Type 1 diabetes mellitus and hepatic sinusoidal fibrosis.
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Adult↗
Biomedical subjects
M L Yeong
Publications and source records attributed to M L Yeong.
Coeliac disease: incidence and prevalence in Wellington 1985-92.
AIM: A retrospective study was carried out in the greater Wellington area. The objectives of this study were to identify an incidence rate, presenting symptoms and clinical features of coeliac disease. METHODS: Histology archives from the Wellington hospital department of pathology over the last eight years (1985-92) were retrieved and analysed. Abnormal duodenal and jejunal histological sections were reviewed. One hundred and seventy seven biopsy specimens from 127 patients were identified for further study from a total of 367 abnormal duodenal and jejunal biopsy specimens. Diagnosis of coeliac disease was based on information from hospital notes, biopsy request forms, and histology reports. Diagnostic criteria used for coeliac disease were evidence of malabsorption, abnormal histology consistent with coeliac disease and clinical improvement following a gluten free diet. RESULTS: Thirty eight patients were diagnosed with coeliac disease 1985-92 in a population of 267,252. Of these 38 only four were children (0-12 years). Overall incidence was 1.8 per 100,000. The estimated overall prevalence was 70 per 100,000, with 14 per 100,000 for children. The live birth rate was 0.1 per 1000. There was a female predominance of 3:1. Patients presented with a diverse range of problems, most commonly diarrhoea, anaemia, weight loss and steatorrhoea. Three out of the 6 patients who had a single problem had anaemia. CONCLUSIONS: The study has demonstrated an overall incidence and prevalence of coeliac disease in the Wellington region similar to overseas figures. However only 11% of the total were children, which is a very low proportion compared to the 50% reported in Sweden and 25% in Edinburgh. Patients presented with a wide range of clinical features. The threshold for small bowel biopsy should be relatively low in any patient considered to have clinical features of malabsorption.
Adolescent↗
Severe aortic stenosis and atherosclerosis in a young man with Tangier disease.
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Adult↗
Actinomycin D associated hepatic veno-occlusive disease--a report of 2 cases.
Until recently, actinomycin D (AMD), a cytotoxic antibiotic, was considered to cause little or no liver damage. There are now reports of liver failure following treatment of childhood cancers with AMD. This report describes the pathological changes in liver biopsy samples taken from 2 children who developed liver failure after combined chemotherapy for Wilms' tumor. The changes were those of nodular hyperplasia, sclerosis of terminal hepatic venules with associated zone 3 hemorrhagic necrosis, and sinusoidal fibrosis. These features were initially ascribed to the veno-occlusive disease caused by pyrrolizidine alkaloids, radiotherapy and some therapeutic drugs but have not been described in detail as a complication of AMD therapy. An additional feature peculiar to these 2 cases was the presence of unexplained extramedullary hematopoiesis.
Child, Preschool↗
Effect of tumour associated tissue eosinophilia on survival of women with stage IB carcinoma of the uterine cervix.
AIMS: To examine the survival of a group of women with stage IB invasive carcinoma of the uterine cervix, divided according to the expression of tumour associated tissue eosinophilia (TATE). METHODS: Histological material from 81 women with stage IB squamous and adenosquamous cervical carcinomas before radiotherapy was assessed for the extent of tissue stromal eosinophilia, quantified using antibodies to human major basic protein. RESULTS: Twenty eight (38%) of the cases demonstrated TATE of over 30 eosinophils/mm2, with 12 (16%) having greater than 100 eosinophils/mm2. Eleven women in the series developed distant spread or recurrent pelvic disease, this group having a stromal eosinophil density significantly less (13.8/mm2) than the remainder (69.9/mm2) (p = 0.03). The actuarial five year survival rate for women with a tumour eosinophil density over 30/mm2 was 92% compared with 70% with a density under 30 mm2, with a significant difference in the survival curves for these two groups (p = 0.03). CONCLUSIONS: As a univariate parameter, a tumour associated tissue eosinophilia of at least modest proportions is associated with statistically improved survival in women with stage IB cervical carcinomas.
Adult↗
Hepatocyte membrane injury and bleb formation following low dose comfrey toxicity in rats.
Comfrey, a popular herbal remedy, contains hepatotoxic pyrrolizidine alkaloids and has been implicated in recent human toxicity. Although alkaloids from other plant sources have been extensively researched, studies on the hepatotoxic effects of comfrey alkaloids are scant. The effects of high dose comfrey toxicity have been studied and the present investigation was undertaken to identify changes associated with relatively low dose toxicity. Eight young adult rats were dosed weekly for six weeks with 50 mg/kg of comfrey derived alkaloids. The animals were dissected one week after the last dose and the livers examined by light and electron microscopy. Changes at the light microscopic level showed vascular congestion, mild zone 3 necrosis and loss of definition of hepatocyte cellular membranes. Extensive ultrastructural abnormalities were identified in the form of endothelial sloughing and the loss of hepatocyte microvilli. A striking finding was florid bleb formation on the sinusoidal borders of hepatocytes. Many blebs were shed into the space of Disse and extruded to fill, and sometimes occlude, sinusoidal lumina. Platelets were frequently found in areas of bleb formation. There was evidence of late damage in collagenization of Disse's space. Hepatocyte bleb formation is known to occur under a variety of pathological conditions but there is little to no information in the literature on the effects, if any, of bleb formation on fibrogenesis and the microcirculation and its role in the pathogenesis of liver disease. The pyrrolizidine alkaloids of comfrey may serve as an experimental tool to study the process of bleb formation and the intimate relationship between hepatocyte and sinusoidal injury in the liver.
Animals↗
The prognosis of adenosquamous carcinomas of the uterine cervix.
OBJECTIVES: Firstly, to identify a cohort of women with invasive adenosquamous carcinomas of the uterine cervix, including mucin-producing squamous cell carcinomas. Secondly, to compare the biological characteristics and behaviour of a cohort of adenosquamous carcinomas with a cohort of non-mucin-producing squamous cell carcinomas. DESIGN: Histological review, retrospective survival analysis. SETTING: Regional multidisciplinary gynaecological oncology service. SUBJECTS: 161 cases of stage 1B and above invasive cervical carcinoma presenting between 1 January 1980 and 31 July 1987. Thirty nine women with adenosquamous carcinomas were compared with 103 women with non-mucin-producing squamous cell tumours. RESULTS: Inclusion of routine stains for mucin in the assessment of histological material resulted in the reclassification of 38 (24%) of the cases, including the identification of 31 mucin-producing squamous cell carcinomas. The survival with adenosquamous tumours was significantly worse than with squamous cell cancers (P = 0.006), 5-year survival rates being 52% and 75% respectively. Multivariate analysis showed that this effect was explained by differences in clinical stage, pelvic lymph node metastasis and vascular invasion by tumour. CONCLUSIONS: The application of routine mucin stains to cervical tumours identifies a group of previously unrecognized adenosquamous cancers. Tumours so identified are likely to pursue a more aggressive clinical course associated with a poorer survival when compared to non-mucin-producing squamous carcinomas.
Adenocarcinoma↗
Synchronous squamous and glandular neoplasia of the anal canal.
A 48 year old man presented with invasive adenocarcinoma in the wall of a non-healing anal fistula. The subsequent abdomino-perineal resection specimen showed residual invasive carcinoma coexisting with in situ carcinoma of anal glands as well as in situ squamous carcinoma of the anal canal. The epithelium of the anal canal had koilocytotic features. DNA hybridisation studies by the dot blot technique showed weak positivity for human papillomavirus (HPV) subtypes 16, 18. This case illustrates a number of important points--namely, anal fistulas, particularly non-healing fistulas should be biopsied to exclude malignancy; some adenocarcinomas of the anal arise in anal glands; the coexistence of glandular and squamous carcinoma with evidence of HPV infection is highly reminiscent of similar synchronous lesions of the uterine cervix and suggests that HPV may have an aetiological role in both squamous and glandular carcinomas of the anal canal.
Adenocarcinoma↗
Lymphoid follicular hyperplasia--a distinctive feature of diversion colitis.
Diversion colitis refers to the inflammatory changes that occur in the defunctioned segment of the large intestine following diversion of the faecal stream. We report the histological features in the defunctioned rectums from seven patients: one each with severe constipation and Behçet's disease, two with Crohn's disease with rectal sparing and three with ulcerative colitis. The appearances of diversion colitis in a previously normal rectum are compared with diversion colitis with superimposed inflammatory bowel disease. Lymphoid follicular hyperplasia was found in all cases. This was marked in patients with inflammatory bowel disease, with or without initial rectal involvement. Other changes comprised surface epithelial degeneration and ulceration, mucosal inflammation including crypt abscesses, and crypt branching. Inflammatory and crypt changes were mild, except in ulcerative colitis where changes were marked and resembled those of the proximal colon. Lymphoid hyperplasia is a distinctive feature in diversion colitis. The term follicular proctitis, previously used to indicate chronic ulcerative colitis exclusively, should be re-examined.
Adult↗
Presentation, duration of symptoms and staging of colorectal carcinoma.
A prospectively recorded, consecutive series of 155 colorectal carcinoma specimens clinically and pathologically staged according to the Australian Clinico-pathological System (ACPS) between April 1987 and May 1989 at Wellington and Kenepuru Hospitals is reviewed. Clinical records were available for retrospective review for 146 of the 155 patients. Change in bowel habit, rectal bleeding and abdominal pain were the most common presenting symptoms. Thirty-five patients presented as emergencies, twenty-six with obstruction and nine with perforation. Abdominal pain resulted in the earliest surgical intervention. The median duration of symptoms prior to diagnosis was 3 months. No correlation existed between tumour stage and duration of symptoms. Earlier diagnosis during the symptomatic phase of colorectal carcinoma is unlikely to contribute significantly to improved overall survival.
Adult↗
Bechet's colitis: a differential diagnosis in inflammations of the large intestine.
A previously well 39 year old woman presented with severe localized and painful anorectal ulceration. There were no other associated symptoms apart from arthritis of the hips and fingers. In the absence of definitive tissue diagnosis, a presumptive diagnosis of Crohn's disease was made. After a period of progression, the inflammation and ulceration subsided with conservative therapy. Following a relatively symptom-free period of 7 years, painful ulceration recurred in the same segment of bowel, which was refractory to steroid therapy but responded to defunctioning of the rectum. Upon excision of the defunctioned rectum, multiple discrete ulcers developed in the remaining colon, with a fistula from the distal sigmoid colon to the midline wound. The patient simultaneously developed painful apthous ulceration of the mouth and throat, and pustules appeared on the perianal skin and trunk for the first time. A colectomy was performed, with good results. The pathology of the colonic lesions is described. The characteristic appearance of these lesions, together with associated 'major' and 'minor' clinical criteria, enabled a diagnosis of Bechet's disease to be made. Although there is some overlap, particularly in the distribution of this condition with Crohn's colitis, the pathologic appearances in Bechet's colitis are relatively distinct. A diagnosis of Bechet's colitis should not be excluded in a patient presenting with atypical inflammatory bowel disease, even if associated clinical criteria are not simultaneously present.
Adult↗
The effects of comfrey derived pyrrolizidine alkaloids on rat liver.
Three groups of young adult rats were fed pyrrolizidine alkaloids derived from Russian comfrey to study the effects of the herb on the liver. Group I animals received a single dose of 200 mg/kg body wt, Group II 100 mg/kg three times a week for 3 weeks and Group III 50 mg/kg three times a week for 3 weeks. All rats showed light and electron-microscopic evidence of liver damage, the severity of which was dose dependent. There was swelling of hepatocytes and hemorrhagic necrosis of perivenular cells. There was a concomitant loss of sinusoidal lining cells with disruption of sinusoidal wall and the sinusoids were filled with cellular debris, hepatocyte organelles and red blood cells. Extravasation of red blood cells was evident. Terminal hepatic venules were narrowed by intimal proliferation, and in Group II and III, reiculin fibres radiated from these vessels. These appearances have been described in veno-occlusive disease due to pyrrolizidine alkaloids from other plant sources such as Senecio and Crotalaria. The safety of comfrey, a widely used herb, in relation to human consumption requires further investigation.
Animals↗
Papillary cystadenocarcinoma of the appendiceal stump with mucocele and peritoneal metastases.
A 54-year-old Polynesian male developed a mucocele of the appendiceal stump 25 years after appendicectomy. Scattered peritoneal deposits up to 0.4 cm in diameter were also identified at laparotomy, and these were confined to the right iliac fossa. The cyst was excised with a right hemicolectomy and histology showed a mucus-producing papillary cystadenocarcinoma arising in the unburied appendiceal stump. There was invasion of the cyst wall and the peritoneal nodules contained metastatic tumour acini. The patient is well 12 months after surgery. This is a case of a rare tumour arising uniquely in an appendiceal stump and producing a mucocele. The term mucocele is discussed and recommendations made for its usage in pathological diagnosis.
Appendectomy↗
Cervical cytology in the Auckland region.
A two week prospective study of the characteristics of women having cervical smears in the Auckland region in 1985 is presented. European and Maori women have about the same rate of smears while Pacific Islanders have a slightly lesser rate. Many women are not having smears taken during pregnancy or at the postnatal examination. Doctors initiate twice as many smears as their patients. More than half of the women had smears taken in less than the three year interval recommended for screening. Five per cent of smears have some degree of cervical intraepithelial neoplasia (CIN) and nearly half of these showed evidence of human papilloma virus (HPV) infection. There is a spectrum extending from young women in their early twenties with HPV infection alone through their later twenties with HPV and CIN and finally women in their thirties and forties with carcinoma-in-situ (CIS) alone.
Adolescent↗
Micrograph magnification--science or fiction?
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Microscopy↗
Neurofibromatosis associated with somatostatinoma: a report of two patients.
Two patients with neurofibromatosis and somatostatinoma are described, one patient in addition having a parathyroid adenoma diagnosed post mortem. The other patient had a partial somatostatinoma syndrome with diabetes, abdominal pain and cholelithiasis. The tumour was diagnosed preoperatively and metabolic studies demonstrated mild diabetes mellitus apparently due to suppression of insulin secretion by somatostatin, since oral glucose tolerance returned to normal post-operatively despite hemipancreatectomy. The tumour also secreted gastrin. There are now 18 reported cases of neurofibromatosis and duodenal carcinoid tumours which makes a genuine association between these two conditions very likely. With the present two cases, seven of the carcinoid tumours in this group have been positively identified as somatostatinomas. The histological finding of psammoma bodies is important in the diagnosis of duodenal somatostatinomas.
Adenoma↗
Clostridium septicum infection in neutropenic enterocolitis.
A 36-year-old woman developed neutropenia following chemotherapy for inoperable carcinoma of the cervix. She suffered acute abdominal pain, nausea, vomiting, and peritonitis of rapid onset. The right hemicolon and 15 cm of terminal ileum were resected at laparotomy and this showed marked edema of the cecum and ileo-cecal valve associated with superficial ulceration of the valve. There was necrosis of submucosal tissues and the muscle wall which contained a large number of Gram-positive bacilli. These showed positive membrane immunofluorescence with specific anti-Clostridium septicum antisera. We identify a case of enterocolitis due to Clostridium septicum infection. This is associated with neutropenia and is often fatal due to the rapid course of and failure to recognize the infection.
Adult↗
Ultrasound guided fine-needle biopsy of abdominal mass lesions.
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Abdominal Neoplasms↗