Scanning electron microscopy of the jejunum in children with protein-energy malnutrition

Samples of jejunum from seven children dying from severe oedematous malnutrition were fixed with intralumenal glutaraldehyde in combination with external immersion, using a rapid autopsy protocol. Selected areas were post-fixed in osmium tetroxide, dehydrated with an ethanol series and critical point dried. After mounting on aluminium stubs, specimens were sputter-coated with a thin layer of gold and palladium. Scanning electron microscopy showed patterns ranging from subtotal villous atrophy, through partial villous atrophy with low ridges, to longer, taller ridges with cerebriform convolutions. In one case, villous height had been interpreted as normal on light microscopy. The scanning electron microscope revealed that the mucosa in this case was composed of ridges and leaf forms. Processing for scanning electron microscopy is simple. The specimens can be viewed and photographed in a relatively short time. In addition, the three-dimensional record provides clarification of ambiguities which often arise from routine histological sections. (AU)

Scanning electron microscopy of the jejunum in children with protein-energy malnutrition

Samples of jejunum from seven children dying from severe oedematous malnutrition were fixed with intralumenal glutaraldehyde in combination with external immersion, using a rapid autopsy protocol. Selected areas were post-fixed in osmium tetroxide, dehydrated with an ethanol series and critical point dried. After mounting on aluminium stubs, specimens were sputter-coated with a thin layer of gold and palladium. Scanning electron microscopy showed patterns ranging from subtotal villous atrophy, through partial villous atrophy with low ridges, to longer, taller ridges with cerebriform convolutions. In one case, villous height had been interpreted as normal on light microscopy. The scanning electron microscope revealed that the mucosa in this case was composed of ridges and leaf forms. Processing for scanning electron microscopy is simple. The specimens can be viewed and photographed in a relatively short time. In addition, the three-dimensional record provides clarification of ambiguities which often arise from routine histological sections.

Ultrastructure of voluntary muscle in childhood malnutrition

This paper is part of a study on the electron microscopy of protein-energy malnutrition, using a rapid autopsy protocol. Samples of voluntary muscle, obtained from eight children dying of severe oedematous malnutrition, were fised in glutaraldehyde within 75 minutes of death. Atrophy of myofibres, increased prominence of satellite cells, and segmental necrobiosis were seen by light microscopy. Electron microscopy showed variable depletion of myofibrils. In the most severe case, there was focal absence of myofibrils, also disorganized Z lines, and absent M bands. Residual atrophic myofibrils measured less than 0.1 æm in width. Other specimens showed sarcomere disorganization, mitochondrial swelling, glycogen depletion, sarcoplasmic oedema, and focal contractions of sarcomeres. Though non-specific, rigor may phosphates. These conditions may exist in severe malnutrition, complicated by terminal infection and metabolic disturbances (AU)

Ultrastructure of voluntary muscle in childhood malnutrition

This paper is part of a study on the electron microscopy of protein-energy malnutrition, using a rapid autopsy protocol. Samples of voluntary muscle, obtained from eight children dying of severe oedematous malnutrition, were fised in glutaraldehyde within 75 minutes of death. Atrophy of myofibres, increased prominence of satellite cells, and segmental necrobiosis were seen by light microscopy. Electron microscopy showed variable depletion of myofibrils. In the most severe case, there was focal absence of myofibrils, also disorganized Z lines, and absent M bands. Residual atrophic myofibrils measured less than 0.1 µm in width. Other specimens showed sarcomere disorganization, mitochondrial swelling, glycogen depletion, sarcoplasmic oedema, and focal contractions of sarcomeres. Though non-specific, rigor may phosphates. These conditions may exist in severe malnutrition, complicated by terminal infection and metabolic disturbances

Age-specific incidence of cancer in Kingston and St Andrew, Jamaica, 1988-1992

During the period 1988 - 1992, a total of 4,030 malignant neoplasms were recorded in Kingston and St. Andrew, Jamaica. These comprised 1,829 males and 2,201 in females. Histological confirmation was obtained in 83.4 percent. The crude incidence rate for males was 128.5, and 136.2 for females. The age-standardized rates (ASR) were 179.9 for males and 166.1 for females. Age-specifics rates by site, sex and age are tabulated. Attention is drawn to increased incidence for cancers of prostate, larynx, bronchus and non-Hodgkin's lymphoma in males. There was also an increase in female breast cancer (crude rate 36.0; ASR 47.1). Invasive cervix cancer has shown no significant change in incidence. Neoplasms of the body of the uterus have increased (crude rate 7.6; ASR 9.5). The rise in cancer of breast and body of uterus suggests that the influence of exogenous oestrogens should be considered (AU)

Age-specific incidence of cancer in Kingston and St Andrew, Jamaica, 1988-1992

During the period 1988 - 1992, a total of 4,030 malignant neoplasms were recorded in Kingston and St. Andrew, Jamaica. These comprised 1,829 males and 2,201 in females. Histological confirmation was obtained in 83.4 percent. The crude incidence rate for males was 128.5, and 136.2 for females. The age-standardized rates (ASR) were 179.9 for males and 166.1 for females. Age-specifics rates by site, sex and age are tabulated. Attention is drawn to increased incidence for cancers of prostate, larynx, bronchus and non-Hodgkin's lymphoma in males. There was also an increase in female breast cancer (crude rate 36.0; ASR 47.1). Invasive cervix cancer has shown no significant change in incidence. Neoplasms of the body of the uterus have increased (crude rate 7.6; ASR 9.5). The rise in cancer of breast and body of uterus suggests that the influence of exogenous oestrogens should be considered

Pathology of the lungs in childhood malnutrition in Jamaica: light and electron microscopy

The autopsy records of 115 children with severe protein-energy malnutrition were reviewed. Sections of the lung histology showed evidence of bacterial pneumonia in 49 percent of cases. An additional 18 percentshowed bronchitis, bronchiolitis or interstitial pneumonitis. Aspiration of gastric contents was evident in 10 percent of cases; 6 percent showed pulmonary oedema and congestion. In the remaining cases, no lung pathology was identified (17 percent). In 8 cases, rapid autopsy examination permitted fixation of lung tissue for electron microscopy. These included 4 cases of bronchopneumonia, one of which was associated with viral pneumonia. Another interstitial pneumonitis, probably of viral aetiology, was also studied. Both these virus-associated cases showed loss of type I pneumocytes and hyperplasia of type II pneumocytes. Another patient with herpes simplex hepatitis showed necrotic emboli in pulmonary capillaries with virions, as well as colonies of interstitial bacteria. One patient with acute pulmonary oedema displayed severe endothelial cell swelling on electron microscopy. In one case, there was no evidence of respiratory changes, apart from desquamation of type I pnuemocytes. Useful information can be obtained on the fine structure of the lung, using samples taken soon after death. (AU)

Pathology of the lungs in childhood malnutrition in Jamaica: light and electron microscopy

The autopsy records of 115 children with severe protein-energy malnutrition were reviewed. Sections of the lung histology showed evidence of bacterial pneumonia in 49 per cent of cases. An additional 18 per cent showed bronchitis, bronchiolitis or interstitial pneumonitis. Aspiration of gastric contents was evident in 10 per cent of cases; 6 per cent showed pulmonary oedema and congestion. In the remaining cases, no lung pathology was identified (17 per cent ). In 8 cases, rapid autopsy examination permitted fixation of lung tissue for electron microscopy. These included 4 cases of bronchopneumonia, one of which was associated with viral pneumonia. Another interstitial pneumonitis, probably of viral aetiology, was also studied. Both these virus-associated cases showed loss of type I pneumocytes and hyperplasia of type II pneumocytes. Another patient with herpes simplex hepatitis showed necrotic emboli in pulmonary capillaries with virions, as well as colonies of interstitial bacteria. One patient with acute pulmonary oedema displayed severe endothelial cell swelling on electron microscopy. In one case, there was no evidence of respiratory changes, apart from desquamation of type I pnuemocytes. Useful information can be obtained on the fine structure of the lung, using samples taken soon after death.

Peroxisomes and the hepatic pathology of childhood malnutrition

Liver specimens obtained immediately after death from eight severly malnourished children were examined by electron microscopy, and compared with seven liver biopsy specimens from children who recovered from malnutrition. The liver cells from the fatal cases showed mitochondrial swelling, with coarse densities in the matrix, cholestasis, depletion of the endoplasmic reticulum and Golgi apparatus, diminished glycogen stores, prominent lipid deposits and focal cytoplasmic degradation. The nucleoli were enlarged. There was marked reducation in peroxisomes. In contrast, the biopsies from recovering children showed good cellular organisation, and a normal frequency of peroxisomes. Multiple factors, including sepsis, may lead to depletion of peroxisomes. Loss of peroximes may interrupt beta-oxidation of long-chain fatty acids and accentuate the accumulation of lipid. Moreover, a reduction in the concentration of catalase may remove one avenue for the detoxification of free radicals. As the concentration of other anti-oxidants, notably glutathione, is also reduced, free radical damage may occur, leading to lipid peroxidation of membranes, mitochondrial damage, pump failure and influx of water and electrolyted into the cell (AU)

Peroxisomes and the hepatic pathology of childhood malnutrition

Liver specimens obtained immediately after death from eight severly malnourished children were examined by electron microscopy, and compared with seven liver biopsy specimens from children who recovered from malnutrition. The liver cells from the fatal cases showed mitochondrial swelling, with coarse densities in the matrix, cholestasis, depletion of the endoplasmic reticulum and Golgi apparatus, diminished glycogen stores, prominent lipid deposits and focal cytoplasmic degradation. The nucleoli were enlarged. There was marked reducation in peroxisomes. In contrast, the biopsies from recovering children showed good cellular organisation, and a normal frequency of peroxisomes. Multiple factors, including sepsis, may lead to depletion of peroxisomes. Loss of peroximes may interrupt beta-oxidation of long-chain fatty acids and accentuate the accumulation of lipid. Moreover, a reduction in the concentration of catalase may remove one avenue for the detoxification of free radicals. As the concentration of other anti-oxidants, notably glutathione, is also reduced, free radical damage may occur, leading to lipid peroxidation of membranes, mitochondrial damage, pump failure and influx of water and electrolyted into the cell.

Hepatic ultrastructure in children with protein-energy malnutrition

Samples of liver from eight children who died from malnutrition with its complications were studied by electron microscopy. Specimens were taken within one hour of death. These tissues had changes consistent with severe terminal illness, including mitochondrial swelling, with loss of matrix granules, disorganization of cristae, and evidence of calcium influx. Glycogen tended to be scanty. Lipid droplets were frequent. Endoplasmic membranes were depleted, and focal cytoplasmic degradation was frequent. Intracanalicular cholestasis was striking in four cases with loss of microvilli. Peroxisomes were depleted. This may be significant as peroxisomes are pivotal in the processing of very long-chain fatty acids in cholic acid metabolism and in elimination of free radicals. The observations were compared with previous reports in the literature, and with seven biopsies taken in 1970 from malnourished children who recovered. One, obtained on the fourth day, from a child with marasmus, showed atrophy of cellular organelles. The other samples were biopsied during the recovery phase, and displayed considerable restoration to normal morphology. Mitochondria had prominent matrix granules. Peroxisomes were frequently seen. There was no evidence of cholestasis (AU)

Immunohistochemistry of lymphocyte B-cell lymphoma of the prostate gland

A case of small lymphocytic B-cell lymphoma occurring in the prostate gland of a 68-year-old man is reported. These tumours are rarely encountered in surgical specimens, and may be confused with an undifferentiated carcinoma. Differentiation is readily made, using immunohistochemical techniques

Cancer in the Caribbean and environs: a comparison of age-standardized rates for 9 population groups

Age-standardized rates for cancer in Kingston and St. Andrew, Jamaica are presented by site and sex, and compared with data from registries in the Caribbean and adjacent regions. These comprise Costa Rica, Cuba, Cali (Colombia), Martinique, the Netherlands Antilles (excluding Aruba), New Orleans (Whites and Blacks) and Puerto Rico. There are significant differences which demand explanation. Overall, the reported rates are highest in New Orleans, which leads in breast cancer, tumours of bronchus, larynx, colon, rectum, pancreas, prostate and bladder. Lymphomas occur most frequently in Whites in New Orleans while Blacks in that city show similiar rates to other registries in the area. Cali (Colombia) and Costa Rica lead in cervical cancer, with Jamaica third. The lowest figure is for Whites in New Orleans. Cali (Colombia) and Costa Rica also have very high rates for gastric cancer, and low rates for colonic. Oesophageal cancer is highest in Blacks in New Orleans, followed by Martinique and the Netherlands Antilles. Jamaica has shown a steady decline for this site over 30 years. The rate in Whites in New Orleans is only one-fourth of that in Blacks. (AU)

The exocrine pancreas in kwashiorkor and marasmus: light and electron microscopy

Histological sections of pancreas and liver from 65 cases of children dying from childhood malnutrition were reviewed. The extent of pancreatic atrophy and fibrosis was compared with fatty change in the liver. Pancreatic atrophy was common, and often associated with severe fatty change in the liver, but also occurred in marasmic children with scanty liver fat. Pancreatic fibrosis, when present, was only of mild degree. Among 16 patients with marasmus, fibrosis was only seen in one pancreas. Fibrosis was recorded in 8/25 cases of kwashiorkor, and in 7/24 cases diagnosed as marasmic-kwashiorkor. Electron microscopy of the pancreas was performed in seven cases, using tissue collected at immediate autopsy. Atrophy and variable amounts of degranulation of acinar cells were seen. There was often disorganization of the endoplasmic reticulum with intracisternal sequestration. Mitochondrial swelling was consistent with terminal anoxia. Centro-acinar cells were prominent. Some acini were dilated and contained fibrillar material. These findings support the pioneer paper by Blackburn and Vinijchaikul (1969) and underlie the importance of pancreatic atrophy in the pathology of protein-energy malnutrition. (AU)

The exocrine pancreas in kwashiorkor and marasmus. Light and electron microscopy

Histological sections of pancreas and liver from 65 cases of children dying from childhood malnutrition were reviewed. The extent of pancreatic atrophy and fibrosis was compared with fatty change in the liver. Pancreatic atrophy was common, and often associated with severe fatty change in the liver, but also occurred in marasmic children with scanty liver fat. Pancreatic fibrosis, when present, was only of mild degree. Among 16 patients with marasmus, fibrosis was only seen in one pancreas. Fibrosis was recorded in 8/25 cases of kwashiorkor, and in 7/24 cases diagnosed as marasmic-kwashiorkor. Electron microscopy of the pancreas was performed in seven cases, using tissue collected at immediate autopsy. Atrophy and variable amounts of degranulation of acinar cells were seen. There was often disorganization of the endoplasmic reticulum with intracisternal sequestration. Mitochondrial swelling was consistent with terminal anoxia. Centro-acinar cells were prominent. Some acini were dilated and contained fibrillar material. These findings support the pioneer paper by Blackburn and Vinijchaikul (1969) and underlie the importance of pancreatic atrophy in the pathology of protein-energy malnutrition.

Electron microscopy of herpes simplex hepatitis with hepatocyte pulmonary embolization in kwashiorkor

We report a case of herpes simplex hepatitis in a child with edematous malnutrition. Electron microscopy showed virus in parenchymal cells. With pulmonary embolization of necrotic, infected hepatic cell fragments. Systemic dissemination of herpes simplex may be related both to the profound immunoincompetence associated with kwashiorkor and to a reduction in the circulating and fixed polyanions that normally inhibit viral attachment to cells.(AU)

Peroxisomes and the fatty liver of malnutrition: an hypothesis 1-3

Peroxisomes play a role in hepatic á-oxidation of fat, a process that results in the production of hydrogen per-oxide. The fatty infiltration of the liver that occurs in severely malnourished children remains unexplained. We observed an almost total absence of peroxisomes in the hepatocytes of these children. We suggest that lack of available peroxisomes could contribute to the development of fatty liver.(AU)

30-year cancer trends in Jamaica: Kingston & St. Andrew (1958-1987)

A total of 19,225 malignant neoplasms were recorded in Kingston & St.Andrew, Jamaica over the 30-year period 1958-1987. The most prevalent cancers in males were those of prostate (12.2 percent), stomach (10.9 percent) and lung (10.7 percent). In females 24.1 percent of cancers occurred in breast and 20 percent were recorded for invasive carcinoma of the cervix. There is a steady improvement in the diagnosis of in situ cervical lesions, and a relative decline in the invasive lesions. Lung cancer in women remains at a low level. A significant decline in cancer of the oesophagus and stomach in both sexes was noted, while neoplasms of colon and rectum maintained a stable pattern. The 30-year trends of lymphomas and leukaemias have shown no increase, although there are changes in classification patterns. (AU)