Biomedical subjects
Publications and source records attributed to W F Kealy.
A case of foetal death with retroplacental haemorrhage at 24 weeks gestation is reported, where the placenta histologically showed diffuse severe chorioangiosis. The latter is an infrequently reported placental vascular anomaly, which recent studies have indicated to be an important sign of neonatal morbidity and mortality.
A case of primary hyperoxaluria which presented with progressive renal failure in a 34 year old woman is reported. The patient died six years following the initial diagnosis and post mortem examination revealed widespread deposition of oxalate crystals in her tissues.
The observation of koilocyte-like features in the squamous epithelium of some endometrial adenoacanthomas prompted an investigation into a possible viral aetiology. These changes closely resemble those that occur in the ectocervical mucosa which are accepted as morphological evidence of human papillomavirus (HPV) infection. Sections of 87 hysterectomy specimens removed for endometrial carcinoma over 12 years, together with preoperative curettings, were reviewed for the presence of acanthomatous change and for appearances suggestive of HPV infection. The ages of the women ranged from 36 to 84 years, average age 62.6. Light microscopical examination showed koilocytosis, papillary formations, and intranuclear eosinophilic inclusions of both squamous and glandular epithelium in some tumours. Immunocytochemistry and DNA in situ hybridisation indicated the presence of HPV antigen in squamous and glandular cells, and perinuclear virus particles characteristic of HPV were seen on electron microscopical examination in those cells with nuclear inclusions. HPV probably infects endometrial adenocarcinomas directly from the cervix but it is unlikely that it has an aetiological role. It is possible, however, that in addition to being a "passenger," the virus may stimulate squamous metaplasia in some adenocarcinomas of the endometrium and may also exert some influence on their behaviour.
All the biopsies of pulmonary mass lesions obtained by percutaneous needle aspiration over a seven year period were reviewed. Emphasis is laid upon the differences in cell typing of malignant tumours when two types of preparation of the same tissue, cytological smears and tissue sections are examined. Some problems in cell typing are discussed and suggestions for improved proficiency are made.
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A case of concomitant angiosarcoma and carcinoma of the left breast in a forty-three year old woman is described. Following a diagnosis of angiosarcoma she was treated by simple mastectomy. Five months later, left axillary lymph node biopsy showed metastatic adenocarcinoma. Retrospective examination of the mastectomy specimen disclosed a concomitant but separate adenocarcinoma. The patient remains well after 3 years. The implications of this rare association are discussed and the long survival gives an opportunity to review the prognosis in breast angiosarcomas.
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Five cases of neonatal necrotising enterocolitis occurred in full-term infants at Kingston Hospital in the space of 15 months. In all cases only the colon was involved. The pathological findings are discussed particularly in relation to the aetiology of the disease.
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A review of the literature has shown that atheroembolism as a cause of clinically evident disease is an entity that is little documented. Sections of tissues from necropsies on patients over the age of 60 years from 1970 to 1977 inclusive were reviewed and examined for evidence of atheroembolism, and an incidence of 0.79% was found. In every case of embolism the aorta showed advanced atheroma, sometimes with aneurysm formation. The ESR in some instances was increased, sometimes markedly so. Some of the problems of antemorten diagnosis are discussed. To emphasise the possible clinical importance of the condition, a rare instance of spinal cord infarction due to atheroembolism is described.
A study of lymphoid-glandular complexes of the large bowel has been undertaken. Sections from 1924 surgical colectomy and proctocolectomy specimens were examined, and lymphoid-glandular complexes were observed in 231. It has been shown that they are distributed throughout the large bowel and occur in all age groups and in normal and disease states. An analogy has been drawn between them, the palatine tonsils, and the bursa of Fabricius. It is concluded that the lymphoid-glandular complex is, most probably, a normal structural entity of the large bowel and that it acts as a local receptor of antigenic material for future immune recognition. It is suggested that microbursa rather than lymphoid-glandular complex is more apt name for this structure.
The lymphoid tissue of the normal colon is compared with that of colons with diverticular disease. Colons with diverticular disease show a significant increase in the number of lymphoid nodules in areas not containing diverticula. Lymphoid-glandular complexes of the colon were studied in relation to diverticular disease. It is suggested that the lymphoid nodules and the lymphoid-glandular complexes of the colon constitute weak points in the bowel wall and may play a part in the pathogenesis of diverticula.