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PubMed1998

Evolution of Schistosoma haematobium-related pathology over 24 months after treatment with praziquantel among school children in southeastern Tanzania.

Little is known about the dynamics of pathology due to schistosomiasis following treatment. Public health authorities in endemic areas require such information to decide on the timing of treatment and re-treatment schedules. A study to assess the rate of clearance and reappearance of pathologic lesions due to Schistosoma haematobium using ultrasound has now been carried out in two schools in southeastern Tanzania, an area of moderate-to-high transmission. Baseline data collection found urinary tract pathology in 67% of 533 children. Lesions of the bladder were significantly associated with egg positivity and microhematuria. The attributable fraction estimate of major bladder lesions due to S. haematobium was 75%. In a cohort study, 224 infected children were examined by ultrasound and then treated with a standard dose of 40 mg of praziquantel/kg of body weight. They were re-examined at two, four, six, 12, 18, and 24 months after treatment. Before treatment, 76% had pathologic lesions of the urinary tract. The proportion showing lesions decreased sharply during the first months after treatment to 11% at six months. At 24 months, lesions were detected in 57%, and 11% had developed new severe pathology. In 18 cases, pathology was present throughout, and 34 did not show any pathology throughout the study. This study provides the first detailed report on the evolution of urinary tract pathology due to S. haematobium infections at the community level. The results will help in making decisions on treatment and re-treatment schedules and more generally will provide a basis for designing control strategies in areas of moderate-to-high transmission.

Adolescent↗
PubMed2006

Role of pathological cardiotocography in evaluating fetal well-being.

OBJECTIVE: To determine the frequency of pathological pattern of cardiotocography (C.T.G) in antepartum and intrapartum period and to evaluate the significance of those patterns in determining fetal well-being. DESIGN: Analytical study. PLACE AND DURATION OF STUDY: The study was conducted at Lady Dufferin Hospital, Karachi from February 2000 to January 2001. PATIENTS AND METHODS: All women with singleton pregnancies of >35 weeks gestation and cephalic presentations were electronically monitored in antepartum and intrapartum period and those with pathological trace were identified according to International Federation of Obstetricians and Gynaecologists (FIGO) classification. After delivery, Apgar score, fetal cord, blood gas values and neonatal intensive care unit admission duration were examined as the main outcome measures. RESULTS: Among the 3701 patients who qualified for the study, 60 (1.62%) had tracing, classified as pathological, of which 44 (73%) were in the intrapartum and 16 (27%) in the antepartum period. Out of these 60 patients, 53 (88.33%) were delivered alive while neonatal death (NNDs) occurred in 9 (16.9%) of the live born babies. There were 07 (11.6%) still births. In 53 of live born babies, Apgar score was <7 at 1 minute in 34 (64.15 %), while it was >7 at 1 minute in 19 (35.84%). Low Apgar score persisted at 5 minutes in 10 (18.86%) cases of pathological CTG. Out of these 10, there were 3(30%) NNDs, while 6 (13.95%) NNDs occurred in those whose apgar had improved to >7 at 5 minute (P=0.9). Cord pH results were available in 31 (58.49 %) cases and were acidotic (<7.20) in 16 (51.61%), pre-acidotic (7.20-7.25) in 9 (29.03%) and normal (7.25-7.35) in 6 (19.35 %). All alive born babies with a pathological CTG tracing were admitted in NICU as per hospital policy. The duration of admission was less than 24 hours in 15 (28.30 %), 2-4 days in 26 (49%) and more than 4 days in 12 (22.64%). CONCLUSION: In this series, an increased frequency of detectable hypoxia on CTG was observed during the intrapartum period as compared to the antepartum period, however, no significant association was found between a pathological CTG recording, fetal APGAR score and acidemia, if a pathological trace is used alone to assess fetal well-being. An increased cesarean section rate in babies with a pathological CTG stresses on the need for additional tests to differentiate hypoxic from non-hypoxic fetuses thus avoiding unnecessary intervention.

Apgar Score↗
PubMed1999

Placental pathologies are not associated with hyperuricemia in preeclamptic pregnancies.

The mechanism of hyperuricemia in preeclampsia remains unknown. As the breakdown of the nuclear rich syncytiotrophoblast might result in the increased formation of uric acid from purine catabolism, the purpose of this study was to investigate whether placental pathologies were associated with hyperuricemia in preeclamptic pregnancies. We retrospectively reviewed medical reports with the availability of maternal serum uric acid levels and placental pathology reports of 83 singleton, preeclamptic pregnant women at Yale-New Haven Hospital. Preeclampsia was defined by the American College of Obstetricians and Gynecologists criteria. Hyperuricemia was defined as, at least greater than or equal to, two standard deviations of normal mean values for gestational age. The placental pathological findings include infarction, syncytial knots, abruption, intravillous thrombosis, and villous pathology (i.e., edema, villitis). The relevance of hyperuricemia to the individual placental pathologic finding and the numbers of placental pathologic findings were investigated. Statistical analyses were performed using contingency table methods. We found that there was no significant correlation between hyperuricemia and individual or multiple placental pathologic findings. We concluded that placental pathologies secondary to ischemic changes may not fully explain hyperuricemia in preeclamptic pregnancies. A prospective study using morphometric measurements is needed to understand the exact role of ischemic placental damage on the maternal serum uric acid level.

Data Interpretation, Statistical↗
PubMed1999

[Central nervous system mechanisms of pathological pain].

Unlike physiologic pain which has a signal, adaptive role, pathologic pain is a pathogenic factor causing disturbances in activity of organism systems. Current views on the nature of pathologic pain are mainly concerned with neurochemical and plastic processes occurring in nociceptive neurons but not with systemic mechanisms of pathological pain. This limitation has been overcome with elaboration of the pathophysiologic theory of generatory and systemic mechanisms of algesic syndromes. According to this theory, a pathogenetic basis for a pathologic pain are formation and functioning of new pathologic integrations within algesthesia system--an aggregate of changed nociceptive neurons acting as a generator of pathologically enhanced excitation and a new pathodynamic organization from changed parts of algesthesia system which represents a pathological algic system. This theory is competent to explain many peculiarities of pain syndromes without denying cell-mediated and neurochemical mechanisms of pathological pain.

Calcium Channels↗
PubMed1997

Reperfusion nerve injury: pathology due to reflow and prolonged ischaemia.

Ischaemia plays an important role in the development of pathological changes in various neuropathies. Nerve pathology in acute ischaemic injury has been delineated longitudinally in peripheral nerve and reperfusion injury could amplify ischaemic pathology. We examined ischaemia/reperfusion-induced pathological changes along the length of sciatic, tibial and peroneal nerves from pelvic to ankle levels. Pathological features were correlated with the degree of postischaemic nerve blood flow (NBF) restoration, measured by a laser Doppler flowmeter, and the blood-nerve barrier function by a horseradish peroxidase (HRP) technique. Major arteries which supply rat hindlimb were occluded for 3, 5, or 7 hours, and reperfusion was accomplished by the removal of vascular clips. Nerve pathology was assessed after 12, 24 and 48 hours, and 5 and 7 days of reperfusion. Pathological alterations at the thigh level included vascular swelling, endoneurial and intramyelinic oedema, demyelination, thrombosis, and red blood cell (RBC) extravasation. A paucity of axonal degeneration was also characteristic at this level. By contrast, the distal nerve from knee to ankle showed evidence of extensive axonal changes, occluded vessels, and panfascicular nerve fibre and vascular degeneration. Postischaemic NBF reflow was confirmed at the thigh level immediately, 24 and 48 hours after reperfusion, whereas NBF restoration at the knee to calf level was less than preischaemic values. HRP leakage was found in both proximal and distal nerve segments. In conclusion, we demonstrated different types of structural changes along the length of ischaemic/reperfused rat sciatic nerves. The present study suggests that pathological abnormalities at the thigh level are most likely due to reoxygenation of ischaemia-inflicted endothelial cells, and distal morphological changes could be induced by prolonged ischaemia resulting from occluded vessels.

Animals↗
PubMed2000

Predicting pathological stage of localized prostate cancer using volume weighted mean nuclear volume.

PURPOSE: With the use of prostate specific antigen (PSA) and transrectal ultrasound guided biopsy of the prostate, increasing numbers of clinically localized prostate cancers have recently been detected. Presently, approximately 60% of men newly diagnosed with prostate cancer are believed to have organ confined disease but at the time of surgery less than 50% are ultimately found to have organ confined disease on final pathological analysis. Prediction of pathological stage before surgery using various prognostic factors is needed to determine whether radical prostatectomy is indicated. We have reported that estimates of volume weighted mean nuclear volume can accurately predict the prognosis of clinically localized prostate cancer treated with androgen ablation. In this study we examine whether estimates of mean nuclear volume can predict the pathological stage of cases treated with radical prostatectomy. MATERIALS AND METHODS: A retrospective, prognostic study of 52 patients with clinically localized prostate cancer (21 cases T1c, 27 T2, 4 T3) diagnosed at Kobe City General Hospital between January 1996 and December 1999 and treated with radical prostatectomy was performed. Unbiased estimates of mean nuclear volume measured from transrectal biopsy specimens were compared with PSA at diagnosis, clinical stage, estimated tumor volume and Gleason score with regard to prediction of pathological stage. RESULTS: Univariate analysis revealed that estimates of mean nuclear volume (p <0.0001), PSA at diagnosis (p = 0.0148) and estimated tumor volume (p = 0.0005) significantly correlated with pathological stage but Gleason score did not (p = 0.2011). In addition, multivariate logistic regression analysis demonstrated that estimates of mean nuclear volume (p = 0. 0073), PSA at diagnosis (p = 0.0277) and estimated tumor volume (p = 0.0197) were significantly independent predictors of pathological stage. CONCLUSIONS: The results of our study suggest that combining PSA and estimated tumor volume with estimates of mean nuclear volume can significantly contribute to the prediction of pathological stage of prostate cancer. We recommend use of these 3 factors to predict pathological stage of prostate cancer before surgery.

Aged↗
PubMed2001

[Standards, options and recommendations: practice guidelines for difficult diagnosis in surgical pathology or cytopathology in cancer patients].

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993 is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for difficult diagnoses in surgical pathology or cytopathology in cancer patients. METHODS: Data were identified by searching Medline and using the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to 71 independent reviewers. RESULTS: The main recommendations to prevent and reduce the number of difficult diagnoses in surgical pathology or cytopathology are: 1) The development of quality insurance programs with use of written procedures in each pathology laboratory (standard). 2) The knowledge of clinical data in order to explain surgical pathology or cytopathology results (standard). 3) The availability of complementary patient informations (radiologic data . . .) can be useful to explain surgical pathology or cytopathology results (option). The main recommendations to detect lesions associated with difficult diagnosis in surgical pathology or cytopathology are: 1) Tumor types known as potential difficult diagnosis in surgical pathology or cytopathology should be reviewed by a second pathologist. 2) The systematic second reviewing for every case is expensive but has to be done when the difficulty is know (sarcoma, lymphoma . . .) by experienced pathologists. The main recommendations to solve difficult diagnosis in surgical pathology or cytopathology are: 1) Block recuts, use of special techniques (immunocytohistochemistry and molecular biology), additional data from clinicians, second opinion by a local pathologist, or new specimen can be required for establishing the diagnosis (options). 2) Outside second opinion by expert pathologist has to be considered once the other steps did not allow to establish surgical or cytopathology diagnosis (recommendations, expert agreement).

Humans↗
PubMed2002

Helical CT of the stomach: differentiation between benign and malignant pathologies, together with the staging of gastric carcinoma.

OBJECTIVES: To evaluate the capacity of Helical Hydro-CT to differentiate between benign and malignant gastric pathologies, and also to measure its usefulness in the staging of gastric carcinoma. PATIENTS AND DESIGN: We perform a cross-sectional study to evaluate the diagnostic efficacy of CT, including patients prospectively. We study 92 patients with a clinical suspicion of gastric pathology using helical CT with a contrast agent (HCTC), water being the oral contrast agent, and i.v. iodine contrast. According to the findings of previous works, we considered stomachs to be normal when the thickness of their wall was less than or equal to 6 mm, with a multilayered appearance that stands out homogeneously with the i.v. contrast. A malignant tumour was diagnosed if the thickness of the wall was greater, together with strong marking by the contrast agent and loss of the normal multilayered pattern. Parietal thickening was classified as gastritis if there was no excessive marking and no loss of the layered pattern. Masses with smooth borders, intraluminal growth and a rounded morphology were diagnosed as sub-mucosal tumours. The results of our 92 studies were compared in all cases with the findings of endoscopic studies, while in the 52 patients treated with surgery they were compared against surgical findings. RESULTS: In 12 of the 92 patients studied using HCTC no gastric pathology was observed by CT or endoscopy. Of the 80 pathological cases CT was used to diagnose 29 as benign pathology, 19 of which were confirmed as such by histology, and 51 cases as malignant pathology, of which 49 were confirmed by histology. We obtained a sensitivity of 81.7% in the diagnosis of malignant pathology and a specificity of 90%, with a PPV of 96% and a NPV of 62%. Regarding TNM staging (in comparison with the 1997 TNM classification), the diagnostic reliability obtained amounted to 56% for T and N, and 87% for M. CONCLUSIONS: Helical hydro CT makes it possible to diagnose advanced gastric carcinoma. Its usefulness basically lies in the evaluation of metastatic neoplastic disease. It has also been shown to be useful in the diagnosis of benign pathologies. It is not a good screening method for the diagnosis of gastric carcinoma.

Aged↗
PubMed2002

[Benign breast diseases: clinical, radiological and pathological correlation].

INTRODUCTION: Benign lesions of the breast are common; however, benign pathological states have always been neglected in comparison to cancer even though they account for as much as 90 percent of the clinical presentations related to breast. A useful classification system for benign breast disease has been described by Love and colleagues and is based on symptoms and physical findings, six general categories have been identified, which include physiological swelling and tenderness, nodularity, mastalgia, dominant lumps, nipple discharge, and inflammation. Another classification system developed by Page and coworkers separates the various types of benign breast lesions into three clinically relevant groups: non-proliferative lesions, proliferative lesions without atypia, and proliferative the histopathological evaluation of the biopsy specimen in order to determine the subsequent risk of developing carcinoma if the lesions represents atypia of lobules or ductal epithelium. OBJECTIVE: The study was made to evaluate the clinical, radiological and pathological correlation of the benign breast lesions. METHODS: We studied women aged 40 years or less that went to the Foundation Rodolfo Padilla Padilla by mastalgia or the presence of a mass. We determined the Kappa coefficient in order to identify the agreement between the three observers according to different pathologies: fibroadenoma, abscess, cyst, mastitis, fibrosis, and cancer. RESULTS: We made 698 breast Ultrasounds in women younger 40 years, we found 52% ultrasound normal and 48% were reported with benign breast pathology: fibroadenomas 38%, cyst 27%, dilated ducts 24%, benign nodule 4%, mastitis 3%, ectasia 2%, and abscess 2%. The correlation was made to 58 patients, finding the following coefficients kappa. Fibroadenoma: when evaluating the clinical examination versus ultrasound: K = 50%. Cysts: when evaluating clinical examination versus ultrasound: K = 17%, when evaluating ultrasound versus pathology: K = 3%. Fibrosis: when evaluating clinical examination versus ultrasound: K = 56%, when evaluating ultrasound versus pathology: K = 50%, when evaluating ultrasound versus pathology: K = 50%. CONCLUSION: The benign breast pathology must be studied carefully because the clinical and ultrasonic evaluation is not conclusive, and the histopathological evaluation of the biopsy specimens sometimes is necessary to discard malignancy.

Adult↗
PubMed2003

[A comparative study on radiology and pathology target volume in non-small-cell lung cancer].

OBJECTIVE: Defining the margin of clinical target volume (CTV) is very important for three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiation therapy (IMRT). In this study, according to the comparison between gross tumor volume (GTV) silhouetted by radiology and pathology in non-small-cell lung cancer (NSCLC), we tried to define the correlation of GTV by radiology and pathology, and assess the degree of correlation to local microscopic extension (ME) among different pathologic types of NSCLC, so as to define the margin of CTV precisely. METHODS: From February 2001 to February 2002, forty-three NSCLC patients after surgical resection were studied. All patients had had CT scans of the chest before surgery and routine pathology examination after surgery. The tumor size at X (lateral direction), Y (ventrodorsal direction) and Z (craniocaudal direction) axes were measured on CT. Also by pathology examination, the tumor size at X, Y, Z axes and the degree of ME at X, Y, Z axes were measured, respectively. RESULTS: Without taking into account the value of ME, there was almost total agreement on the GTV by radiology and pathology in three dimensions. The mean value of ME was 2.18 mm for adenocarcinoma (ADC) and 1.33 mm for squamous cell carcinoma (SCC) (P = 0.001). But, taking into account 95% of the ME, a margin of 7 mm and 5 mm must be allowed for ADC and SCC, respectively. CONCLUSION: There exists a correlation of GTV by radiology and pathology. In the target volume defining for 3DCRT and IMRT, we could use the GTV by radiology instead of the GTV by pathology, with the ME being different for ADC and SCC. To cover 95% of the ME, the margin from GTV to CTV must be extended to 7 mm and 5 mm for ADC and SCC, respectively.

Adult↗
PubMed1992

[Pathologic-HRCT correlation of pneumoconiosis--a study on inflation-fixed lungs].

High resolution computed tomography (HRCT) findings were correlated with pathologic features of 14 inflation-fixed postmortem lungs with pneumoconiosis to evaluate the ability of HRCT to depict pneumoconiotic changes. The results are as follows: 1) Irregular peribronchiolar and interlobular fibrosis was the most constant pathologic feature in all lungs. This pathologic finding corresponded to an area of hazy increased density or reticular density on HRCT. The reticular density on HRCT became coarser with the progression of fibrosis. Mild fibrosis, confirmed by histologic procedures, could not be detected with HRCT. 2) Subpleural curvilinear line seen on HRCT in 5 lungs corresponded to band-like zone of fibrosis containing bronchioles or zone of collapsed alveoli with fibrotic thickening on histologic sections. A subpleural band-like zone of organized pneumonia was recognized in 2 cases. Subpleural patchy density was seen on HRCT in 8 cases. Five of them were histologically a focus of fibrosis and the other 3 were localized pulmonary edema, organized pneumonia, or atelectasis without fibrosis. 3) Pneumoconiotic nodules were located at centrilobular portion or along interlobular septa on histologic sections. These location were correspond to HRCT findings. They were round with irregular borders and were surrounded by a zone of enlarged air space. Overall 71% (182/256) of pathologically proved nodules were seen on HRCT, but 63% (52/83) of small "p" type nodules (smaller than 1.5 mm) could not be detected. Enlarged air space at the periphery of the nodules was seen on HRCT in 78% (122/156) of those pathologically proved. 4) A total of 12 lesions of progressive massive fibrosis was found in 5 lungs. An irregular border, seen on HRCT in all lesions, was pathologically based on the fibrosis extending into the surrounding alveoli and partially confluencing pneumoconiotic micronodules. Pleural indentation was seen in 8 lesions. Patent residual bronchi, spared from destructive fibrotic change, were seen as strand-like air density on HRCT in 4 of 6 lesions. 5) Focal emphysema was found pathologically in 9 of the 14 lungs. They appeared as non-peripheral, small low-attenuation area with a central dot on HRCT. The dot histologically corresponded to fibrosis around centriacinar bronchovascular bundle. The limit of visibility of this form of emphysema on HRCT was 2.0 mm in size. When emphysema was complicated by pneumonia, some showed honeycomb appearance on HRCT. 6) It is concluded that HRCT can detect and quantify the various pneumoconiotic changes of the lung and the HRCT-pathological correlation data presented here will be useful for the interpretation of the findings in clinical cases of pneumoconiosis.

Aged↗
PubMed2004

[The clinical characteristic of electroglottography curves of pathological voice in adult].

OBJECTIVE: To discuss the clinical characteristic of Electroglottography (EGG) curves of pathological voice in adult. METHOD: Four hundred and fifty-three adults with pathological voices were examined by EGG and the abnormal EGG curves were analyzed. RESULT: (1) the EGG cycle was composed of contact phase (CP) and open phase (OP), the ratio of CP/OP was between 0.70 to 2.95, otherwise it was abnormal; (2) the CP was composed of closing-contact phase (CCP) and contact-opening phase (COP); the OP was composed of opening-open phase (OOP) and open-closing phase (OCP); (3) the abnormal formations of every phases in vibration cycle contained: smooth CCP, notches in CCP, flat in wave peak, steep COP, notches in COP, knurls in COP, knurls in OOP and in OCP; duplicate waves and irregular waves were fewer, but they reflected the special vibratory patterns of pathological voices; (5) Each abnormal formation fell as the follow: COP>OP>CCP. Each pathological voices presented different characteristics; (6) combined variance appeared in part pathological voices, such as single vocal polyps, double vocal polyps, Reinke edema and glottic laryngocarcinoma. COP combined with OOP was the most usual. CONCLUSION: The abnormal variance formations of EGG curves of pathological voices in adult are intricate and they have inherent relations with each other. The establishment of OP variance increases the pathological EGG and the OP abnormities is CP abnormities. There are different orientations and rules in different pathological voices.

Adult↗
PubMed2005

[Pathologic proximal femoral fractures in children in an unicameral bone cyst].

PURPOSE OF THE STUDY: Proximal femoral fractures in children are rare, pathologic fractures being extremely rare. Despite many meanings these fractures are still "unsolved" there are some definite rules for treatment of true accidental injuries. Pathologic fractures are outstanding with their extremely rare incidence. The aim of the study is to overview a large clinical material, find out the incidence of this pathologic fracture, the extent and shape of the unicameral bone cyst (UBC), specific therapeutic approach, technical problems of eventual osteosynthesis, number of reoperations and sequels. MATERIAL: Altogether 49 children with 50 accidental and pathologic fractures of proximal part of the femur treated in the Regional Pediatric Trauma Centre of the Department of Pediatric and Trauma Surgery, 3rd Faculty of Medicine, Charles University, Prague. METHODS: Retrospective and prospective study of children (0 to 15 years of age) treated with proximal femoral accidental and pathologic fractures during the 20 year period (from August 1984 to November 2004). Classification of fractures according to Delbet and Colonna. Diagnosis of bone cyst with plain X-rays, eventually CT scans. RESULTS: During the 20 years period (August 1984 to November 2004) 49 children with 50 proximal femoral fractures were treated in the Department. Four patients sustained a pathologic fracture through an unicameral bone cyst. Two of these latter children were treated by an open reduction and osteosynthesis with the use of the proximal femoral AO-ASIF angled-plate and two children nonoperatively using skeletal traction because of impossibility of insertion of the osteosynthetic material without a damage of the growth plate. Subsequent operations of the UBC were necessary in these two children. All four patients recovered well without sequels. DISCUSSION: Pathologic fractures in UBC are usually treated nonoperatively and the cyst itself is treated after fracture healing. Proximal femoral impairment is the exception from this rule because of weigh bearing necessity. However, there may be problems with insertion of the implant when the cyst is very near to capital physis and traction treatment is then the method of choice with a delay of operative treatment of the cyst. CONCLUSIONS: Pathologic proximal femoral fractures in UBC are extremely rare and need individual approach. Some of them should be operated on the others primarily treated by traction with secondary operation of the cyst. Complications can be frequent.

Bone Cysts↗
PubMed2006

[HSC transplantation-associated intestinal thrombotic microangiopathy: clinical pathological features, diagnosis criteria and treatment].

Thrombotic microangiopathy (TMA) is a lethal transplantation-associated complication which exactly likes acute intestinal graft-versus-host disease (GVHD) in the clinical manifestation. 373 consecutive patients with hematological diseases received family HLA matched or mismatched HCT from May, 2002 to July, 2004. To analyse the clinical and pathological characteristics of TMA, 30 patients who suffered from severe diarrhea and received colonoscopic examination and gut biopsy were retrospectively analyzed. The results indicated that 7 patients originally diagnosed as gut GVHD showed the pathological evidence of enteric TMA. The incidence of TMA was 7 out of 30 specimen (23.3%). Pathological evidence of enteric TMA shown microvascular disorder characterized by thrombus in the capillary without infiltration of lymphocytes and perivascular hemorrhages in the mucosa, swelling and focal denudation of epithelial cells. All patients with TMA were associated with cytomegalovirus (CMV) antigenemia/disease. Among these patients, 4 cases, who only showed TMA without the evidence of gut GVHD pathologically, displayed treatment-resistant bloody diarrhea, renal failure, veno-occlusive disease, hemorrhagic cystitis, hemolytic anemia as well as thrombocytopenia. But the other 3 cases, with co-existence of both TMA and GVHD pathological characteristics had better treatment response. Survival analysis indicated that 3 patients with TMA-GVHD survived for 461 to 536 days but three out of four TMA patients died from VOD with liver failure as well as multiple organ failure during 101 to 254 days after HCT. In conclusion, to better diagnose those patients with severe and refractory diarrhea following HCT, pathological examination may indicate crux evidence to identify intestinal TMA from gut GVHD. Furthermore, this primary report has first evidenced that TMA and TMA-GVHD are two pathologically well-recognized subtypes with the difference between the pathological characteristics, treatment response and clinical outcomes.

Graft vs Host Disease↗
PubMed2006

Pathological gambling: comorbid psychiatric diagnoses in patients and their families.

OBJECTIVES: Pathological gambling is a highly prevalent and disabling impulse control disorder. Recent studies have consistently demonstrated that pathological gamblers respond well to treatment with selective serotonin reuptake inhibitors, mood stabilizers and opioid antagonists. These findings have supported the observation that pathological gambling is associated with anxiety and mood spectrum disorders as well as addictive disorders. METHODS: Fifty-two male pathological gamblers and their first-degree relatives (n=93) completed a semi-structured DSM-IV-based diagnostic interview as well as a series of data collection instruments including the South Oaks Gambling Scale, the Hamilton Rating Scale for Depression, the Hamilton Rating Scale for Anxiety, the Yale-Brown Obsessive-Compulsive Scale, and the Young Mania Rating Scale. The study subjects and their first-degree relative were compared to demographically matched normal controls (n=96). RESULTS: We found higher prevalence of alcohol, substance abuse, problematic gambling, depression, and anxiety disorders in the pathological gamblers and their first-degree relatives than in the control group. In particular, the scores on the Hamilton Rating Scale for Depression, the Hamilton Rating Scale for Anxiety, and the Yale-Brown Obsessive-Compulsive Scale were higher in the study group than in the control group. CONCLUSIONS: Our finding of a high prevalence of psychiatric comorbidity in pathological gamblers and their families raises the question of the proper classification of pathological gambling in the DSM-IV. Furthermore, the pattern of psychiatric disorders seen in the first-degree relatives can lead to new insights about the etiopathology of pathological gambling.

Adult↗
PubMed1994

Significant medical pathology uncovered by a comprehensive male infertility evaluation.

OBJECTIVE: To determine if there was a specific screening regimen that could identify all patients with significant medical pathology found during a comprehensive male infertility evaluation. DESIGN: A retrospective study. SETTING: Two university-based male infertility clinics. PATIENTS: Thirteen patients with male factor infertility identified with significant medical pathology. MAIN OUTCOME MEASURES: Initial presentation, history, physical examination, semen analysis, and hormone profile. RESULTS: The identification of significant medical pathology was uncovered in 13 of 1,236 patients (1.1%) presenting to a male infertility clinic. The pathology was identified with a thorough history in 4 of 13 patients (30.8%) and by a complete physical examination in 8 of 13 patients (61.5%). Semen analyses were available on 12 patients, and 1 patient was anejaculatory. Two patients were azoospermic. Of the patients with sperm present, the mean sperm concentration was 8.6 x 10(6)/mL (range, 0.8 to 27), and the mean sperm motility was 32.0% (range, 0% to 65%). In 5 patients, endocrine abnormalities were specifically related to the subsequent pathology identified. A tumor was identified in 10 patients (6 testicular tumors, 3 brain tumors, and 1 spinal cord tumor). Two patients had ejaculatory dysfunction as a result of mesonephric duct anomalies affecting the ejaculatory duct or bladder neck closure. One patient had Klinefelter's syndrome. CONCLUSIONS: There was no pathognomonic finding on history, physical examination, semen analysis, or hormone profile that identified all patients with significant medical pathology. The significant medical pathology identified was represented in all semen quality groupings, that is, azoospermia, severe oligospermia, mild oligospermia, and normospermia. We recommend a comprehensive urologic evaluation for all male partners of infertile couples with a male factor or unexplained infertility in an attempt to identify significant and potentially treatable medical pathology before engaging in a series of therapies with assisted reproductive techniques.

Adult↗
PubMed1996

Standard versus age-specific prostate specific antigen reference ranges among men with clinically localized prostate cancer: A pathological analysis.

PURPOSE: Age-specific prostate specific antigen (PSA) references ranges have been suggested to account for the age-dependent nature of the serum PSA concentration. It has been hypothesized that reference ranges of 0 to 2.5 ng./ml.serum PSA (40-49 years), 0 to 3.5 ng./ml. (50-59 years), 0 to 4.5 ng./ml. (60 to 69 years) and 0 to 6.5 ng./ml. (70 to 79 years) would detect fewer (potentially insignificant) prostate cancers in older men and more (potentially curable) cancers in younger men. MATERIALS AND METHODS: To investigate the pathological stage of tumors that would be affected by the use of age-specific PSA references ranges, we reviewed the medical records for 4,597 men with clinically localized (stage T1c, T2, or T3a) prostate cancer, with an average age of 62 +/- 7 years (range 38 to 76), who underwent radical prostatectomy between 1984 and 1994 at our institutions. Favorable pathological results were defined as organ-confined disease or capsular perforation with a Gleason score of less than 7, and unfavorable pathological results were defined as capsular perforation with a Gleason score of 7 or more, seminal vesicle invasion or lymph node involvement. RESULTS: Overall, 18% of the men had PSA levels less than the standard PSA reference range (4.0 ng./ml.) compared to 22% when using the age-specific ranges. There were 74 more cancers detected in men younger than 60 years with the use of age-specific ranges, of which 81% had favorable pathological results. Among the men 60 years or older, 191 of 252 cancers (76%) not detected by using age specific ranges less than 3% were also stage T1c and 95% of these undetected T1c cancers were of favorable pathological status. Of those cancers not detected in older men with the age-specific ranges were of favorable pathological status. Of those cancers not detected in older men with age-specific ranges less than 3% were also stage T1c and 95% of these undetected T1c cancers were of favorable pathological status. Age-specific PSA reference ranges increased the potential for detection of prostate cancer by 18% in the younger men and decreased the detection by 22% in the older men. CONCLUSIONS: Among these men with clinically localized prostate cancer, age specific PSA references ranges increased the detection of more potentially curable tumors in young men and decreased the detection of less advanced tumors in the older men compared to the standard reference range of 4.0 ng./ml. Among older men with nonpalpable (stage T1c) tumors age-specific PSA references ranges would have detected fewer tumors. However, 95% of these "missed" tumors would have had favorable pathological findings.

Adult↗
PubMed1997

Emerging and reemerging infections. Progress and challenges in the subspecialty of infectious disease pathology.

Emerging and reemerging infections are attracting greater attention from the public health and medical communities. Pathologists and other physicians are increasingly aware of the importance of the subspecialty of infectious disease pathology as a tool for diagnosis, surveillance, and research of emerging infections. In this communication, we describe the role that infectious disease pathologists have played during the last 2 years in broadening our understanding of selected emerging infections, including such examples as new variant Creutzfeldt-Jakob disease and bovine spongiform encephalopathy, leptospirosis, microsporidiosis, Ebola hemorrhagic fever, and cyclosporiasis. The significance of providing pathology services, especially the autopsy, to patients with potentially hazardous communicable diseases is discussed with the supposition that it is unethical to exclude or withhold health care from a patient based on his or her underlying disease or on risk factors for acquiring a disease. The increasing occurrence of infectious diseases imported into the United States and other nations, including human immunodeficiency virus-1 group O, dengue fever, tuberculosis, malaria, diphtheria and cholera in immigrants and travelers, and Ebola virus in nonhuman primates, emphasizes the necessity for pathologists of having competence with infectious disease pathology. It is critical that new generations of pathologists not only be trained in the subspecialty of infectious disease pathology, but that they also be willing participants in the diagnosis and investigation of infectious diseases. The lack of training programs for infectious disease pathologists, as well as the deficiency in infectious disease pathology support for ongoing and future epidemiologic investigations and research, has led to the broadening of pathology services and initiation of a dedicated section of Infectious Disease Pathology at one of the nation's premier public health institutions, the Centers for Disease Control and Prevention in Atlanta, Ga. Together with preexisting groups of medical and veterinary infectious disease pathologists at universities, the Armed Forces Institute of Pathology, the US Army Medical Research Institute of Infectious Diseases, and the National Institutes of Health, this new program will significantly strengthen the capability of the United States to respond to future challenges of emerging and reemerging infections, both in this country and abroad.

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