of injury must be determined by indirect laryngoscopy so that specific therapy can be given. Surgery using microscopic laryngoscopy via a transoral approach has added a new dimension to the diagnosis and therapy of laryngeal diseases and is especially important in the management of arytenoid dislocation, granuloma formation, and vocal cord paralysis.

Analyses of Extravascular Fluids

The examination of fluid collections from the pericardial, pleural, and abdominal cavities and the joints remains a frequent adjunct to other diagnostic techniques.1Normally these serous cavities contain only small amounts of fluid for lubrication. A wide variety of pathologic conditions may cause abnormal collections of fluid which are classified according to composition as transudate or exudate. Atransudateis formed by an alteration in the normal mechanisms that regulate the exchange of fluid between the vascular and extravascular compartments. This interchange of fluid between the blood and the tissue spaces is controlled by the balance between the capillary blood pressure forcing fluid into the tissue spaces and the osmotic pressure of the plasma proteins which returns fluid into the vascular compartment. The protein molecules diffuse to a limited extent. The small molecules, such as water, electrolytes, and crystalloids, diffuse back and forth rapidly. The concentration of the small

Cellular Aspects of Developmental Pathology.

In this new textbook of pediatric pathology, the author has concentrated on disease at the cellular level. In addition to an introductory chapter on the Nature of Developing Cells, Tissues and Organs, there are chapters on Reactions to Injury, Neoplasia, Genetic Diseases of Cells and Cellular Metabolism, Metabolic, Nutritional and Chemical Injuries, Infectious Injury, and Immune Injury and Hyperergic Tissue Reactions. The first two chapters provide a good introduction to the processes and reactions peculiar to pediatric pathology, and although there may be occasional disagreement on minor points, these chapters provide particularly interesting reading for pediatricians and pathologists alike. The later chapters contain a great deal of information about a wide variety of pathologic conditions, but, as is inevitable in a book of this size, many subjects are perforce omitted or are inadequately covered. There is a comprehensive and current list of references, and the indexing is good. Occasional passages

GYNECOMASTIA: A REVIEW AND AN ANALYSIS OF 160 CASES

Excerpt Gynecomastia has been reported as an accompaniment of certain physiologic states and a wide variety of pathologic conditions. It is the purpose of this paper to (1) define gynecomastia, (2)...

ENDOBRONCHIAL GEOTRICHOSIS

Case Reports1 February 1954ENDOBRONCHIAL GEOTRICHOSISRICHARD MINTON, M.D., RODOLFO V. YOUNG, M.D., EDWARD SHANBROM, M.D.RICHARD MINTON, M.D.Search for more papers by this author, RODOLFO V. YOUNG, M.D.Search for more papers by this author, EDWARD SHANBROM, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-40-2-340 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptINTRODUCTIONThe fungus Geotrichum, like Monilia, has been reported to cause a wide variety of pathologic conditions as well as to be a nonpathogen. Tonsillitis,1conjunctivitis, bronchitis,2cutaneous lesions,3ulcerative rectal lesions,4pulmonary diseases5and septicemia6, 7have been attributed to the organism. Two cases of Geotrichum septicemia are reported in an infant and in a debilitated aged individual.6-7With these exceptions the English literature has been concerned mainly with bronchopulmonary geotrichosis. In 1934 Smith8reported five cases, two pulmonary and three bronchial. In 1946 Kunstadter, Pendergrass, and Schubert9reported one case of pulmonary and two of bronchial geotrichosis. Reeves,10...Bibliography1. Cortese F: Tonsillitis caused by Geotrichum candidum , Valsalva 9: 149, 1933. Google Scholar2. Smith DT: Fungus diseases of the lungs, 1947, Charles C. Thomas, Springfield, Illinois, p. 17. Google Scholar3. Castellani A: Mycotic eczematous dermatitis of the toes probably due to Geotrichum, Rotundatum castellani, 1911. Google Scholar4. AlmeidaLacaz FCS: Fungus of the genus Geotrichum isolated from ulcerous lesions of the rectum, Folia Clin. et Biol. 12: 57, 1940. Google Scholar5. Magalhass O: Lung infection with Geotrichum pulmoneum , Rev. med.-cir. do Brasil 41: 263, 1933. Google Scholar6. KaliskiBeeneMattman SRMLL: Geotrichum in the blood stream of an infant, J. A. M. A. 148: 1207, 1952. CrossrefMedlineGoogle Scholar7. BendoveAshe RABI: Geotrichum septicemia, Arch. Int. Med. 89: 107, 1952. CrossrefGoogle Scholar8. Smith DT: Oidiomycosis of the lungs, J. Thoracic Surg. 3: 241, 1934. CrossrefGoogle Scholar9. KunstadterPendergrassSchubert RHRCJH: Bronchopulmonary geotrichosis, Am. J. M. Sc. 211: 583, 1946. CrossrefMedlineGoogle Scholar10. Reeves RJ: The incidence of bronchomycosis in the South, Am. J. Roentgenol. 45: 513, 1941. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Ancon, Canal Zone*Received for publication June 19, 1953.From the Medical Service, Gorgas Hospital, Ancon, Canal Zone. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByTonsillitis in a Weaner Pig Associated with Geotrichum CandidumGeotrichosisGeotrichosisBronchial Geotrichosis with Fungemia Complicating Bronchogenic CarcinomaDisseminated Geotrichosis in a DogMykosenMiscellaneous fungus diseasesMykosen der inneren OrganeEndoscopy 1 February 1954Volume 40, Issue 2Page: 340-343KeywordsCandidaConjunctivitisInfantsMedical servicesPulmonary diseasesSepsis Issue Published: 1 February 1954 PDF DownloadLoading ...

Pulmonary Edema

EDEMA OF THE lungs produces shadows on roentgen examination which may be confused with those due to other conditions. Most frequently they simulate pneumonia. Other pulmonary diseases which cause diffuse shadows, such as coccidioidomycosis, Boeck's sarcoid, and miliary tuberculosis, may occasionally cause confusion, and pulmonary infarcts sometimes produce a picture resembling that of edema. It is the purpose of this paper to discuss the factors involved in the production of pulmonary edema, and to correlate these with the roentgen findings. Although the roentgen appearance of edema of the lungs varies considerably, certain constant features are seen in the majority of cases. (1) Edema tends to be diffuse and bilateral. Local or segmental involvement may occur, but it is the exception rather than the rule. (2) The apices and extreme bases tend to be clear. (3) There is often a diffuse increase in density of the lung fields, due to the increase in the caliber of the vascular shadows and small focal areas of alveolar edema. (4) A rather rapid shift in position or variation in extent is apparent on serial films. (5) The heart is usually enlarged. Causes of Pulmonary Edema Pulmonary edema is caused by or associated with a wide variety of pathological conditions. The present discussion will be limited to pulmonary edema o~curring in conjunction with (1) cardiac failure, (2) nephritis, and (3) excessive parenteral administration of fluids. Three basic physiological changes singly or in combination may cause pulmonary edema. They are increased intracapillary hydrostatic pressure, decreased osmotic pressure of the blood, and altered permeability of the capillary wall. The normal hydrostatic pressure in the alveolar capillaries is estimated at between 8 and 10 mm. Hg. This is approximately 15 mm. lower than in the capillaries of the systemic circulation. The osmotic pressure of the blood is constant throughout the entire cardiovascular system. It is normally 25 to 30 mm. Hg. This pressure is an attracting force opposing the hydrostatic pressure, which, if greater than the osmotic pressure, will cause fluid to diffuse out of the capillary into the interstitial tissues. The osmotic pressure of the blood is due largely to the serum protein, the normal level of which is about 7 gm. per cent. The constituents of the serum protein which create osmotic pressure are the serum albumin and globulin, which are normally present in a proportion of 4.4 gm. per cent albumin to 2.6 gm. per cent of globulin. The albumin molecule is considerably smaller than the globulin molecule. This, in conjunction with the greater relative quantity of albumin, causes it to. exert most of the osmotic pressure. Each gram per cent of serum albumin creates osmotic pressure estimated as 5.5 mm. Hg. Each gram per cent of serum globulin exerts a pressure of 1.4 mm. Hg.

A Simple Technic for Cerebral Arteriography

Egas Moniz (2), in 1927, introduced a specialized roentgen technic whereby it is possible, with the aid of certain radioopaque substances injected into the vascular supply of the brain, to visualize normal and abnormal cerebral vessels. The illustrations of his monograph, covering a wide variety of pathological conditions, can be duplicated with a relatively simple procedure now used in our department. The purpose of this communication is to present briefly this simple technic. Robb and Steinberg (14), in 1939, and Stewart, Breimer, and Maier, in 1941 (16), reported the successful use of diodrast to demonstrate the chambers of the heart and the pulmonary circulation. Gross (5, 6), after experience with cerebral arteriography in dogs, expressed a preference for a 50 per cent solution of diodrast rather than colloidal thorium dioxide, or thorotrast, which Egas Moniz believed most suitable of the available radio-opaque substances. Eisenstein and Taylor (3), who reported a case of porencephalic cyst with arteriographic studies, used thorotrast as their contrast medium. The difference of opinion in regard to the technic of cerebral arteriography is understandable in view of the relative newness of the procedure. Our technic has been worked out in assisting the surgeons of the neurosurgical division of Duke University Hospital. Co-operation between the neurosurgeon and roentgenologist is essential to gratifying results. In each individual case, the two should plan the type of demonstration most desired before any procedure is instituted, and discuss any modifications which may be necessary. If this is done, good visualization of the cerebral arteries is not beyond the potentiality of the average 200-milliampere fast Bucky diagnostic unit. Co-ordination and team-work of all persons concerned assures good results. Abnormalities of arteries of the anterior and middle fossae are relatively easy to show (Figs. 1 and 3), but the arterial channels of the posterior fossa are usually poorly filled and less detail is obtainable. Changes in and about the circle of Willis are the most easily demonstrated (Figs. 2 and 4). For a contrast medium, our experience is limited to the use of thorotrast. To date, we have encountered none of the untoward effects or potential dangers described by Gross (5) and others. The radioactivity of thorium dioxide, recognized for some time, does not necessarily contraindicate its use for arteriography, when only a small amount is injected as in the procedure presented here. In our department thorotrast has been used for the roentgen demonstration of the liver and spleen in a number of patients, seen over a period of years, without dangerous effects.

Leukemoid Reaction in Carcinomatous Skeletal and Splenic Metastases: A Case Report

Leukemoid reactions have been reported as occurring in a wide variety of pathologic conditions. The reaction may be indistinguishable from a true leukemia, or it may be a hyperleukocytosis with relatively few immature cells giving no great difficulty in diagnosis. Heck and Hall (1) observed leukemoid reactions of the myeloid type in pyogenic and non-pyogenic infections, miliary tuberculosis, hemolytic anemias, pernicious anemia, polycythemia vera, and Hodgkin9s disease, in active regeneration of the bone marrow, massive hemorrhage, granulocytopenia, diseases of the bone and bone marrow, malignant metastases, multiple myeloma, and osteosclerosis, and in such miscellaneous conditions as diabetic coma and chemical poisoning (mustard gas). The lymphatic type of leukemoid reaction has been observed by Krumbhaar (2) in infectious mononucleosis, pertussis, measles, typhoid fever, and acute infections, such as puerperal sepsis. Carcinoma causing a leukemoid reaction simulating true leukemia has been reported by only a few observers. Heck and Hall observed only two instances, a case of breast carcinoma and a carcinoma of the prostate. In both, skeletal metastases were present, and in the first, splenic metastases as well. Jackson (3) reports two cases in which gross hyperplasia of the bone marrow followed bony metastases from intrathoracic cancer. In a case recorded by Sala and Stein (4) splenic and skeletal metastases from carcinoma of the breast produced an unusual leuko-erythroblastic leukemoid picture of chronic lymphatic character.

CONGENITAL DEMYELINATING ENCEPHALOPATHY

The term sclerosis has been used to cover a wide variety of pathologic conditions. Pelizaeus-Merzbacher disease, arising late in childhood and apparently familial, is characterized by but incomplete demyelination, followed by slowly progressive gliosis.1Schilder's2so-called encephalitis periaxialis diffusa, on the other hand, occurs in infancy or early childhood, is not familial and runs a much more rapid course. The demyelination is more acute and complete and the gliosis less profound, being proportional to the chronicity of the process. A third type was described by Krabbe,3which resembles Schilder's disease but is familial and leads to more marked gliosis. The literature contains the reports of many cases, each differing in some respect from the others, and the task of bringing order out of chaos seems insuperable. Neuburger and Schob4divided diffuse scleroses into three groups: (a) blastomatous, (b) exogenous-inflammatory and (c) endogenous-degenerative. The first

LEUKEMOID REACTIONS OF THE MYELOID TYPE

By the term leukemoid reaction is meant a blood picture that closely resembles, or is indistinguishable from, that of the various types of leukemia. At necropsy, however, leukemic changes in the organs and tissues of the body are lacking. Reactions of the leukemoid type have been recognized for many years, and it is now known that they occur with a wide variety of pathologic conditions. Our experience leads us to believe that they are much more frequently encountered than was formerly thought. Since it is essential that these reactions be distinguished from the leukemias, it is important that practitioners in all branches of medicine have a general idea concerning those diseases with which leukemoid reactions may be encountered. In attempting to group these leukemoid reactions, we realize that some of them might well be placed under two headings. As time goes on, however, other groups of cases will undoubtedly be

MONONUCLEAR ERYTHROPHAGOCYTOSIS IN THE BLOOD OF A NEW-BORN INFANT

Ehrlich,¹in 1891, was probably the first to note phagocytosis of red blood corpuscles by leukocytes in the circulating human blood. While this phagocytic phenomenon has been observed for the various types of leukocytes, polymorphonuclear neutrophils and eosinophils, the mononuclear cells have been most frequently noted as erythrophagocytes. This report deals with erythrophagocytosis by mononuclear cells. The occurrence of this condition has been observed in a wide variety of pathologic conditions, but it has never been reported as seen in the circulating blood of a healthy person. In reviewing the previous reports in the literature on mononuclear erythrophagocytosis, I found that the cases observed by Connal²were the only ones found in which its occurrence was reported in infancy or childhood. His observations on native South African children were made on malarial patients ranging in age from 1 year upward. He was unable to demonstrate phagocytosed erythrocytes in