ABSTRACT
The aim of the study was to estimate the degree of lung damage in patients with alpha(1)-antitrypsin (alpha1AT) deficiency, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF) at the time of lung transplantation. Using unbiased stereological methods, lung-, bronchial- and vessel-volume, capillary length, and alveolar surface area and densities were estimated in recipient lungs from 21 consecutive patients with pre-transplant diagnoses including COPD (n=7), alpha1AT deficiency (n=6) and CF (n=8). Six unused adult donor lungs served as controls. Information relating to patient demography and pre-transplant lung function was obtained by retrospective chart review. Disease groups differed significantly with respect to demographics and pre-transplant lung function. Total lung volume was similar in all groups. Bronchial volume was significantly larger in CF patients compared to the control group (p<0.0001) and to the other two diagnostic groups: alpha1AT deficiency (p=0.0001) and COPD (p<0.0001). Alveolar surface density and capillary length density were significantly lower in patients with alpha1AT deficiency and COPD compared to controls (p<0.0001, respectively) and to patients with CF (p<0.0002, respectively). There were no correlations between clinical lung function and morphometric measurements. We conclude that unbiased microscopic stereological morphometry is an evolving science with the potential to elucidate pulmonary disease pathogenesis.
Subject(s)
Lung Diseases/pathology , Lung Transplantation , Lung/pathology , Adult , Cystic Fibrosis/pathology , Cystic Fibrosis/surgery , Female , Humans , Lung Diseases/surgery , Male , Microscopy , Middle Aged , Pulmonary Disease, Chronic Obstructive/pathology , Pulmonary Disease, Chronic Obstructive/surgery , Pulmonary Fibrosis/pathology , Pulmonary Fibrosis/surgery , alpha 1-Antitrypsin Deficiency/pathology , alpha 1-Antitrypsin Deficiency/surgeryABSTRACT
BACKGROUND: Chimerism is suggested to predict a more favourable prognosis in solid organ transplantation. MATERIAL AND METHOD: Forty-eight bronchoalveolar lavages from 10 patients (5 females and 5 males) who had received sex-mismatched donor lungs were monitored for varying periods of time, of up to 2 years, at regular intervals (median 3.0 (0.5-24) months). To investigate the chimerism in macrophages and lymphocytes in bronchoalveolar lavage cells a cloned 2.12 kilobase large biotinylated Y-chromosome-specific DNA-probe was used for in situ hybridization. RESULTS: Donor macrophages disappeared in seven patients within the first 6 months after surgery (median 3.0 (1-6) months). But 15% donor macrophages could be detected in one patient 1 year and 10% in 2 patients two years after surgery. Donor lymphocytes disappeared in all patients within 3 months (median 1 (0.5-3) months). There was no correlation between periods or severity of acute rejection and percentage of donor macrophages and donor lymphocytes in bronchoalveolar lavage. None of the patients developed obliterative bronchiolitis. CONCLUSION: Macrophage chimerism in lung may exist for several years. Whilst our results do not elucidate the role of local macrophage chimerism, they do not currently support the view that chimerism prevents rejection.
Subject(s)
Bronchoalveolar Lavage Fluid/cytology , Chimera , Lung Transplantation/pathology , Lymphocytes/pathology , Macrophages/pathology , Chimera/genetics , Chimera/immunology , DNA Probes , Female , Graft Rejection/etiology , Humans , In Situ Hybridization , Lung Transplantation/adverse effects , Lung Transplantation/immunology , Lymphocytes/immunology , Macrophages/immunology , Male , Prognosis , Tissue Donors , Y Chromosome/geneticsABSTRACT
OBJECTIVES: to test the hypotheses that increased acute phase reactants predict elevated levels of lipoproteins and increased plaque volume as well as echolucency of carotid plaques. MATERIALS AND METHODS: the study included 258 patients with >or =50% carotid artery stenosis. Acute phase reactants (orosomucoid, C-reactive protein (CRP)) were measured in the fasting state, and ultracentrifugated lipoproteins before and after a standardised fat load test. Echogenicity of carotid plaques was detected using high-resolution B-mode ultrasound and computer-assisted image processing. A subgroup of 81 patients underwent carotid endarterectomy. RESULTS: on linear regression analysis orosomucoid levels were positively associated with fasting and postprandial levels of all triglyceride-rich lipoproteins, and negatively associated with HDL cholesterol (p -values <0.0001); results for CRP were less pronounced. Orosomucoid and CRP both predicted the presence of an increased carotid plaque volume on univariate analysis (p =0.01 and p =0.02). Finally, orosomucoid was negatively associated with echolucency of carotid plaques ( p =0.05). CONCLUSIONS: elevated levels of acute phase reactants are strongly associated with elevated levels of triglyceride-rich lipoproteins, increased plaque volume, and borderline significantly associated with echolucency of carotid plaques. Elevated acute phase reactants possibly predict severity of atherosclerosis, and presence of lipid-rich, rupture-prone plaques.
Subject(s)
Arteriosclerosis/blood , C-Reactive Protein/metabolism , Carotid Stenosis/blood , Lipoproteins/blood , Orosomucoid/metabolism , Aged , Analysis of Variance , Area Under Curve , Arteriosclerosis/diagnostic imaging , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/surgery , Chi-Square Distribution , Endarterectomy, Carotid , Female , Humans , Image Processing, Computer-Assisted , Linear Models , Male , Middle Aged , Predictive Value of Tests , Risk Factors , Ultrasonography, Doppler, ColorABSTRACT
OBJECTIVE: Echolucency of carotid atherosclerotic plaques, as evaluated by computerized B-mode ultrasonographic images, has been associated with an increased incidence of brain infarcts on cerebral computed tomographic scans. We tested the hypotheses that characterization of carotid plaques on spiral computed tomographic images correlates with that on computerized B-mode ultrasonographic images and that spiral computed tomographic imaging predicts the histomorphometric plaque content. METHODS: The study included 38 patients with neurologic symptoms and at least 50% stenosis of the ipsilateral carotid artery. High-resolution B-mode ultrasonographic images and spiral computed tomographic images of carotid plaques were computer processed to yield a quantitative measure, the gray scale level of the plaque. RESULTS: The mean Hounsfield value for spiral computed tomographic images correlated with the gray scale median for B-mode ultrasonographic images (univariate linear regression analysis: r = 0.45; P = .01) and the histologic content of calcification in the plaque (r = 0.34; P = .04) but not with lipid, hemorrhage, or fibrous tissue in the plaque. CONCLUSIONS: Spiral computed tomographic imaging seems to correlate with B-mode ultrasonographic imaging for showing plaque characteristics. Spiral computed tomographic attenuation was also correlated with the amount of calcification noted on histologic examination but not with lipid and hemorrhage, the components thought to characterize vulnerable, rupture-prone plaques.
Subject(s)
Carotid Arteries/pathology , Carotid Stenosis/pathology , Tomography, X-Ray Computed/methods , Carotid Arteries/chemistry , Carotid Stenosis/surgery , Endarterectomy, Carotid , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Ultrasonography, Doppler, ColorABSTRACT
A number of intriguing fibrovascular mesenchymal proliferations with benign or low grade malignant potential have recently been described. Giant cell angiofibroma was introduced as an entity by Dei Tos et al. in 1995 and initially considered to be a lesion of the orbit. We describe an extraorbital example, indicating that giant cell angiofibroma is not confined to the orbit. Immunologically, giant cell angiofibroma is positive for CD 34, bcl-2 and vimentin, and negative for epithelial and muscle markers, and S-100. The tumor shares several morphological and immunological properties with giant cell fibroblastoma and solitary fibrous tumor, yet it features a histology sufficiently characteristic to allow its categorization as a separate entity. The recommended treatment is complete but conservative excision. Metastases have not been reported.
Subject(s)
Angiofibroma/pathology , Giant Cell Tumors/pathology , Orbital Neoplasms/pathology , Angiofibroma/immunology , Female , Giant Cell Tumors/immunology , Humans , Middle Aged , Orbital Neoplasms/immunologyABSTRACT
We have estimated lung volume, bronchial volume, vessel volume, alveolar surface area and capillary length in patients who died of lung failure due to emphysema and chronic obstructive pulmonary disease (COPD) and in patients with no clinical signs of respiratory disease. Unbiased morphometric methods were applied to the right lung. The patients with emphysema had equal lung volumes and bronchial and vessel volumes compared to the control group. The alveolar surface area and surface density were significantly decreased to about 67%, of control values. The capillary length and length density were significantly decreased to about 68% of control values. The proportional decreases in alveolar surface area and capillary length suggest that compensatory capillary proliferation has not occurred. These unbiased morphometric studies of emphysema have yielded results in end-stage emphysema that are comparable to those previously reported using biased methods. However, the unbiased methods may provide new insights when applied to earlier stages of the disease.
Subject(s)
Bronchi/blood supply , Bronchi/pathology , Emphysema/pathology , Lung/blood supply , Lung/pathology , Aged , Aged, 80 and over , Bias , Capillaries/pathology , Emphysema/epidemiology , Female , Histological Techniques/statistics & numerical data , Humans , Male , Middle Aged , Pulmonary Alveoli/blood supply , Pulmonary Alveoli/pathology , Reproducibility of ResultsABSTRACT
BACKGROUND: Echo-lucency of carotid atherosclerotic plaques on computerized ultrasound B-mode images has been associated with a high incidence of brain infarcts as evaluated on CT scans. We tested the hypotheses that triglyceride-rich lipoproteins in the fasting and postprandial state predict carotid plaque echo-lucency and that echo-lucency predicts a high plaque lipid content. METHODS AND RESULTS: The study included 137 patients with neurological symptoms and > or = 50% stenosis of the relevant carotid artery. High-resolution B-mode ultrasound images of carotid plaques were computer processed to yield a measure of echogenicity (gray-scale level). Lipoproteins were measured before and hourly for 4 hours after a standardized fatty meal. A subgroup of 58 patients underwent endarterectomy. On linear regression analysis, echo-lucency (low gray-scale level) was associated with elevated levels of fasting and postprandial plasma triglycerides (P=.0002 and P=.002), IDL cholesterol (P=.0009 and P=.006), and VLDL/chylomicron remnant cholesterol (P=.0003 and P=.0004) and triglycerides (P=.0003 and P=.003), the area under the plasma triglyceride curve 0 to 4 hours after a fatty meal (P=.001), and body mass index (P=.0001). On ANCOVA, body mass index, fasting IDL cholesterol, and fasting plasma triglycerides were independent predictors of echo-lucency. Echo-lucency was associated with increased relative plaque lipid content (P=.02). CONCLUSIONS: Increased plasma levels of triglyceride-rich lipoproteins predict echo-lucency of carotid plaques, which is associated with increased plaque lipid content. Because echo-lucency has been associated with a high incidence of brain infarcts on CT scans, triglyceride-rich lipoproteins may predict a plaque type particularly vulnerable to rupture.
Subject(s)
Arteriosclerosis/blood , Arteriosclerosis/diagnostic imaging , Carotid Artery Diseases/blood , Carotid Artery Diseases/diagnostic imaging , Lipids/blood , Lipoproteins/blood , Triglycerides/blood , Carotid Arteries/diagnostic imaging , Cholesterol, LDL/blood , Endarterectomy, Carotid , Female , Humans , Male , Middle Aged , Reproducibility of Results , UltrasonographyABSTRACT
OBJECTIVE: To relate the histological composition of carotid artery plaques with morphology as evaluated by B-mode ultrasound. DESIGN: Prospective study. MATERIAL AND METHODS: Seventy-eight symptomatic patients underwent carotid endarterectomy after preoperative ultrasound Duplex scanning evaluating plaque morphology. Morphometric analysis of the removed specimen was performed in order to quantify content of lipid, haemorrhage, calcification and fibrous tissue. RESULTS: Echolucent plaques contained more lipid (p = 0.01) and less calcification (p = 0.01) and fibrous tissue (p = 0.03) than echo-rich plaques. Intraplaque haemorrhage was directly related to lipid content (p = 0.004) and inversely related to amount of fibrous tissue in the plaque (p = 0.02). CONCLUSION: The intensity of the reflected B-mode ultrasound signal appears related to the histological composition of the plaque. The association between intraplaque haemorrhage and a high lipid content may support the theory of the lipid-rich plaque being more prone to rupture.
Subject(s)
Arteriosclerosis/diagnostic imaging , Carotid Stenosis/diagnostic imaging , Hemorrhage/diagnostic imaging , Lipids/analysis , Arteriosclerosis/pathology , Arteriosclerosis/surgery , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/pathology , Carotid Stenosis/pathology , Carotid Stenosis/surgery , Endarterectomy, Carotid , Female , Hemorrhage/pathology , Humans , Lipoproteins/blood , Male , Middle Aged , Prospective Studies , Reproducibility of Results , Risk Factors , UltrasonographyABSTRACT
The parachordoma is a seldom, benign tumor of uncertain histogenesis. A case in a 25-year-old man is presented. The parachordoma in the present study reacted with antibodies to GFA, S-100, NSE and vimentin, but not with antibodies to EMA, keratin and NF. Differential diagnoses are the chordoma, the extraskeletal myxoid chondrosarcoma and the subcutaneous sacrococcygeal myxopapillary ependymoma. The immunohistochemical reactions of these tumors were compared and we found that the parachordoma had an immunologically different staining pattern. The parachordoma is thus immunologically different from the chordoma, the extraskeletal myxoid chondrosarcoma and the subcutaneous sacrococcygeal myxopapillary ependymoma. We conclude that the parachordoma is an entity of its own. The immunohistochemical reactions indicate that the parachordoma is a neuroepithelial tumor with glial differentiation.
Subject(s)
Chordoma/pathology , Soft Tissue Neoplasms/pathology , Adult , Biomarkers, Tumor/analysis , Chordoma/surgery , Diagnosis, Differential , Glial Fibrillary Acidic Protein/analysis , Humans , Immunoenzyme Techniques , Male , Sacrococcygeal Region/pathology , Sacrococcygeal Region/surgery , Soft Tissue Neoplasms/surgeryABSTRACT
We compare the effectiveness of morphometric methods for estimating lung parameters. Various stereological methods are applied on human lungs and described in detail. The lung volume was estimated by Cavalieri's principle and by fluid displacement. Both methods are reliable, but Cavalieri's principle is superior when systematic sections are needed or when volumes of parts of the lung are wanted. Point counting demonstrated that 87.5% of the lung is parenchyma, 5.4% is vessel volume, and 7.1% is bronchia volume. Alveolar surface was estimated on vertical and isotropic uniform random tissue (IUR) sections. The capillary length and length density was estimated on projected images of vertical slices (Gokhale method) and on IUR sections. Only minute differences were found whether IUR sections or vertical sections were used. Of the total variation, approximately 2% was due to the stereological variation and approximately 98% was due to the biological variation on IUR sections and vertical sections. Estimates for volumes, surfaces, and lengths coming from model-based and design-based methods gave similar results for human lungs. In our hands, the design-based methods were easier to use and required less time. However, only the design-based methods offer the guarantee of an unbiased estimate.
Subject(s)
Lung Volume Measurements/methods , Lung/blood supply , Pulmonary Alveoli/anatomy & histology , Aged , Aged, 80 and over , Capillaries/anatomy & histology , Female , Humans , Male , Middle AgedABSTRACT
A case of long term retention of a bronchial foreign body in a 62-year old female patient is presented, which mimicked lung carcinoma. Despite a negative history of choking, the diagnosis airway foreign body should be kept in mind.
Subject(s)
Airway Obstruction/etiology , Foreign Bodies/diagnosis , Lung Neoplasms/diagnostic imaging , Pleura/diagnostic imaging , Airway Obstruction/diagnosis , Bronchography , Diagnosis, Differential , Diagnostic Errors , Female , Foreign Bodies/surgery , Humans , Lung Neoplasms/surgery , Middle Aged , PneumonectomyABSTRACT
Coccidioidomycosis is an acute, generally mild, respiratory disease that rarely becomes chronic or disseminated and fatal. The aetiologic agent is Coccidioides immitis, a dimorphic fungus growing in soil. The fungus is endemic in hot semi-arid areas in the USA and South America. Human beings and animals become infected by inhaling dust with arthroconidia. The fungus gives rise to either a purulent or a granulomatous inflammation or both. Clinically and radiologically, it can be confused with neoplasms and tuberculosis. The disease may be fatal in immuno-deprived persons who are also at risk of reactivation of a latent infection. Coccidioidomycosis can be detected serologically. The standard treatment of severe illness is Amphotericin B. The authors present the first histologically and serologically verified case of pulmonary coccidioidomycosis in Denmark. An increased number of coccidioidomycosis can be expected with increased travelling and an increased number of immuno-deprived persons.
Subject(s)
Coccidioidomycosis , Lung Diseases, Fungal/diagnosis , Pneumonia/microbiology , Coccidioidomycosis/diagnosis , Coccidioidomycosis/immunology , Coccidioidomycosis/therapy , Humans , Lung Diseases, Fungal/immunology , Lung Diseases, Fungal/microbiology , Male , Middle Aged , Pneumonia/immunology , Pneumonia/therapyABSTRACT
A histologic examination was made of all appendices delivered to the Dept. of Pathology, Sundby Hospital, Copenhagen, in 1980-87, to ascertain the incidence of Enterobius vermicularis (pinworm) and the possible relation to acute appendicitis. Altogether 2267 appendices were examined, and E. vermicularis was identified in 4.1%. The highest incidence occurred in the 6- to 15-year age group. Infestation was more frequent in female than in male appendices, with the ratio of 1 male to 1.8 females, except in the 11- to 15-year age group, in which the ratio was 1. There was a highly significant difference in the incidence of E. vermicularis in normal appendices and in inflamed appendices, which may indicate that 1) the presence of E. vermicularis in the appendix can give the symptoms of acute appendicitis, or 2) E. vermicularis leaves or does not enter an inflamed appendix.