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PubMed2002

[Timeliness of 5,979 surgical pathology reports].

OBJECTIVE: To analyze the influence of prelaboratory and intralaboratory factors on the turnaround time of the reports in order to develop a reference database for continuous quality improvement, a retrospective study of the timeliness was reported. METHODS: Using cluster sampling of a total of 5,979 pathology reports selected by sampling a single month's reports from each quarter of the year 2000, of which there were 5,250 cases from routine biopsy and 729 cases from operative specimen. The timeliness and the factors that influence the turnaround time of the two types of surgical pathology reports were analyzed. RESULTS: 4,872 pathology reports of 5,250 routine biopsy cases were completed in 3 working days, and 613 of 729 cases of the operative specimens were completed in 4 working days. The percentage was 92.8% and 84.1% respectively. Factors that significantly contributed to the increase in turnover time of biopsy reports included request of immunohistochemical staining, delayed arrival of the operative specimen at the laboratory after frozen section, additional recutting, intradepartment consultation and decalcification etc. As for the operative cases, several factors were associated with delayed report: second day arrival of the operative specimen at the laboratory after frozen section, lack of the adequate clinical history, request for immunohistochemical staining etc. CONCLUSIONS: The majority of surgical pathology reports in the department can be completed timely and the timeliness meets the general standard. Only about 10 percent of the reports were delayed because of some prelaboratory and intralaboratory factors, for which there were 33.5% and 66.5% respectively for routine biopsy, and 50.9% and 49.1% respectively for operative specimen.

Humans↗
PubMed1991

A6--a new 45RO monoclonal antibody for immunostaining of paraffin-embedded tissues.

The authors report on the extensive characterization, on normal and pathologic tissues, of the T-cell-specific monoclonal antibody (MoAb) A6, which the authors previously found to identify a fixation- and paraffin-embedding-resistant epitope. A6 reacted with most T lymphocytes, macrophages, and Langerhans' cells of normal tissues and with peripheral T-cell lymphomas (31 of 34), Ki-1+ lymphomas (12 of 18), and T-cell leukemias (1 of 5). All cases of X and non-X histiocytosis examined and monocytic leukemias with mature phenotype only were A6 positive. Three of 47 cases of B-cell lymphoma and leukemia were labeled. Hairy cell leukemias, multiple myelomas, and Hodgkin's and Reed-Sternberg cells were negative. The A6 reactivity was preserved with different fixatives (formalin, Bouin's fluid, Carnoy's fixative, and B5) and decalcification procedures and was slightly enhanced by trypsin digestion. The pattern of reactivity of A6 was similar to that obtained with MoAb UCHL-1, recognizing the CD45RO determinant of leukocyte common antigen; however, in pathologic tissues, A6 labeled a higher percentage of cells than UCHL-1. Cross-blocking and enzyme digestion studies (Pronase E [Sigma Chemical, St. Louis, MO] and neuraminidase [Sigma Chemical]) indicated that the two MoAbs may identify close epitopes on the same molecule. In conclusion, the authors' study indicates that A6 is an excellent reagent for detection of the CD45RO molecule on paraffin-embedded normal and pathologic tissues.

Antibodies, Monoclonal↗
PubMed1996

[The anterior commissure of the larynx in the subperichondral functional surgery of the glottic plane: critical evaluation on the basis of a serial section study in normal and neoplastic laryngeal specimens].

It is a well-known fact that the clinical growth of laryngeal cancer varies according to the site of its origin. A number of macro and microscopy studies have attempted to explain the various routes it follows in spreading. The anatomical features of the anterior commissure, the conus elasticus and posterior commissure condition the direction and extent of tumour spreading as do the blood supply in the glottis and the distribution of mucous glands in the glottis and subglottis. Of the various regions of the larynx, the anterior commissure has provided perhaps the greatest challenge to investigators in that its boundaries as well as its morphology are still not clear. The possible spreading of glottic cancers exceeding these anatomic structures is very difficult to evaluate using two dimensional picture given by laryngoscopy as well as the images provided by TC and NMR which justifies a different behavior of same stage. Therefore these elements, in addition to the absence of a universally accepted clinical definition of the boundaries of AC, justify the diagnostic, pathologic, and therapeutic problems linked to AC carcinoma. Eight normal adult larynges were studied by microdissection and serial section after fixation in 10 percent formalin followed by decalcification. These specimens were dissected according to the stages of "evisceratio laryngis" performed in our Department for the treatment of T1a, T1b tumors. Our observations confirm that the island located at the anterior insertion of the thyroarytenoid muscle, easy reached during subperichondral dissection, cannot be identified with the so-called tendon described by Broyles. The specimens shown circumstantiate the fact that this fibrous-cartilagineous island act as a barrier and that when the neoplasia does start to spread into this segment, this fibrous area forces it to spread mainly along the surface. Our observations were confirmed by histologic examination of 6 surgical specimens after "evisceratio laryngis" performed on T1a, T1b tumors. Clinical positive results in subjects treated employing "evisceratio laryngis" appear to further confirm of our interpretation to these morphological observations.

Culture Techniques↗
PubMed2001

Nutrient arteries of the temporomandibular joint: an anatomical and a pathological study.

We have identified an artery which is a sub-branch of the inferior alveolar artery, and propose to call it the temporomandibular branch. Mandibular bones of 36 autopsy cases (ages 23-85; 20 males and 16 females) were examined. Contrast media were injected into the inferior alveolar artery, decalcification was conducted, and photographs were taken using soft X-ray equipment (Softex: Nippon Softex, co. CSM type). Then, an examination was conducted concerning sclerosis of these arteries. Next, H.E., Azan, and Pap silver stains were used for microscopic specimens to examine arteriosclerosis of the temporomandibular joint. The artery that sub-branches toward the temporomandibular branch, branches out immediately after the inferior alveolar artery and enters the mandibular foramen, becoming the artery that supplies the temporomandibular joint. This temporomandibular branch travels slightly downward, forward of the inferior alveolar artery, and turns back toward the mandibular base. It advances to the mandibular joint almost directly. The route taken was classified into three types. Toward the head of the mandible, the temporomandibular branch, after passing over the neck of the mandible, divides into two sub-branches, anterior and posterior. In our pathological study of the temporomandibular branch, there were a small number of cases with slight intimal thickening and mild elastosis. As regards sclerotic changes, particularly in cases more than 50 years old. There were very few cases showing intimal changes. Sclerotic changes of the artery supplying the head of the mandible increase with age. The same can be said of the about the constriction rate. These findings correlated with subject age.

Adult↗
PubMed2005

Identification of mislabeled specimen by molecular methods: case report and review.

Specimen misidentification is a common cause of errors in surgical pathology. We report a case where bone-marrow biopsies from patients of different genders were mislabeled and molecular methods were applied to resolve the identity. A short tandem repeat (STR)-polymerase chain reaction-based assay, commonly used in paternity testing, was employed in an attempt to assign the correct identity to the specimens. However, the specimens had been processed by decalcification and the DNA yield was poor. One of the markers in the assay is the non-STR amelogenin locus that distinguishes the X and Y chromosomes. This amelogenin marker results in a product of low molecular weight, enabling unequivocal resolution of identity despite a poor DNA yield. The prevalence of errors in pathology due to specimen misidentifications is reviewed.

Bone Marrow Cells↗
PubMed1990

[Development of plaque-induced gingival pockets in an animal experiment].

Single teeth and resected jaw specimens including periodontal tissue were prepared as saw-cut thin-ground specimens without previous decalcification. The specimens were classified into 4 stages of pathogenesis to allow studies into the mechanisms of gingival pocket formation. Examination of the preparations under the light microscope indicated that the pathologic gingival pockets caused by microbial plaque might be formed by degenerative alterations in the second or third innermost cell layer of the junctional epithelium. The intercellular contacts were dissolved and, thus, cyst-like cavities were formed within the epithelium. The contact between tooth enamel/cementum--basal membrane--epithelial cells, however, was maintained. Artifacts could be ruled out by comparing preparations of single teeth with those of entire jaw segments.

Animals↗
PubMedDate not supplied

Otosclerotic stapes: morphological and microchemical correlates. An electron microscopic and x-ray analytical investigation.

A total of 32 otosclerotic stapes is thin-sectioned without decalcification and examined using transmission and scanning electron microscopes, with a nondispersive x-ray analyzer attached to the latter. These otosclerotic stapes are classified as spongiotic, sclerotic, or preotosclerotic, accoring to their pathologic characteristics and state of mineralization. Either diffuse or patchy demineralization in the ground substance appears to be the initial stage of otosclerosis, and this area coincides with preotosclerotic lesions (also known as blue mantle) in light microscopy. Therefore, it is interpreted that demineralization precedes the destruction of ground substance in the preotosclerotic lesion. Bone mineral deposits in new otosclerotic bone appear to be related to the collagen fibrils that are embedded in the ground substance. No mineral deposit could be seen without the ground substance deposition; therefore, it is suggested that this ground substance is the single most important factor in the poor mineralization of the otosclerosis. The sclerotic lesions are well mineralized and show a typical pattern of hydroxyapatite by x-ray diffraction study. We could not confirm the notion that the sclerotic lesion is hypermineralized as compared to the normal stapes. The spongiotic lesions are poorly mineralized, with low calcium salt. Using the Ca/P ratio and x-ray diffraction pattern as criteria, it was determined that spongiotic lesions belong to unstable, immature bone.

Bone Marrow↗
PubMed1996

Working experience with a new vacuum-accelerated microwave histoprocessor.

Methods of microwave and vacuum-accelerated fixation, dehydration, and paraffin embedding are described, using a new type of vacuum and temperature stabilizable microwave histoprocessor: MFX-800. The whole histoprocessing cycle lasts 3.5-5.5 h, depending on the thickness of the tissue blocks. Well-preserved structural detail, intense staining, and good antigen preservation were achieved with various tissues. This new histoprocessing facility is recommended for routine pathology laboratories in speeding up their processing procedures.

Decalcification Technique↗
PubMedDate not supplied

A modified "soft surface specimen technique" for examination of the inner ear.

A new surface preparation method was devised for assessing intracochlear vessels and sensorineurepithelium. The method is a combination of the conventional osmic acid stained surface preparation method and a surface preparation technique with injection of Prussian blue and decalcification of the cochlea. Such a combination preserves most advantages of each and eliminates many of the disadvantages. To preserve the delicate sensory and nervous structures we examined variations of the preparation, paying particular attention to fixation, staining, and decalcification procedures and solutions. Varying the preparation had a less marked effect on external wall structures than on the basilar membrane; the primary changes consisted of variation in staining contrast. The method proved useful for demonstrating the normal anatomy and pathological changes in cochlear vasculature and in sensorineural and supporting structures of the labyrinth in light and phase contrast microscopy at moderate magnifications.

Animals↗
PubMed1983

A new technique for the study of temporal bone pathology.

A new technique for the study of the temporal bone at autopsy is presented in which thin slices of the fixed bone are prepared on a special cutting machine which preserves the configuration of the delicate anatomical structures. Selected areas are then processed for light microscopy. There is thus opportunity for gross examination, only a short period for immersion in acid for decalcification if required, and special histological procedures may also be carried out. The method is quick and technically easier than serial sectioning and storage of the smaller numbers of sections from each case is less of a problem. Temporal bones which have been perfused through the perilymph within 3 h of death may also be cut in the same way in order to allow removal of samples of membranous labyrinth for surface preparation or electron microscopy, avoiding the need for drilling to reach the membranous labyrinth, and being quicker and less damaging.

Histological Techniques↗
PubMedDate not supplied

Bone marrow biopsy (BMB). I. Generalities, material and method, normal structure of bone marrow, pathological conditions.

The authors presented in their first note generalities concerning the normal and pathological structure of bone marrow (BM), based on their personal experience (1,500 BMB) and on the literature. A short historical survey and the adopted research method are presented. The advantage of Burkhardt's myelotomy with its technical process by embedding in synthetic resins to avoid decalcification are discussed. The authors have used Jamshidi's cannula (or some other similar needle) with the subsequent embedding in paraffin after decalcification. Further papers will analyse the approach, by BMB, of the myeloproliferative disorders, myelodysplasia, lymphomas and Hodgkin's disease, cancer metastases and medullar aplasia.

Biopsy, Needle↗
PubMed1987

A histologic evaluation of a mandibular cross section one year after augmentation with hydroxyapatite particles.

A pathologic mandibular fracture in a 35-year-old woman 1 year after the attempted filling of a bone defect with particulate, dense hydroxyapatite resulted in a partial mandibular resection, allowing observation of cross sections of the mandible and associated soft tissue. Thin tissue sections were examined without decalcification. This permitted excellent observation of the hydroxyapatite particles, the bone, and the soft tissue. Osseointegration had occurred only in the areas closely associated with the bone. The immobility of the particles was a prerequisite for involvement with new bone formation. Hydroxyapatite particles in areas that allowed any mobility were surrounded by connective tissue with no bone formation evident. Heterogeneous particles were observed, indicating the possibility of a lack of purity in the hydroxyapatite ceramic, which may have contributed to the resorption of the particles. These findings, as well as other clinical and experimental findings, lead us to question the concept of hydroxyapatite as a bioactive ceramic that induces osteogenesis or osteoconductivity.

Adult↗
PubMed1997

Sheet plastination of the larynx for whole-organ histology.

Whole organ serial sections of the larynx are recognized to improve the assessment of laryngeal pathology. The human larynx with its complex anatomy of different types of tissue with their marked differences in hardness complicate the cutting process. The methods established are either very costly, time consuming and prone to artefacts, or sections are too thick for a histological work-up. Prior decalcification causes major shrinkage, thus morphometry is not feasible. We describe a technique of sheet plastination to produce whole-organ sections which allows a full-scale histological investigation without prior decalcification. Deep-frozen larynges are cut into 4-micron-thick sections using an ordinary slicing machine. Slices are dehydrated in acetone and plastinated in Biodur E50/E7/ AE10/E700. These specimens are cut into sections of about 80 microns thickness using a diamond-wire saw. An ultra-milling device reduces the section thickness down to about 10 microns. Surface staining of different kinds like Richardson, methylene blue or Paragon yields sufficient contrast for exact diagnosis. Deplastination and consecutive paraffin-like staining is possible, but results are not yet fully satisfying. Histological sheet plastination produces almost artefact- and shrinkage-free whole-organ sections in a period of about 1 week. The technique is useful for studies of micromorphometry or tumor spread. Theoretically, application of immunohistochemical staining methods seems to be possible. This might lead to mapping the proliferation activity of laryngeal cancer as it is presented on whole-organ sections.

Artifacts↗
PubMed1992

Bromodeoxyuridine immunohistochemistry for evaluating age-related changes in the rat mandibular condyle decalcified by intravenous infusion.

Age-related changes in cell proliferation kinetics of the mandibular condyle were studied in Sprague-Dawley rats using bromodeoxyuridine (BrdUrd) immunohistochemistry in decalcified, paraffin-embedded tissues. Intraperitoneal injection of 40 mg/kg BrdUrd was given 1 hr before animal sacrifice. Continuous perfusion of EDTA solution via the left ventricle shortened the decalcification time. Immunohistochemical staining was performed with monoclonal anti-BrdUrd antibody. BrdUrd labeled cells, i.e., the S-phase cells, were clearly visible with well-preserved cytological detail. Their nuclei exhibited homogeneously stained granules. The labeling index in the intermediate zone of the condyle decreased with increasing age of the animals. This method is useful for evaluating physiological and pathological changes of the rat mandibular condyle as well as other bones and joints.

Aging↗
PubMed1988

Nutritional secondary hyperparathyroidism in a lion cub.

A female lion cub about 5 months old from a litter raised artificially in a lion park, was euthanased and necropsied. The history was one of poor growth, lameness, a reluctance to move and skeletal malformations with disproportionately large head and feet. The cub had been fed meat and milk supplemented with calcium and vitamins. All the bones in the body were exceptionally soft and flexible. The long bones, vertebrae and ribs were easily split in half with a knife. The scapulae were deformed and medially curved. The long bones were shorter and thicker in diameter than normal, with very thin cortices. Numerous pathological fractures exhibiting minimal callus formation were present. The ribs were rounded, abnormally curved and very short in comparison to the length of costal cartilages. Radiographically, a marked osteoporosis was observed. Histopathological examination revealed a severe diffuse fibrous osteodystrophy with very little bone present. The osteoid was improperly mineralised and tissue sections for microscopy were cut without any need for prior decalcification. Little space for haemopoietic tissue remained. The lesions were considered consistent with those in animals raised on a diet containing excessive phosphates and low calcium.

Animals↗
PubMedDate not supplied

Otospongiosis: morphologic and microchemical investigation after NaF-treatment.

Element analysis of microareas of otospongiotic specimens is described. A total of 36 otospongiotic stapes are ultrasectioned without decalcification and examined using a transmission and a scanning electron microscopy (STEM-mode). The latter was equipped with an energy dispersive x-ray analyzer. Twenty of the stapes came from patients who have had sodium fluoride (NaF) treatment (15 to 45 mg/day) for a minimum of 12 months. The otospongiotic stapes are classified as spongiotic and sclerotic according to their pathologic characteristics and state of mineralization. Using the Ca/P ratio as criterion--measured by the characteristic x-ray fluorescence--it was shown in a blind study that the NaF-treated otospongiotic stapes had a statistically higher Ca/P ratio, indicating that the fluoride may stabilize otospongiotic lesions, particularly the spongiotic type with unstable mineralization.

Adolescent↗
PubMed2001

Valvuloplasty with glutaraldehyde-treated autologous pericardium in patients with complex mitral valve pathology.

BACKGROUND: Severe mitral regurgitation associated with complex mitral valve disease often precludes successful surgical repair. The feasibility and the results of valvuloplasty with glutaraldehyde-treated autologous pericardium remain largely unknown. METHODS: The cases of 63 patients who underwent operation within an 11-year period were studied. A pretreated autologous pericardial patch was used for leaflet extension plasty, for paracommissural plasty, as a substitute for part of the leaflet, and for reimplantation of ruptured papillary muscles to eliminate severe mitral regurgitation. Patients with a severely calcified annulus after en bloc decalcification had straddling endoventricular pericardial patch annuloplasty for reconstruction of the affected atrioventricular groove. Chordal replacement with a strip of pericardium was chosen if no suitable chordae were available. Pericardium-reinforced suture annuloplasty was used in patients with acute endocarditis resistant to medical therapy. Associated valvuloplasty procedures with Carpentier techniques were also employed. RESULTS: There were no operative deaths in this series. At a mean follow-up of 61.1 months (range, 4 to 132 months), mitral regurgitation was absent or trivial in 92.1% of patients by echocardiography. Freedom from reoperation was 95.2% at 1 year and 5 years. Thromboembolic events have not been detected. Thirty percent of patients returned to sinus rhythm. Two patients required valve replacement. CONCLUSIONS: Our beneficial results indicate that glutaraldehyde-treated autologous pericardium is suitable for valvuloplasty. It provides durable and predictable repair of valves that might otherwise need to be replaced because of the complex mitral valve disease. The technique is reliable, allows further efficacious repair possibilities, and improves postoperative outcomes. Whether it can prevent late deterioration and calcification requires more investigation.

Adult↗