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Atypical Pattern (atypical + pattern)

Distribution by Scientific Domains

Medical Sciences	83%

Selected Abstracts

Reliability of patterns of hippocampal sclerosis as predictors of postsurgical outcome

EPILEPSIA, Issue 9 2010
Maria Thom
Summary Purpose:, Around one-third of patients undergoing temporal lobe surgery for the treatment of intractable temporal lobe epilepsy with hippocampal sclerosis (HS) fail to become seizure-free. Identifying reliable predictors of poor surgical outcome would be helpful in management. Atypical patterns of HS may be associated with poorer outcomes. Our aim was to identify atypical HS cases from a large surgical series and to correlate pathology with clinical and outcome data. Methods:, Quantitative neuropathologic evaluation on 165 hippocampal surgical specimens and 21 control hippocampi was carried out on NeuN-stained sections. Neuronal densities (NDs) were measured in CA4, CA3, CA2, and CA1 subfields. The severity of granule cell dispersion (GCD) was assessed. Results:, Comparison with control ND values identified the following patterns based on the severity and distribution of neuronal loss: classical HS (CHS; n = 60) and total HS (THS; n = 39). Atypical patterns were present in 30% of cases, including end-folium sclerosis (EFS; n = 5), CA1 predominant pattern (CA1p; n = 9), and indeterminate HS (IHS, n = 35). No HS was noted in 17 cases. Poorest outcomes were noted for no-HS, and CA1p groups with 33,44% International League Against Epilepsy (ILAE) class I at up to 2 years follow-up compared to 69% for CHS (p < 0.05). GCD associated with HS type (p < 0.01), but not with outcome. Conclusions:, These findings support the identification and delineation of atypical patterns of HS using quantitative methods. Atypical patterns may represent distinct clinicopathologic subtypes and may have predictive value following epilepsy surgery. [source]

Histologic findings in recurrent HBV

LIVER TRANSPLANTATION, Issue S2 2006
Swan N. Thung
Key Concepts: 1The histopathologic presentation of hepatitis B (HB) infection in liver allografts is generally similar to that seen in the nonallografts. 2An atypical pattern of recurrent HB, i.e., fibrosing cholestatic hepatitis (FCH) occurs in a small number of patients. These patients present with a severe cholestatic syndrome, which may clinically resemble acute or chronic rejection. 3There are several other possible causes of acute and chronic hepatitis in liver allografts that may need to be considered. 4Hepatitis B virus (HBV) infection in the liver allograft can easily be confirmed by performing immunohistochemical stains for hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg). The expression pattern of these HBV antigens varies and is sometimes helpful in determining whether the liver injury is mainly from the HBV or from other causes in coexistence with the HBV infection. 5Histological grading of the necroinflammatory activity and staging of the fibrosis should only be applied when the changes are related to the recurrent HB. 6The pathology of liver transplantation is complex; therefore, clinical correlations remain extremely important in arriving at the final and correct diagnosis. Liver Transpl 12:S50,S53, 2006. © 2006 AASLD. [source]

Solutes, but not cells, drain from the brain parenchyma along basement membranes of capillaries and arteries: significance for cerebral amyloid angiopathy and neuroimmunology

NEUROPATHOLOGY & APPLIED NEUROBIOLOGY, Issue 2 2008
R. O. Carare
Elimination of interstitial fluid and solutes plays a role in homeostasis in the brain, but the pathways are unclear. Previous work suggests that interstitial fluid drains along the walls of arteries. Aims: to define the pathways within the walls of capillaries and arteries for drainage of fluid and solutes out of the brain. Methods: Fluorescent soluble tracers, dextran (3 kDa) and ovalbumin (40 kDa), and particulate fluospheres (0.02 ,m and 1.0 ,m in diameter) were injected into the corpus striatum of mice. Brains were examined from 5 min to 7 days by immunocytochemistry and confocal microscopy. Results: soluble tracers initially spread diffusely through brain parenchyma and then drain out of the brain along basement membranes of capillaries and arteries. Some tracer is taken up by vascular smooth muscle cells and by perivascular macrophages. No perivascular drainage was observed when dextran was injected into mouse brains following cardiac arrest. Fluospheres expand perivascular spaces between vessel walls and surrounding brain, are ingested by perivascular macrophages but do not appear to leave the brain even following an inflammatory challenge with lipopolysaccharide or kainate. Conclusions: capillary and artery basement membranes act as ,lymphatics of the brain' for drainage of fluid and solutes; such drainage appears to require continued cardiac output as it ceases following cardiac arrest. This drainage pathway does not permit migration of cells from brain parenchyma to the periphery. Amyloid-, is deposited in basement membrane drainage pathways in cerebral amyloid angiopathy, and may impede elimination of amyloid-, and interstitial fluid from the brain in Alzheimer's disease. Soluble antigens, but not cells, drain from the brain by perivascular pathways. This atypical pattern of drainage may contribute to partial immune privilege of the brain and play a role in neuroimmunological diseases such as multiple sclerosis. [source]

How reliably can autoimmune hypophysitis be diagnosed without pituitary biopsy

CLINICAL ENDOCRINOLOGY, Issue 1 2010
Trevor A. Howlett
Summary Autoimmune hypophysitis is a rare chronic inflammatory condition of the pituitary gland which typically presents with hypopituitarism and a pituitary mass. Cases involving anterior pituitary alone (65%) are six times more common in women, typically presenting during pregnancy or postpartum (57%). Anterior and posterior pituitary involvement (25%) are twice as common in women, and neurohypophysis alone (10%) occurs equally in both sexes. It has a prevalence of around 5 per million, an annual incidence of 1 in 7 to 9 million and in our experience represents the known or suspected cause of 0·5% of cases of hypopituitarism, <1% of pituitary masses and 2% of nonfunctioning macro lesions presenting to an endocrine clinic. However, ,missed' cases of autoimmune hypophysitis may be the aetiology of some other unexplained cases of hypopituitarism. Clinically, headache and visual disturbance are common. Anterior hypopituitarism shows a characteristic but atypical pattern of deficiency of ACTH followed by TSH, gonadotrophins and prolactin deficiency or hyperprolactinaemia. Eighteen percent of cases have evidence of another autoimmune condition. On magnetic resonance imaging (MRI), autoimmune hypophysitis is typically symmetrical and homogeneous with thickened but undisplaced stalk in contrast to typical findings with pituitary tumours. Ultimately, the histological diagnosis of autoimmune hypophysitis can only be confirmed by surgery but a presumptive diagnosis can often be made on the basis of a combination of context and clinical features, and pituitary biopsy is not always clinically necessary for effective clinical management of the patient. [source]

Reliability of patterns of hippocampal sclerosis as predictors of postsurgical outcome

The climatology of small-scale orographic precipitation over the Olympic Mountains: Patterns and processes

THE QUARTERLY JOURNAL OF THE ROYAL METEOROLOGICAL SOCIETY, Issue 633 2008
Justin R. Minder
Abstract The climatology of small-scale patterns of mountain precipitation is poorly constrained, yet important for applications ranging from natural hazard assessment to understanding the geologic evolution of mountain ranges. Synthesizing four rainy seasons of high-resolution precipitation observations and mesoscale model output (from the Penn State/NCAR MM5), reveals a persistent small-scale pattern of precipitation over the ,10 km wide, ,800 m high ridges and valleys of the western Olympic Mountains, Washington State, USA. This pattern is characterized by a 50,70% excess accumulation over the ridge crests relative to the adjacent valleys in the annual mean. While the model shows excellent skill in simulating these patterns at seasonal time-scales, major errors exist for individual storms. Investigation of a range of storm events has revealed the following mechanism for the climatological pattern. Regions of enhanced condensation of cloud water are produced by ascent in stable flow over the windward slopes of major ridges. Synoptically generated precipitation grows by collection within these clouds, leading to enhanced precipitation which is advected by the prevailing winds. Instances of atypical patterns of precipitation suggest that under certain conditions (during periods with a low freezing level, or convective cells) fundamental changes in small-scale patterns may occur. However, case-studies and composite analysis suggest that departures from the pattern of ridge-top enhancement are rare; the basic patterns and processes appear robust to changes in temperature, winds, and background rainfall rates. Copyright © 2008 Royal Meteorological Society [source]