Interobserver variation in interpretation of serial liver biopsies from patients with chronic hepatitis C.

Reliable and accurate assessment of liver histopathology in patients with chronic hepatitis C is important for decision regarding treatment and for evaluation of therapy. However, little data on interobserver variation have been published. In this study, five specialist histopathologists evaluated 46 liver biopsies from 20 patients treated with interferon-alpha. Knodell's and Ishak's scoring systems, De Groote's classification and a four level general necro-inflammatory activity score (GNAS) were applied. Besides kappa statistics, slide by slide analysis was performed. We defined an acceptable slide by slide agreement as eight of ten observer pairs agreed on 80% of the slides. The best agreement was seen for Knodell's and Ishak's fibrosis score, De Groote's classification and GNAS (mean weighted kappa (kappa(w)) = 0.49, 0.51, 0.50 and 0.44, respectively). By condensing data from Knodell's and Ishak's scores to presence or absence of cirrhosis and piecemeal necrosis respectively, concordance was substantial concerning cirrhosis (mean kappa = 0.69 and 0.72, respectively) but only moderate concerning piecemeal necrosis (mean kappa = 0.40 and 0.39, respectively). Slide by slide analysis showed the highest agreement on Knodell's fibrosis score and GNAS; only one point of difference in score was to be accepted to obtain 'eight of ten' agreement. In contrast, five points of difference were necessary to accept in order to reach the same agreement for Knodell's total activity score. Moreover, in serial biopsies the GNAS was sufficient to detect changes in disease activity following treatment. Thus, a simple scoring system with four category scales was reproducible and sufficient for detection of therapy induced changes.

Biochemical, virological and histopathological changes in Danish blood donors with antibodies to hepatitis C virus.

BACKGROUND: Previous studies have indicated that the presence of antibodies to Hepatitis C virus (HCV) is indicative of current HCV infection irrespective of S-alanine aminotransferase (S-ALT) values. STUDY DESIGN AND METHODS: Over three years, all confirmed anti-HCV-positive blood donors form the Blood Banks of Copenhagen County were consecutively evaluated. Seven women and 14 men with a median age of 34 years were included. Serum HCV-RNA was measured with an in-house developed single PCR. Liver biopsies were classified according to standard criteria. RESULTS: All were asymptomatic at presentation with no history of liver disease. Previous intravenous drug abuse and/or tattooing were identified in 16. Seventeen blood donors were evaluated biochemically and histologically. Serum HCV-RNA was detectable in 14, all of whom had histopathological changes in their liver biopsy including chronic active hepatitis and active cirrhosis. Twelve of the 14 HCV-RNA-positive donors had elevated S-ALT. In the three HCV-RNA-negative donors, S-ALT was normal. Two of these had normal liver biopsies, whereas the third had minimal changes. CONCLUSION: To diagnose and evaluate the activity of chronic HCV infection, liver biopsy and HCV-RNA assessment are essential in confirmed anti-HCV-positive individuals irrespective of symptoms and S-ALT levels.

Pulmonary nodules due to Corynebacterium ulcerans.

A 53 year old male with symptoms of coughing for 6 months presented with bilateral multiple pulmonary nodules suggestive of metastatic disease. By surgical resection 4 out of 6 nodules were removed. Histopathological examination showed granulomatous necrotizing inflammation with growth of Corynebacterium ulcerans, which did not produce diphtheria toxin. The patient was treated with penicillin for 1 week. Follow-up for 2 yrs showed no sign of recurrence.

[Justification of routine autopsies after postoperative death]. / Berettigelsen af rutinemaessig obduktion ved postoperativ død.

Over a period from September 1981 to January 1983 data were collected from 97 autopsies following postoperative death (non-cardiac surgery). The autopsy rate was 73%. In 40% of the autopsies discrepancies were found between the clinical diagnosis and the cause of death found at autopsy. In 9% of the autopsies knowledge of the lesions that caused death might have changed the management of the patient and thus possibly also the prognosis. Since clinical practice has not changed considerably despite a ten year interval we consider the findings still valid today. Taking into account the decreasing rate of autopsy we want to stress that an important possibility of quality control of diagnosis and treatment in hospitals is about to be lost.

[Determination of estrogen receptor status in breast cancer by immunocytochemical examination of fine-needle aspirates]. / Bestemmelse af mammakarcinomers østrogenreceptorstatus ved immuncytokemisk undersøgelse på finnålsaspirat.

Estrogen receptor status was determined by immunocytochemical examination of fine-needle aspirates in 109 cases of primary invasive breast carcinoma. The results were compared with those from biochemical determination performed on tumor cytosols. Positive agreement was found between qualitative determination (positive/negative) by the two methods in 83% of the cases, and after semiquantitative stratification into three groups the results corresponded in 76%. The predictive value of a positive result on fine-needle aspirate was 96%, and 57% of a negative result. It is concluded that immunocytochemical determination of estrogen receptor status of breast carcinomas on fine-needle aspirate with the applied technique cannot replace the current standard biochemical method.

Disseminated peritoneal leiomyomatosis with malignant change, in a male.

Disseminated peritoneal leiomyomatosis (DPL) is a rare disorder, characterized by the occurrence of multiple leiomyomas scattered throughout the peritoneal cavity. Until this report DPL had been observed only in women and there is only one previous case with malignant change. A case of DPL in a male, complicated by sarcomatous transformation is reported. DPL has a definite malignant potential; patients with the disease should be followed closely for signs of progression.

Mucoepidermoid tumors of salivary glands. A long term follow-up study.

Mucoepidermoid tumors of salivary glands are relative rare and it has often been difficult to correlate the pathologic features and clinical aspects. The literature recommends long term follow-up studies. The object of the present study was therefore to follow this recommendation. The clinico-pathological features of 39 mucoepidermoid tumors are presented. The material was retrieved from the files of the pathological institute, Rigshospitalet, Copenhagen, during the period 1941-75. All patients, 24 males, 15 females, were followed for a minimum of 5 years. The lesions were classified into low grade (13 cases), intermediate grade (14 cases) and high grade (12 cases). The corresponding 5, 10 and 15 years cumulative survival rates were 92%, 92%, 92% for low grade, 47.4%, 47.4%, 35.5% for intermediate grade and 0%, 0%, 0% for high grade tumors. Thus we found a close correlation between pathology and clinical course. Furthermore, a 5 year observation period appeared an acceptable approach, because 17 of the 18 patients who succumbed of the disease, did so within 4 years following surgery. We consider all grades of mucoepidermoid tumors to be potential malignant. In our study one patient with a low grade tumor died of the disease.

Prediction of cardiac risk in non-cardiac surgery.

This prospective study was carried out to develop a model for the prediction of cardiac risk in non-cardiac surgery. Detailed data were collected concerning the preoperative status of 2609 consecutive patients, who were followed closely during the postoperative course. Fatal or life-threatening cardiac complications occurred in 68 patients (2.6%). By utilizing logistic regression, a model for prediction of cardiac risk was developed. The model contained six significant preoperative predictor variables: Congestive heart failure (with 3 degrees of severity); ischaemic heart disease (with 2 degrees of severity); diabetes mellitus; serum creatinine above 0.13 mmol l-1; emergency operation; and the type of operation (two categories). With this model it seems possible to discriminate between patients with very different levels of cardiac risk.