Rudolf Ludwig Karl Virchow was among the
greatest minds in medicine in the 19th century. As a
result of his hard work and determination, great strides were
made in the fields of pathological and physiological
medicine. Virchow was born in Schivelbein, Pomeranian,
Prussia on October 13, 1821. He attended Friederich
Wilheim Institute where he studied to become a physician with a
passion for pathological histology.
Throughout his studies, Rudolf Virchow
also performed a plethora of research disproving that phlebitis
was the cause of most diseases. Once he graduated from
Friederich Wilheim Institute, Virchow went on to study at the
University of Berlin where he became a medical doctor in 1843
.
He was employed as an intern at Charite
Hospital in Berlin but was suspended on March 31, 1849 due to
his liberal view of the German government. He was
championed as the founder of cellular pathology because of his
extensive research that disease is created and reproduced at the
cellular level of the body. However, he did not
accept Pasteur's germ theory, and in later life devoted
himself to archaeology and anthropology, forming a close
friendship with Schliemann and collaborating in the excavation
of Troy.
Rudolf Virchow was not only a brilliant
physician and researcher but he was a father and husband as
well. In 1850 he married Rose Mayer and throughout their
marriage they became parents of 6 children, three sons and three
daughters .
Rudolf Virchow was always busy
attempting to better the lives of the German people. Even
at the time of his death on September 5, 1902 in Berlin, Rudolf
Virchow was still serving on committees and counsels and working
diligently as editor of journals in medical education . He was
constantly working to provide quality health care to his
patients and fighting for the their rights with the German
Government
born on December 27, 1822 in Dole, in the
region of Jura, France. His discovery that most infectious
diseases are caused by germs, known as the "germ theory of
disease", is one of the most important in medical history.
His work became the foundation for the
science of microbiology, and a cornerstone of modern medicine.
Pasteur's phenomenal contributions to microbiology and
medicine can be summarized as follows. First, he championed
changes in hospital practices to minimize the spread of disease
by microbes. Second, he discovered that weakened forms of a
microbe could be used as an immunization against more virulent
forms of the microbe. Third, Pasteur found that rabies was
transmitted by agents so small they could not be seen under a
microscope, thus revealing the world of viruses. As a result he
developed techniques to vaccinate dogs against rabies, and to
treat humans bitten by rabid dogs. And fourth, Pasteur developed
"pasteurization", a process by which harmful microbes in
perishable food products are destroyed using heat, without
destroying the food.
Louis Pasteur discovered the method for the attenuation
of virulent microorganisms that is the basis of vaccination. He
developed vaccines against chicken cholera, anthrax and swine
erysipelas. After mastering his method of vaccination, he
applied this concept to rabies. On July 6, 1885, Pasteur tested
his pioneering rabies treatment on man for the first time : the
young Joseph Meister was saved.
Carl Rokitansky (1804 – 1878)
Investigation of the pathology of the CNS
lesions continued throughout the 19th century, with developments
in microscope technology allowing the analysis to become
increasingly detailed.
This slide shows a portrait of Carl
Rokitansky, one of the most outstanding morphological
pathologists of the 19th century. Working at the Institute of
Pathology in Vienna,
he was one of the first to examine MS
lesions microscopically .
Rokitansky made a particularly important
observation
in 1857 when he noticed 'fatty
corpuscles' in the MS lesions. Charcot later described these as:
"the
wreck and detritus resulting from the disintegration of the
nerve-tubes
During the 1950s,
James Gowans revealed the life cycle of the lymphocyte, whose
role was at that time completely obscure. Gowans showed that
the small lymphocyte continuously recirculated from the blood
to the lymph and back again to the blood. He later
demonstrated that this cell was at the centre of the
immunological response.
James Gowans
History of the Microscope
The Development of the Microscope
(Janssen / circa 1590’s)
Although the original microscope was a
rather simple device, its ability to magnify the range of
human vision paved the way for a revolutionary discovery of
microbial life. Credit for the initial device has
historically been given to a Dutch craftsman, Zacharias
Janssen, working in the Netherlands late in the 16th century
as a spectacle maker. These tradesmen, considered to be the
world’s finest, had been using concave lenses for more than
a century to correct far-sightedness. Janssen subsequently
extrapolated this approach to visual amplification by
creatively attaching two such lenses at opposite ends of
hand-held tube. Janssen’s device was unquestionably
primitive, but the microscope (from Greek words meaning "to
see small"), would shortly reveal a hitherto
unimagined realm of life.
From ancient times, man has wanted to see
things far smaller than could be perceived with
the naked eye.
This
led to the construction, in the 16th century, of a
magnifier composed of a single convex lens, and
this, in turn, led to the eventual development of
the microscope
Perhaps
the most famous early pioneers in the history of
the microscope are Digges of England and Hans and
Zcharias Janssen of Holland
But it was Antony van Leeuwenhoek who
became the first man to make and use a real
microscope.
Leeuwenhoek
ground and polished a small glass ball into a lens
with a magnification of 270X, and used this lens
to make the world's first practical microscope
Because it had only one lens,
Leeuwenhoek's microscope is now referred to as a
single-lens microscope. Its convex glass lens was
attached to a metal holder and was focused using
screws.
After his historic invention, Leeuwenhoek
continued to devote himself to studies base on the
microscope. His discoveries included bacteria,
bellanimalcules and spermatoza. Leeuwenhoek
actually constructed a total of 400 microscopes
during his prolific lifetime
The magnification ratio of a single-lens
microscope like the one invented by Leeuwenhoek is
calculated in the same way as calculations are
made for a simple magnifying glass.
250mm--accepted
to be the distance of most distinct vision--is
divided by the length of the lens.
To increase the power of a single-lens
microscope, the focal length has to be reduced.
However, a reduction in focal length necessitates
a reduction of the lens diameter, and after a
point, the lens becomes difficult to see through
To solve this problem, the compound
microscope system was invented in the seventeenth
century. This type of microscope incorporates more
than one lens so that the image magnified by one
lens can be further magnified by another
day, the term "microscope" is generally
used to refer to this type of compound microscop
in the compound microscope, the lens
closer to the object to be viewed is refers to as
the "objective", while the lens closer to the eye
is called the "eyepiece"
Since its invention, the compound microscope has
made tremendous contributions to the progress of
science. Using a compound microscope that he had
built himself, the 17th-century Englishman Robert
Hooke discovered the fact that living things are
composed of cells
n the medical world, Louis Pasteur of
France used a compound microscope to discover
yeast fungus, while Karl J. Ebert, a German
bacteriologist, employed a compound microscope in
his discovery of Eberthella Thyphosa
It was also a compound microscope that
Robert Koch discover tubercle and cholera bacilli
The 19th century saw dramatic progress in
the development of the microscope, thanks to the
contributions of such great minds as Carl Zeiss,
who devoted significant effort to the manufacture
of microscopes, Ernst Abbe, who carried out a
theoretical study of optical principles, and Otto
Schott, who conducted research on optical glass
renal
lithiasis very very interesting for
those ho like me love mmedical history.
U.S.M.L.E
review sites:
Kaplan
Qbankstill
serves as the industry standard. Your subscription
provides access to more than 2000 questions that
can be sorted by both discipline and organ system
http://usmle-easy.com/public/sample-exams.aspx
USMLEasy from McGraw-Hill is a diagnostic
and self-assessment tool with a bank of 2,5000+
online USMLE™-type questions to study, practice,
and simulate the test-taking experience for Step 1
and Step 3.
eMedicine Case Studies(Largest
on-line
clinical knowledge base, relevant, practical,
current articles written by experts from
multiple medical specialties. FREE
registration provides full access to site's
many features.)
MedicalRounds(Hundreds
of
cases presented in traditional Powerpoint
format. Access is FREE--registration is
required if you wish to claim CME.)
Pathology Online Case Studies
(Sponsored by the University of Pittsburgh
School of Medicine. Cases are indexed by both
patient history and diagnosis. Comprehensive.)
Primed Case Studies
(FREE registration allows full access to many
well designed and delivered case
presentations.)
http://www.flickr.com/photos/pulmonary_pathology- An
extensive collection of high quality macroscopic
and microscopic PULMONARY PATHOLOGY images that is
very well organized and easily searchable. More
than 1000 images.
In the 60's, people took acid to make
the world weird. Now the world is weird and people
take Prozac to make it normal.
SOME GENERAL DEFINITION
PATHOLOGY
The branch of medical
science that studies the causes and nature and effects
of diseases therefore pathology will not mean
autopsy but other as biopsy of tissue to know what is
going on , cytology as papsmears in one word anything
that will be seen under microscope after tissue
removal [surgery] is part of the pathology. Agood
surgeon should be a good pathologist in understanding
the disease and pathway.
PATHOLOGY:
the study of the reaction of the body to disease
DISEASE: any departure from a state of health
ANATOMIC PATHOLOGY: tissues and organs
CLINICAL PATHOLOGY: blood and other body fluids
FORENSIC PATHOLOGY:the application of the science and methods of
pathology
to the resolution of problems of the law and issues of
public interest
do you think a biopsy or
FNA is needed
Thyroid wasn't even
described in scientific literature until in 1656
Thomas Wharton made a distinction between it and the
larynx, but for 200 more years its function
(regulation of the body's metabolism) was completely
unknown. Goiters are excessive enlargements of
the thyroid, which may be caused by iodine deficiency,
or by an excess of thyroid stimulating hormone.
Because we salt everything with iodized salt, iodine
deficiency is never a problem in America, but it is
elsewhere in the world.
Guideline
to Progesterone levels during pregnancy:
•
1-28 ng/ml Mid Luteal Phase (Average is over 10 for
un-medicated cycles and over 15 with medication use)
• 9-47 ng/ml First trimester
• 17-146 ng/ml Second Trimester
• 49-300 ng/ml Third Trimester
===============================
Coombs
test(also
known as Coombs' test, antiglobulin test or AGT)
refers to two
clinical
blood tests used in immunohematology and
immunology.
The two
Coombs tests are the direct Coombs test (also
known as direct antiglobulin
test
or DAT), and the indirect Coombs test (also
known as indirect antiglobulin test or IAT).
The
direct Coombs test (also known as the direct
antiglobulin test or DAT) is
used
to detect if antibodies or complement system
factors have bound to RBC
surface
antigensin
vivo.
The
indirect Coombs test (also known as the indirect
antiglobulin test or IAT)
is a
used to detect in-vitro antibody-antigen
reactions
the death scene: the medical
examiner has jurisdiction and presides over the board
; but the law enforcement agency has ultimate
jurisdiction over the scene
observation of the body:
position, clothing
estimation of the postmortem
interval:
1) rigor mortis:
Temperature of
body
Stiffness of
body
Time since death
Warm
Not stiff
Not dead - more
than three hours
Warm
Stiff
Dead between 3 to
8 hours
Cold
Stiff
Dead between 8 to
36 hours
Cold
Not stiff
Dead in more than
36 hours
Rigor mortis should never
be the only basis for estimating time of death
Ca++ pumps run out of ATP
Ca++ cannot be removed
continuous contraction
eventually tissues break down
definition: the stiffening of
the muscles after death due to chemical changes in the
muscle fibers (depletion of ATP, lowered pH)
retard rigor -- cold
(hypothermia, decreased environmental
temperature); decreased muscle mass (elderly,
disabled, emaciated, and young children infants);
some drugs/poisons (carbon monoxide)
applications:
actually a relatively crude
indicator of the time of death
if present in an antigravity
position (position does not correlate with
surroundings), may indicate that the body was
moved after the development of rigor
2) livor mortis:(discoloration)
definition: the red-purple
discoloration caused by the settling of the blood in
the dependent portions of the body due to gravity
-timetable:
onset: minutes -few (2-4)
hrs
fixed: 8 -12 hrs - point at
which livor cannot be displaced by blanching
(pressure) or by turning the body
applications:
time of death - also a crude
indicator
color
may provide clue
relating to cause or circumstances of death -- * cherry-red: carbon
monoxide; cyanide; cold (refrigeration /
hypothermia) * green-brown: drugs or
poisons causing methemoglobin or sulfhemoglobin
formation in the blood
may indicate movement of the
body after death (after development of livor); a dual
pattern may result if a body is moved after partial
development of livor
mimics:
contusion (bruise): bleeding
into the tissues due to blunt force: will not
blanchwith pressure
suffusion: purple
discoloration of face and neck due to obstructed
venous return of blood in hear failure or
compression of the chest ("traumatic asphyxia")
3) algor mortis:
definition: cooling of the body
after death
timetable:
first few hrs: 2.0-2.5
degrees F/hr
first 12 hrs: 1.5-2.0 F/hr
12 -30 hrs: 1.0-1.5 F/hr
* plateau occurs at
beginning and end of cooling
variables:
environmental temperature
body fat (decreased rate of
heat loss)
clothing (amount and type;
affects rate of heat loss)
active air currents -
increase heat loss by convection
body temperature at the
time of death; one cannot assume that the
body temperature at the time of death is normal
conditions resulting in hyperthermia:
infection/sepsis; hypermetabolic states; drugs;
(cocaine, PCP, amphetamines); vigorous activity
conditions producing hypothermia: shock; exposure
to cold; drugs (alcohol)
clues from the surrounding
environment: furniture, food, medication, drugs,
electrical appliances
activity: WHAT WAS THE DECEDENT
DOING AT THE TIME OF THE FATAL EVENT
The
decomposition of a body can be divided into
several stages, even if the duration of each
stage will vary a lot:
2-3 days:
green staining begins on the right side of the
abdomen. Body begins to swell.
3-4 days:
staining spreads. Veins go "marbled" - a
browny black discoloration
5-6 days:
abdomen swells with gas. Skin blisters
2 weeks:
abdomen very tight and swollen.
3 weeks:
tissue softens. Organs and cavities bursting.
Nails fall off
4 weeks:
soft tissues begin to liquefy. Face becoming
unrecognisable
4-6
months: formation of adipocere, if in damp
place. This is when the fat goes all hard and
waxy.
A body
without a coffin will be decayed within 12
years.
Stage
Description
Initial
Decay
Carcase
appears fresh externally but
is decomposing internally due
to the activities of bacteria,
protozoa and nematodes present
in the animal before death
Putrefaction
Carcase
swollen by gas produces
internally, accompanied by
odour of decaying flesh
Black
putrefaction
Flesh
of creamy consistence with
exposed parts black. Body
collapses as gases escapes.
Odour of decay very strong
Butyric
fermentation
Carcase
drying out. Some flesh remains
at first, and cheesy odour
develops. Ventral surface
mouldy from fermentation
Dry
decay
Carcase
almost dry; slow rate of decay
IMMUNOHISTOCHEMISTRY
Immunohistochemical methods are
based on immunoenzimatic reactions using antibodies
(mono or polyclonal) to detect cell or tissue antigens,
Several possibilities exist of
visualizing such interactions, by using different
enzymes (peroxidase, alkaline phosphatase, etc.) or
different cromogens (DAB, AEC, Fast RED, etc.).
TYPES OF DEATHS REQUIRING
NOTIFICATION OF
THE MEDICAL EXAMINER
all deaths due to violence,
including accidents, suicides, and homicides, or any
deaths in which an injury is felt to be
contributory to the death; includes mechanical,
electrical, thermal injuries, extremes of heat and
cold and atmospheric pressure, and intoxication by
chemicals or drugs
any sudden, unexpected,
and/or unexplained death of an individual -
adult, child, or infant - in apparent good health
deaths in custody: city or
county jails, police custody, hospitalized prisoners
deaths occurring in the absence
of a physician's attendance; specifically, in the
state of Michigan, death occurring more than 1 0 days
after the deceased was last seen by a physician (or if
the physician is unable to determine accurately the
cause of death)
sudden, unexpected or
unexplained deaths related to diagnostic or
therapeutic procedures, including abortions
deaths occurring in unusual
places or under suspicious circumstances
deaths occurring as the result
of a suspected communicable disease or a threat to
public health
deaths involving the possibility
of neglect
sudden deaths at the workplace
Rembrandt Harmenszoon van Rijn
(1606-1669): The Anatomy Lecture of Dr. Nicolaas Tulp (1593-1674) in
1632
The
pathologist usually has the last word in medicine,
because
he does the autopsy. He tells everyone else what the correct
diagnosis should have been and why the treatments didn't work.
He
can also be the ace in the hole for a malpractice defense
attorney, and the secret weapon of the plaintiff's attorney.
the
pathologist is one that knows everything but to late
surgeon
is the guy that knows and act
internist is the guy that knows nothing and cook to get the
answer
ASCITES
HERPES
APOPTOSIS
congestive
hepatomegaly
BRAIN ABSCESS
DVT
HORSESHOE KIDNEY
POLYCYSTIC KIDNEY [CONGENITAL]
PROSTATE HYPERPLASIA
TREPANATION
Seeking
a snapshot of historic human cancer rates over seven
millennia, a team of archaeologists and medics
examined 3,160 skeletons in a collection at the
Croatian Academy of Sciences and Arts. Above, a
femur, or thigh bone, shows signs of a benign tumor
around the joint.
Photograph courtesy Mario Slaus
collegiate power lifting
championships at Penn State. The unfortunate competitor, who
expressed a plea to remain anonymous, remembered to surgeons
that he was " stuck" at the bottom of a personal best attempt in
the squat lift when he "sort of pulled his stomach in and pushed
extra hard, at the same time as trying to complete the lift."
He remembers a loud
popping, splattering noise then a fierce stabbing pain and then
not being able to move from the squat position. He remained in
this position for about half an hour, since trying to stand
caused him overwhelming agonizing pain. Paramedics arrived and
applied anesthesia on the spot and carried him to an ambulance.
He was rushed to surgery, where surgeons described the trauma as
an explosive and aggravated prolapse of the bowel". Meanwhile it
was revealed that the weight was removed from his shoulders at
the time of the incident by two "spotters" on either side of the
lifter. The third spotter who was standing behind the lifter was
unfortunately sprayed with fecal matter at the time of the
incident. This spotter promptly fainted when he realized the
extent of of the injury to the lifter, who was a personal
friend.
This compounded the task
of first aid officers who were at a loss as to how to treat the
injury to the lifter in any case, who remained in the squatting
position moaning in pain much to the consternation of the
helpless audience. The hapless lifter had successful surgery to
relieve the prolapse, but remained immobilized with his feet
elevated in stirrups for 2 weeks to ensure "internal compliance
with the surgery and that the organs retracted successfully".
To add insult to injury, the ex-lifter
required rectal stitching to partially occlude the anal orifice
and stitch the rectal passage (which had significantly expanded
and torn during the prolapse) and also was put on a low fiber
low residue diet to combat flatulence to avoid any possibility
of a recurrence. [rotten.com]
Avicenna, b. 980, Bukhara, Iran d. 1037, Hamadan Arabic
IBN SINA, in full ABU 'ALI AL-HUSAYN IBN 'ABD ALLAH IBN SINA,
Iranian physician, the most famous and influential of the
philosopher-scientists of Islam. He was particularly noted for
his contributions in the fields of Aristotelian philosophy and
medicine.
He composed the Kitab ash-shifa' ("Book of Healing"), a
vast philosophical and scientific encyclopaedia, and the Canon
of Medicine, which is among the most famous books in the history
of medicine.
Marked expansion of most or all of
the triads by a mixed infiltrate containing numerous
blasts and eosinophils with inflammatory spillover into
the periportal parenchyma
A minority of the ducts are cuffed
and infiltrated by inflammatory cells and show only mild
reactive changes such as increased nuclear:cytoplasmic
ratio of the epithelial cells
Most or all of the ducts
infiltrated by inflammatory cells. More than an
occasional duct shows degenerative changes such as
nuclear pleomorphism, disordered polarity and
cytoplasmic vacuolization of the epithelium
As above for 2, with moderate or
severe perivenular inflammation that extends into the
perivenular parenchyma and is associated with
perivenular hepatocyte necrosis