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The qualitative and quantitative features of cell nuclei in tissue sections play an important role in diagnostic histopathology; variations in staining intensity and measuring procedures may interfere with their proper evaluation. To... more
The qualitative and quantitative features of cell nuclei in tissue sections play an important role in diagnostic histopathology; variations in staining intensity and measuring procedures may interfere with their proper evaluation. To identify nuclear features that are relatively insensitive to these technical variables, the influence of critical steps in a scanning-stage densitometer measuring system was studied on 87 quantitative nuclear image (QNI) features in histologic sections of lung tissue. The influences of the following measuring variations were evaluated: interactive segmentation (with and without median filtering; with and without 5% uniform distributed noise added); scanning (with and without median filtering); calibration of the photomultiplier (different background localizations and different intensity levels); and time. In addition, the influence of artificially changed intensity variations was investigated. The results showed that, while the coefficient of variation (CV) induced by variations in the measuring system was usually low (below 10%), for some QNI features the CV can be high (up to 216%). The influence of artificial variations in intensity was restricted: only a minority of the QNI features showed a significant difference. Of the 87 QNI features, 35 had a CV of less than 10%, and 25 of these were significantly correlated with each other. Thus, only ten uncorrelated, low-CV QNI features remained; these belonged to all of the different QNI feature categories used. These features may be diagnostically important since they may best describe the morphologic properties of the nuclei. The results of this study should help in selecting quantitative nuclear image features that are less sensitive to variations in the measuring procedure and staining intensity.
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Experimental acute hypertension in male Wistar rats was produced by metaraminol infusion to systemic blood pressure levels of 190-210 mm Hg. After 20 sec or 30 min the animals were killed by perfusion fixation with 8% formaldehyde... more
Experimental acute hypertension in male Wistar rats was produced by metaraminol infusion to systemic blood pressure levels of 190-210 mm Hg. After 20 sec or 30 min the animals were killed by perfusion fixation with 8% formaldehyde perfusion. The barrier passage of exogenous HRP (75 mg i.v.) given 10 min before killing (5 rats) and the passage of endogenous anti-HRP antibodies of the IgG class (8 rats, produced by antigenic stimulation beforehand) were compared electron microscopically by semiquantitation of tracer location in unstained ultrathin sections. Five rats served as controls. The number of tracer-filled vesicles was consistently lower in anti-HRP rats than in HRP rats: not only during acute hypertension but also in the controls. The penetration of both tracers into the basement membrane and brain parenchyma, however, was comparable. Anti-HRP was more prominent in the endothelial cytoplasm. Vesicular transport and penetration through the plasma membrane with diffuse cytoplasmic passage tend to be the most likely transport mechanisms, the former for HRP and the latter for the antibody.
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The clinical presentation, the morphological findings, and the clinical outcome of 27 patients with biopsy-proven acute interstitial nephritis were studied. All patients except one presented with acute renal failure. Typical clinical... more
The clinical presentation, the morphological findings, and the clinical outcome of 27 patients with biopsy-proven acute interstitial nephritis were studied. All patients except one presented with acute renal failure. Typical clinical findings were often absent. Only four patients showed the classical triad of pyrexia, rash and arthralgia. In more than half of the patients an increased blood eosinophil count was not present. Kidney biopsy is therefore needed to establish the diagnosis of acute interstitial nephritis. In many patients acute interstitial nephritis was diagnosed in the biopsy when clinically this type of kidney disease was not expected. In 17 patients renal function improved spontaneously after withdrawal of the drug responsible or treatment of the infection. In ten patients who showed further deterioration of renal function in the first 2 weeks after admission, prednisone therapy was instituted. In all of them improvement of renal function was observed, with six returning to normal.
Research Interests: Adolescent, Biopsy, Humans, Kidney, Female, and 7 moreMale, Clinical Sciences, Aged, Middle Aged, Adult, Prognosis, and Creatinine
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... 1 year. At admission, neurological examination revealed no abnormalities, but cerebral angiography indicated a left temporal avascular lesion that caused upward displacement of the left middle cerebral artery (MCA). On computerized ...
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The morphological similarity of the lining of arachnoid cysts to subdural neurothelium and the mesothelium of arachnoid granulations suggested that the latter tissues might be the origin of arachnoid cysts. Transport Na+-K+-adenosine... more
The morphological similarity of the lining of arachnoid cysts to subdural neurothelium and the mesothelium of arachnoid granulations suggested that the latter tissues might be the origin of arachnoid cysts. Transport Na+-K+-adenosine triphosphatase was shown by enzyme ultracytochemistry to be an indication of secretory activity in the lining of arachnoid cysts and in the endothelial lining of arachnoid granulations. This secretory activity suggests the existence of a biochemical mechanism for cerebrospinal fluid absorption at these granulations separate from the mechanisms already demonstrated.
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Résumé Le Campylobacter pylori a été isolé universellement sur biopsies de muqueuse gastrique de patients atteints de dyspepsie non-ulcéreuse, d’ulcus duodénal ou gastrique, et aussi chez des patients asymptômatiques, mais uniquement... more
Résumé Le Campylobacter pylori a été isolé universellement sur biopsies de muqueuse gastrique de patients atteints de dyspepsie non-ulcéreuse, d’ulcus duodénal ou gastrique, et aussi chez des patients asymptômatiques, mais uniquement lorsqu’ils présentaient une gastrite chronique active, la disparition spontanée du C. pylori n’a jamais été observée au cours de périodes de surveillance d’une durée supérieure à deux ans. Chez tous les patients traités par Cimétidine ou sucralfate, les cultures pour C. pylori demeurent positives et les scores de gastrite sont inchangés. La disparition du C. pylori immédiatement après traitement chez les patients souffrant de dyspepsie non-ulcéreuse, a été observée après administration de subcitrate de bismuth colloïdal (45 %), amoxycilline (68 %), ou une association subcitrate de bismuth colloïdal et amoxycilline (90 %), évolution strictement parallèle à l’amélioration des scores de gastrite. Chez environ 60 % des patients dont la culture pour C. pylori était négative en fin de traitement, une rechute est survenue dans le mois suivant, avec une nouvelle élévation du score de gastrite. Lorsque le C. pylori est éradiqué, on constate la complète disparition des anomalies inflammatoires.
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Of a total series of 103 patients with preoperatively diagnosed carcinoma of the head of the pancreas (including ampullary carcinoma, carcinoma of the distal part of the common bile duct and pancreatic duct and acinar cell carcinoma), 78... more
Of a total series of 103 patients with preoperatively diagnosed carcinoma of the head of the pancreas (including ampullary carcinoma, carcinoma of the distal part of the common bile duct and pancreatic duct and acinar cell carcinoma), 78 underwent pancreatic resection. The remaining 25 had palliative surgical treatment, either a gastric or biliary bypass, and are not included in the present study. Three of the 78 patients who underwent pancreatic resection died, and ten patients required early reoperation. Predictive criteria could be formulated for the prognosis and outcome of the patients with carcinoma of the head of the pancreas. The most reliable index for survival time of the patients proved to be the radicality of the resection, which was directly related to the differentiation of the primary tumor. Forty-three of 48 patients who underwent radical resection are alive, with a survival time ranging from three to 49 months. Eleven of 23 patients who underwent palliative resection are alive, with a survival time ranging from two to 29 months. Of 44 patients with well or moderately differentiated adenocarcinoma who underwent radical resection, 38 are alive, with a survival time ranging from six to 41 months (mean of 29 months).
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A feasibility study showed that quantitative nuclear image (QNI) analysis, in which the morphology of the nucleus is described by a number of mathematical parameters, can be used to make the therapeutically and prognostically important... more
A feasibility study showed that quantitative nuclear image (QNI) analysis, in which the morphology of the nucleus is described by a number of mathematical parameters, can be used to make the therapeutically and prognostically important distinction between small cell lung carcinoma (SCLC) and non-SCLC, which can be difficult to make with subjective histologic typing. In the present study, the effects of sample size and sample site on the QNI features were investigated. For all sample sites in a given tumor, comparison was made between the histologic classification, the ultrastructural findings and the classification based on the QNI features. Using a running mean, it was found that a sample size of 25 nuclei is sufficiently large. Histologic and quantitative classifications of samples from different sites of the same tumors were in agreement with regard to the separation of SCLC and non-SCLC in 19 of 20 sections. In the case in which disagreement occurred in one section, the ultrastructural findings supported the quantitative classification. These data indicate that sampling from different sites has no essential influence on the QNI classification of lung carcinomas.
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Fifty patients with proximal malignant biliary obstruction confined to or above the junction of the main hepatic ducts underwent surgical treatment. Group A patients (n = 30) underwent complete or partial removal of the tumor with no... more
Fifty patients with proximal malignant biliary obstruction confined to or above the junction of the main hepatic ducts underwent surgical treatment. Group A patients (n = 30) underwent complete or partial removal of the tumor with no supplementary procedure, group B patients (n = 20) complete removal of the tumor and a supplementary procedure. Additional procedures were liver resection alone (11/20), and liver resection plus resection and reconstruction of regional vascular structures (9/20). Reconstruction of the intrahepatic biliary tree was carried out in all patients using intrahepatic cholangiojejunostomies between common segmental hepatic stomata and a Roux-en-Y jejunal loop. In each common segmental hepatic stoma, two or three segmental hepatic ducts were drained. Transanastomotic tubes were used only temporarily. Eight patients died, three from group A (3/30) and five from group B (5/20). Survivors were relieved of jaundice and had no subsidiary cholangitis or problems associated with the anastomotic tubes. Seventeen patients of group A and 12 of group B are alive, with a mean survival of 29 and 31 months, respectively. Both alternatives offer good results. The choice of the surgical approach should be based on a precise evaluation of each patient's anatomical and individual clinical peculiarities.
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For the evaluation of differential diagnostic parameters, hepatocellular carcinoma (HCC, n = 26), liver cell adenoma (n = 4), focal nodular hyperplasia (n = 8), and secondary liver tumors (n = 15) were studied with histologic and... more
For the evaluation of differential diagnostic parameters, hepatocellular carcinoma (HCC, n = 26), liver cell adenoma (n = 4), focal nodular hyperplasia (n = 8), and secondary liver tumors (n = 15) were studied with histologic and immunohistochemical methods. The study was performed on formalin-fixed, paraffin-embedded tissue sections, and, in some cases, also on frozen sections. The diagnostic contribution of the demonstration of alpha-fetoprotein, alpha-antitrypsin, hepatitis B surface antigen, carcinoembryonic antigen (CEA), and biliary glycoprotein I (BGPI), compared with routine hematoxylin-eosin and reticulin stains was evaluated. For the differentiation between HCC, adenoma, and focal nodular hyperplasia, immunohistochemistry contributed less than the strict application of histologic criteria. Immunohistochemistry of CEA and BGPI, however, appeared to be of help in differentiating between primary and secondary liver tumors as follows: CEA is consistently absent in liver cell tumors, while a bile canalicular staining pattern was seen in 80% of HCC due to the presence of BGPI reactivity.
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Endosonography (ES) was used for the preoperative TNM (1987) staging of tumors in 43 patients with pancreatic cancer and 24 patients with ampullary carcinomas. These results were correlated with the histologic findings of resected... more
Endosonography (ES) was used for the preoperative TNM (1987) staging of tumors in 43 patients with pancreatic cancer and 24 patients with ampullary carcinomas. These results were correlated with the histologic findings of resected specimens. Early-stage tumors could be distinguished from advanced stages of cancer with ES. Detailed images of ductular and parenchymal abnormalities allowed distinction between pancreatic and ampullary carcinomas based on anatomic location. The overall accuracy of ES in the assessment of tumor classification in pancreatic and ampullary carcinoma was 92% and 88%, respectively. In diagnosing regional lymph nodes in pancreatic and ampullary tumors the accuracy of ES was 74% and 54%, respectively. For diagnosing metastatic lymph nodes in pancreatic and ampullary carcinoma the accuracy of ES was 91% and 80%, respectively. The prevalence of lymph node metastases in T1 pancreatic cancers and T1 ampullary carcinomas was 40% and 0%, respectively. Discrimination b...
Research Interests: Radiology, Humans, Ultrasonography, Female, Male, and 4 moreAged, Middle Aged, Adult, and Endoscopes
Many organophosphorus compounds, including the organophosphate insecticides, may cause polyneuropathy of delayed onset. An exception is parathion, which has been considered the prototype of nonneurotoxic cholinesterase inhibitors.... more
Many organophosphorus compounds, including the organophosphate insecticides, may cause polyneuropathy of delayed onset. An exception is parathion, which has been considered the prototype of nonneurotoxic cholinesterase inhibitors. Nevertheless, we describe a patient with delayed polyneuropathy after suicidal ingestion of parathion.
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... Booth L, Holdstock G, MacBride H, Hawtin P, Gibson JR, Ireland A, Bamforth J, DuBoulay CE, Lloyd RS, Pearson AD. ... Please address requests for reprints to Dr. Janet Horn, Bla-lock 1111, The Johns Hopkins Hospital, 600 North Wolfe... more
... Booth L, Holdstock G, MacBride H, Hawtin P, Gibson JR, Ireland A, Bamforth J, DuBoulay CE, Lloyd RS, Pearson AD. ... Please address requests for reprints to Dr. Janet Horn, Bla-lock 1111, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, Maryland 21205. ...
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Research Interests: Risk, Biopsy, Hepatitis B, Humans, Liver, and 4 moreChronic Disease, Hepatitis, Clinical Sciences, and Time Factors
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Serial graft biopsies (n = 78) from 12 liver transplant recipients (followed clinically up to 47 months) were studied with the use of histology, histochemistry, immunostaining, and electron microscopy. Planned-protocol needle biopsy... more
Serial graft biopsies (n = 78) from 12 liver transplant recipients (followed clinically up to 47 months) were studied with the use of histology, histochemistry, immunostaining, and electron microscopy. Planned-protocol needle biopsy specimens were taken from the graft before removal from the donor, 1 hour after transplantation, on the eighth day, and at yearly intervals. Nonprotocol biopsies were taken when deterioration of the clinical condition made a decision on changes in the regimen necessary. The protocol biopsies provided a baseline for graft condition and diagnostic histopathologic features. In these biopsies signs of hyperacute rejection, chronic rejection, or the recipient's previous liver disease were not observed. Mild acute rejection was regularly present on the eighth day, possibly due to a lag phase in the effect of immunosuppression. The syndromes in the nonprotocol biopsies included "pure" parenchymal cholestasis, reversible acute rejection resembling chronic active hepatitis, viral infection, and acute bacterial cholangitis. Each of these syndromes correlated with a separate histopathologic entity. Therefore, these entities proved to be of diagnostic value. It is concluded that a graft biopsy may substantially add to the pathogenetic interpretation, differential diagnosis, and management of major graft syndromes in orthotopic liver transplant recipients.
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A patient with longstanding erythroderma and decreased sweat secretion due to the classical adult form of pityriasis rubra pilaris is described. The patient did not respond to oral megadoses of Vitamin A, even though a large increase of... more
A patient with longstanding erythroderma and decreased sweat secretion due to the classical adult form of pityriasis rubra pilaris is described. The patient did not respond to oral megadoses of Vitamin A, even though a large increase of liver content of Vitamin A was demonstrated. Retinol-binding protein levels in serum of this patient and his relatives were normal. Danazol (Danatrol, Winthrop) therapy caused an increase of retinol-binding protein level, but clinical improvement did not occur.
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Research Interests: Risk, Biopsy, Hepatitis B, Humans, Liver, and 4 moreChronic Disease, Hepatitis, Clinical Sciences, and Time Factors
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Ninety patients with pancreatic duct, distal bile duct, and ampullary carcinoma underwent pancreatic resection. Following a standard policy of resection based on surgical findings, all the patients who had resection first underwent... more
Ninety patients with pancreatic duct, distal bile duct, and ampullary carcinoma underwent pancreatic resection. Following a standard policy of resection based on surgical findings, all the patients who had resection first underwent subtotal extended pancreatectomy (n = 68) and if they were considered not to fulfill the criteria for this operation, total pancreatectomy (n = 22). Thus, 68 of the 90 patients (72%) were managed with subtotal pancreatic resection irrespective whether they had ampullary, pancreatic duct, or distal common bile duct carcinoma. On the basis of our results, subtotal duodenopancreatectomy is regarded as the method of choice for many patients with pancreatic duct, distal bile duct, or ampullary carcinoma.
Research Interests: Methods, Prospective studies, Humans, Female, Male, and 5 moreClinical Sciences, Aged, Middle Aged, Adult, and Duodenum
Liver biopsies of six previously normal hosts (Group I, NH), with recent or acute CMV infection, and autopsy liver samples of four immunocompromised hosts (Group II, ICH) with overwhelming CMV infection have been studied in an occasional... more
Liver biopsies of six previously normal hosts (Group I, NH), with recent or acute CMV infection, and autopsy liver samples of four immunocompromised hosts (Group II, ICH) with overwhelming CMV infection have been studied in an occasional survey. In both groups, portal tract involvement, bile duct inflammation, liver cell degeneration and parenchymal granulomas were present. In Group I, a randomly distributed hepatitis with predominant involvement of the periportal areas was present, including sinusoidal arrays of lymphocytes and lymphohistiocytic aggregates. In contrast, in Group II liver cell damage was more extensive and the inflammatory infiltration only scarce. Intracellular viral inclusion bodies were found only in Group II, both in liver cells and in bile duct epithelium. Morphologically, the presence of viral inclusion bodies correlated well with the immunohistologic demonstration of CMV specific "late" (CMV-LA) or structural antigens. In addition, CMV-specific &quo...
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The morphology and immunohistology in a case of malignant atrophic papulosis (Degos' disease), a rare vascular disorder of unknown etiology, are described. The vascular lesions affected middle class and small arteries and veins... more
The morphology and immunohistology in a case of malignant atrophic papulosis (Degos' disease), a rare vascular disorder of unknown etiology, are described. The vascular lesions affected middle class and small arteries and veins throughout the body and were histologically characterized by intimal proliferation in the absence of any appreciable inflammation. The lesions were categorized as early, intermediate or late. Early lesions consisted of cellular proliferation and edema of the intima with signs of immune complex deposition (IgM, C3). Thrombosis was occasionally present as a secondary phenomenon in the affected vessel segments. In intermediate lesions the edema decreased and smooth muscle proliferation became apparent. Late lesions consisted of acellular intimal sclerosis with hyalinization and narrowing or obliteration of the vascular lumen. The media of the vessels remained always intact. In comparing these features to the pathology and pathogenesis of other vascular disorders they resembled the vascular lesions in a murine model of lupus erythematodes in which also considerable intimal proliferation occurred with thrombotic occlusion, but without appreciable inflammation. The murine model is associated with sustained low levels of circulating immune complexes and it is tempting to assume the same for Degos' disease. The notion of an immune complex mediated non-inflammatory condition underlying this severe and often fatal vascular disorder of mainly young males may contribute to the eventual finding of a successful therapeutical regimen.
Research Interests: Adolescent, Humans, Male, Skin, Skin Diseases, and 3 moreClinical Sciences, ENDOTHELIUM, and Renal Artery
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... any loss of neuroblasts may be compensated for by increased mitotic activity of the ventricular zone (Ebels, Peters & Thijs, 1975). ... the most vulnerable period to the axonal reaction, while under normal circumstances the... more
... any loss of neuroblasts may be compensated for by increased mitotic activity of the ventricular zone (Ebels, Peters & Thijs, 1975). ... the most vulnerable period to the axonal reaction, while under normal circumstances the population of neuroblasts in the anterior horn and dorsal ...