Electron microscopy in surgical pathology.
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Biomedical subjects
Publications and source records attributed to M J Williams.
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A male infant is described with severe micrognathia and bilateral duplication of the proximal phalanges of the index fingers, an association which is characteristic of the Catel-Manzke syndrome. In addition, he had dislocatable knees, which have not been described in this disorder before.
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A total of 617 patients diagnosed by their general practitioner, according to set criteria, as having premenstrual symptoms were treated in general practice for three menstrual cycles with either pyridoxine or placebo. Treatment was randomized and administered blind. In the 434 patients analyzed, an improvement was found in 7 of the 9 symptoms assessed for both treatments, but the differences between treatments did not reach conventional significance levels. However, improvement as measured by global assessment after three cycles was significantly greater in the patients treated with pyridoxine (p less than 0.02).
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Although the capability of electron microscopy to contribute to histopathologic diagnosis in selected instances, e.g., renal biopsies and biopsies of certain tumors, is generally recognized, its contribution in a broader range of surgical pathology accessions is not well established. To gain further information concerning this aspect of the use of electron microscopy, 7,193 surgical pathology reports, 290 (4 per cent) of which included electron microscopic findings, were analyzed; these reports represented all such accessions during the same single month at 20 VA medical centers. It was found that malignancies constituted 62 per cent of the lesions examined by electron microscopy but only 20 per cent of the total number of surgical cases examined by light microscopy. It was also found that the distribution of specimens by tissue site of origin differed considerably for specimens examined by electron microscopy and light microscopy; positive contributions of electron microscopy to diagnosis were found in 146 of the 290 electron microscopy cases (50 per cent), with higher percentages found in malignancies and in certain tissue site subsets (lower respiratory tract, soft tissue, kidney, skin, and lymph nodes with metastases); failure to examine some specimens (lung metastases to lymph nodes or other tissues and endobronchial biopsy specimens) suggests slight, but common, underutilization of electron microscopy in diagnosis.
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A computer program was developed to simplify the conventional method for determining the maximal contractile element shortening velocity at zero load (Vmax) by analysis of pressure-velocity graphs during the isovolumic contraction period. From an uncalibrated left ventricular (LV) pressure signal and its first derivative (dP/dt), the graph relating developed LV pressure (Pd) to the corresponding instantaneous value of (dP/dt)/28 Pd was constructed by the computer. The segment of the graph that encompassed approximately the second half of the isovolumic contraction period, as determined by analysis of the dP/dt waveform, was then extrapolated to provide V'max on the ordinate. This V'max was compared with the conventional Vmax obtained from calibrated LV and aortic pressure signals. In 5 dogs both in the control state and during inotropic (epinephrine, propranolol) and noninotropic interventions (phenylephrine or dextran infusion), a high degree of correlation was found relating V'max and Vmax both derived by either linear (Vmax = 0.91 V'max + 0.14; r = 0.933; P less than 0.001) or exponential (Vmax = 0.99 V'max - 0.06; r = 0.959; P less than 0.001) extrapolation of the pressure-velocity graph to zero load. By use of this program, Vmax can be easily and reliably estimated from the uncalibrated LV pressure signal and its first derivative.
Five pathologists from the United States visited the Soviet Union for three weeks in April 1978 to learn of the training in and the practice of pathology in that country. The major observations of the Americans were that (1) pathology is a medical specialty in the Soviet Union, with practice limited to anatomic pathology; (2) exfoliative cytology and clinical pathology are not part of pathology; (3) interest, both clinical and experimental, in occupational, environmental, and geographic pathology is conspicuous; (4) an autopsy rate of 90% to 95% is customary; and (5) there is an organized and hierarchical framework for practice, with career patterns established early and change infrequent.
Acute proliferative retrolental fibroplasia (RLF) has been studied in premature infants employing a Zeiss fundus camera and fluorescein angiography. A total of 164 angiograms have been performed on 122 infants. At the present time, angiography is reserved for studying infants with peculiar or puzzling fundus pictures. A dose of 0.1-0.4 cc of 10% sodium fluoresceinate is employed, depending on the age and the weight of the baby. Fluorescein clearly outlines the major arteriovenous shunt in the retina, which is the hallmark of acute RLF. The shunt fills with fluorescein and leaks it profusely. On regression, a fine brush border of capillaries is seen in the region where the shunt previously had been located. Study of the population susceptible to RLF reveals it to be the smallest sickest babies in the premature nursery.
Most infants in the UK are bottle fed with cows' milk formulae that are alleged to provide less than the minimum requirement for linoleic acid, i.e. 1% of the total dietary energy. 20 term infants fed solely on a modified cows' milk formula that provided 0.55% of the energy from linoleic acid were therefore examined for evidence of deficiency. Rates of growth in length and weight, measured during the first 3 months of life, were identical with those of 20 wholly breast-fed infants. Voluntary food intakes (kcal/kg per day) followed the normal pattern. The fatty acid composition of the plasma lipids showed changes characteristic of a low intake of linoleic acid, but triene:tetraene ratios did not indicate a deficiency state, and clinical signs of deficiency were not observed. These findings suggest that the requirement for linoleic acid is substantially less than was formerly believed. The small amount of alpha-linolenic acid present in cows' milk may however exert a sparing effect on linoleic acid.
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Phasic coronary arterial flow responses to nitroglycerin were evaluated in 15 open-chest greyhounds before and after aorta-coronary saphenous vein grafting. Coronary flow was measured with electromagnetic probes proximal and distal to the vein graft site. Simultaneous measurements of branchiocephalic flow, aortic and left atrial pressure, left ventricular pressure, and dp/dt were made. Grafts were placed during normothermic hemodilution cardiopulmonary bypass and induced ventricular fibrillation. Before grafting, intravenous nitroglycerin (0.6 mg.) elicited an abrupt rise in diastolic coronary flow which decreased as aortic pressure fell and systolic coronary flow increased. However, after grafting, nitroglycerin elicited no change in diastolic coronary flow, whereas systolic coronary flow increased and aortic pressure fell. In 6 control dogs treated similarly except for aorta-coronary grafting, coronary flow responses to nitroglycerin were unchanged. These acute experiments suggest that, in dogs with aorta-coronary saphenous vein grafts, the coronary dilating effect of nitroglycerin is virutally abolished.
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Leukocytes from 33 patients with Crohn's disease, 20 patients with ulcerative colitis, and 20 patients with ankylosing spondylitis were tested for evidence of abnormal migration in the presence of preparations of colon from a patient with Crohn's disease. None of the patients was on treatment with immunosuppressive drugs. The test was also performed with leucocytes from 12 health subjects. Significant alteration was seen in the Crohn's disease group, particularly when the antigen used was mitochondrial or microsomal fraction of colon mucosa, whereas the patients in the ulcerative colitis group showed reactivity only with the whole colon homogenate and not with the subcellular fractions. The ankylosing spondylitis group showed no statistical difference from the normal controls with any of the antigens.