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PubMed1975

The pathologist and the geriatric autopsy.

In the past forty years the autopsy rate in many large institutions has fallen drastically to a level of only 20-25 per cent. The large number of diagnostic errors revealed in autopsy records is in itself a cogent reason for a return to higher standards. The inhibitory effect of high cost would be modified by the use of central regional pathology services and by reimbursement from third-party insurance carriers. The end-result would be a higher quality of medical care for all patients, not excepting those in the geriatric age group.

Age Factors↗
PubMed2005

Unraveling the mystery of the gastroesophageal junction: a pathologist's perspective.

The gastroesophageal junction (GEJ), which is defined as the point where the distal esophagus joins the proximal stomach (cardia), is a short anatomic area that is commonly exposed to the injurious effects of GERD and/or Helicobacter pylori infection. These disorders often lead to inflammation and intestinal metaplasia (IM) of this anatomic region. The true gastric cardia is an extremely short segment (<0.4 mm) of mucosa that is typically composed of pure mucous glands, or mixed mucous/oxyntic glands that are histologically indistinguishable from metaplastic mucinous columnar epithelium of the distal esophagus. In patients with GERD, whether physiologic or pathologic, the length of cardia-type epithelium increases and extends proximally above the level of the anatomic GEJ into the distal esophagus. Columnar metaplasia of the distal esophagus represents a squamous to columnar metaplastic reaction that develops from an esophageal stem cell and may pass through an intermediate phase characterized by the presence of a type of epithelium that possesses a mixture of squamous and columnar features, termed multilayered epithelium. In contrast, IM of the gastric cardia represents a columnar to columnar cell metaplastic reaction that develops from a gastric stem cell located in the deep foveolar compartment of the gastric mucosa. Intestinal metaplasia, particularly the incomplete type, is widely believed to represent the precursor lesion upon which dysplasia and cancer arises. The frequency of IM is probably greater in metaplastic columnar epithelium in the esophagus secondary to GERD, than in cases of true gastric carditis secondary to H. pylori, and may be a reason why there is a higher risk of carcinoma in the former compared to the latter. A variety of clinical, endoscopic, histologic, and histochemical methods can be used to distinguish GERD-induced columnar metaplasia of the distal esophagus from H. pylori-induced inflammation of true gastric cardia, and these are outlined in this review, but further controlled studies are needed to critically evaluate these techniques. Further prospective trials are needed to adequately evaluate the different etiologic and pathogenetic mechanisms and, most importantly, the risk of malignancy in these two conditions.

Cardia↗
PubMed1980

Factor assay (VIII and IX) results in the College of American Pathologists Survey Program (1976-1979).

Data from the 1976-1979 CAP Surveys for Factor VIII assays are reviewed. Beginning in 1979, Factor IX assays were also performed by survey participants. Data was obtained from approximately 2500 laboratories and the different instrument-reagents are ranked according to precision and sensitivity. Also, the results of questionnaires on specific assay techniques (1977 through 1979) are analyzed. A trend was noted indicating an increasing number of laboratories are now performing factor assays. There is poor correlation between precision and sensitivity of most systems (i.e., instrument and reagent combination). For any given system, there was considerable variation in precision from a normal Factor VIII levels specimen to a low Factor VIII specimen. This was also the case with respect to Factor IX assays. With respect to the technical aspects of factor assays there was marked interlaboratory variation (i.e., dilution of normal plasma used to construct standard curve, etc.). The need for standardization of factor assays is evident from the survey data.

Factor IX↗
PubMed1997

How clean is a mini-pig?--Impressions and suggestions of a pathologist working in the field of toxicology.

Gross and histopathological investigations of more than 100 minipigs revealed: 1. Findings due to repeated blood sampling. For anatomical reasons the thyroid gland of pigs can be injured during blood sampling. Histopathological investigation of thyroid glands often revealed inflammatory and reparative fibrotic changes of this organ. Depending on the grade of damage, thyroid hormone levels may vary. To avoid misinterpretation of results, most careful blood sampling by experienced personnel is recommended. 2. Findings due to viral, bacterial and parasitic infections. These concerned mainly the lungs which often showed pneumonic alterations. In case of parasitic invasion, the skeletal muscles may reveal degenerative changes due to sarcosporidia (re-) infection. Therefore, optimal hygienic conditions, e.g. during blood sampling, and continuing health monitoring are recommended. 3. Findings due to preventive iron administration. Months after preventive iron-dextran administration at the breeding station, histopathological examination revealed siderin accumulation in a number of organs, namely in the cells of the mononuclear phagocytic system in liver and kidneys. As a unique finding an intraglomerular siderin deposition in the mesangial cells with subsequent glomerulosclerosis in certain glomeruli was observed.

Animals↗