Subject(s)
Hepatic Encephalopathy/diagnosis , Liver Failure/diagnosis , Pregnancy Complications/diagnosis , Prenatal Diagnosis , Acute Disease , Adult , Blood Cell Count , Blood Chemical Analysis , Blood Gas Analysis , Delivery, Obstetric , Diagnosis, Differential , European Union , Female , Hepatic Encephalopathy/blood , Hepatic Encephalopathy/pathology , Hepatic Encephalopathy/urine , Humans , Liver Failure/blood , Liver Failure/pathology , Liver Failure/urine , Pregnancy , Pregnancy Complications/blood , Pregnancy Complications/pathology , Pregnancy Complications/urine , Pregnancy Trimester, Third , Stillbirth , UrinalysisABSTRACT
UNLABELLED: PURPOSE AND MATERIALS AND METHODS: Because of the inaccuracies in clinical staging of endometrial cancer, the International Federation of Gynecology and Obstetrics (FIGO) in 1988 changed the staging of endometrial cancer to surgical staging consisting of intraoperative findings and histologic evaluation of the specimen. A decade later, 1998, the United States Society of Gynecologic Oncologists published Practice Guidelines for the surgical staging of endometrial cancer. The purpose of this study was to review the use of lymph node sampling and peritoneal washings in 100 consecutive cases of clinical stage I endometrial cancer and compare these results to the Practice Guidelines of the Society of Gynecologic Oncologists. RESULTS: The vast majority of patients (86%) had peritoneal washings and frozen section (69%) of the uterus. However, only slightly more than half (52%) had palpitation of the pelvic and/or para-aortic lymph nodes. Most encouraging and consistent with the Society of Gynecologic Oncologists' Guidelines is that 87% of the patients with histologically more aggressive cancers (grade III or deep myometrial invasion), had lymph node sampling as did 90.5% with more aggressive histologic subtypes. CONCLUSION: Notwithstanding these results, there is still the need in the 21st century for more uniform guidelines for the surgical staging of endometrial cancer.
Subject(s)
Adenocarcinoma/surgery , Endometrial Neoplasms/surgery , Lymph Node Excision , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Endometrial Neoplasms/mortality , Endometrial Neoplasms/pathology , Female , Hospitals, Community , Humans , Neoplasm Staging , New York , Retrospective Studies , Survival Analysis , Treatment OutcomeABSTRACT
Frequency, pathogenesis and morphological features of toxoplasmosis were assessed in a consecutive autopsy study. Among 204 patients who died from AIDS in Zurich during 1981-1990, 46 (23%) showed morphological evidence of cerebral toxoplasmosis. In 38 out of 46 cases (83%), toxoplasmosis was restricted to the central nervous system (CNS) and, therefore, pathogenetically classified as reactivation of a latent infection. Acute, systemic toxoplasmosis most frequently involved heart and lungs in addition to the CNS and was observed in 7 cases (15%). These patients probably acquired the infection during HIV-induced immunosuppression. Latent infection with intracerebral tissue cysts but no inflammatory response was present in only one case. Diffuse, necrotizing toxoplasma encephalitis with widespread, confluent areas of necrosis was mainly observed during the early period of the AIDS epidemic and restricted to 6 patients (13%) who did not receive chemotherapy. The majority of patients (83%) had multiple, macroscopically well-circumscribed abscesses with preferential location in the cerebral hemispheres. Of all CNS regions, the rostral basal ganglia were most frequently affected (78% of cases). Since 1989, chronic, burnt-out lesions were observed. These were mainly composed of lipid-laden macrophages and immunocytochemistry for Toxoplasma gondii usually failed to detect the parasite. This changing pattern of CNS lesions probably reflects improved clinical management of patients with AIDS.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Brain/pathology , Toxoplasmosis, Cerebral/complications , Acquired Immunodeficiency Syndrome/pathology , Adolescent , Adult , Age Factors , Aged , Child , Female , Humans , Male , Middle Aged , Risk Factors , Toxoplasmosis, Cerebral/pathologyABSTRACT
The endstage in a patient suffering from acute myeloid leukemia secondary to myelodysplastic syndrome was characterized by bleedings, anemia, pain in the upper abdomen and ascites. At autopsy the radicles of the portal veins were occluded by leukemic infiltrates and fibrosis. These lesions block the perfusion of the liver presinusoidally and, together with the anemia (hypoalbuminemia), result in ascites resistant to all therapy.
Subject(s)
Embolism/etiology , Leukemia, Myeloid, Acute/complications , Portal Vein , Ascites/etiology , Humans , Leukemia, Myeloid, Acute/pathology , Male , Middle Aged , Neoplasm Invasiveness , Neoplastic Cells, Circulating , Portal Vein/pathologyABSTRACT
The incidence of HIV encephalopathies was determined in an ongoing consecutive autopsy study. Among 345 patients who died from AIDS in Switzerland during 1981-1990, 68 (19%) showed morphological evidence of HIV encephalopathy. Two major histopathological manifestations were observed. Progressive diffuse leukoencephalopathy (PDL) was present in 33 cases and is characterized by a diffuse loss of myelin staining in the deep white matter of the cerebral and cerebellar hemispheres, with scattered multinucleated giant cells but little or no inflammatory reaction. Multinucleated giant cell encephalitis (MGCE) was diagnosed in 32 cases; it's hallmarks are accumulations of multinucleated giant cells with prominent inflammatory reaction and focal necroses. In 3 patients both types of lesions overlapped. Brain tissue from 27 patients was analyzed for the presence of HIV gag sequences using the polymerase chain reaction (PCR) with primers encoding a 109 base pair segment of the viral gene. Amplification succeeded in all patients with clinical and histopathological evidence for HIV encephalopathy but was absent in AIDS patients with opportunistic bacterial, parasitic and/or viral infections. Potential mechanisms by which HIV exerts it's adverse effects on the human CNS are discussed.
Subject(s)
AIDS Dementia Complex/epidemiology , Acquired Immunodeficiency Syndrome/complications , AIDS Dementia Complex/etiology , AIDS Dementia Complex/pathology , Adolescent , Adult , Aged , Blotting, Southern , Brain/microbiology , Brain/pathology , Child , Child, Preschool , DNA, Viral/genetics , Electrophoresis, Polyacrylamide Gel , Female , Gene Amplification , Genes, Viral/genetics , HIV/genetics , HIV/isolation & purification , Humans , Immunohistochemistry , Incidence , Infant , Male , Middle Aged , Nucleic Acid Hybridization , Opportunistic Infections/epidemiology , Opportunistic Infections/pathology , Polymerase Chain Reaction , Switzerland/epidemiologyABSTRACT
55 patients with acute pancreatitis were treated at this institution between 1979 and 1984. The female/male ratio was 3:2. Biliary pancreatitis was found in 51%. In 15% alcohol was the cause, while in 34% the etiology remained unknown. The main symptoms were acute abdominal pain (100%), nausea and vomiting (51%), fever (35%), and peritoneal irritation (27%). Twenty-two patients were treated conservatively, while the remainder underwent surgery either in or after the acute phase of the disease. Hospital mortality was 0% for a Ranson Score up to 4.25% for 5/6 and 50% for greater than 6.
