RESUMO
Autonomic nerves in jejunal mucosa of HIV-infected patients show severe structural damage on electron microscopic examination. The aim of this study was to quantify loss of autonomic axons from the lamina propria of HIV-infected patients in different clinical stages of disease. Jejunal biopsies were taken from 19 HIV-antibody-positive homosexual men and from 10 control patients. Autonomic fibres in the mucosa were stained with a neurone-specific polyclonal antibody, PGP 9.5. The density of axons was quantified by a point-counting technique using a Lennox eyepiece graticule under light microscopic examination. There was significant reduction in axonal density in the villi of HIV-infected patients [mean, 9.0; standard deviation (s.d.), 4.7] compared with controls (mean, 15.3; s.d., 5.2; P = 0.003), and in the pericryptal lamina propria of HIV-infected patients (mean, 17.8; s.d., 5.4) compared with controls (mean, 27.3; s.d., 6.2; P = 0.0002). Although autonomic denervation occurs throughout the jejunal mucosa of HIV-infected patients, there was no correlation between the clinical stage of HIV disease and the degree of denervation. The denervation was greatest in patients with the most severe diarrhoea, but this difference was not significant. This study provides the first quantitative morphological evidence for depletion of autonomic nerves in the jejunum of patients infected with HIV. Autonomic neuropathy may contribute to chronic diarrhoea in HIV disease.
Assuntos
Sistema Nervoso Autônomo/patologia , Infecções por HIV/patologia , Mucosa Intestinal/inervação , Jejuno/inervação , Complexo Relacionado com a AIDS/complicações , Complexo Relacionado com a AIDS/patologia , Axônios/patologia , Biópsia , Tecido Conjuntivo/patologia , Denervação , Diarreia/patologia , Infecções por HIV/complicações , Soropositividade para HIV/complicações , Soropositividade para HIV/patologia , Homossexualidade , Humanos , Mucosa Intestinal/patologia , Jejuno/microbiologia , MasculinoRESUMO
OBJECTIVE: The concept that HIV infection per se alters small intestinal mucosal structure and function (HIV enteropathy) remains controversial and in this study we report in vitro experiments designed to elucidate the matter. METHODS: Twenty pairs of human fetal intestinal tissue explants were maintained in vitro for up to 14 days; one explant of each pair was incubated and infected with HIV, and the other served as a matched uninfected control. At various times after infection, explant culture fluid and tissue were removed, p24 concentration was measured and tissue formalin fixed. Explant tissue was embedded in paraffin wax and sections stained by an immunoperoxidase method directed against proliferating cell nuclear antigen (PCNA). The percentage of proliferating crypt and villous epithelial cells, stained by PCNA, was calculated in paired samples. The difference between the percentage for paired samples was designated delta crypt proliferation (delta CP) and delta villous proliferation (delta VP), respectively. Epithelial cell proliferation was deemed to be enhanced if the percentage of PCNA-stained cells was greater in the HIV-infected than in the control tissue. RESULTS: Explant culture fluid from tissue exposed to HIV showed a progressive rise in p24 antigen (Ag) level, indicating HIV infection of these explants. Fifteen pairs of explants showed progressively positive delta CP with time (P < 0.01) indicating crypt hyperplasia and all 20 pairs of explants showed positive delta VP, indicating hyperplasia of villous epithelial cells. CONCLUSIONS: This study provides direct evidence that HIV stimulates epithelial cell proliferation in intestinal mucosa. HIV-infected human intestinal explants provide a model of crypt hyperplastic villous atrophy previously described as HIV enteropathy and detected in clinical biopsy specimens from HIV-infected patients.
Assuntos
HIV-1/fisiologia , Mucosa Intestinal/microbiologia , Atrofia , Biomarcadores , Divisão Celular , Epitélio/microbiologia , Epitélio/patologia , Proteína do Núcleo p24 do HIV/análise , Humanos , Hiperplasia , Mucosa Intestinal/embriologia , Mucosa Intestinal/patologia , Proteínas Nucleares/análise , Técnicas de Cultura de Órgãos , Antígeno Nuclear de Célula em ProliferaçãoRESUMO
Jejunal biopsies from 11 HIV-infected male homosexuals, without secondary enteropathogen infection, were examined at ultrastructural and light microscope level. Subjects were clinically categorized into four groups: asymptomatic (3), AIDS-related complex (4), persistent generalized lymphadenopathy (1), and AIDS (3). All 11 biopsies, including the three from asymptomatic HIV-infected individuals, showed extensive damage to autonomic nerve fibres in the lamina propria. These findings show that HIV infection damages the enteric autonomic nerves. Since asymptomatic HIV-infected individuals had similar damage, this appears to be an early event in the course of HIV infection.
Assuntos
Síndrome da Imunodeficiência Adquirida/patologia , Sistema Nervoso Autônomo/patologia , Jejuno/inervação , Adulto , Soropositividade para HIV/patologia , Humanos , Mucosa Intestinal/inervação , Mucosa Intestinal/patologia , Jejuno/patologia , Masculino , Microscopia Eletrônica , Pessoa de Meia-IdadeRESUMO
A case of pilar tumour of the scalp, treated by local excision and radiotherapy, later metastasised to the neck. The variable histological growth patterns of the primary tumour and its metastases are described. It is concluded that the pilar tumour is a genuine neoplasm of the hair follicle that is occasionally capable of malignant behaviour.
Assuntos
Neoplasias de Cabeça e Pescoço/secundário , Couro Cabeludo , Neoplasias Cutâneas/patologia , Idoso , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Couro Cabeludo/patologiaRESUMO
Multiple myeloma is a neoplastic disorder caused by the proliferation of a transformed B lymphoid progenitor cell that gives rise to a clone of immunoglobulin-secreting cells. Other plasma cell tumours include solitary plasmacytoma of bone (SPB) and extramedullary plasmacytomas (EMP). Despite an apparent common origin there exist pathological and clinical differences between these neoplasms and the association between them is not completely understood. A case of IgG multiple myeloma that presented with typical clinical and laboratory features, including a bone marrow infiltrated by well differentiated plasma cells, is reported. The tumour had an unusual evolution, with the development of extensive extramedullary disease while maintaining mature histological features.
Assuntos
Mieloma Múltiplo/patologia , Plasmócitos/patologia , Idoso , Humanos , Rim/diagnóstico por imagem , Masculino , Mieloma Múltiplo/diagnóstico por imagem , Invasividade Neoplásica , Pâncreas/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
AIMS: To compare the density of neuroendocrine cells in rectal biopsy specimens from human immunodeficiency virus (HIV) infected individuals with that of a control group. METHODS: Neuroendocrine cells in rectal biopsies were identified using an immunohistochemical stain for chromogranin and subsequently quantified using a method of linear intercept. RESULTS: Neuroendocrine cells were found to be significantly decreased in the HIV positive group. CONCLUSIONS: Loss of neuroendocrine cells may contribute to apoptotic bodies seen in this condition. This could be related to infection of these cells with HIV and could contribute to diarrhoeal disease in HIV infection.
Assuntos
Infecções por HIV/patologia , Sistemas Neurossecretores/patologia , Reto/patologia , Biópsia , Humanos , Técnicas Imunoenzimáticas , Mucosa Intestinal/patologia , MasculinoRESUMO
A 67 year old man with myelodysplasia was admitted as an emergency with a six week history of rectal bleeding and diarrhoea. Barium enema showed an irregular polypoid filling defect in the lateral wall of the proximal rectum near the rectosigmoid junction. Histology showed this to be a granulocytic sarcoma (extramedullary granulocytic leukaemia; chloroma) infiltrating the bowel. A low index of suspicion of this lesion results in an incorrect diagnosis in many such cases. A chloroacetate esterase immunoperoxidase stain will confirm the granulocytic nature of the tumour cells.
Assuntos
Leucemia Mieloide/complicações , Síndromes Mielodisplásicas/complicações , Neoplasias Retais/complicações , Idoso , Humanos , Imuno-Histoquímica , Leucemia Mieloide/patologia , Masculino , Síndromes Mielodisplásicas/patologia , Neoplasias Retais/patologiaRESUMO
Jejunal biopsy specimens from 20 human immunodeficiency virus (HIV) positive male homosexual patients were analysed and compared with those of a control group to determine whether the abnormalities were caused by the virus or by opportunistic infection. The degree of villous atrophy was estimated with a Weibel eyepiece graticule, and this correlated strongly with the degree of crypt hyperplasia, which was assessed by deriving the mean number of enterocytes in the crypts. The density of villous intraepithelial lymphocytes fell largely within the normal range, either when expressed in relation to the number of villous enterocytes or in relation to the length of muscularis mucosae. Villous enterocytes showed mild non-specific abnormalities. Pathogens were sought in biopsy sections and in faeces. Crypt hyperplastic villous atrophy occurred at all clinical stages of HIV disease and in the absence of detectable enteropathogens. An analogy was drawn between HIV enteropathy and the small bowel changes seen in experimental graft-versus-host disease. It is suggested that the pathogenesis of villous atrophy is similar in the two states, the damage to the jejunal mucosa in HIV enteropathy being inflicted by an immune reaction mounted in the lamina propria against cells infected with HIV.
Assuntos
Síndrome da Imunodeficiência Adquirida/patologia , Mucosa Intestinal/patologia , Jejuno/patologia , Adulto , Biópsia , Epitélio/patologia , Humanos , Linfócitos/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
The completeness of skin cancer registration in the Yorkshire region was evaluated for the year 1994 by the independent case ascertainment method. Patients diagnosed with skin cancer were identified from regional pathology laboratories, inpatient and outpatient hospital departments and general practices, and were matched against records held by the Northern and Yorkshire Cancer Registry and Information Services (NYCRIS). Out of 5987 skin cancer cases identified from 14 pathology laboratories, 123 general practices, 16 NHS Trusts inpatient databases and 7 dermatology outpatient departments, 83.5% had a matching record on the Cancer Register. The proportion of registered malignant melanoma (MM) and non-melanoma skin cancer (NMSC) cases were 87.5% (95% confidence interval (CI) 84.0-90.4) and 83.1% (95% CI 81.9-84.2) respectively. Skin cancers found in the pathology laboratories, the main notification sources of the registry, were under-ascertained by 15% (10% MM and 15% NMSC). Cases identified from general practices had a significantly lower proportion of matching registry records in comparison with other information sources. No record of histological confirmation could be found for 11% MM and 13% NMSC. Complete capture of pathology laboratory information, histological confirmation of all lesions suspected of skin cancer and routine receipt of hospital patient administration system information supplementary to that from pathology laboratories are measures that would provide the most substantial improvement to ascertainment of skin cancer data.
Assuntos
Prontuários Médicos/normas , Avaliação de Resultados em Cuidados de Saúde , Sistema de Registros/normas , Neoplasias Cutâneas/epidemiologia , Instituições de Assistência Ambulatorial , Inglaterra/epidemiologia , Medicina de Família e Comunidade , Registros Hospitalares , Humanos , Laboratórios Hospitalares , Melanoma/epidemiologia , Melanoma/etiologia , Melanoma/prevenção & controle , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/prevenção & controleRESUMO
Small intestinal absorptive function was investigated in six patients with the acquired immunodeficiency syndrome (AIDS) who had diarrhoea and weight loss. Proximal function was assessed by [14C]Triolein test of fat absorption. Distal function was determined by a test of bile acid absorption in which the loss of radio-labelled synthetic bile acid, 75seleno-23-homocholic acid-taurine ([75Se]HCAT), from the enterohepatic circulation was quantified by abdominal gamma-scanning and by a vitamin B12-intrinsic factor absorption test. Concurrently indirect tests of small intestinal bacterial overgrowth ([14C]glycocholate and breath hydrogen) were carried out. In addition, jejunal histological examination and stool microscopy and culture for enteropathogens were performed. Fat absorption was reduced in all six patients, four of whom had jejunal villous atrophy. Bile acid and vitamin B12 absorption were normal in four subjects. Enteropathogens were not detected in any of the four subjects with normal terminal ileal absorptive function. In contrast, reduced bile acid and vitamin B12 absorption were detected in two of six subjects. Both patients had an enteropathogen (Cryptosporidium spp. and Isospora belli) present on stool and jejunal histological examination. Neither subject had evidence of small-intestinal bacterial overgrowth. AIDS patients therefore may have normal ileal absorptive function in the presence of jejunal disease. Infection with Cryptosporidium spp. or I. belli may however, be associated with severe ileal dysfunction.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Criptosporidiose/complicações , Doenças do Íleo/complicações , Doenças do Jejuno/complicações , Síndromes de Malabsorção/complicações , Síndrome da Imunodeficiência Adquirida/metabolismo , Adulto , Atrofia , Criptosporidiose/metabolismo , Gorduras na Dieta/metabolismo , Feminino , Humanos , Hiperplasia , Doenças do Íleo/metabolismo , Doenças do Íleo/patologia , Absorção Intestinal , Doenças do Jejuno/metabolismo , Doenças do Jejuno/patologia , Síndromes de Malabsorção/metabolismo , Síndromes de Malabsorção/patologia , Masculino , Pessoa de Meia-Idade , Vitamina B 12/metabolismo , Redução de PesoRESUMO
Indium-111 leucocyte scanning has been shown to be a highly accurate technique for detecting abscesses and assessing inflammatory bowel disease. We have encountered two cases of colonic carcinoma which presented as suspected inflammatory bowel disease and were found to localise 111In-labelled granulocytes. Histology revealed an acute inflammatory infiltrate in these tumours. These results indicate that 111In granulocyte scanning has limitations in the diagnosis of inflammatory bowel disease.
Assuntos
Colite Ulcerativa/diagnóstico por imagem , Neoplasias do Colo/diagnóstico por imagem , Doença de Crohn/diagnóstico por imagem , Índio , Radioisótopos , Idoso , Neoplasias do Colo/patologia , Diagnóstico Diferencial , Feminino , Granulócitos , Humanos , Pessoa de Meia-Idade , CintilografiaRESUMO
Symptomatic oncocytic disease of the larynx is rare. Review of the world literature reveals that isolated, symptomatic cases of oncocytoma of the larynx have been previously reported to involve discrete sites usually the laryngeal ventricles and vestibular folds. A unique case of multifocal cystic oncocytic hyperplasia necessitating laryngectomy is reported. CT scan of the larynx suggested destruction of the cartilage. Malignant histological features were not present. This report raises the question whether previously described cases of oncocytoma of the larynx also had diffuse involvement. If oncocytosis is a diffuse process then it is suggested that patients should be kept under review for recurring lesions.
Assuntos
Adenoma/patologia , Cistadenocarcinoma/patologia , Neoplasias Laríngeas/patologia , Adenoma/diagnóstico por imagem , Idoso , Cistadenocarcinoma/diagnóstico por imagem , Humanos , Hiperplasia/diagnóstico por imagem , Neoplasias Laríngeas/diagnóstico por imagem , Laringe/diagnóstico por imagem , Laringe/patologia , Masculino , RadiografiaRESUMO
Synovial chondromatosis of the temporomandibular joint is a rare, benign condition of metaplastic change of the synovium. A case is reported and the world literature is reviewed.
Assuntos
Condroma/patologia , Membrana Sinovial/patologia , Transtornos da Articulação Temporomandibular/patologia , Idoso , Humanos , MasculinoRESUMO
The purpose of the investigation was to determine the relative oxygen consumption (VO2), heart rate and oxygen pulse associated with the constituent elements of an exercise-to-music class. Six women exercise-to-music leaders with a mean(s.d.) age, weight and height of 33.2(5.2) years, 51.0(2.8) kg and 157.9(5.6) cm respectively, completed five distinct exercise-to-music movement elements. The movement elements were of a locomoter (circuit, jump and low impact) and callisthenic (prone and side/supine) nature. The movement elements were distinguishable from one another in terms of their movement patterns, posture and tempo. Relative VO2 values were greatest for the circuit element (40.6 ml kg-1 min-1) and least for the side/supine element (20.0 ml kg-1 min-1). The differences in VO2 between the locomotrr and callisthenic elements were significant (circuit approximately jump approximately low impact > prone approximately side/supine). However, effect size data suggested that the differences between the low impact and jump elements and the prone and side/supine elements were of practical significance (circuit approximately jump > low impact > prone > side/supine). With a single exception similar parametric statistics and effect size trends were identified for absolute heart rate. Specifically, the heart rate associated with the low impact element was not significantly greater than the prone element. The oxygen pulse associated with the locomotor elements was significantly greater than the callisthenic elements (circuit approximately jump approximately low impact > prone > side/supine). This suggested that heart rate may be an inappropriate index for making comparisons between exercise-to-music elements. Reasons for differences in oxygen uptake values between movement elements are discussed.
Assuntos
Exercício Físico/fisiologia , Frequência Cardíaca/fisiologia , Música , Consumo de Oxigênio/fisiologia , Pulso Arterial/fisiologia , Adulto , Feminino , Humanos , Locomoção/fisiologia , Decúbito Ventral/fisiologia , Troca Gasosa Pulmonar , Corrida/fisiologia , Decúbito Dorsal/fisiologia , Suporte de Carga/fisiologiaRESUMO
A patient who abstained from alcohol consumption but who had asymptomatic chronic progressive hepatomegaly, mild disturbance of liver function tests and hepatitis resembling alcoholic hepatitis (nonalcoholic steatohepatitis) developed glucose intolerance several years after the hepatitis was diagnosed. The patient had a family history of both diabetes and chronic liver disease. A lesion resembling alcoholic hepatitis in a patient who denies alcohol consumption, may be diabetic or pre-diabetic in aetiology and such a patient should be followed up with glucose tolerance tests.
Assuntos
Diabetes Mellitus Tipo 2/complicações , Fígado Gorduroso/patologia , Glucose/metabolismo , Hepatite/complicações , Diabetes Mellitus Tipo 2/genética , Diagnóstico Diferencial , Fígado Gorduroso/genética , Feminino , Teste de Tolerância a Glucose , Hepatite/etiologia , Hepatite/genética , Hepatite Alcoólica/diagnóstico , Humanos , Fígado/patologia , Testes de Função Hepática , Pessoa de Meia-Idade , Fatores de TempoRESUMO
AIMS: To describe a third case of congenital pulmonary acinar dysplasia, comparing its clinicopathological features with those of the two previous cases and with cystic adenomatoid malformations. METHODS AND RESULTS: An externally normal female infant was born to a 25-year-old after a normal pregnancy. Ventilation was not established. At autopsy the hypoplastic lungs showed bronchial development but no acinar development, resembling the pseudoglandular phase of 16 weeks gestation. As in the previous cases the infant was female, born at term with unaffected older sibling(s): however, no intrapulmonary haematopoietic tissue was identified in the present case. Cystic adenomatoid malformations also resemble microscopically the pseudoglandular phase but are focal pulmonary hyperplasias rather than generalized pulmonary hypoplasias. CONCLUSION: Congenital acinar dysplasia is a rare, apparently sporadic lethal developmental defect resulting in pulmonary hypoplasia due to failure of lung development beyond the pseudoglandular phase seen at 16 weeks gestation.
Assuntos
Alvéolos Pulmonares/anormalidades , Anormalidades Múltiplas/etiologia , Brônquios/anormalidades , Brônquios/patologia , Evolução Fatal , Feminino , Humanos , Recém-Nascido , Pulmão/anormalidades , Pneumopatias/congênito , Pneumopatias/patologia , Alvéolos Pulmonares/patologiaRESUMO
We describe the cases of two young women who died due to air embolism during sexual intercourse early in the puerperium.