A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, in fulfillment of the requirements for the degree of Master of Medicine in the branch of Internal Medicine Johannesburg, 2015 / Lymphadenopathy is a common clinical presentation of disease in South Africa (SA), particularly in the era of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) coinfection. Methods Data from 560 lymph node biopsy reports of specimens from patients older than 12 years at Chris Hani Baragwanath Academic Hospital (CHBAH) between 1 January 2010 and 31 December 2012 was extracted from the National Health Laboratory Service (NHLS), division of Anatomical Pathology. Cytology reports of lymph node fine needle aspirates (FNAs) performed prior to lymph node biopsy in 203 patients were also extracted from the NHLS. Consent was not obtained from participants for their records to be used as patient information was anonymized and de-identified prior to analysis. Results The majority of patients were female (55%) and of the African/black racial group (90%). The median age of patients was 40 years (range12-94). The most common indication for biopsy was an uncertain diagnosis (more than two differential diagnoses entertained), followed by a suspicion for lymphoma, carcinoma and TB. Overall, malignancy constituted the largest biopsy pathology group (39%), with 36% of this group being carcinoma and 27% non-Hodgkin lymphoma. 22% of the total sampled nodes displayed necrotizing granulomatous inflammation (including histopathology and cytology demonstrating definite, and suspicious for mycobacterial infection), 8% comprised HIV reactive nodes; in the remainder no specific pathology was identified (nonspecific reactive lymphoid hyperplasia). Kaposi sarcoma (KS) accounted for 3% of lymph node pathology in this sample. Concomitant lymph node pathology was diagnosed in four cases of nodal KS (29% of the subset). The co-existing pathologies were TB and Castleman disease. HIV-positive patients constituted 49% of this study sample and the majority (64%) of this subset had CD4 counts less than 350 cells/ul. 27% were HIVnegative and in the remaining nodes, the HIV status of patients was unknown. The most common lymph node pathologies in HIV-positive patients were Mycobacterial infection (31%), HIV reactive nodes (15%), non-Hodgkin lymphoma (15%) and nonspecific reactive lymphoid hyperplasia (15%). Only 9% were of Hodgkin lymphoma. In contrast, the most common lymph node pathologies in HIV-negative patients were nonspecific reactive lymphoid hyperplasia (45%), carcinoma (25%) and Mycobacterial infection (11%). In this group, non-Hodgkin lymphoma and Hodgkin lymphoma constituted 9% and 8%, respectively. There were more cases of high-grade non-Hodgkin lymphoma in the HIV-positive group compared to the HIV-negative group. FNA and lymph node biopsy had excellent agreement with regard to Hodgkin lymphoma (K 0.774, SE 0.07, 95% CI 0.606-0.882, p=0.001), and good agreement with regard to non-Hodgkin lymphoma (K 0.640, SE 0.07, 95% CI 0.472-0.807, p=0.001), carcinoma (K 0.723, SE 0.069, 95% CI 0.528-0.918, p=0.001), and mycobacterial infection (K 0.726, SE 0.07, 95% CI 0.618-0.833, p=0.001). Conclusions The most common lymph node pathologies in CHBAH are malignancies, nonspecific reactive lymphoid hyperplasia, necrotizing granulomatous inflammation and HIV reactive nodes. The distribution of disease differed in HIV-positive patients. Overall, adequate FNA samples of lymph nodes have been found to have good correlation with lymph node biopsy findings in our setting.

計算機超聲引導針放置模擬系統近年受到醫學界密切關注。在過去十年，為應付各種需要，大量模擬系統被研發。與傳統訓練方法比較，使用計算機模擬系統作訓練擁有多種優點。例如：可控訓練環境，能重複使用的數據庫，以及客觀評核。至今，研究的主要方向依然是物理建構的模擬。雖然，更真實及更仔細的模擬系統能引發新的教學概念，系統開發的重點應該著眼於對訓練的影響。 / 本論文研究計算機超聲引導針放置模擬系統的最新發展。首先，我們會介紹計算機模擬系統的各個範疇及於醫學訓練的基本應用。使用計算機模擬系統作訓練用途的成效會被討論。然後，我們會討論幾種針對訓練成效的改進技術。這些技術包括一個動態訓練場景生成框架，綜合遊戲概念的方法，以及一種以臨床技術為本的穿刺提示規劃法則。它們對訓練的影響利用實驗作驗證。接著，我們介紹一個評核穿刺軌跡可視化技術的框架。我們的研究發現，穿刺軌跡的可視化技術對用家放置針的準確度有顯著的影響。這意味著模擬系統中穿刺軌跡的可視化技術需要經過非常小心的設計。最後，我們介紹一個超聲材質的描述器。這個描述器針對超聲材質的比較而設計。超聲材質的比較不止是在超聲模擬系統中重要的一環，更能被應用在各種醫學圖像的研究中。 / Computer-based ultrasound guided needle placement simulators have gained extensive attention of the medical society. In the last decade, a lot of simulators have been proposed to suit different purposes. Advantages of using computer-based simulators over traditional training include controlled training environment, reusable case database and objective evaluation. Yet, the most studied aspect of computer-based simulators remains the simulation of physical situations. Though a more realistic and detailed simulation enables new training concepts, the origin of any development shall be its effect on training. / This thesis studies the latest development of computer-based ultrasound guided needle placement simulators. We first introduce basic aspects of computer-based simulators and their applications on medical training. The effects on computer-based training over traditional methods are discussed. Secondly, we present various techniques that aim for effective training. These techniques include a framework for dynamic case generation, an integration of serious game concepts, and a recommendation scheme based on clinical practices. Their impacts on training are evaluated through various experiments. Thirdly, we present an evaluation framework for the visualization of needle access pathway. Our study shows that the adoption of visualization techniques significantly affects users' performance of needle alignment. This implies that a careful design of the visual effect inside a simulator is necessary. Lastly, we present a descriptor for ultrasound textures. This descriptor is designed for ultrasound textural comparison which is an important step for not only ultrasound simulators but also other medical imaging applications. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Chan, Wing Yin. / Thesis (Ph.D.) Chinese University of Hong Kong, 2014. / Includes bibliographical references (leaves 100-114). / Abstracts also in Chinese. / Chan, Wing Yin.

nÃo hà / INTRODUÃÃO: as glomerulopatias ainda sÃo uma das principais causas de insuficiÃncia renal crÃnica no mundo. à crescente o surgimento de registros de glomerulopatias em diversos paÃses, inclusive no Brasil. Os dados sobre incidÃncia e prevalÃncia das glomerulopatias no Brasil sÃo escassos. As conseqÃÃncias da lesÃo glomerular sÃo basicamente: proteinÃria, hematÃria, queda de filtraÃÃo glomerular, podendo evoluir para oligo-anÃria e hipertensÃo arterial decorrente da retenÃÃo de sÃdio. OBJETIVOS: determinar o perfil clÃnico, patolÃgico e epidemiolÃgico dos pacientes em acompanhamento no ambulatÃrio de glomerulopatias do ServiÃo de Nefrologia do Hospital Geral de Fortaleza. MÃTODOS: a populaÃÃo do estudo consistiu de pacientes portadores de doenÃa glomerular, submetidos à biÃpsia renal que foram atendidos no ambulatÃrio do serviÃo de Nefrologia do Hospital Geral de Fortaleza, CearÃ, durante o perÃodo de fevereiro de 2010 e setembro de 2011. RESULTADOS: foram incluÃdos no estudo um total de 168 pacientes. A idade mÃdia foi de 37  14 anos, variando de 14-77 anos. Desse total 84 pacientes (50%) eram do sexo feminino. Na avaliaÃÃo dos resultados das amostras biopsiadas obteve-se uma mÃdia de 20  12 glomÃrulos por amostra. Um total de 154 biÃpsias (92,2%) apresentaram um nÃmero maior ou igual a 8 glomÃrulos por amostra. SÃndrome nefrÃtica, foi a principal apresentaÃÃo clÃnica, correspondendo a um total de 113 pacientes (67,3%). As glomerulopatias mais prevalentes foram a GESF (19,6%), a LesÃo MÃnima (17,9%), a Glomerulopatia Membranosa (16,7%) e a Glomerulonefrite LÃpica (11,9%). As glomerulopatias primÃrias foram mais prevalentes, total de 124 casos (74,7%). Em relaÃÃo a resposta ao tratamento medicamentoso instituÃdo, 81 pacientes (68,6%) responderam ao tratamento.CONCLUSÃO: a GESF foi a glomerulopatia primÃria mais freqÃente e sÃndrome nefrÃtica a forma clÃnica de apresentaÃÃo mais comum na admissÃo. As amostras das biÃpsias renais colhidas foram satisfatÃrias em 92,2% dos casos. / INTRODUCTION: glomerulonephritis still are one of the main causes of Chronic Renal Failure (CRF). The number of cases is increasing, especially in Brazil. There are few data regarding the incidence and prevalence of glomerulonephritis in our country. Glomerular damage results in proteinuria, hematuria, decrease in glomerular filtration rate (GFR), oliguria, anuria and hypertension due to sodium overload. OBJECTIVES: the aim of this study is to determine the clinical, pathological and epidemiological features of the patients with glomerular diseases followed at the General Hospital of Fortaleza. METHODS: the study population consisted of patients with biopsy proven glomerular disease followed at the Nephrology Department of the General Hospital of Fortaleza, CearÃ, in the period between February 2010 and July 2011. RESULTS: a total of 168 patients were included. The mean age was 37  14 years. The mean number of glomeruli in each renal biopsy was 20  12. A total of 154 biopsies (92,2%) had at least 8 glomeruli per sample. Half of them were women, 84 patients (50%). The most common clinical presentation at admission was nephrotic syndrome, observed in 113 patients (67,3%). The most prevalent glomerulonephritis were Focal Segmental Glomerulosclerosis (FSGS) (19,6%), Minimal Change Disease (17,9%), Membranous Nephropathy (16,7%), and Lupus Nephritis (11,9%). Primary glomerulopathies were more common, 124 cases (74,7%). A total of 81 patients (68.6%) presented a good response to therapy, and 37 patients (31,4%) did not respond well to treatment. CONCLUSION: FSGS was the most frequent glomerulonephritis in the present study, and nephrotic syndrome was the most common clinical presentation at admission. Renal biopsies had an adequate sample size in 92,2%.

Photocopy (Vol. 1) / 2v. : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Pathology, 1981

The objectives of this project were: 1) to determine if live animal lung biopsy could be used to characterize early pathologic changes in the bovine lung associated with bovine respiratory disease (BRD), 2) determine if specific infectious respiratory pathogens can be identified in association with early pathological changes, and 3) determine whether pulmonary pathology characterized by live animal lung biopsy at arrival and at the time of initial BRD diagnosis was associated with health and production outcomes of feedlot steers in a commercial feedlot.<p> A live animal percutaneous lung biopsy technique was developed to obtain a lung sample from the right middle lung lobe in intercostal space (ICS) 4 using a Bard® Magnum® reusable biopsy instrument and a modified 4-mm (8g) biopsy needle. The lung biopsy procedure was limited to 2 attempts per biopsy time. In the technique development, 34 animals chronically affected with BRD were utilized, 20 animals in the preliminary development followed by 14 additional animals in a commercial feedlot setting. The technique resulted in 1 fatality of 34 steers (2.9%) and lung parenchyma was harvested in 19 of 34 steers (55.9%) chronically affected with BRD. In addition, in the commercial feedlot setting this procedure was determined to take about 20 minutes per animal.<p> The final study was performed on one hundred feedlot steers considered at high risk of developing BRD from twenty pens within a commercial feedlot. Study animals were enrolled in three different groups: sick on arrival (ARR-SA) consisting of 27 study animals and 13 matched control animals; pen pulls with no fever (PP-NF) consisting of 14 study animals and matched 7 controls; and pen pulls with an undifferentiated fever (PP-UF) consisting of 26 study animals and 13 matched controls. Live animal percutaneous lung biopsies were collected from the right middle lung lobe at 3 different times within the first 30 days of the feeding period, about 2 weeks apart. All samples were histopathologically evaluated and were assessed for the presence of <i>Mycoplasma bovis</i>, <i>Mannheimia haemolytica</i>, Histophilus somni and bovine viral diarrhea virus with immunohistochemistry.<p> A total of 295 lung biopsies were performed yielding 210 (71.2%) lung samples that were sufficient for histopathological evaluation. A histopathology score was awarded to each biopsy based on certain histopathological lesions being present. Only 20 lung biopsy samples from 19 animals received a histopathology score (ie, pulmonary lesions were present) with the most common score being a 1 (maximum score is 20). There were too few lung biopsy samples with a histopathology score to reveal any association with subsequent health events.<p> Immunohistochemistry (IHC) was performed on all lung biopsies recovered yielding one lung sample to be positive for both <i>Mannheimia haemolytica</i> and <i>Mycoplasma bovis</i> from the PP-UF group. There were too few positive samples to reveal any association between IHC and histopathology score.<p> A post mortem evaluation was performed by a study veterinarian on all study animals who died or were humanely euthanized due to poor treatment response. In this study only 4 steers died or were euthanized due to poor treatment response and 3 control steers were humanely euthanized. There were too few animals to reveal any association between histopathology score and post mortem diagnosis.<p> On entry into the feedlot, weights between ARR-SA and the PP-UF and PP-NF groups were significantly different (p<0.05). This is likely an effect of the different processing groups of cattle. At study allocation, the body weights of ARR-SA and PP-UF, PP-UF and their matched controls, and PP-NF and their matched controls were also significantly different (p<0.05). This is likely due to the PP-UF and PP-NF groups experiencing illness for a longer period of time resulting in greater weight loss than the ARR-SA animals as well as the control animals, who were not clinically sick.<p> The live lung biopsy procedure utilized in this study did not appear to cause any long lasting adverse effects as the BRD case fatality rates from the study animals were comparable to the overall case fatality rates reported by the feedlot for fall placed calves. In fact, the study animals experienced a decreased fatality rate compared to the feedlots overall fatality rate. This may be due to the study animals inadvertently being monitored more closely as the pen checkers were aware of and participating in the study. On post mortem evaluation there was no evidence of adhesions at the biopsy site. This procedure was performed on 134 feedlot steers resulting in only 2 acute deaths as a direct result of the live animal percutaneous lung biopsy procedure.<p> The results of this study indicate that live animal, percutaneous lung biopsy can be performed safely on feedlot steers in a commercial feedlot with few clinical side effects. In this study there were only 2 fatalities in 134 steers (1.5%) due to the biopsy procedure or 2 fatalities per 349 sampling times (0.6%) This technique did not prove useful either as a diagnostic tool for the determination of early lung pathology in BRD or as prognostic indicator for health and production outcomes. However, this lung biopsy technique may be a useful diagnostic tool for chronic pneumonia assessment.

The objectives of this project were: 1) to determine if live animal lung biopsy could be used to characterize early pathologic changes in the bovine lung associated with bovine respiratory disease (BRD), 2) determine if specific infectious respiratory pathogens can be identified in association with early pathological changes, and 3) determine whether pulmonary pathology characterized by live animal lung biopsy at arrival and at the time of initial BRD diagnosis was associated with health and production outcomes of feedlot steers in a commercial feedlot.<p> A live animal percutaneous lung biopsy technique was developed to obtain a lung sample from the right middle lung lobe in intercostal space (ICS) 4 using a Bard® Magnum® reusable biopsy instrument and a modified 4-mm (8g) biopsy needle. The lung biopsy procedure was limited to 2 attempts per biopsy time. In the technique development, 34 animals chronically affected with BRD were utilized, 20 animals in the preliminary development followed by 14 additional animals in a commercial feedlot setting. The technique resulted in 1 fatality of 34 steers (2.9%) and lung parenchyma was harvested in 19 of 34 steers (55.9%) chronically affected with BRD. In addition, in the commercial feedlot setting this procedure was determined to take about 20 minutes per animal.<p> The final study was performed on one hundred feedlot steers considered at high risk of developing BRD from twenty pens within a commercial feedlot. Study animals were enrolled in three different groups: sick on arrival (ARR-SA) consisting of 27 study animals and 13 matched control animals; pen pulls with no fever (PP-NF) consisting of 14 study animals and matched 7 controls; and pen pulls with an undifferentiated fever (PP-UF) consisting of 26 study animals and 13 matched controls. Live animal percutaneous lung biopsies were collected from the right middle lung lobe at 3 different times within the first 30 days of the feeding period, about 2 weeks apart. All samples were histopathologically evaluated and were assessed for the presence of <i>Mycoplasma bovis</i>, <i>Mannheimia haemolytica</i>, Histophilus somni and bovine viral diarrhea virus with immunohistochemistry.<p> A total of 295 lung biopsies were performed yielding 210 (71.2%) lung samples that were sufficient for histopathological evaluation. A histopathology score was awarded to each biopsy based on certain histopathological lesions being present. Only 20 lung biopsy samples from 19 animals received a histopathology score (ie, pulmonary lesions were present) with the most common score being a 1 (maximum score is 20). There were too few lung biopsy samples with a histopathology score to reveal any association with subsequent health events.<p> Immunohistochemistry (IHC) was performed on all lung biopsies recovered yielding one lung sample to be positive for both <i>Mannheimia haemolytica</i> and <i>Mycoplasma bovis</i> from the PP-UF group. There were too few positive samples to reveal any association between IHC and histopathology score.<p> A post mortem evaluation was performed by a study veterinarian on all study animals who died or were humanely euthanized due to poor treatment response. In this study only 4 steers died or were euthanized due to poor treatment response and 3 control steers were humanely euthanized. There were too few animals to reveal any association between histopathology score and post mortem diagnosis.<p> On entry into the feedlot, weights between ARR-SA and the PP-UF and PP-NF groups were significantly different (p<0.05). This is likely an effect of the different processing groups of cattle. At study allocation, the body weights of ARR-SA and PP-UF, PP-UF and their matched controls, and PP-NF and their matched controls were also significantly different (p<0.05). This is likely due to the PP-UF and PP-NF groups experiencing illness for a longer period of time resulting in greater weight loss than the ARR-SA animals as well as the control animals, who were not clinically sick.<p> The live lung biopsy procedure utilized in this study did not appear to cause any long lasting adverse effects as the BRD case fatality rates from the study animals were comparable to the overall case fatality rates reported by the feedlot for fall placed calves. In fact, the study animals experienced a decreased fatality rate compared to the feedlots overall fatality rate. This may be due to the study animals inadvertently being monitored more closely as the pen checkers were aware of and participating in the study. On post mortem evaluation there was no evidence of adhesions at the biopsy site. This procedure was performed on 134 feedlot steers resulting in only 2 acute deaths as a direct result of the live animal percutaneous lung biopsy procedure.<p> The results of this study indicate that live animal, percutaneous lung biopsy can be performed safely on feedlot steers in a commercial feedlot with few clinical side effects. In this study there were only 2 fatalities in 134 steers (1.5%) due to the biopsy procedure or 2 fatalities per 349 sampling times (0.6%) This technique did not prove useful either as a diagnostic tool for the determination of early lung pathology in BRD or as prognostic indicator for health and production outcomes. However, this lung biopsy technique may be a useful diagnostic tool for chronic pneumonia assessment.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.

There is no abstract available for this thesis.

Diss. (sammanfattning). Uppsala : Sveriges lantbruksuniv. / Härtill 5 uppsatser.