Pathology
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We report a case of a solitary osteochondromatous tumor on the hand of a 38 yr old man. This had radiological and histological features distinct from an osteochondroma and demonstrated the features first described as bizarre parosteal osteochondromatous proliferation. These lesions have a tendency for local recurrence but no metastatic behaviour has yet been reported. We highlight 2 histological features which have not been previously described.
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A 65-year-old male developed a rapidly progressive disease characterized by severe hemolysis, with spur cells (acanthocytes) and liver disease. Autopsy findings were consistent with a diagnosis of idiopathic hemochromatosis. Investigation of the patient's family uncovered four out of five first degree relatives with significantly raised serum ferritin levels. ⋯ Spur cell anemia is a recognized, though rare, complication of alcoholic liver disease and indeed the patient had a regular alcohol intake of up to 50 g daily. Although the alcohol intake could have contributed to the formation of spur cells, the possible association with hemochromatosis should be considered. A diagnosis of hemochromatosis has important implications for family members.
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The key to an adequate assessment of the hemostatic status of an individual patient is a full and adequate medical history and proper physical examination, and no set of screening tests can replace this. The vast majority of patients thus assessed will require no tests and the coagulation laboratory staff can concentrate on the full assessment of the small number of patients who will be identified as being at risk. The assessment of disturbances of hemostasis is a logical, and basically quite simple, sequence of tests.
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Diffuse alveolar damage may be caused by any one or more of a large number of injurious agents. While the etiology may be diverse, the pathology is relatively uniform ranging from an acute exudative phase characterized by protein-rich interstitial and alveolar edema, through to a reactive subacute proliferative phase characterized by interstitial fibroplasia and collagenization together with granular pneumocyte hyperplasia. Interstitial inflammation is a variable feature and of course mixed exudative and proliferative features are common. ⋯ In diffuse alveolar damage associated with shock, recent work suggests mediation of the cellular injury via complement activation following tissue injury, with the major pathology being due to lysosomal enzyme damage from phagocytes chemotactically attracted to the lung. Etiological factors in diffuse alveolar damage are numerous and details of appropriate primary therapy are therefore diverse. The pathogenesis and pathology are however relatively uniform, calling for uniform supportive therapeutic measures of the clinical adult respiratory distress syndrome.
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A review of gastric brush cytology from 488 patients and esophageal brush cytology from 108 patients over a 7-yr period was undertaken. 80 gastric brushings and 20 esophageal brushings were positive for malignancy. The microscopic appearances of the brush specimens are described and illustrated. Histological correlation was possible in 429 gastric and 85 esophageal brush cases and supported the validity of a positive cytological diagnosis. Brush cytology of the stomach and esophagus is a useful and reliable procedure which can improve the diagnostic yield of endoscopic examinations.