Fast Chromotrope Aniline Blue Special Stain Is a Useful Tool to Assess Fibrosis on Liver Biopsy During Transplantation.

BACKGROUND: Assessment of potential liver allograft donors with frozen sections has clinical relevant consequences for the transplant recipient. Several clinical risk factors have been identified that increase the risk of transplantation failure and it is critical for the pathologist to become familiar with the histologic criteria for donor liver suitability. In this setting an accurate and reliable assessment of fibrosis is crucial. We sought to report the value of the rapid chromotrope aniline blue stain (CAB) in a transplantation clinical work-flow for scoring liver fibrosis. MATERIALS AND METHODS: Twenty consecutive intraoperative donor liver biopsy specimens were evaluated by a pathologist at the Transplant Pathology Board Room, AOUI Verona, during 24-hour on-call service. The stage of fibrosis was evaluated according to Ishak score ranging from 0 to 6 (absent to cirrhosis) using hematoxylin and eosin stain (H&E) plus rapid CAB special stain. After a 3-week washout period, only the slides stained with H&E were re-assessed for fibrosis stage by the same pathologist blinded to donor patient data. RESULTS: Combination H&E-CAB staging fibrosis score was higher in 20%, lower in 10%, and the same in 70% of biopsy specimens as determined using only H&E stain alone. Rapid CAB stain takes 20 minutes longer than H&E stain alone. CONCLUSIONS: CAB staining may be performed on frozen tissue from liver biopsy during a transplantation process without a significant delay in diagnosis. Combination H&E-CAB staining improves sensibility of interpretation of fibrosis.

Serial recordings of auditory brainstem responses in severe head injury: relationship between test timing and prognostic power.

ABRs have proved to be very accurate prognostic indicators in severe head injury, even when predictions are based on single ABR recordings. In this study we submitted 30 severely head-injured patients to serial ABR recordings (during the clinical course of posttraumatic coma) in order to verify whether the ABR prognostic power may depend on test timing in relation to the injury. 15 patients (50%) died, 5 (16.7%) remained vegetative, 2 (6.6%) severely disabled and 8 (26.7%) recovered. All recovered patients had normal ABR throughout clinical course, while severely disabled and vegetative patients showed at least transently ABR abnormalities (namely, an interpeak latency of waves V-I greater than 4.48 ms). Among dead patients, 8 showed steady and 3 transient ABR abnormalities during the clinical course, while 2 of 3 patients with normal ABR dead from extracranial complications. ABRs were significantly related to the outcome at any time, but gave more accurate prognostic indications on days 3-6 after the injury. The use of serial ABR recordings appeared to improve the outcome predictions in comparison with single ABR tests. Finally our result confirm the previously reported existance of a breakpoint between reversible brainstem dysfunction and irreversible brainstem damage defined by an IPL V-I of about 4.50 ms.

Short latency evoked potentials: new criteria for brain death?

The aim of this study was to evaluate whether the auditory brain stem responses (ABR) and short latency somatosensory potentials (SEP) from median nerve stimulation are effective tools in the confirmation of brain death. Thirty six brain dead patients were submitted to ABR and 24 to SEP in the same session. All waves of the ABR were absent in 28 (77.8 per cent) patients, while only wave I was present in the others (22.2 per cent). In SEP recordings the components later than P13 were absent in 17 (70.8 per cent) of cases; in the remaining seven patients (29.2 per cent) a N13/P13 dissociation (namely, retention of the cervical N13 and absence of the far-field P13) was found. The results suggest that SEP and ABR are reliable tools in the diagnosis of brain death and should be included in the criteria: they enable the functional status of two pathways in the brainstem to be checked, which cannot be explored by the clinical examination.

Auditory and somatosensory evoked potentials in brain-dead patients.

The short latency evoked potentials, allowing to assess the brain stem's function, can supply useful information in the diagnosis of Brain Death (BD). 15 BD patients were submitted to the auditory brain stem response (ABR); in 7 cases somatosensory evoked potentials from the medial nerve (SEP) were also recorded. The ABR was absent in 11 cases (73.3%), while in 3 cases only the I wave was present (20%); in one case the low-voltage I-V waves were present. Regarding the SEP, in 3 cases (42.9%) only the N9-N13 and P9-P13 waves were present, while in another 3 cases (42.9%) a N13/P13 dissociation was observable. In the remaining case, which presented a still reproducible I-V interval, the SEP was normal, thus excluding the diagnosis of BD. The ABR and the SEP, which are not roughly influenced by general anaesthetics and sedatives, are thus helpful in diagnosing BD. The SEP seems able to supply useful information more frequently than the ABR, but their combined use can guarantee maximum security of excluding false positives.

Sensorimotor central conduction time in comatose patients.

Motor evoked potentials (MEPs) following magnetic stimulation were recorded in 22 patients comatose as a result of head injury (13 cases), stroke (7 cases) or anoxia (2 cases). Somatosensory evoked potentials (SEPs) from median nerve were recorded as well in 19 cases in the same session. Thirteen patients died or remained vegetative (59.1%), 3 were severely disabled (13.6%) and 6 showed a good recovery (27.3%). MEPs were significantly related to the outcome; they appeared to be a more accurate prognostic indicator than the Glasgow Coma Scale (GCS). However, 1 out of 6 patients with bilaterally absent MEPs (16.7%) showed a good recovery. SEPs were significantly related to the outcome as well, but the combined use of SEP and MEP improved the outcome prediction, decreasing the rate of false negatives. Two patients had normal sensorimotor function, 13 a combined sensorimotor dysfunction, while 4 had a pure motor dysfunction. Our results suggest that SEPs and MEPs may improve the assessment of sensorimotor dysfunction in comatose patients. A significant relationship between MEPs and outcome appears to exist, but the assessment of MEP reliability requires further study.