Biomedical subjects
Publications and source records attributed to A Linhartová.
Hepatitis D virus (HDV) is a small, RNA-containing virus that requires the concomitant presence of Hepatitis B virus (HBV) in an obligate manner for its survival and pathogenicity. HDV infection is very uncommon in Czech Republic. The results of antiviral therapy of hepatitis D patients are not satisfactory. Alpha-interferon (alpha-IFN) in high doses (9-10 MU three times a week for 12 months) is usually recommended.
Within serological surveys 2001, prevalence of markers of hepatitis viruses A (anti-HAV), B (anti-HBc, HBsAg, anti-HBs) and for the first time also C (anti-HCV) was investigated. Sera were collected in 2001 and tested by respective kits AxSYM, Abbott. HAV: 2,623 sera were tested for the presence of anti-HAV antibodies. Comparison with serological surveys of 1984 and 1996 revealed again shifts of the age prevalence curve for anti-HAV antibodies towards higher age groups corresponding to time intervals between epidemiological surveys. High prevalence rates of anti-HAV antibodies (more than 20%) were only found for the population age groups who lived in the period of high incidence of VHA, i.e. up to 1965. The prevalence of anti-HAV antibodies increased by about 5-10% in the population under 20 years of age, the increase being significant and assumingly attributable to vaccination against VHA, and remained the same as in 1996 in the age group 20-29 years. HBV: 2,568 sera were tested for the presence of anti-HBc antibodies and 76 reactive specimens were further tested for the presence of HBsAg and anti-HBs antibodies. The prevalence of anti-HBc antibodies continuously increases with age. The total prevalence of anti-HBc antibodies calculated for the Czech population is 5.59% compared to 6.95% recorded in 1996. The calculated prevalence rate of HBsAg is 0.56% and that of anti-HBs antibodies is 3.99% for the non-vaccinee population. HCV: The prevalence rate of anti-HCV antibodies was 0.2% with 6 out of 2,950 sera testing positive. Age dependence could not be assessed because of the small number of positive persons. HCV infection is known to afflict high-risk groups, likely to escape a general serological survey, rather than the normal population.
A fibrolamellar variant of hepatocellular carcinoma with metastases in 2 regional lymph nodes was surgically removed from a girl, 17 years of age. This type of tumor has a typical histological pattern. Prognosis is found to be better than that of the common hepatocellular carcinoma.
Electron microscopy is an important supplementary tool in bioptic diagnosis of bone marrow lesions. The hematologically specialised clinical pathologist should better resort to it for all bone marrow investigations. The routine pathologist can focus attention at least on certain diagnostic cases, such as children, or on sequential biopsies with specific diagnostic problems. It will be necessary, in such cases, to use proper fixation and, before further processing to cut the bone marrow sample into small pieces without delay. Electron microscopy has worked well, in the context of our own material, for differential diagnosis between various forms of myelogenous leukemia, hypereosinophilia of bone marrow and lymphocytic leukemia as well as between immature multiple myeloma and malignant lymphoma, centrocytic/centroblastic malignant lymphoma and nodular sclerosis of Hodgkin's disease and in the diagnosis of megakaryocytic leukemia.
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In an endeavor to delineate an alveolar configuration that would reasonably mirror the natural state, polygonal shapes of normal alveoli were tabulated in histological sections from inflation-fixed specimens of 16 men aged 16-48 years. The resulting alveolar population varied from three- to ten-sided polygons with a preponderance of tetragons, pentagons, and hexagons. These observations were compared with the possible combinations of polygonal sections through various polyhedral models proposed by other workers and the five classical regular polyhedrons. The potential types of sections through the regular dodecahedron, i.e., a twelve-sided shape with faces consisting of pentagons, seemed to fit best with present findings, and this is suggested as an idealized configuration that might be useful in various geometric determinations, e.g., estimates of alveolar surface area and volume.
Lung tissue appearing macroscopically normal and remote from pathological lesions was examined in semithin and ultrathin sections of surgically excised lobes or entire lungs of 14 patients. Thin areas and apertures were found occupying some of the intercapillary areas of alveolar septa. Thin areas differ from normal intercapillary areas both by their lesser mean thickness and structure; collagenous and elastic fibers, processes of fibrocytes and intercellular substance are absent. Either two layers or only one layer of epithelial lining are encountered in such thin areas. Septal apertures correspond mostly to pores of Kohn by their dimensions. Only some exceed these dimensions or appear in a higher amount per length unit of the alveolar septum. In accordance with other authors we believe that both the thin portions and the apertures of alveolar septa could represent an early phase of destruction in initial stages of pulmonary emphysoma. Continuous epithelial lining in two emphysematous bullae is presented. Structurally, the lining cells are similar to type 2 alveolar epithelial cells, but their bronchiolar origin also has to be considered.
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To elucidate interrelations of airway inflammation and emphysema, bronchi from subjects with severe panlobular and centrilobular disease and normal lungs were compared. This disclosed an intense infiltration with chronic inflammatory cells, mucous gland hypertrophy, and thickening of bronchi, primarily in association with emphysema having a panlobular configuration. These changes complement a generalized thickening and inflammation of nonrespiratory bronchioles previously observed in these cases. We conclude that the panlobular pattern may be a close function of inflammatory thickening of the conductive airways to respective lungs and lung parts, but centrilobular emphysema is not reliant on these changes. The precursory defect for the centrilobular lesion instead has been shown to be a more peripherally oriented respiratory bronchiolitis around the centers of lobules.
Histological measurements in cases of severe paniobular and centrilobular emphysema and in normal lungs disclosed a generalized thickening of the walls of small airways in the panlobular group. With mathematical models, this was depicted as a potential basis for airway closure at higher than normal lung volumes and trapping of air. Lungs with mixtures of panlobular and centrilobular emphysema predominate in the general population, and the obstructive component of airways in this setting is likely a net result of multiple lesions. These may be common in varying degrees to both varieties of disease but especially characteristic of one form. Bronchiolar thickening is one such general process. Present findings suggest that this is prone to be linked to emphysema with a panlobular pattern.
Fenestrations of alveolar septa were found in 8 patients from a group of 9 in samples of macroscopically normal tissue from resected lobes or the whole lungs. Number and diameter of fenestrations related to the length of septa were in correlation with the severity of obstruction examined before operation. Most fenestrations were empty, less often were filled by pneumocytes 2, once by pneumocyte 1. Small fenestrations occurred in intercapillary parts of septa. Junctional complexes between pneumocyte 1 processes were found in margins of fenestrae. When destruction exceeded intercapillary parts of septa capillary circulation was damaged.
Our investigation of the radially affixed alveoli of nonrespiratory bronchioles showed that the interalveolar interval was basically constant for normal bronchioles of all sizes, with a mean value of 0.146 mm. The mean interalveolar interval increased significantly to 0.173 and 0.209 mm, respectively, in the two most severe grades of emphysema. The pattern of alveolar affixment to the walls of bronchioles was also altered in emphysema, with irregular interruptions, variations in size and shape of abutting luminal spaces, and loss of alveolar attachment surface. These changes reflected the disruptive phase of emphysema and corroborated previous studies. A dominant extrinsic force normally responsible for bronchiolar patency is thus compromised. Any bronchiole so affected would logically be prone to collapse or contracture of its wall, luminal deformities, diminution of luminal caliber, and retarded airflow.
One-time examination of the normal tissue of the major salivary glands outside the pathologic foci revealed sebaceous cells in the glandular ducts in about 10% out of 433 patients. In 8 of 45 patients with salivary gland was examined for the second time in a new operation material in necropsy with a time delay of 18 days to 13 years. Sebaceous cells were found in 2 examination in 3 persons, i.e. in almost 38%, which is statistically significantly higher percentage than in the group in the first examination. All 3 observations were positive up to 5 years after repeating excision. Dependence on the patient's age or on the basic diagnosis was not found. In carcinoma of the parotid gland extensive colonies of the sebaceous cells were present in the carcinoma at autopsy of this woman aged 81 a solitary carcinomatous focus in the lung was found 13 years after the removal of the tumor of the parotid gland. Microscopically it revealed the structure of a bronchiologenic carcinoma.
In the severest forms of emphysema the distance between neighbouring alveolar septa inserting to the walls of non respiratory bronchioles increases, and that by their disappearance. This reduces one of the externally acting forces which keep the bronchiole open, which subsequently results in secondary bronchial narrowing.
Among 103 girls between the ages of 1 year and the prepubertal period, who came to autopsy, the incidence of columnar epithelium on the ectocervix was 42.7%. The extent of this change was mostly small, exceeding 30% of the length of the ectocervix in only 9 subjects. In some girls, only areas of squamous metaplasia or residual columnar structures (glands, channels, nabothian cysts) were present. The diagnosis of columnar epithelium in photographs at low magnification or by colposcopy is least exact among older girls. Such diagnostic difficulties appear to be related mainly to the small extent of columnar epithelium and to the diminished structural difference between areas of the original squamous epithelium and the columnar epithelium on the ectocervix.
In an endeavour to elucidate the anatomical basis for the increased resistance to airflow which characterises the most peripheral conducting air passages in pulmonary emphysema, lumina of nonrespiratory bronchioles of lungs with mainly centrilobular disease were assessed for two- and three-dimensional features by: (1) determination of percentage conformity of the lumina of individual bronchioles in histological sections to hypothetical planes through cylinders (ie, ellipses with the same areas and circumferences), and (2) comparison of luminal areas at regular intervals along bronchiolar longitudinal axes. The lumina of most nonrespiratory bronchioles from normal lungs conformed closely to their respective ellipses, thus corroborating previous observations that they are normally cylindroid. In contrast, there was a substantial excess of plane section deformities in the lumina of nonrespiratory bronchioles from the emphysematous specimens. The incidence of stenotic bronchioles (by both diameter and area determinations) was also greatly increased in emphysema. Since there was a strong positive association between such stenotic lesions and bronchiolar deformity, the latter was concluded to be a major factor in bronchiolar restriction. Furthermore, these characteristics seemed to have three-dimensional expression, for the lumina of stenotic bronchioles in emphysema were irregular in a longitudinal fashion.
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A series of vaginal specimens from 327 autopsied female fetuses and girls up to the age of 13 years was studied. In one case the upper portion of the vagina was lined by an one-row mucus-free colomnar epithelium similar in appearance to that of the corpus endometrium.--In 21 girls, there were residual thelium.--An incomplete differentiation of the surface squamous epithelium was encountered in 7 girls.--Eight girls revealed dysontogenetic cysts in the deeper levels of the vaginal wall. When compared with similar lesions in adults, the typical columnar epithelium of the endocervical type, cysts with squamous lining, as well as adenocarcinoma were not encountered in the young age group examined. With the exception of cysts, the frequency of individual lesions in the vaginas of our series diminished with the increasing age towards puberty.