Pathology of diffuse malignant pleural mesothelioma

Intravenous administration of liposome-encapsulated hemoglobin (LEH) in rats led to an early (within 15 min) decline of hemolytic complement (C) activity in the plasma along with a significant, parallel rise in thromboxane B2 (TXB2) levels. The TXB2 response was inhibited by co-administration of soluble C receptor type 1 (sCR1) with LEH, as well as by C depletion with cobra venom factor. These observations provide evidence for a causal relationship between LEH-induced C activation and TXB2 release, and suggest that sCR1 could be useful in attenuating the acute respiratory, hematological and hemodynamic side effects of LEH described earlier in the rat.     

Pathology and pathogenesis of mucoviscidosis (author''s transl)

The section of the cat's mesotympanum, denuded of mucosa, to Silastic and gelatin film was studied and compared with the contralateral control ear, which was also denuded of mucosa. The ears were studied by horizontal pathological sections taken one, two, four, and six months post-lympanotomy and insertion of either gelatin film or Silastic. The Silastic, gelatin film and control ears were compared for inflammatory reaction, amount of fibrosis, and the quality and quantity of mucosal regeneration. The inflammatory reaction was increased in the ears with Silastic compared with their corresponding control ears or to the ears with gelatin film. The amount of fibrosis and the quality and quantity of mucosal regeneration was essentially the same in the Silastic, gelatin film, and control ears. This study shows that both substances are well tolerated in the middle ear and that neither substance stimulated or inhibited the regrowth of mucosa or fibrous tissue when compared with the control.     

Peripharyngeal space. Pathology

Tumors are the most frequent pathological pattern found in the peripharyngeal space. Topographically, intrinsic and extrinsic tumors can be distinguished. Intrinsic tumors are mostly salivary, nervous and vascular. Extrinsic tumors extend from the oral cavity, pharynx and parotid gland. MRI globally gives more impressive results than CT. Diagnosis of the tumor type often remains dubious in intrinsic tumors. CT-guided biopsy is then required.     

Malignant mesothelioma. Diagnosis and treatment

In over 90% of cases, mesothelioma initially presents as a banal pleural effusion, contributing no orientation to the diagnosis. The pleural fluid can even disappear after initial puncture. For early diagnosis, simple puncture, with or without biopsy, does not suffice. Thoracoscopy is 98% diagnostic. The course depends on the stage, the histological type and the general status. A new international TNM classification has been proposed to allow comparison of series and to choose a treatment appropriate to the stade: at stage I, intrapleural, local immuno-chemotherapy treatment gives good results; at stages II and III, surgery followed by radiation therapy are indicated; at stage IV, symptomatic treatment alone is justified.     

Psychology and Speech Pathology.

Comment by John L. Boland, Jr. on the statement called Principle 5.43 in "Psychology and Its Relations with Other Professions." Boland argues that Principle 5.43 suggests that speech pathologists (speech therapists, speech correctionists) "do not assume the responsibilities for professional decisions" and therefore do not have professional status. Speech pathology is, I infer, a sort of limbo for psychologists with limited training. If this is not true, I see no reason why this publication should take upon itself the job of defining the job of the speech pathologist. The kindest thing Boland can say about Principle 5.43 is that it is almost unbelievably snobbish. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Malignant pleural mesothelioma. II. Modern therapeutic concepts

In the second part of our review of malignant pleural mesothelioma, we reviewed current concepts of the treatment of this highly malignant disease. Although there are still advocates for the use of best supportive care to the treatment of these patients, the accumulated evidence favorizes the combined modality approach. Surgery, followed by postoperative external beam radiotherapy (or intraoperative radiotherapy), offers increased response rates and median survival as well as a higher percentage of patients surviving a two-year period. Although widely tested, both single-agent and multiple-agent chemotherapy did not succeed in transmitting high response rates into an improved survival. New treatment approaches are needed to improve poor survival in patients with malignant pleural mesothelioma.     

Malignant mesothelioma of the pleura. Morphometric study

Between April 1994 and October 1996 on account of complicated obstruction of the lacrimal pathways temporarily into the lacrimal efferent system 144 silicone cannulas were inserted in 127 children aged 4 months to 9 years. A standard procedure was used, with the children under general inhalation anaesthesia, in collaboration of an ophthalmologist and otorhinolaryngologist using endonasal optics. By October 1996 100 cannulas were extubated, on average after 4.1 months. The effectiveness of the procedure evaluated on the basis of clinical manifestations and the Dye Disappearance test is 81%.     

Localized malignant mesothelioma. A clinicopathologic and flow cytometric study

Six examples of malignant mesothelioma appearing as a localized pleural mass are described. There were four women and two men, ranging in age from 42 to 76 years. A history of asbestos exposure was obtained from three patients. The tumors ranged in size from 2.8 to 10 cm. Two were pedunculated and four were sessile with broad-based pleural attachments. Histologically, three tumors were purely epithelioid and three were biphasic. Immunohistochemical stains in all six cases were positive for cytokeratin and negative for carcinoembryonic antigen. Five were also positive for epithelial membrane antigen. Five were negative for Leu-M1, while one showed focal staining in a peripheral membrane pattern. Electron microscopy in two purely epithelioid tumors showed long, thin microvilli, well-developed desmosomes, and numerous tonofilaments. Flow cytometry showed an aneuploid DNA content in four tumors and a diploid content in one. Flow cytometry in five cases identified a DNA aneuploid cell population in four tumors and a diploid population in one. Three patients showed signs of local recurrences 4, 7, and 18 months after excision and died of their disease 12, 10, and 24 months after diagnosis, respectively. Three patients are well with no evidence of disease 8, 24, and 96 months after diagnosis. These findings indicate that malignant mesotheliomas of the pleura may rarely appear as a localized mass. The biologic behavior of such tumors is difficult to predict, but some patients survive disease-free for a long time after surgical excision.     

Single ventricle. New embryological-anatomical classification. I. Pathology and physiology

The different nomenclatures which have been given to this malformation are discussed, defining the single ventrical as a single ventricular chamber without an interventricular septum and generally with two well defined atrioventricular orfices, although in some cases there is only one mitral-tricuspid ring. Twelve cases of single ventricle, proven by necropsic study, were examined. A new embriological-anatomical classification was proposed based on the location of the outflow tract (concordant or discordant in relation to the situs viscerae of which it is a part) and the troncoconal morphology (crossed great vessels, transposition of the great arteries, and truncus arteriosus), presenting some examples of these malformations. The pathological characteristics of the malformation in each of the established groups is described, as well as the physiopathology in the most frequent varieties. The defects associated with single ventricle are studied.     

Developmental lumbar spinal stenosis. Pathology and surgical treatment

The purpose of this presentation is to outline the extent of surgical resection necessary for complete decompression of the neural elements in spinal stenosis and to introduce a system for the evaluation of disability in patients with spinal stenosis. Sixteen patients with the confirmed diagnosis of lumbar spinal stenosis were evaluated by the system. Ten cases were treated surgically. Indications for operative treatment were 1) intolerable pain in average daily living, 2) progressively worsening or significant degree of motor weakness, and 3) sphincter dysfunction. Satisfactory results from operative treatment were expected only after adequate and thorough decompression. The extent of surgical decompression was determined by clinical evaluation, myelographic examination, and by the type of disease process exhibited. The most common cause of unsatisfactory results was inadequate decompression of spinal contents. The extent of adequate decompression is described according to three different variations of pathologic anatomy of spinal stenosis: a) concentric contraction of the spinal canal, b) sagittal flattening of the spinal canal, and c) stenosis caused by anomalous articular process(es). No excellent results were obtained even after thorough and adequate decompression of spinal contents.     

Neuroendocrine tumors of the lung. Pathology and molecular biology

The cortical connections of visual area 3 (V3) and the ventral posterior area (VP) in the macaque monkey were studied by using combinations of retrograde and anterograde tracers. Tracer injections were made into V3 or VP following electrophysiological recording in and near the target area. The pattern of ipsilateral cortical connections was analyzed in relation to the pattern of interhemispheric connections identified after transection of the corpus callosum. Both V3 and VP have major connections with areas V2, V3A, posterior intraparietal area (PIP), V4, middle temporal area (MT), medial superior temporal area (dorsal) (MSTd), and ventral intraparietal area (VIP). Their connections differ in several respects. Specifically, V3 has connections with areas V1 and V4 transitional area (V4t) that are absent for VP; VP has connections with areas ventral occipitotemporal area (VOT), dorsal prelunate area (DP), and visually responsive portion of temporal visual area F (VTF) that are absent or occur only rarely for V3. The laminar pattern of labelled terminals and retrogradely labeled cell bodies allowed assessment of the hierarchical relationships between areas V3 and VP and their various targets. Areas V1 and V2 are at a lower level than V3 and VP; all of the remaining areas are at a higher level. V3 receives major inputs from layer 4B of V1, suggesting an association with the magnocellular-dominated processing stream and a role in routing magnocellular-dominated information along pathways leading to both parietal and temporal lobes. The convergence and divergence of pathways involving V3 and VP underscores the distributed nature of hierarchical processing in the visual system.     

The floppy mitral valve. Study on pathogenesis

The pathogenesis of the floppy valve syndrome is not fully solved. An almost invariable histological finding is the great accumulation of mucinous material in the valve leaflets and constitutes the basis of the valvular theory of the syndrome. The presence of a mucinous layer in normal valves-- the zona spongiosa--is not well recognised. To establish the normal range of the extent of this zone, 50 excised mitral valves from patients aged 2 to 89 years and who died as a result of road traffic accidents or non-cardiac causes have been analysed by measuring the thickness of the zone in relation to the valve thickness. A range of 0 to 60 per cent was found and this was not influenced by age. The findings were compared with 50 patients clinically diagnosed as suffering from the floppy valve syndrome. A value of over 60 per cent (range 62 to 94%) was found in 43 patients. The increase in the extent of the mucinous material was considered to be a secondary change in the thickened fibrosa which normally accompanies the floppy valve syndrome. Measurements of zona spongiosa falling within the normal range were found in seven patients. The clinical features, complications, and accompanying conditions have also been analysed. Chordal rupture had occurred in 20 patients, infective endocarditis in three, and calcification was found in four valves. In four patients the aortic valve was also involved and accompanying aortic root dilatation in an additional patient. It is suggested that these patients should not be included in the group of Marfan's forme fruste, nor in the typical floppy mitral valve syndrome. Apart from the valvular theory, the myocardial theory in the pathogenesis of the syndrome has been discussed and the components ensuring normal mitral valve function have been reviewed. It is concluded that an inherent, prominent zona spongiosa predisposes to the floppy valve syndrome, particularly if any one of the components of normal valve function is abnormal.     

Pathology of Penicillium marneffei. An emerging acquired immunodeficiency syndrome-related pathogen

OBJECTIVE: To summarize current knowledge regarding the opportunistic dimorphic fungal pathogen Penicillium marneffei. Clinical presentation, differential diagnosis, mycology, histopathology, diagnostic serology, in vitro antifungal agent susceptibility testing, and therapy are discussed for human immunodeficiency virus-infected individuals primarily living in Southeast Asia. DATA SOURCES: Critical evaluation of peer-reviewed publications located through an electronic literature database search, supplemented by unpublished observations, were used to prepare this report. STUDY SELECTION: Studies were selected based on either the fungal name Penicillium marneffei, penicilliosis, penicilliosis marneffei, or a combination of these. DATA EXTRACTION: Articles were reviewed with appropriate data being abstracted and then synthesized into the review. DATA SYNTHESIS: Differential diagnostic criteria for tissue diagnosis and laboratory identification of the fungus are detailed. The usefulness of mycoserology and antifungal therapy are evaluated. CONCLUSIONS: Penicillium marneffei is an emerging pathogen, primarily among patients with acquired immunodeficiency syndrome residing in Southeast Asia. Although infection caused by P marneffei is endemic to this portion of the world, cases are being diagnosed and treated involving individuals who have traveled to this region. Penicilliosis marneffei can clinically resemble tuberculosis, molluscum contagiosum, cryptococcosis, and histoplasmosis. The successful treatment of P marneffei infection is dependent on its rapid and accurate diagnosis.     

IGF/IGFBP axis in cartilage and bone in osteoarthritis pathogenesis

In the context of joint biology, insulin-like growth factor-1 (IGF-1) is the most likely candidate to affect the anabolism of cartilage matrix molecules. Mechanisms for controlling the effects of IGF-1 include alterations in the level of this growth factor, its receptor and/or the IGF-1 affinity or availability to its receptor. Disturbance of any one of the above elements may induce a disregulation of the mechanisms involved in the local control of joint tissue integrity. This review focuses on recent studies of the IGF system, and the potential relevance of these results to in vivo effects in osteoarthritic (OA) tissues. It has been shown that, although the IGF-1's expression and synthesis are increased in OA cartilage, chondrocytes are hyporesponsive to IGF-1 stimulation. This phenomenon appears to be related, at least in part, to an increased level of IGF-binding proteins (IGFBP). The IGFBP have a high affinity for IGF-1, and appear to be important biomodulators for IGF action. Though to date seven IGFBP have been cloned and sequenced, disregulation in IGFBP-3 and -4 appears instrumental to arthritic disorders. Proteolytic activity directed against IGFBP has been found in both cartilage and bone; this activity appears to belong to serine- and/or metallo-proteases families. It has been suggested that a thickening of the subchondral bone participates in OA pathophysiology, and that IGF-1 production by bone and/or subchondral bone cells may contribute to these changes. An abnormal regulation of subchondral bone formation via an increase in the local activation of IGF-1 in bone cells, possibly via abnormal IGFBP synthesis due to aberrant PA/plasmin regulation of the IGF-I/IGFBP system, is believed to be a plausible hypothesis.