Archives of pathology & laboratory medicine
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Arch. Pathol. Lab. Med. · Aug 1986
The likelihood ratio. An improved measure for reporting and evaluating diagnostic test results.
The principles and use of likelihood ratios are presented as an aid to the reporting and interpretation of diagnostic data. Likelihood ratios can be determined for multiple levels of test results and provide a readily comprehensible and convenient measure for computing the posttest probability of disease. ⋯ By incorporating all the raw data, the use of likelihood ratios can improve the assessment of the clinical utility of test results. Their application to the diagnostic performance of serum creatine kinase concentrations in predicting patients with suspected myocardial infarction is discussed.
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Sixty-five fly maggots were retrieved from the nasal cavity of an unconscious 64-year-old man who had been admitted 18 days earlier with diabetic hyperosmolar coma. The larvae were identified as Cochliomyia macellaria, an organism commonly associated with myiasis in the United States. The clinical time sequence indicates that this infection was acquired in the hospital. This incident provides further evidence that immobile and debilitated patients are at risk to acquire myiasis.
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Arch. Pathol. Lab. Med. · May 1985
Case ReportsImmunopathologic studies of adult linear IgA bullous dermatosis.
Three cases of adult linear IgA bullous dermatosis were examined to determine the types of IgA present in the basement membrane zone. IgA 1 subclass, without IgA2, was identified in all three cases; J chain was identified in only one case. Secretory component was absent in all cases. ⋯ These findings are further evidence of the distinction between dermatitis herpetiformis, which has polymeric IgA1, and adult linear IgA bullous dermatosis and may suggest an extragut site for the origin of the antibodies. The second observation is that the antibodies in adult linear IgA bullous dermatosis show limited expression of heavy and light chains and molecular size that cannot be explained by origin in any compartment. The origin of this limitation cannot be determined from the present data, but possible explanations include a monoclonal or oligoclonal origin of the plasma cells secreting the anti-basement membrane antibodies, genetic restriction of either the immunoglobulin repertoire or helper T-cell response such that only an IgA subpopulation is permitted to be produced in response to the antigen, and selective absorption from the sera or deposition in the skin.
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To elucidate interrelations of airway inflammation and emphysema, bronchi from subjects with severe panlobular and centrilobular disease and normal lungs were compared. This disclosed an intense infiltration with chronic inflammatory cells, mucous gland hypertrophy, and thickening of bronchi, primarily in association with emphysema having a panlobular configuration. ⋯ We conclude that the panlobular pattern may be a close function of inflammatory thickening of the conductive airways to respective lungs and lung parts, but centrilobular emphysema is not reliant on these changes. The precursory defect for the centrilobular lesion instead has been shown to be a more peripherally oriented respiratory bronchiolitis around the centers of lobules.
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Arch. Pathol. Lab. Med. · Apr 1984
Case ReportsPulmonary oxygen toxic effect. Occurrence in a newborn infant despite low PaO2 due to an intracranial arteriovenous malformation.
A newborn infant with a massive left to right shunt secondary to a cerebral arteriovenous malformation required continuous oxygen therapy in high concentrations. Despite high PO2, the infant maintained low to normal PaO2 concentrations. Light and ultrastructural studies of the lungs demonstrated typical changes of acute pulmonary oxygen toxicity, including degeneration of capillary endothelium and type I pneumonocytes, interstitial edema, and alveolar exudation. These observations confirm earlier experimental animal studies that demonstrated that the alveolar Po2 concentration and not the Pao2 is the major factor contributing to pulmonary oxygen toxic effect.