Histopathologic approach to metabolic liver disease: Part 1.
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Biopsy↗
Biomedical subjects
J E Dimmick
Publications and source records attributed to J E Dimmick.
Histopathologic approach to metabolic liver disease: Part 2.
In this, part 2 of the histopathologic approach to the diagnosis of metabolic disease of the liver, the steatotic, cirrhotic, and neoplastic groups are addressed. See the previous issue, Volume 1, Number 3, of Pediatric and Developmental Pathology for part 1 [1]. The perspective concludes with a tabulated assessment of the likelihood of diagnostic ascertainment.
Adult↗
Biliary atresia and cytomegalovirus infection: a DNA study.
The cause of extrahepatic biliary atresia (EHBA) is undetermined in most instances, but an infectious agent is widely suspected. Cytomegalovirus (CMV) infection has been associated with intrahepatic bile duct destruction and paucity, raising the question of its role in EHBA. We identified 12 children in the past 5 years with biliary atresia and examined the bile duct biopsy. These showed acute/chronic inflammation and epithelial degeneration. CMV inclusions were not identified. We used in situ hybridization and the polymerase chain reaction (PCR) for CMV-DNA on formalin-fixed, paraffin-embedded tissue. All samples showed the presence of amplifiable DNA using beta-globin primers. No biopsy tissue showed CMV DNA using specific probes and primers. The absence of demonstrable CMV DNA by in situ hybridization and PCR in EHBA biopsies implies that it is unlikely that this virus has any major role in the pathogenesis of this condition.
Bile Ducts↗
Spectrum of gastritis in celiac disease in childhood.
Celiac disease (CD) may cause changes throughout the gastrointestinal tract. The pathology is best described in the distal duodenum and jejunum. It is also associated with lymphocytic gastritis (LG) and varioliform gastritis in adults and children, but the histologic spectrum in the gastric biopsy and the clinical implications are undefined. In this report we relate our experience with the clinical, endoscopic, and histologic changes in gastric biopsies in CD in childhood. Slides (hematoxylin and eosin stained) were reviewed from 33 celiac children, 5 having had more than 1 gastric biopsy during a 7-year period. Gastric intraepithelial lymphocyte (IEL) counts were compared with those of 10 histologically normal controls (normal range, 1-7 IEL/100 antral or body epithelial cells) and 10 nonceliac chronic gastritis (CG) biopsies without H. pylori (normal range, 1-19 IEL/100 antral cells), noting changes in the epithelium and lamina propria (LP). LG was present in 29/33 initial biopsy sets. Fifteen of 29 showed LG/CG. The IEL number was greater in LG/CG than in LG only (27.2 +/- 9.3, n = 14 vs. 18.6 +/- 13.4, n = 15 in the antrum; 23.5 +/- 2.8, n = 4 vs. 13.0 +/- 8.4 in the body). In CD the difference between these mean values and those of normal and nonceliac CG controls was statistically significant. In CG/LG the inflammatory infiltrate was predominantly diffuse/superficial in the LP; mucin depletion was noted in 11/15. The IELs were in the LG/CG range in two CG controls. The IELs were normal at follow-up in five cases. There were no statistically significant differences between the groups with respect to clinical parameters or gastric endoscopic findings. No child had varioliform gastritis. We conclude that in CD children, the stomach is endoscopically unremarkable but may show LG, or LG/CG with or without mucin depletion, or occasionally appear normal. Gastric histology returned to normal with gluten withdrawal. Normal gastric histology is not typical, but does not exclude CD.
Biopsy↗
Intrahepatic bile duct paucity and cytomegalovirus infection.
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Adolescent↗
A model to begin reengineering the laboratory. How do you change an outmoded laboratory structure?
If a traditionally structured laboratory cannot incorporate new technologies efficiently and can no longer meet its changing service demands, it may require reengineering. A model is presented that can be followed by the laboratory director and a small group of planning colleagues to begin the process. The model was effectively used at British Columbia's Children's and Women's Hospitals (BCCH/WH) to review their laboratory structure and redraft it for the future. The model considers the external and internal pressures facing the laboratory. Technological trends, which have significant impact on laboratory service, are also incorporated into the model. The current list of services, staff expertise, and laboratory specialties is used as the base in the model to formulate the opportunities for improvements and identify the future direction of the laboratory. These opportunities are the context for the vision of the future laboratory. With this vision in mind and a creative planning approach, a new optimum laboratory structure can be outlined. This model begins the reengineering process and can be applied to any laboratory where there is the need for dramatic improvements to accommodate the changes in today's rapidly evolving health-care environment.
British Columbia↗
Strategies for a successful organizational transition. Identifying staff roles and fulfilling their needs during changing times.
For a successful reorganization of the laboratory, there is a role for each staff member to play during the transition. The role of those in laboratory administration is that of leading change agent. Corporate support staff, such as those in a human resources department, can advise the laboratory director in their areas of expertise. The role of the medical and technical supervisory staff is that of chief implementers of the plan. General laboratory staff has a confusing dual role--not only must they continue to provide laboratory services during the transition, but they also may have to change what they are doing and how they are doing it. Success also depends on meeting the individual personal needs of staff. Laboratory directors and administrators want to make a meaningful contribution to health care. Corporate support staff need to feel that they are a part of the change process. Supervisors' needs vary--coping with the loss of identity, position, or territory will be difficult for some; others will want to be involved in all stages of planning and implementation. The major need of the general laboratory staff is stability. Strategies are listed for each staff grouping to help the laboratory director coordinate staff roles and satisfy staff needs during the transition period.
Attitude of Health Personnel↗
Mucin histochemistry of the developing gastroesophageal junction.
Mucin histochemistry was performed on the squamocolumnar junction (Z-line) of the gastroesophageal region of 49 autopsied previable fetuses, stillbirths, infants, and young children, using alcian blue pH 2.5/periodic acid-Schiff (PAS) and alcian blue pH 1.0/PAS stains. Sialylated and neutral mucins were present in most and sulfated mucin in many cases. In only one fetus was a heterotopic focus of goblet cells found in the distal esophagus. This study confirms that the presence of acidic mucins in columnar epithelium, without goblet cells, at the Z-line and adjacent cardia is common in this age group. Undue reliance on mucin stains to identify metaplastic columnar epithelium, in the absence of goblet cells, may result in overdiagnosis of Barrett's esophagus in children.
Child↗