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At least 1,639 records · Page 91Linked to original sources
PubMed1997

Collection of surgical specimens in total joint arthroplasty. Is routine pathology cost effective?

A retrospective review of 715 consecutive cases of total joint arthroplasty (283 hips, 432 knees), performed for a variety of indications during 1992 and 1993, was undertaken to assess the cost effectiveness of routine pathologic examination. The charts were reviewed for preoperative, operative, and pathologic diagnosis, and any discrepancies in diagnosis were noted. Particular attention was paid to pathologic findings suggestive of neoplasia or rheumatoid arthritis that were not noted in the preoperative or operative diagnoses. Six of the 715 cases fit into this category, but all failed to have any clinical significance. No alteration in patient care resulted from routine pathologic examination. This paper questions the necessity of routinely submitting pathologic specimens in uncomplicated total hip and knee arthroplasty.

Aged↗
PubMed2002

The intralaminar nuclei assigned to the medial pain system and other components of this system are early and progressively affected by the Alzheimer's disease-related cytoskeletal pathology.

The intralaminar nuclei of the human thalamus are integrated into the ascending reticular activating system and into limbic, oculomotor and somatomotor loops. In addition, some of them also represent important components of the medial pain system. We examined the occurrence and severity of the Alzheimer's disease (AD)-related cytoskeletal pathology and beta-amyloidosis in the seven intralaminar nuclei (central lateral nucleus, CL; central medial nucleus, CEM; centromedian nucleus, CM; cucullar nucleus, CU; paracentral nucleus, PC; parafascicular nucleus, PF; subparafascicular nucleus, SPF) in 27 autopsy cases at different stages of the cortical neurofibrillary pathology (cortical NFT/NT-stages I-VI) and beta-amyloidosis (cortical phases 1-4). The CEM, CL, PF, and SPF are slightly affected at stage II (corresponding to preclinical AD). They are markedly involved at stages III and IV (i.e. incipient AD) and severely affected at stages V and VI (i.e. clinical AD). In the PC and CU, the cytoskeletal pathology is mild at stage III, marked at stage IV, and severe at stages V-VI, whereas the CM is only mildly affected at stages IV-VI. In all of the intralaminar nuclei, deposits of the protein beta-amyloid occur for the first time during the final phase of cortical beta-amyloidosis. Functionally, the cytoskeletal pathology encountered in the intralaminar nuclei may contribute to the memory and affective symptoms, attention deficits, and dysfunctions related to horizontal saccades and smooth pursuits seen in AD patients. Equally important, however, are the findings that the cytoskeletal pathology developing within the intralaminar nuclei assigned to the medial pain system (CEM, CL, CU, PC, PF) as well as within other components of this system begins already during the preclinical or incipient phases of AD. Given this fact, the question arises as to whether non-discriminative aspects mediated by the medial pain system could be employed to identify individuals in the very earliest stages of AD.

Aged↗
PubMed2001

Rethinking cystic fibrosis pathology: the critical role of abnormal reduced glutathione (GSH) transport caused by CFTR mutation.

Though the cause of cystic fibrosis (CF) pathology is understood to be the mutation of the CFTR protein, it has been difficult to trace the exact mechanisms by which the pathology arises and progresses from the mutation. Recent research findings have noted that the CFTR channel is not only permeant to chloride anions, but other, larger organic anions, including reduced glutathione (GSH). This explains the longstanding finding of extracellular GSH deficit and dramatically reduced extracellular GSH:GSSG (glutathione disulfide) ratio found to be chronic and progressive in CF patients. Given the vital role of GSH as an antioxidant, a mucolytic, and a regulator of inflammation, immune response, and cell viability via its redox status in the human body, it is reasonable to hypothesize that this condition plays some role in the pathogenesis of CF. This hypothesis is advanced by comparing the literature on pathological phenomena associated with GSH deficiency to the literature documenting CF pathology, with striking similarities noted. Several puzzling hallmarks of CF pathology, including reduced exhaled NO, exaggerated inflammation with decreased immunocompetence, increased mucus viscoelasticity, and lack of appropriate apoptosis by infected epithelial cells, are better understood when abnormal GSH transport from epithelia (those without anion channels redundant to the CFTR at the apical surface) is added as an additional explanatory factor. Such epithelia should have normal levels of total glutathione (though perhaps with diminished GSH:GSSG ratio in the cytosol), but impaired GSH transport due to CFTR mutation should lead to progressive extracellular deficit of both total glutathione and GSH, and, hypothetically, GSH:GSSG ratio alteration or even total glutathione deficit in cells with redundant anion channels, such as leukocytes, lymphocytes, erythrocytes, and hepatocytes. Therapeutic implications, including alternative methods of GSH augmentation, are discussed.

Antioxidants↗
PubMed1997

The relationship of hepatitis history and pathological diagnosis of primary liver cancer.

During the analysis of risk factors in relation to primary liver cancer, we noticed an association between the confirmed (as opposed to probable) pathologic diagnosis of liver cancer and a positive history of hepatitis. This report pursues the observation using data from the Selected Cancers Study. Study subjects included 168 men who lived in areas covered by eight cancer registries in the U.S., and were pathologically diagnosed with confirmed or probable primary liver cancer during 1984-1988. The results showed that men with confirmed primary liver cancer were six times more likely to have a hepatitis diagnosed within 3 years before liver cancer detection, compared with those with probable primary liver cancer. Further analyses showed that men with a confirmed primary liver cancer or with a recent hepatitis more likely had a tissue specimen obtained from a surgery, and less likely had one from an aspiration. Upon adjustment for type of specimen, the association between pathological confirmation of primary liver cancer and recent hepatitis persisted. The results raised questions whether recent hepatitis and its pathologic changes influence choice of tissue-collecting procedure and ultimate pathological diagnosis of primary liver cancer. Other factors that might be related to the findings also need to be examined in future studies.

Adolescent↗
PubMed1989

Pathological changes related to long-term impaction of third molars. A radiographic study.

Pathological changes related to impacted 3rd molars (ITM) were studied in a radiographic investigation of 2128 randomly selected patients. In radiographs from 644 patients, 1211 ITM were noted. Pathological changes were observed in 25 of 477 (5.2%) maxillary ITM and in 59 of 734 (8%) mandibular ITM. A pathologically widened pericoronal space (indicating a dentigerous cyst) was observed in 5 of 477 maxillary and 43 of 734 mandibular ITM (p less than 0.001). Other pathologic changes observed were resorption of the 2nd molars (1% in the maxilla, 1.5% in the mandible) or loss of marginal bone on the distal aspect of the second molars (4% in the maxilla, 1% in the mandible). The risk of pathological sequelae because of ITM, apparently, is low. Prophylactic surgical removal should, therefore, be regarded with some reserve, particularly in view of the high frequency of deep impactions, with greater risk for surgical complications.

Adult↗
PubMed2000

Does cardiac conduction pathology contribute to sudden unexpected death in epilepsy?

Heart weights have been reported to be increased in those dying suddenly and unexpectedly from epilepsy (SUDEP) and it has been suggested that cardiac pathology including cardiac conduction pathology and coronary artery atheroma may contribute to SUDEP. The purpose of this study was to perform a detailed controlled study of the microscopic pathology of the cardiac conduction system in SUDEP cases, in addition to assessing coronary artery atheroma and other cardiac pathology. The hearts of ten SUDEPs and ten control subjects (no history of epilepsy and a cause of death not primarily cardiac) were examined macroscopically and microscopically by two pathologists blinded to the patient group. Morphological abnormalities of the cardiac conduction system that could have possibly contributed to death were not increased in the SUDEP group (four cases showed such changes in the SUDEP group vs. six in the control). There was no significant difference between the maximal percentage coronary artery stenoses between the two groups and no increased prevalence of other cardiac pathology in the SUDEP group. However, since subtle abnormalities of the conduction system were identified in some of the epileptic deaths, it is still feasible that these may contribute to death by causing cardiac arrhythmia, when associated with apnoea, bradycardia or other cardiac arrhythmia related to an epileptic seizure.

Adolescent↗
PubMed1997

Clinical and pathological response to primary chemotherapy in operable breast cancer.

Neoadjuvant chemotherapy is used to improve patients' survival in locally-advanced and inflammatory breast cancer and to increase conservative surgical procedures in bulky tumours. Pathological complete responses are unusual. The aim of this pilot study was to assess the clinical and pathological response rates and to evaluate toxicity with a new protocol of primary chemotherapy in 50 high-risk breast cancer patients. All tumours were > 3 cm and had at least one other adverse prognostic factor: lymph node involvement (32 N1, 6 N2), SBR grade III (20), aneuploidy (29), negative hormonal receptors (19). Patients were treated by 3-week cycles of THP-doxorubicin 20 mg/m2 D1 to 3, vinorelbine 25 mg/m2 D1 and 4, cyclophosphamide 300 mg/m2 and 5-fluorouracil 400 mg/m2 D1 to 4 (TNCF). 38 patients received G-CSF or GM-CSF support. After 4-6 cycles, all underwent surgery (39 conservative, 11 modified radical). Tumour response was assessed clinically, by mammography and echography and on pathological specimens. An objective clinical response was observed for 43 patients: 26 complete (51%) and 18 partial (37%). After pathological review, 11 patients (22%) were devoid of any tumour cells, 4 others (8%) had only in situ carcinoma. From 253 evaluated cycles, grade III-IV toxicity occurred, 81% with neutropenia, 25% with anaemia, and 20% with thrombocytopenia. All patients recovered. This regimen induced a severe but not life-threatening haematological toxicity and resulted in a high pathological response rate (30%).

Adult↗
PubMed1999

Molecular pathology and future developments.

There has already been a 'molecular' revolution in pathology. Demonstrating transcription of specific single genes or small gene sets and their protein products by in situ hybridisation and immunocytochemistry is routine in diagnostic and experimental pathology. A perhaps-greater revolution is imminent with the application of more recently established and emergent technologies in pathology. These include new approaches to polymerase chain reaction (PCR); simultaneous studies of multiple genes and their expression using oligonucleotide and cDNA arrays; serial analysis of gene expression (SAGE); expressed sequence tag (EST) sequencing, subtractive cloning and differential display; high-throughput sequencing; comparative genomic hybridization, multiplex fluorescence in situ hybridisation (FISH) (spectral karyotyping); reverse chromosome painting; knockout and transgenic organisms; laser microdissection and micro-machining; and new methods in bio-informatics, 'data mining' and data visualisation. Molecular methods will profoundly change diagnosis, prognosis and treatment targeting in oncology and elucidate fundamental mechanisms of neoplastic transformation. Individual susceptibility to specific diseases will become assessable and screening will be refined. The new molecular biology will be most fruitful in partnership with classical approaches to pathology: the expectation that molecular methods alone will answer all pathological questions is unrealistic. A further challenge for the biomedical community in the 'genome era' will be to ensure that the benefits of these sophisticated technologies are enjoyed globally.

Biopsy↗
PubMed2001

Do immune cells promote the pathology of dystrophin-deficient myopathies?

Many features of dystrophin-deficient muscle pathology are not clearly related to the loss of mechanical support of the muscle membrane by dystrophin. In the present review, evidence that supports a role for the immune system in promoting the pathology of dystrophinopathy is presented. The findings summarized here indicate that specific, cellular immune responses by cytotoxic T-lymphocytes and helper T-lymphocytes contribute to muscle pathology in dystrophin-deficient muscle, and that removal of specific lymphoid cell populations can reduce muscle pathology. In addition, innate immune responses may also promote dystrophinopathies by the tremendous infiltration of myeloid cell populations into the dystrophic muscle. Loss of normal redox homeostasis by dystrophin-deficient muscle may increase its sensitivity to free radical-mediated damage by myeloid cells. Collectively, the observations presented here suggest that the contribution of the immune system to dystrophinopathies may be significant, and that therapeutic approaches based upon immune interventions may ameliorate the pathological progression of dystrophin deficiency.

Animals↗
PubMed2001

Early puberty and early sexual activity are associated with bulimic-type eating pathology in middle adolescence.

PURPOSE: To examine the associations between early pubertal timing and early advanced sexual development with bulimic-type eating pathology in middle adolescents. METHODS: A total of 19,321 boys and 19,196 girls aged 14-16 years (mean age 15.3 years, standard deviation 0.59) responded to the School Health Promotion Study, a class-room survey among Finnish adolescents about health, health behavior, and school experiences. Bulimic-type eating pathology was assessed with a questionnaire formulated according to the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders IV (DSM-IV) criteria. Pubertal timing was assessed by self-reported age at menarche or oigarche. Statistical methods were used chi-square and logistic regression. RESULTS: Bulimic-type eating pathology among girls was associated with early menarche, early sexual experiences, and increasing age. Among boys, onset of ejaculations at the normative age was protective for bulimic-type eating pathology, and the risk was elevated among very early and late maturers. Early sexual experience was associated with bulimic-type eating pathology. CONCLUSION: To prevent bulimia nervosa and to create opportunities for early intervention, attention should be paid to early maturing girls and off-time maturing boys, as well as those with early onset of sexual activity.

Adolescent↗
PubMed1996

Memory for objects presented early after intracarotid sodium amytal: a sensitive clinical neuropsychological indicator of temporal lobe pathology.

Results from a simple test of post-recovery recognition of objects presented immediately after intracarotid sodium amytal (ISA) injection were compared with those obtained using the 'Montreal' anterograde memory test procedure of post-recovery recognition of items presented later after injection in 16 patients with unilateral temporal lobe pathology undergoing routine bilateral ISA testing prior to epilepsy surgery. All 16 patients were given both memory tests following injection on both sides. Significantly fewer 'early objects' were recognized when injection was contralateral to pathology than when injection was ipsilateral to pathology (i.e. contralateral to an intact hemisphere), whereas there was no significant difference in the number of 'Montreal' anterograde items recognized regardless of side of pathology. Memory for objects presented early after ISA appears to be a sensitive measure although its potential as a valid indicator of temporal lobe pathology needs to be further refined.

Adolescent↗
PubMed2003

Autosomal recessive parkinsonism linked to parkin gene in a Tunisian family. Clinical, genetic and pathological study.

OBJECTIVES: To report clinical, pathological and genetic findings in a Tunisian kindred with autosomal recessive juvenile parkinsonism (AR-JP) linked to parkin gene. BACKGROUND: AR-JP has been mapped to chromosome 6q and is caused by several mutations of the parkin gene (Park 2). Pathological features in AR-JP are characterized by neuronal loss in substantia nigra (SN) without Lewy bodies (LB). PATIENTS AND METHODS: Three affected siblings with juvenile Parkinson's disease were studied. Pathological examination of the brain was performed in one of them. Linkage studies and mutation analysis of the parkin gene were performed. RESULTS: Clinical picture was characterized by the association of rest tremor, bradykinesia and rigidity. Parkinsonian signs markedly improved with levodopa treatment in the three siblings. Dystonia was observed in one patient and diurnal fluctuations of parkinsonian signs in another one. Linkage analysis showed homozygous haplotypes in patients as compared to unaffected individuals and mutation analysis of the parkin gene revealed a homozygous two-base AG deletion in exon 2 (101-102). Pathological examination of the brain in one patient showed marked loss of pigmented neurons with extraneuronal free melanin in the lateral and medial parts of the SN associated to a slight spongiosis and astrocytic gliosis. In the locus coeruleus, there was also loss of pigmented neurons without gliosis. No LB or neurofibrillary tangles were found neither by traditional nor by histo-immunological stainings. CONCLUSION: This Tunisian kindred with AR-JP linked to a micro-deletion of the parkin gene shows clinical similarities with the previously reported Japanese and European families. Pathological features of this kindred are compared to what has been reported in AR-JP families linked to large exonic deletions of this gene.

Adult↗
PubMed2002

Correlation of SPECT with pathology and seizure outcome in children undergoing epilepsy surgery.

SPECT can be used to image regional cerebral blood flow (rCBF) and has been shown to help localize the seizure focus in partial epilepsies as part of the presurgical evaluation. Few studies have explored the possible relation between preoperative SPECT and underlying pathology, or any relation to postsurgical outcome. In this study preoperative ictal and interictal rCBF in relation to the histopathological diagnosis and outcome in a series of 35 children (24 females, 11 males; mean age 9.6 years, age range 11 months to 18 years) who had undergone resective surgery for epilepsy were retrospectively evaluated. A correlation between ictal hyperperfusion and the underlying responsible pathology was shown, with a consistent ictal increase in perfusion in developmental pathologies and Rasmussen's encephalitis, and consistent interictal hypoperfusion in hippocampal sclerosis (HS). No rCBF study parameter appeared to relate to outcome but in the group with HS the best outcome was seen in those with localizing ictal rCBF. The varied group of pathologies from hemispherectomy had excellent outcome but the SPECT findings had little to contribute over the abnormalities detected on MRI. In conclusion, rCBF studies remain a useful presurgical investigation in children with partial epilepsy, especially where HS, cortical dysplasia, or inflammatory disease are the underlying pathology. However, rCBF studies add little to the investigation of children with seizures secondary to benign tumours or cerebral infarcts, or where hemispherectomy is the likely preferred surgical option.

Adolescent↗
PubMed2004

Personality pathology and outcome in recurrently depressed women over 2 years of maintenance interpersonal psychotherapy.

BACKGROUND: Empirical data on the impact of personality pathology on acute treatment outcome for depression are mixed, in part because of challenges posed by assessing trait-like personality patterns while patients are in an active mood episode. To our knowledge, no previous study has examined the effect of personality pathology on maintenance treatment outcome. By maintenance treatment we refer to long-term treatment provided to prevent depression recurrence among remitted patients. METHOD: Structured Clinical Interviews for the DSM-III-R Personality Disorders (SCID-II) were obtained on a sample of 125 recurrently depressed women following sustained remission of the acute mood episode and prior to entering maintenance treatment. SCID-II interviews were then repeated following 1 and 2 years of maintenance interpersonal psychotherapy. RESULTS: At the pre-maintenance assessment, 21.6% of the sample met SCID-II personality disorder criteria. Co-morbid personality pathology was related to an earlier age of onset, more previous depressive episodes, and a greater need for adjunctive pharmacotherapy to achieve remission of the acute mood episode. Co-morbid personality pathology predicted both higher rates of depression recurrence and a shorter time to recurrence over the 2-year course of maintenance treatment. Notably, among those patients who remained depression-free, continuous levels of personality pathology steadily declined over the 2-year course of maintenance therapy. CONCLUSIONS: Results highlight the need for early and effective intervention of both episodic mood disorder and inter-episode interpersonal dysfunction inherent to the personality disorders. Future maintenance treatment trials are needed to clarify the relationship between episodic mood disorder and personality function over time.

Adult↗
PubMed1999

Pathological alcohol involvement: a developmental disorder of young adulthood.

In 1987, we began a longitudinal study of the offspring of alcoholic parents and have been following this group of young adults from their freshman year in college throughout their transition into later young adulthood. The goal of this review is to highlight some of the findings we consider most important and relevant to the development of pathological alcohol involvement in young adulthood. Courses of pathological alcohol involvement in young adulthood are outlined. Predictors of both the development and course of pathological alcohol use in young adulthood are also addressed, including family history of alcoholism, personality, alcohol use motivations, and role transitions. While certainly a problem in its own right, pathological alcohol involvement can also affect the attainment of important life tasks and success in various life roles. Consequently, we also examine the effects of pathological alcohol involvement on later role transitions and role attainment. Finally, prevention, policy, and treatment issues surrounding this stage of life are discussed.

Adolescent↗
PubMed2000

Is the SOGS an accurate measure of pathological gambling among children, adolescents and adults?

The South Oaks Gambling Screen (SOGS) is widely used to assess the prevalence of pathological gambling. For a variety of reasons, this instrument may not provide an accurate rate of the prevalence of pathological gambling. In this paper, one source of error in data provided by the SOGS is investigated. It is argued that individuals may not fully understand the meaning of some items, and that clarification of the meaning of misunderstood items may in some cases lead to a changed score on the scale. The present study evaluates respondents' understanding of the SOGS items. The results from three studies are reported, each using a different sample: grade school children, adolescents and adults. It was hypothesised that (1) participants would not understand some items of the SOGS, (2) problem gamblers and probable pathological gamblers would be more inclined to interpret items incorrectly than would non-problem gamblers and, (3) consistent with the first two hypotheses, clarification of items would decrease the number of participants identified as problem gamblers or probable pathological gamblers. The data obtained supported hypotheses 1 and 3. Furthermore, hypothesis 2 was supported for grade school children, but not for adolescents or adults. These results are consistent with recent literature on endorsement and acquiescence phenomena, and have implications for prevalence studies of probable pathological gambling.

Journal Article↗
PubMed2002

Parental bonding in pathological gambling disorder.

The purpose of this study was to examine the role of perceived parenting behavior in the childhood of patients with pathological gambling disorder (PGD). Thirty-three outpatient subjects with DSM-IV pathological gambling disorder, and no other current Axis I disorders, completed the Parental Bonding Instrument (PBI), which measures subjects' recollections of parenting on dimensions of care and protection. PBI scores of pathological gamblers were compared to normal controls. Subjects with PGD had significantly lower maternal and paternal care scores than the control subjects (22.6 +/- 8.9 vs. 26.9 +/- 7.3 on maternal care [p = 0.010], and 17.4 +/- 9.6 vs. 23.8 +/- 7.6 on paternal care [p = 0.001]). In terms of parental bonding patterns based on a combination of care and protection, the pathological gamblers reported low rates of optimal parenting and high rates of neglectful parenting. These preliminary findings suggest that neglectful parenting appears to be associated with pathological gambling disorder.

Adult↗
PubMed2001

Obsessive-compulsive features in pathological lottery and scratch-ticket gamblers.

The results of this study support the notion that pathological gamblers drawn from the community would score higher on all three scores from the YBOCS than light gamblers. Consistent with hypotheses, pathological gamblers (lottery and scratch ticket) reported more obsessions, compulsions, and avoidance behavior than the light gamblers, and also reported having more urges to engage in injurious behaviors to themselves and others. These findings provide evidence that pathological gambling falls in a spectrum or family of disorders which have obsessive-compulsive disorder at its core. These findings support McElroy, Hudson, Philips, et al.'s (1993) suggestions of similarities between OCD and Impulse Control Disorders, and extend Blaszczynski (1999) findings of overlap between pathological gamblers and OCD in a treatment population. Heavy gamblers also reported significantly more hoarding symptoms and compulsive buying than light gamblers. More research in this area may show further evidence of a spectrum of disorders with obsessive compulsive disorder at its core, and show further links between impulse control disorders (such as pathological gambling) and OCD.

Adult↗