Biomedical subjects
Publications and source records attributed to A C Quaglia.
The term of pathophysiognomy is to describe the conditioning exercised by the structure, position, and function of an organ on the characteristic configuration of a pathological process and, as the case may be, even upon the possibility of its development.
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The degree of arteriosclerotic changes in the aorta and major vessels was inversely related to obesity (P less than 0.05) in an unselected series of 300 autopsies on subjects older than 50 years who had no hypertensive diseases. In addition, out of 11 subjects with very severe obesity, 9 showed no arteriosclerosis, and only 2 showed mild arteriosclerosis.
An increased prevalence of nocardiosis has been reported in patients receiving immunosuppressive therapy, or affected by immunodeficiency disorders and autoimmune diseases. A case of severe Nocardia lung infection with pleurisy and hematogenous spread to the
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The data arising out of an extensive series of necropsies and operations on cases of mesothelioma observed between 1960 and 1974 in Genoa, a town where the incidence of this type of cancer is high, are reported. Macro- and microscopic and traditional histochemical diagnostic criteria are discussed and judgest to be largely insecure for a diagnosis of mesothelioma. In doubtful cases only the use of the electronic microscope is considered valid for diagnostic purposes. Particular attention is paid to the finding of endocytoplasmatic microfilaments of actomyosin type in mesotheliomatous cells and of microvill on free surfaces and at cell interfaces. For comparative purposes, ultrastructural findings in tumours which often involve pleural metastasis and are able to simulate a mesothelioma, are reported.
We have previously described a few peculiar myocardial abnormalities occurring in AIDS patients. In this report we have extended out observations on twenty-eight additional cases where the presence of perivessel fibrosclerosis and sclerosis mostly of intramural arteries, as well focal myocytolysis were confirmed at the autopsy.
More than 50% of AIDS patients show adrenal compromise. The major pathological findings include inflammatory changes of both the cortical and medullary portion with necrosis and haemorrhage. The principal determinant of these abnormalities appears to be CMV infection. We also report the occurrence of focal or subtotal hypophyseal necrosis in the setting of AIDS. These alterations of endocrine glands may deserve attention in the management of the patients.
After a brief philologic introduction on some correlated concepts of pathogenesis we suggest the concept of pathological physiognomy of the organs. This concept express the conditioning that the peculiar structure, topography and function of an organ exercise on the characteristic configuration (and sometimes even on the possibility) of a pathological process in it. As fondament of this concept we report several examples of pathology.
Our studies on pathology of AIDS point to four major conclusions. 1) The brain is often directly affected by the HIV infection (with the characteristics of subacute microglial encephalitis with pathognomonic multinucleated giant cells) and then by opportunistic infections such as Cytomegalovirus, Herpes-virus, Papova-virus JC (with progressive multifocal leucoencephalopathy), Mycobacterium tuberculosis, Toxoplasma gondii, Cryptococcus neoformans, Candida albicans and Aspergillus fumigatus; opportunistic neoplasms (i.e. B cell lymphoma mostly pluricentric) could also developed. 2) The heart is frequently involved as well; perivascular sclerosis and myocytolysis are the hallmarks of a peculiar cardiomyopathy. 3) In the lung viral, bacterial, fungal an protozoan severe infections are frequently present: common are those caused by Cytomegalovirus and Pneumocystis carinii. Frequently thin fibrotic interalveolar septa are observed (with consequent alteration of hematosis). 4) Adrenal (most frequently) and pituitary may display necrotic-hemorragic areas (in adrenals chiefly due to Cytomegalovirus). These may be extensive enough to explain the occurrence of clinical syndromes of endocrine insufficiency.
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Pathologic findings in 25 autopsies of AIDS. The common and severe changes of the central nervous system, lungs, adrenals, heart, kidneys and gonads are reviewed in a series of autopsies of AIDS. In the brain, HIV infection induces directly inflammatory infiltrates including the typical multinucleated giant cells described by Sharer. In addition, primary lymphomas are seen as well as reactive and inflammatory lesions that are caused by opportunistic infections, such as those of poliomavirus, Cytomegalovirus and Toxoplasma gondii. In the lung, interstitial inflammation prevails, which may be related to direct HIV infection and include rare multinucleated giant cells like the ones described by Sharer. Opportunistic infections are often associated, and are commonly sustained by Cytomegalovirus and Pneumocystis carinii. A peculiar findings is the evolution from septal inflammation to fine fibrosis and hyaline degeneration, either focal or diffuse. We believe that the severe respiratory insufficiency that is commonly seen in the advanced stages of AIDS could be related to the interstitial damage. In the adrenal gland, the most common change is Cytomegalovirus infection affecting both the cortex and the medulla, and inducing massive necrosis in the cortex with little or no reaction. Again, adrenal involvement should be related to adrenal functional insufficiency, which may be over-looked clinically because of the preponderant lesions of other sites. In the heart, myocarditis is often discrete, and may be complicated by perivascular fibrosis and rare foci of myocytolysis; in some cases primary lymphomas may also develop. In the kidney, several histological lesions are found, including glomerular damage with segmental necrosis, cortical areas of hyporeactive necrosis, and mild interstitial inflammation. In the gonads, the changes are partly induced by drug abuse, and consist of atrophy with secondary hypoplasia of the germ cells and interstitial fibrosis. In conclusion, the most important abnormalities consist of opportunistic infections, hyporeactive necrosis, fibrotic evolution of the inflammatory infiltrates and neoplasias (Kaposi's sarcoma and lymphomas). In this work, the changes of the lymphoid organs are only mentioned, for they have been widely reviewed elsewhere.
Lesions of the central nervous system were seen in 13/22 autopsies of Italian subjects affected by the acquired immune deficiency syndrome and including 19 intravenous drug addicts. Multinucleated cells similar to those originally described by Sharer et al. [1985] in response to direct central nervous system lesions by the human immune deficiency virus were seen in five subjects. Isolated or multiple opportunistic infections of the brain including cerebral toxoplasmosis (7 cases), progressive multifocal leukoencephalopathy (4), cytomegalovirus encephalitis (3), and tuberculous meningoencephalitis (2) were recognized. Finally, three cases of primitive cerebral lymphoma of large round cells were found. The central nervous system is a target, like the lymphoid tissue, of direct damage for the human immune deficiency virus, and it is frequently affected by opportunistic infections due to the immunological impairment sustained by the acquired immune deficiency syndrome.
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