Prevalencia de lesiones intraepiteliales cervicales de bajo y alto grado en pacientes en edad fértil. Maracaibo. Estado Zulia / Prevalence of intrepelitelial, cervical low and high grade injuries in patients in the fertile age. Maracaibo. Zulia state

Determinar la prevalencia de las lesiones intraepiteliales cervicales de bajo y alto grado en pacientes de edad fértil en la consulta de ginecología del centro Materno pediatrico Zulia, en el período comprendido febrero 2016 -febrero 2018 Maracaibo, Estado Zulia. Métodos: Se realizó un estudio descriptivo retrospectivo en el que se incluyeron mujeres entre los 15 y 44 años, que acudieron a la consulta de Ginecología obstetricia del centro materno pediátrico Zulia para el periodo comprendido febrero 2016 ­ febrero 2018. Se evaluó la normalidad de las variables cuantitativas, empleándose la mediana o el promedio con sus varianzas según su distribución, y frecuencias y proporciones para las variables categóricas. Resultados: Se incluyeron 150 pacientes. La mediana de la edad fue 29 años con rango (R: 15-43 años), la mediana del número de partos 1 (R: 0-3). Uso de métodos anticonceptivos, la mayoría utilizaba ACO. El 60% de las citologías se reportaron como negativas, 20 % lesión de bajo grado (LSIL), 10% células escamosas atípicas de significado indeterminado (ASC-US), 2% lesiones de alto grado (HSIL), 2,3% células escamosas atípicas de significado indeterminado de alto grado ASC-H, 3,3% células glandulares atípicas de significado incierto (ASGUS) y 2% carcinoma invasor. Conclusión: La prevalencia de las anormalidades citológicas fue alta en todos los grupos analizados, sin embargo, existe un mayor número de LSIL hacia la tercera década de la vida y en aquellas que iniciaron su vida sexual después de los 40 años. De igual manera se encontró una relación inversa entre el número de partos, planificación familiar hormonal y aparición de lesiones pre neoplásicas(AU)

To determine the prevalence of cervical intraepithelial lesions of low and high grade in patients of fertile age in the gynecology clinic of the Zulia maternity center, in the period February 2016-February 2018 Maracaibo, Zulia State. Methods: A retrospective descriptive study was carried out that included women between 15 and 44 years old, who attended the obstetrics gynecology clinic of the Zulia pediatric maternity center for the period February 2016-February 2018. The normality of the quantitative variables, using the median or average with their variances according to their distribution, and frequencies and proportions for the categorical variables. Results: 150 patients were included. the median age was 29 years with range (R: 15-43 years), the median number of births 1 (R: 0-3). Using contraceptive methods, most used ACO. 60% of cytologies were reportedas negative, 20% low grade lesion (LSIL), 10% atypical squamous cells of undetermined significance (ASC-US), 2% high grade lesions (HSIL), 2.3% cells Atypical squamous of indeterminate significance of high grade ASC-H, 3.3% atypical glandular cells of uncertain significance (ASGUS) and 2% invasive carcinoma. Conclusion: The prevalence of cytological abnormalities was high in all the groups analyzed, however, there is a greater number of LSIL in the third decade of life and in those who began their sexual life their 40 years. Likewise, an inverse relationship was found between the number of births, hormonal family planning and the appearance of pre-neoplastic lesions(AU)

Necrobiosis lipoidica en un paciente con prediabetes / Necrobiosis lipoidica in a prediabetic patient

La necrobiosis lipoidica es una dermatosis poco frecuente, de origen desconocido. Puede observarse en pacientes sin alteración de la glucosa, pero frecuentemente está asociada a la diabetes mellitus bien establecida. Menos común es que estas lesiones en la piel aparezcan en estadios prediabéticos. Se describe el caso de una paciente femenina, de 65 años de edad, que hace 10 años comenzó a presentar una lesión papuloeritematosa de 1 cm, con bordes bien definidos, en la cara lateral interna de la pierna derecha. Recientemente le realizan biopsia de la lesión dermatológica y prueba de tolerancia a la glucosa oral, y se diagnostica necrobiosis lipoidica y tolerancia a la glucosa alterada respectivamente. Se piensa que los pacientes con esta enfermedad deben tener seguimiento a largo plazo, para diagnosticar oportunamente diabetes mellitus u otros estados prediabéticos(AU)

Necrobiosis lipoidica is a rare dermatosis of unknown origin. It can be observed in patients with unaltered glucose indexes but frequently associated to well-established diabetes mellitus. It is even less common that this type of skin lesions occur in pre-diabetic staging. This is the case of 65 years-old woman, who had presented 1 cm-long papulloerythematous lesion with well-defined contours for 10 years in the inner lateral side of her right leg. She had been recently biopsied in her cutaneous lesion and made a glucose-tolerance test, which yielded necrobiosis lipoidica and altered glucose tolerance. It is considered that the patients with this disease should be followed-up for a long period to timely diagnose diabetes mellitus or other pre-diabetic conditions(AU)

Negative Biopsy after Referral for Biopsy-Proven Gastric Cancer

BACKGROUND/AIMS: Repeat endoscopy with biopsy is often performed in patients with previously diagnosed gastric cancer to determine further treatment plans. However, biopsy results may differ from the original pathologic report. We reviewed patients who had a negative biopsy after referral for gastric cancer. METHODS: A total of 116 patients with negative biopsy results after referral for biopsy-proven gastric cancer were enrolled. Outside pathology slides were reviewed. Images of the first and second endoscopic examinations were reviewed. We reviewed the clinical history from referral to the final treatment. RESULTS: Eighty-eight patients (76%) arrived with information about the lesion from the referring physician. Among 96 patients with available outside slides, the rate of interobserver variation was 24%. Endoscopy was repeated at our institution; 85 patients (73%) were found to have definite lesions, whereas 31 patients (27%) had indeterminate lesions. In the group with definite lesions, 71% of the lesions were depressed in shape. The most common cause of a negative biopsy was mistargeting. In the group with indeterminate lesions, 94% had insufficient information. All patients with adequate follow-up were successfully treated based on the findings in the follow-up endoscopy. CONCLUSIONS: A negative biopsy after referral for biopsy-proven gastric cancer is mainly caused by mistargeting and insufficient information during the referral.

Apoptotic and anti-apoptotic seromarkers for assessment of disease severity of non-alcoholic steatohepatitis

This study aimed to find out non-invasive markers for the assessment of severity of non-alcoholic steatohepatitis [NASH] in an attempt to decrease the need for liver biopsy. It also aimed to evaluate the key role of apoptosis in the pathogenesis of the disease and the suggested role of anti-apoptotic factors in therapeutic modalities and disease prognosis. The serum levels of soluble Fas [s. Fas], s. Fas ligand, cytokeratin 18 [CK-18] fragment and Bcl-2 were measured in 80 patients and 15 non-hepatic subjects as control. The patients were divided based on histological examination of liver biopsy into three groups. Group I included 40 patients with NASH, group II had 40 patients with non-alcoholic fatty liver disease [NAFLD] non-NASH and group III had 15 non-hepatic subjects as control. Apoptosis of hepatocytes was assessed by morphological examination using a light microscope and expressed as number per square millimeter. There was a significant increase in the serum levels of s. Fas, s. Fas ligand and CK-18 fragments in the NASH group. The anti-apoptotic protein Bcl-2 showed significantly low levels in NASH patients. Apoptosis of hepatocytes was significantly higher in the NASH group. The degree of apoptosis was inversely correlated with the level of Bcl-2. A significant correlation between both s. Fas and CK-18 fragment with liver histology with regard to lobular inflammation and ballooning was found. Increased serum levels of s. Fas and CK-18 fragment in the NASH group and its correlation with the severity of disease suggested the key role of apoptosis in NASH pathogenesis which can be used for the assessment of the severity of NASH. A high level of anti-apoptotic Bcl-2 in NAFLD suggests its protective role in disease progress

Differential expression of alpha-smooth muscle actin and vascular endothelial growth factor in skin biopsy of patients with systemic sclerosis: a histological and immunohistochemical study

Vasculopathy is a hallmark of systemic sclerosis [SSc]. It contributes to many of its clinical manifestations and precedes fibrosis. The aim of this study was to investigate the expression of alpha-smooth muscle actin [alpha-SMA] in skin biopsy of patients with SSc and correlate it with other manifestations of vasculopathy, including those seen on fundus fluorescein angiography and tissue vascular endothelial growth factor [VEGF] expression. This study included 25 patients with SSc and 10 healthy individuals. Patients underwent full history taking and a clinical examination. All participants underwent fundus fluorescein angiography. Skin biopsy was examined by H and E staining, Mallory triple staining, and immunohistochemical staining for alpha-SMA and VEGF. Histological examination showed loss of dermal papillae, hypovascularity of the dermis, and subepidermal fibrosis. Immunohistochemical staining of the vessel wall in skin biopsy samples showed a statistically highly significant increase in VEGF and a highly significant decrease in alpha-SMA in patients as compared with controls. There was a highly significant positive correlation between VEGF and duration of illness, Raynaud's phenomenon, digital ulcers, disease activity score, and modified Rodnan Skin Score. As regards alpha-SMA, there was a highly significant negative correlation with Raynaud's phenomenon, disease activity score, modified Rodnan Skin Score, and VEGF, whereas there was a significant negative correlation with digital ulcers. The strongest correlation [r] for the duration of illness was found with alpha-SMA, followed by VEGF. alpha-SMA was found to be correlated to different manifestations of vasculopathy in SSc. It was found to be one of the early markers of vasculopathy among the other studied variables. Besides its diagnostic role in SSc vasculopathy, it could play a role in impaired vasculogenesis, making it a potential therapeutic target in the management of SSc

Effect of aromatase inhibitors on the endometrium and ovary with their possible role in ovulation in adult albino rats: a histological, immunohistochemical, morphometric, and hormonal assay

Aromatase inhibitors act by inhibiting estrogen synthesis and depletion of its concentrations in the circulation. The aim of the study was to investigate the effect of exemestane and letrozole on the endometrium and ovary with their possible role in ovulation in adult albino rats. Thirty adult female albino rats were used and divided into control and experimental groups. Rats in the experimental group were further divided into subgroup IIA and subgroup IIB. In subgroup IIA each rat was given exemestane at 1 mg/kg/day and in subgroup IIB each rat was given letrozole at 5 mg/kg/day by means of a gastric tube for five consecutive ovarian cycles. Specimens from their ovaries and endometrium were taken and prepared for H and E staining and for immunohistochemical staining for vascular endothelial growth factor study. Morphometric study of endometrial thickness and surface area percentage of immunoreaction in the endometrium was evaluated. Hormonal assay of luteinizing hormone and follicular stimulating hormone was carried out. Significant decrease in endometrial thickness was observed in the exemestane-treated group. The letrozole-treated group revealed significantly thickened endometrium. The exemestane-treated group showed markedly disturbed ovarian architecture in the form of thickened germinal epithelial cell layer and multiple corpora lutea with atretic follicles. The letrozole-treated group revealed an ovarian cortex with multiple stages of follicular development. The vascular endothelial growth factor immunoreaction of the letrozole-treated group showed significant highly positive cytoplasmic reaction. Significant decrease in luteinizing hormone level in the exemestane group and significant increase in the letrozole group were detected. It is concluded that letrozole improved the endometrial thickness and may have a role in ovulation induction. In contrast, exemestane led to disruption of the endometrium and ovary. Therefore, not all aromatase inhibitors help in ovulation

Histological study on the effect of vitamin C on ischemia reperfusion injury in the adult rat ovary

Ovarian torsion may cause serious complications such as infertility in young women. Conservative management includes detorsion and reperfusion of the twisted segment. However, it may have local and systemic consequences due to production of large amounts of reactive oxygen species during reperfusion of ovaries. The present work aimed to study the possible histological and immunohistochemical changes due to ischemia-reperfusion injury in rat ovaries and the possible protective effect of vitamin C as an antioxidant. A total of 32 albino rats were divided into four groups. Group I was the control sham-operated group [either sham operated only, or with vitamin C administration]. In group II rats, ovarian ischemia was induced by torsion of the right adnexa. In rats of group III, 4 h of ischemia followed by reperfusion was performed. In rats of group IV, 4 h of ischemia was followed by 50 mg/kg vitamin C administration, which was injected intravenously, and then reperfusion was performed. Except for the ischemia group, all other groups were subdivided into two subgroups from which the right ovaries were surgically removed either after 5 h or after 2 weeks of starting the experiment. From the ischemia group ovarian samples were taken after 5 h only. Specimens were processed for paraffin sections and stained with H and E and with an immunohistochemical stain for apoptotic marker p53. Image analysis and statistical analysis of the obtained results were carried out. Severe vascular congestion, edema, hemorrhage, and increased P53 immunoreaction were detected in the ovaries after ischemia, which became less marked after reperfusion and considerably improved with vitamin C administration, especially after 2 weeks. Vitamin C treatment can help in protecting the ovaries from ischemia-reperfusion injury after detorsion

Role of semirigid thoracoscopy in the diagnosis of exudative pleural effusion: Assiut University Hospital experience

The procedure of medical thoracoscopy provides a window into the pleural space to perform biopsy under direct visualization, particularly when thoracocentesis and closed pleural biopsy are inconclusive. The development of the semirigid thoracoscope, which is handled similarly to a bronchoscope, has made this procedure feasible and successful by most pulmonologists. It remains unknown whether certain pleural lesions, as visualized on thoracoscopy, has potential diagnostic value. We aimed to assess diagnostic value of the semirigid thoracoscope and correlate endoscopic finding with the histological diagnosis. From January 2010 to January 2012, 64 diagnostic medical thoracoscopies were performed to 64 patients with undiagnosed pleural effusion, in a tertiary care university hospital. All patients had thoracoscopy with visually directed biopsies and pleural lesion rating under local anaesthesia and mild sedation. Endoscopic findings were classified as: pleural thickening, nodules, adhesions and whitish lymphedema. The yield of the thoracoscopic biopsy in reaching final diagnosis was [98.4%]. Thoracoscopic diagnosis of malignancy in our study was [76.6%] whereas benign diagnosis was [23.4%]. Thoracoscopy was well tolerated under local anaesthesia and in most cases it was a one day procedure. Significant relations were found between endoscopic and pathology findings. Presence of nodules and lymphedema had a trend a positive relation with malignancy, p-value [0.002] and [0.009] respectively. Medical thoracoscopy is a simple relatively low-cost procedure. In the hands of experienced physicians it is generally safe, and highly effective at achieving a histological diagnosis. The presence of nodules and lymphedema, carries a high possibility of the effusion to be of a malignant etiology

Serum profiles of extracellualr matrix degradation inhibitors across the stages of liver fibrosis in chronic hepatitis C patients

Tissue inhibitor metalloproteinase-1 [TIMP-1] and alpha-2 macroglobulin [AMG] are extracellular matrix degeneration inhibitors that have been demonstrated to increase with liver fibrosis. However, date are lacking regarding their patterns of change. This study analyses their detailed serum profile across liver fibrosis stages in chronic hepatitis C [CHC]. Serum TIMP-1 and AMG measurements were evaluated for 78 adult male CHC patients versus liver fibrosis [F] stages [METAVIR F0-F4]. The performance characteristics for discrimination of sequential [close stages], significant [F >/= 2], and advanced [F >/= 3] fibrosis were assessed. Both TIMP-1 and AMG correlated significantly with fibrosis [r=0.31, p=0.005; r=0.37, p=0.001, respectively], but failed to discriminate sequential stages. For discrimination of significant fibrosis, the areas under receiver operating characteristics curves were small [0.59 and 0.57, respectively]. T a cut-off value of 743 ng/ml, TIMP-1 showed a 100% specificity [with 17.6% sensitivity], while at a cut-off of 3 gm/l, AMG showed 73.5% sensitivity [with 36.4% specificity]. A similarly modest discrimination was noted for advanced fibrosis. Interestingly, AMG showed an early rise with significantly higher values in F0 compared with healthy controls [3.6 +/- 1.1 vs. 1.8 +/- 0.6, respectively]. Neither TIMP-1 nor AMG could discriminate the sequential stages of fibrosis. Their modest performances for discrimination of significant and advanced fibrosis are related to the wide normal range f TIMP-1 and the early rise of AMG. A longitudinal monitoring would give a better understanding of their true changes, and examine whether patients having high AMG levels at F0 would be fast fibrosers or respond differently to therapy

Análisis descriptivo de 561 biopsias con diagnóstico de melanoma entre los años 2006 y 2012 en un laboratorio de dermatopatología de la región metropolitana / Descriptive analysis of 561 biopsies with melanoma diagnosis between 2006 and 2012

Durante las últimas décadas la incidencia de melanoma maligno(MM) ha aumentado en gran parte de los países del mundo. Entre los factores más importantes en el desarrollo de un MM está el fototipo del paciente y la exposición a radiación UV. Nuestro país cuenta con escasa información epidemiológica respecto a MM. En este trabajo se analiza la información disponible en las biopsias de piel con diagnóstico de MM procesadas en un laboratorio de dermatopatología en un periodo de siete años. La muestra contó con 561 biopsias, de los cuales el 60,61 por ciento correspondió a sexo femenino, la edad promedio de la muestra fue 54,14 años. Respecto a la localización de las lesiones, el 34,33 por ciento se encontró en extremidades inferiores, 25,70 por ciento en tronco, 21,68 por ciento en cabeza y cuello y 18,27 por ciento en extremidades superiores. El diagnóstico histológico fue melanoma in situ en el 52,88 por ciento de los pacientes e infiltrante en el 47,12 por ciento. Este último grupo se analizó en base al índice de Breslow, observando que el 32,68 por ciento de los pacientes se encontraba en etapa T1. Este trabajo es un aporte para el desarrollo de mayor información epidemiológica respecto a MM, pero dado que se trata de casos exclusivos del sector privado de salud, no es extrapolable a toda la población. Por esto sería de gran utilidad realizar un estudio similar en pacientes atendidos en hospitales, especialmente para revisar el espesor que tienen los melanomas al momento del diagnóstico.

During the last decades, incidence of malignant melanoma (MM) has raised in most countries of the world. Skin phototype and sun exposure are the most important factors related with the development of MM. In our country the epidemiological information in MM is scarse. In this study we analyze available information of skin biopsies with MM diagnosis processed in a dermatopathology lab in a period of 7 years. We analyzed 561 biopsies, 60,61 percent females, with average age of 54,14 years. The lesions were located on lower extremities in 34,33 percent, 25,70 percent on trunk, 21,68 percent on head and neck and 18,27 percent on upper extremities. The histologic diagnosis was in situ melanoma in the 52,88 percent cases and infiltrative melanoma in 47,12 percent cases. Of this last group 32,68 percent were on T1 stage (Breslow index). This study is contributing to the development of more epidemiological information on MM. Because all the cases belong to private practice, we cannot extrapolate the information to global population. It would be useful to replicate this study on public hospital population, with special attention on MM thickness at the diagnosis.

Effect of subcutaneous phosphatidylcholine injection used in the treatment of localization obesity on the histological structures of human skin and subcutaneous tissue: a pilot study

Multiple clinical trials have supported the idea that subcutaneously injected phosphatidylcholine [PPC] leads to a reduction in localized fat collection. However, only a few histological studies that explain the mechanism of action of PPC have been published. This study aimed to evaluate the clinical and detailed histological changes in the skin and subcutaneous tissue after PPC injection. Ten female patients with local fat deposits [upper outer thigh] were assessed after a single session of subcutaneous injection with PPC on the basis of thigh circumference measurement, and histological examination of skin biopsy specimens was carried out before and 1 and 2 months after treatment. Histological sections were stained with H and E, Masson's trichrome [for collagen fibers], and by aldehyde fuchsin [for elastic fibers], followed by morphometric study and statistical analysis. Two months after injection, a statistically significant reduction in thigh circumference was found [P=0.045], with leathery tight skin texture at the injected area. Histological examination revealed dermal inflammatory responses 1 month after injection, with destruction of fat cells. These observations were reduced after 2 months with evidence of regenerating fat cells. Statistical analysis showed a significant increase in collagen area% [P=0.025] and statistically nonsignificant increase in elastic fiber area% at the end of the study. A single session of subcutaneous PPC injection had an evident lipolytic effect, with noticeable contouring and skin tightening due to regenerative effect on skin connective tissue, particularly dermal collagen. However, lipolytic effect was partially temporary because of regeneration of fat cells

interpreting physician is essential to avoid inaccurate diagnosis of PET-CT: a case report

The presence of a pulmonogist in the process of interpreting chest PET-CT is quite crucial, as the clinical findings will prevent any miss leading interpretations that result an inaccurate diagnosis

Cirugía menor en un centro de salud familiar y concordancia clínico patológica / Minor surgery in a family health center and clinicopathological concordance

INTRODUCCIÓN: Los servicios de Atención Primaria de Salud(APS) realizan Cirugía Menor(CM), evidenciándose beneficios como optimización de recursos y promoción de la actividad preventiva, diagnóstica y terapéutica. OBJETIVO: Describir la actividad de CM en un centro de APS y analizar la concordancia clínica-patológica de las lesiones...

INTRODUCTION: Primary Health Care (PHM) services perform minor surgery (MS), displaying benefits such as resource optimization and the promotion of preventive, diagnostic and therapeutic activities. OBJECTIVE: Describe the MS activity from a PHM center and analyse the clinicopathological concordance of the lesions…

Aspectos epidemiológicos e anatomopatológicos do hemagiossarcoma em cães: 40 casos (1965-2012) / Epidemiological and pathological aspects of hemangiosarcoma in dogs: 40 cases (1965-2012)

Os aspectos epidemiológicos e anatomopatológicos de casos de hemangiossarcoma em cães da Região Central do RS foram estudados. Dos casos avaliados (n=40), cães idosos e da raça Pastor Alemão foram nitidamente os mais afetados (72,2% e 20% dos casos, respectivamente), visto que na população total de cães necropsiados nesse mesmo período (n=7.063) essa faixa etária e raça tiveram comparativamente uma prevalência bem mais baixa (14,6% e 10,1% dos casos, respectivamente). Na necropsia (n=40), os tumores ocorreram quase sempre como nódulos (92,5%) e, menos frequentemente, como massas (37,5%), e afetaram principalmente: baço (62,5%), pulmão (60%), fígado (52,5%), peritônio (42,5%), rim (37,5%), encéfalo (30%), pleura (25%) e coração (22,5%). Hemoperitônio (42,5%) e, consequentemente, anemia (22,5%) foram vistos com certa frequência. Na histologia (n=25), os hemangiossarcomas eram principalmente bem diferenciados (84%), de baixo grau (64%) e com estroma escasso (84%), mas frequentemente (68%) havia áreas com células demonstrando algum grau de atipia. Necrose, hemorragia e trombose foram vistos em todos os casos, mas hematopoiese extramedular (28%) e proliferação angiomatosa benigna (12%) foram achados menos comuns. Na imuno- -histoquímica (n=24), utilizando anticorpo anti-fator de von Willebrand, todos os casos demonstraram marcação de intensidade variável com um padrão citoplasmático finamente granular. Em relação à classificação anatômica, 55% dos hemangiossarcomas foram considerados como multicêntricos, 30% como primários com metástase(s) e 15% como solitários. Esse artigo discute esses resultados e propõe, com base em combinações de órgãos afetados, um esquema de separação entre hemangiossarcomas primário com metástase(s) e multicêntrico, a fim de tentar homogeneizar a maneira com que patologistas veterinários referem-se a esse neoplasma.

Epidemiological and pathological aspects of hemangiosarcoma in dogs from the Central Region of the State of Rio Grande do Sul, Brazil. Out of the studied cases (n=40), aged dogs (72.2% of the cases) and dogs of German shepherd breed (20% of the cases) were clearly more frequently affected since in the total population of necropsied dogs in the same period (n=7,063) this age group and breed were comparatively less represented (respectively 14.6% e 10.1% of the cases). At necropsy (n=40) most tumors (92.5%) occurred as nodules and less frequently as masses (37.5%), affecting mainly the spleen (62.5%), lung (60%), liver (52.5%), peritoneum (42.5%), kidney (37.5%), brain (30%), pleura (25%), and heart (22.5%). Hemoperitoneum (42.5% of the cases) and resultant anemia (22.5% of the cases) were also observed. On histological examination (n=25), most hemangiosarcomas (84%), were, in general, well differentiated, of low grade (64%) and possessed a scant stroma (84%), although frequently (68%) focal areas with cells displaying some degree of atypia were seen. Necrosis, hemorrhage, and thrombosis were observed in all cases, however extramedullary hematopoiesis (28%) and benign angiomatous proliferation (12%) were less common findings. In all cases submitted to immunohistochemistry staining (n=24) the tumor cells displayed a finely granular positive staining when using anti-factor von Willebrand. Regarding anatomical classification, 55% of the hemangiosarcomas were considered as multicentric, 30% as primary tumors with one or more metastasis and 15% were solitary tumors. This paper discusses these results an suggests, based on the combination of affected organs, a scheme for setting apart primary hemangiosarcoma with metastasis from multicentric hemangiosarcoma, aiming to uniformize communication between pathologists regarding this tumor.

Results of a control quality strategy in cervical cytology / Resultados de uma estratégia de controle de qualidade em colpocitologia

Objective: To determine the efficacy of a quality control strategy in cervical cytology in the detection of high-grade squamous intraepithelial lesions. Methods: Forty-two patients were selected who underwent a Pap smear and cervical uterine biopsy between April 2008 and December 2009, with evidence of a high-grade squamous intraepithelial lesion in one or both tests. The statistical parameters of the smear test were calculated before and after systematic meetings for review of the archived test results (6 years), in which the following was done: interobserver diagnostic consensus; cytohistological correlation, with the latter as gold standard; and evaluation of the therapeutic status of each patient. Results: Once these controls were applied, it was noted that sensitivity and positive likelihood ratio of the test for high-grade squamous intraepithelial lesion increased 9.5% (34.5 to 44%) and 0.45% (1.64 to 2.09%), respectively, while specificity remained at 79%. Reduction in interference of false-negative results associated with errors in the analytical phase of the cytological productive process gave an estimate of failures in collection of the specimens (pre-analytical phase). Conclusion: In addition to improving the performance of the cytological diagnosis of the high-grade squamous intraepithelial lesion, the proposed quality control strategy allows a reflection on the causes of incorrect or conflicting scrutiny.

Objetivo: Determinar a eficácia de uma estratégia de controle de qualidade em colpocitologia na detecção da lesão intraepitelial escamosa de alto grau. Métodos: Foram selecionadas 42 pacientes que realizaram Papanicolaou e biópsia cervicouterina entre abril de 2008 e dezembro de 2009, com evidência de lesão intraepitelial escamosa de alto grau em um ou em ambos os exames. Os parâmetros estatísticos do esfregaço foram calculados antes e após reuniões sistematizadas de revisão dos exames arquivados (6 anos), nas quais se procedeu a: consensualização diagnóstica interobservadores; correlação cito-histológica, sendo a última padrão-ouro; e avaliação do status terapêutico de cada paciente. Resultados: Aplicados tais controles, observou-se que a sensibilidade e a likelihood ratio positiva do teste para lesão intraepitelial escamosa de alto grau aumentaram 9,5% (34,5 para 44%) e 0,45% (1,64 para 2,09%), respectivamente, enquanto sua especificidade se manteve em 79%. A redução da interferência dos falso-negativos associados a erros na fase analítica do processo produtivo citológico traz estimativa das falhas de coleta do material (fase pré-analítica). Conclusão: Além de melhorar o desempenho do diagnóstico colpocitológico de lesão intraepitelial escamosa de alto grau, a estratégia de controle de qualidade proposta permite refletir sobre as causas de escrutínio incorreto ou discordante.

effect of chronic intermittent hypoxia in the evolution of NASH

Obstructive sleep apnea [OSA] causes chronic intermittent hypoxia [CIH] during sleep. OSA is associated with nonalcoholic steatohepatitis [NASH] in obese individuals and may contribute to progression of nonalcoholic fatty liver disease [NAFLD] from steatosis to steatohepatitis. To assess the potential role of hypoxia in the development of NASH in obstructive sleep apnea patients. Nocturnal polysomnography was performed in 60 consecutive patients for clinical suspicion of OSA. We investigated fasting blood glucose, serum insulin, TNF-alpha, ABG and liver enzymes for 30 patients with nocturnal polysomnographic recording of OSA and for 15 patients without recording OSA used as controls. Liver biopsy was offered to 15 of 30 patients with elevated liver enzymes. Patients with OSA had significantly higher levels of insulin and were more insulin-resistant according to HOMA-IR than in controls. We found that the parameters which significantly correlated with AHI were elevated liver enzyme, BMI, ultrasound grading, TNF-alpha and HOMA-IR in patients group but did not find a similar correlation in controls. Liver biopsy showed steatosis with lobular necrosis or hepatocyte ballooning in the 15 patients, associated with fibrosis in 5 patients. Hypoxic stress of obstructive sleep apnea may be implicated in the evolution of insulin resistance and steatohepatitis in obese individuals

Diagnostic value of ultrasound guided biopsy in patients with malignant pleural effusion

To study the diagnostic value of ultrasound guided biopsy in patients with malignant pleural effusion. This study involved 40 patients with malignant pleural effusion of indeterminate aetiology. All patients had a contrast CT chest performed and were divided into 3 Groups according to their radiologic appearance: GROUP 1: 10 patients having pleural effusion only. GROUP 2: 15 patients having pleural effusion and pleural thickening. GROUP 3: 15 patients having pleural effusion and pleural mass lesions. All 3 groups of patients underwent ultrasound examination in the Radiology department. In patients of Groups 2 and 3, ultrasound fluid aspiration and ultrasound guided core biopsy of the pleura were attempted. Patients of all 3 Groups performed Medical thoracoscopy in the interventional pulmonology unit. In Group 1 patients, US guided biopsy was contraindicated and could not be performed due to absence of pleural thickness, nodulation or masses. Thoracoscopy was performed in them all with a sensitivity reaching 90%. In Group 2, a malignant aetiology was reached in 5/10 cases whom had adequate tissue retrieval [sensitivity 50%]. In Group 3, 12/15 patients were diagnosed by US guided biopsy [sensitivity 80%]. The mean sensitivity of US guided biopsy in both Groups was 65%. Thoracoscopy was then performed successfully in all of patients in Groups 2 and 3 with a diagnostic sensitivity of 100% each. The mean diagnostic sensitivity of thoracoscopy for all 3 Groups was 96.7%. The US guided pleural biopsy with a Tru-cut needle is simple, safe and well tolerated. It is especially useful for patients with pleural tumour, thickened pleura, small amounts of pleural effusion or loculated pleural effusion

Sleep pattern changes in patients with liver cirrhosis

Liver cirrhosis is considered as a major cause of mortality worldwide and is the most common non-neoplastic cause of death among hepatobiliary and digestive diseases. One of the least studied complications of liver cirrhosis is the disturbed sleep pattern, which is being increasingly recognized as a major health problem affecting the quality of life. This study included two groups; the first group consisted of 30 patients diagnosed as liver cirrhosis based on abdominal ultrasound and liver biopsy and the second group consisted of 10 healthy subjects served as controls. ESS was calculated for every patient and all patients were subjected to complete overnight polysomnography to detect sleep disturbances among all participants. Our results showed that cirrhotic patients had ESS, AHI and OSA significantly higher than the control group [16.4 +/- 2.6 vs 11.1 +/- 1.8, P = 0.0001; 10.9 +/- 8.5 vs 2.4 +/- 1.6, P = 0.005 and 3.1 +/- 3.1 vs 1.1 +/- 0.9, P =0.03, respectively]. The percentage of sleep efficiency was significantly lower in cirrhotic patients than the control group [61.9 +/- 12.9 vs 73.1 +/- 7.6 [P = 0.02]]. Also, the percentages of S1, S3-S4 and REM sleep in relation to the total sleep time were significantly higher in the cirrhotic patients than the control group [P = 0.01, 0.02 and 0.06, respectively] while the percentage of S2 was significantly lower [P = 0.02]. Cirrhotic patients of Child class C had ESS, AHI and OSA significantly higher and sleep efficiency significantly lower than cirrhotic patients of classes A and B [P = 0.001 for all]. Cirrhotic patients with tense ascites had ESS, AHI and OSA significantly higher and sleep efficiency lower than patients with mild, moderate, or no ascites. This study revealed that cirrhotic patients had disturbed sleep pattern, correlating with the degree of cirrhosis

Optimal Number of Endoscopic Biopsies in Diagnosis of Advanced Gastric and Colorectal Cancer

Endoscopic biopsy is necessary to confirm a histopathologic diagnosis. Currently, 6 to 8 biopsies are recommended for diagnosis of a suspected malignant lesion. However, multiple biopsies may result in several problems, such as an increased risk of bleeding, procedure prolongation, and increased workload to pathologists. The aim of this study was to clarify the optimal number of endoscopic biopsy specimens required in diagnosis of advanced gastrointestinal cancer. Patients who were diagnosed with advanced gastrointestinal cancer during endoscopy were included. Five specimens were obtained sequentially from viable tissue of the cancer margin. Experienced pathologists evaluated each specimen and provided diagnoses. A total of 91 patients were enrolled. Fifty-nine subjects had advanced gastric cancer, and 32 had advanced colon cancer. Positive diagnosis rates of the first, second, and third advanced gastric cancer specimens were 81.3%, 94.9%, and 98.3%, respectively, while positive diagnosis rates of advanced colon cancer specimens were 78.1%, 87.5%, and 93.8%. Further biopsies did not increase positive diagnosis cumulative rates. This study demonstrated that three specimens were sufficient to make correct pathologic diagnoses in advanced gastrointestinal cancer. Therefore, we recommend 3 or 4 biopsies from viable tissue in advanced gastrointestinal cancer to make a pathologic diagnosis during endoscopy.

HIV-1 (P24) Protein in Cervical Carcinomas.Tissue Samples [Histopathological and immunohistochemical study in Ethiopian Women]

HIV/AIDS remains the major developmental challenge for Ethiopia. Cancer cervix is the most prevalent in Ethiopian women where the HIV-1-infection increases the risk for the development of such cancers. This study was designed to identify immunohistochemically the HIV-1 directly in cervical cancer tissue samples independently from the HIV serology status of the patient. This is a retrospective study on formalin fixed and paraffin embedded cervical tissue at Pathology Unit Department of Medial Laboratory Sciences, college of Public Health and Medical Sciences Jimma University South-Western Ethiopia. The study covered 115 cervical tissues with invasive carcinoma; collected during the period of January 2008 till December 2010. The clinical data were received from the pathology biopsy request sheet. The slides were re-evaluated histopathologically and all specimens were studied immunohistochemically for identifying the HIV [P24] in the cancer cervix cells. HIV-l/p24 immunohistochemistry study of the cervical cancer tissues revealed positive immunostaining in 22 cases; 19.1%. The HIV-l/p24 was diffusely cytoplasmic with various degrees of staining intensities. Positive cytoplasmic staining was detected in the cervical epithelial cancer cells and also detected in the lymphocytes present in the intervening stroma. The identification of HIV-1 in the cytoplasm of the epithelial cervical cancer cells may contribute to cell cycle disruption or the virus itself may have a direct carcinogenic effect making it in someway for the development and progression of cancer cervix