RESUMEN
Despite its relative rarity in industrialized countries, rabies continues to cause significant mortality worldwide with annual deaths estimated at over a hundred thousand. Recent epizootics in wild animals in the United States have renewed fears of rabies in this country. Additionally, nucleotide analysis to determine the source species for human rabies infections has led to new recommendations regarding exposure to bats. Fortunately, excellent human and animal vaccines are available and the development of new cell culture vaccines should help ease the current vaccine shortages. Travelers to developing countries should consider preexposure vaccination to avoid difficulties obtaining rabies immune globulin, which is in short supply worldwide, for postexposure prophylaxis should an exposure occur.
Asunto(s)
Animales Salvajes , Vacunas Antirrábicas , Rabia/epidemiología , Rabia/prevención & control , Adolescente , Adulto , Anciano , Animales , Embrión de Pollo , Niño , Preescolar , Quirópteros , Brotes de Enfermedades/veterinaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rabia/economía , Mapaches , Estados Unidos/epidemiologíaRESUMEN
Volatile substance abuse is the deliberate inhalation of volatile substances to achieve intoxication. We discuss the history and pathophysiological effects of commonly abused volatile substances. We explore three deaths and one serious accident in active duty military settings. The causes for abuse in the military environment are numerous and include remote duty, peer influence, low cost, rapid onset, limitation of ethanol use, difficult detection/screening for use, and lack of knowledge among users and authorities. The lethality of these substances and their casual use can constitute a threat to military readiness. Our experience suggests an increase in the use of these substances in the military paralleling their increasing use in the general population. Education and awareness training could limit fatalities and decrease the threat in military and civilian populations.
Asunto(s)
Exposición por Inhalación , Personal Militar , Trastornos Relacionados con Sustancias/etiología , Adulto , Aerosoles , Resultado Fatal , Femenino , Gases , Humanos , Masculino , Trastornos Relacionados con Sustancias/prevención & controlRESUMEN
We present an infant born with a giant congenital pigmented nevus. The placenta revealed nests of nevus cells in the chorionic villi on the fetal side of circulation. These findings are consistent with four reports in the literature to date.
Asunto(s)
Nevo Pigmentado/congénito , Enfermedades Placentarias/patología , Neoplasias Cutáneas/congénito , Femenino , Humanos , Recién Nacido , Nevo Pigmentado/complicaciones , Nevo Pigmentado/patología , Placenta/patología , Enfermedades Placentarias/complicaciones , Embarazo , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/patologíaRESUMEN
Currently, there is lack of a histologic classification of squamous cell carcinoma of the cervix that correlates significantly with patient survival. This study investigated the survival predictive value of two immunohistochemical markers, the blood group A,B,H isoantigens and the Oxford Ca antigen, on conventional histologic sections of tumor tissues from 85 surgically treated patients with Stage IB squamous cell cervical cancer. The results indicated that the two antigens are two distinct markers, neither of which correlates with tumor grade. The expression of the A,B,H isoantigens is significantly related to patient survival after adjustment for the depth of stromal invasion of the tumor, whereas the Oxford Ca antigen has no survival predictive value.
Asunto(s)
Sistema del Grupo Sanguíneo ABO/inmunología , Antígenos de Neoplasias/inmunología , Carcinoma de Células Escamosas/inmunología , Neoplasias del Cuello Uterino/inmunología , Anticuerpos Monoclonales , Antígenos de Carbohidratos Asociados a Tumores , Carcinoma de Células Escamosas/mortalidad , Femenino , Histocitoquímica , Humanos , Inmunoquímica , Recurrencia Local de Neoplasia , Estadificación de Neoplasias/métodos , Proyectos Piloto , Pronóstico , Proyectos de Investigación , Coloración y Etiquetado , Neoplasias del Cuello Uterino/mortalidadRESUMEN
Accurate assessment of lymph node metastasis in cervical cancer is imperative to treatment plan. A histologic sampling method is suggested in which surgically excised lymph nodes are dissected at multiple levels before paraffin embedding. This approach proves to be a more sensitive procedure than the current bisection method in detecting metastasis.
Asunto(s)
Ganglios Linfáticos/patología , Metástasis Linfática/diagnóstico , Neoplasias del Cuello Uterino/patología , Femenino , Técnicas Histológicas , HumanosRESUMEN
Cytologic preparations were made from 53 biopsies of osseous and related lesions submitted for intraoperative diagnosis. Smears made by scraping the surface of the lesion and spreading the material obtained on a glass slide were most commonly used. These preparations were found to be valuable adjuncts to frozen sections because cytologic details were so much more clearly visible. Among specific diagnostic features found to be particularly helpful were the large numbers of nuclei found in most of the multinucleated cells from giant-cell tumors but in few osteoclasts from other lesions; the metachromatic staining of osteoid in air-dried, Romanowsky-stained smears from osteosarcomas; and the ease with which multinucleated cells can be identified in smears from chondrosarcomas. The characteristic appearance of chondroblasts from a chondroblastoma; the distinctive appearances of osteoclasts and multinucleated histiocytes from eosinophilic granulomas; the unique appearance of synovial cells from pigmented synovitis; and the ease with which small cells of a metastatic carcinoma could be distinguished from hematopoietic bone-marrow cells were other significant findings. These and other features of the lesions encountered are presented in greater detail.
Asunto(s)
Neoplasias Óseas/patología , Huesos/patología , Enfermedades Óseas/patología , Neoplasias Óseas/secundario , Neoplasias Óseas/cirugía , Huesos/cirugía , Condroblastoma/patología , Condrosarcoma/patología , Granuloma/patología , Granuloma de Células Gigantes/patología , Humanos , Osteosarcoma/patología , Sarcoma de Ewing/patologíaRESUMEN
An ultrastructural study was performed on 104 sequential fluids in which more than eight malignant cells per ten high-power fields were found by routine light microscopy. The study included fluids associated with mesotheliomas, melanomas, lymphomas, squamous-cell carcinomas, small-cell anaplastic (oat-cell) carcinomas, and adenocarcinomas. Electron microscopic examination reliably separated lymphoid from epithelial malignancies and benign from reactive and malignant mesothelial cell proliferations. It also suggested or identified a primary site for the adenocarcinomas. Ultrastructural examination of fluids can be a valuable adjunct to routine light microscopy of cytology specimens. No false-positive diagnoses were encountered. Sampling was the most significant limitation for this technique.
Asunto(s)
Líquidos Corporales/citología , Neoplasias/ultraestructura , Adenocarcinoma/patología , Adenocarcinoma/ultraestructura , Neoplasias de la Mama/patología , Neoplasias de la Mama/ultraestructura , Carcinoma de Células Pequeñas/patología , Carcinoma de Células Pequeñas/ultraestructura , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/ultraestructura , Femenino , Neoplasias Gastrointestinales/patología , Neoplasias Gastrointestinales/ultraestructura , Humanos , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/ultraestructura , Linfoma/patología , Linfoma/ultraestructura , Melanoma/patología , Melanoma/ultraestructura , Mesotelioma/patología , Mesotelioma/ultraestructura , Microscopía Electrónica , Neoplasias/patología , Neoplasias Ováricas/patología , Neoplasias Ováricas/ultraestructura , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/ultraestructura , Neoplasias Uterinas/patología , Neoplasias Uterinas/ultraestructuraAsunto(s)
Cirrosis Hepática Alcohólica/complicaciones , Peritonitis Tuberculosa/diagnóstico , Adulto , Ascitis/etiología , Diagnóstico Diferencial , Femenino , Fiebre/etiología , Hemorragia/diagnóstico , Humanos , Hígado/patología , Dolor/etiología , Radiografía Abdominal , Tomografía Computarizada por Rayos XRESUMEN
Cytologic preparations from lymph nodes and lymphoid lesions in other tissues permit accurate intraoperative diagnosis of a number of lesions that are not commonly identifiable with certainty in conventional frozen sections. The clarity of cytologic detail in smears or imprints allows recognition of Hodgkin's and non-Hodgkin's lymphomas, certain metastatic tumors such as melanoma or oat cell carcinoma, and some nonneoplastic disorders, all of which must be diagnosed on the basis of cellular alterations. The characteristic cytologic features of these disorders are presented. Cytologic preparations also have proved valuable in evaluating lesions that usually can be diagnosed with frozen sections. For these lesions, the ability to see cytologic details provides greater diagnostic certainty. For some necrotic, calcified, or fatty specimens, smears or imprints are the only preparations possible. With alcohol fixation and rapid hematoxylin and eosin or Papanicolaou staining, the preparations are ready for examination within 2 minutes after the specimens are received. The cytologic presentations are essentially identical to those of aspiration biopsies. Use of each type of preparation helps develop and maintain the diagnostic skills needed for the other.
Asunto(s)
Citodiagnóstico , Ganglios Linfáticos/patología , Metástasis Linfática/diagnóstico , Linfoma/diagnóstico , Diagnóstico Diferencial , Secciones por Congelación , Humanos , Periodo Intraoperatorio , Metaplasia , Coloración y EtiquetadoRESUMEN
A case of hepatic myelolipoma is described, including the angiographic and computed tomographic appearance. Only three such cases have been reported previously.
Asunto(s)
Lipoma/fisiopatología , Neoplasias Hepáticas/fisiopatología , Femenino , Humanos , Lipoma/diagnóstico por imagen , Lipoma/patología , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Persona de Mediana Edad , RadiografíaRESUMEN
The authors have tested 51 instrumented calf spines in vitro, using a scoliosis simulator, to evaluate the adequacy of fixation and nature of acute failure seen with various methods of scoliosis instrumentation. Tests were performed in compressive loading, rotation, and forward bending on the following instrumentation systems: (I) Harrington distraction, (II) Harrington distraction plus compression connected by transverse approximators, (III) Harrington distraction plus segmental laminar wires, and (IV) Luque double "L" rods plus segmental laminar wires. The study demonstrated that the addition of segmental fixation to scoliosis instrumentation provides improved stability because of (a) multiple fixation sites and (b) prevention of deformity, especially kyphosis, within the instrumented segment (an important contributor to hook cutout when a single Harrington distraction rod is tested). Failure with the Harrington rod was always by fracture at the metal-bone interface, while failure with the Luque method always occurred outside the instrumented segment.
Asunto(s)
Dispositivos de Fijación Ortopédica , Escoliosis/cirugía , Animales , Bovinos , Movimiento , Presión , Estrés MecánicoRESUMEN
The mechanical effectiveness of applying transverse forces by segmental spinal instrumentation to correct scoliosis is examined in this paper. Comparisons with traditional Harrington instrumentation are made on the basis of each method's potential to produce corrective bending moments and their ability to transfer this correction to the spine. Recognizing the scoliosis is a three-dimensional deformity, biomechanical evaluations are performed in each of the three anatomic planes, with special attention paid to maintaining normal sagittal plane contour and transverse plane derotation. Such an analysis indicates that segmental spinal instrumentation has a clear mechanical advantage over traditional Harrington instrumentation in providing and maintaining correction. Proposed improvements include the development of instrumentation which can be segmentally attached to the vertebra without invading the spinal canal.
Asunto(s)
Dispositivos de Fijación Ortopédica , Escoliosis/cirugía , Fenómenos Biomecánicos , Humanos , PresiónRESUMEN
Para-aortic and pelvic lymph nodes surgically removed from 50 female patients were examined for glandular inclusions. The findings were correlated with fallopian tube changes in patients whose lymph nodes were found to contain inclusions. Seven of the 50 patients had lymph node glandular inclusions; in six, the inclusions were located primarily in the cortical or capsular regions and were few in number. Of these six patients, four had acute or chronic salpingitis. The seventh patient had exuberant lymph node glandular inclusions initially interpreted as metastatic adenocarcinoma and salpingitis isthmica nodosa. This patient is discussed in detail. The association of lymph node glandular inclusions with salpingitis has been reported twice previously; one of these two patients had salpingitis isthmica nodosa. These findings suggest a definite relationship between tubal disease lymph node glandular inclusions. The rare exuberant form of glandular inclusions is benign and should not be confused with adenocarcinoma. It appears definitely associated with salpingitis isthmica nodosa. We suggest two different mechanisms for the pathogenesis of these inclusions. The first is "benign metastasis" from the proliferating tubal epithelium to the draining lymph nodes. The second is a proliferative stimulus responsible for salpingitis isthmica nodosa which also acts on preexisting glandular inclusions to produce the extensive nodal lesion.