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100 Cases In Clinical Pathology !FULL!


100 Cases in Clinical Pathology and Laboratory Medicine presents 100 clinical scenarios commonly seen by medical students and junior doctors in the emergency department, outpatient clinic, operating theatre or in general practice. A succinct summary of the patient's history, examination and initial investigations is followed by questions on each case, with particular emphasis on the interpretation of the results and in which an understanding of the underlying clinical pathology is central to arriving at the correct diagnosis. The answer includes a detailed discussion on each topic, providing an essential revision aid as well as a practical guide for students and junior doctors, especially those preparing for undergraduate and postgraduate examinations.




100 Cases in Clinical Pathology



Making speedy and appropriate clinical decisions, and choosing the best course of action to take as a result, is one of the most important and challenging parts of training to become a doctor. Fully revised and updated for this second edition, these true-to-life cases will teach students and junior doctors to recognize important clinical conditions, to request the appropriate pathological investigation and correctly interpret those results, and, as a result, to develop their diagnostic and management skills.


Few detailed clinico-pathological correlations of Parkinson's disease have been published. The pathological findings in 100 patients diagnosed prospectively by a group of consultant neurologists as having idiopathic Parkinson's disease are reported. Seventy six had nigral Lewy bodies, and in all of these Lewy bodies were also found in the cerebral cortex. In 24 cases without Lewy bodies, diagnoses included progressive supranuclear palsy, multiple system atrophy, Alzheimer's disease, Alzheimer-type pathology, and basal ganglia vascular disease. The retrospective application of recommended diagnostic criteria improved the diagnostic accuracy to 82%. These observations call into question current concepts of Parkinson's disease as a single distinct morbid entity.


Cardiac Insufficiency (CI) is a common pathology worldwide. It is a clinical syndrome characterized by chronic symptoms (e.g. dyspnea, fatigue) that may be accompanied by physical signs (e.g. crepitations, peripheral edema) caused by a structural and/or functional cardiac abnormality, which causes a decrease in cardiac output [1] . CI is a major global public health problem affecting 40 million people worldwide in 2015 [2] . CI represents one of the leading causes of hospitalization, morbidity and mortality, especially among the elderly [3] . In western countries, the incidence and prevalence of CI are increasing due to the aging of the population [1] . The prevalence was estimated at 1% - 2% of the adult population [1] [4] , while the incidence rate is generally estimated at 2 to 5 per 1000 people annually [5] [6] . In Africa, CI is one of the main circumstances in the discovery of cardiovascular disease with an incidence of 1 to 3 per 1000 people annually and a prevalence of 3 to 20 per 1000 people annually, often at an advanced stage [7] . According to World Health Organization estimates, cardiovascular disease is the second leading cause of death in Africa. In 2015, nearly 1.2 million people died of heart disease in Africa, which is more than Malaria and Tuberculosis combined [8] . Despite improvements observed in the survival of patients with CI in recent years, overall prognosis remains poor [3] [9] with 50% survival estimates at 5 years after initial CI diagnosis [10] [11] . However, in Chad, we do not have data on this pathology. The objective of this work was to identify the etiology of CI in Chad.


Regarding the etiologies of CI (Table 3), Rheumatic heart valve disease was found in 48% of cases including (11%) Mitral stenosis, (13%) Mitral insufficiency, (06%) Mitral diseases, (3%) Aortic stenosis, (2%) Aortic insufficiency, (4%) Aortic disease, and (9%) Polyvalvulopathy. The dysfunctions of the prosthetic valves were found in (2%) of cases all in the mitral position, which were mechanical and bioprosthetic. 22% of Dilated cardiomyopathies (DCM) including (8%) primary DCM, (4%) Ischemic DCM, (5%) Peripartum DCM, (3%) Ethyl DCM, (1%) Cardiothorosis DCM and (1%) Rhythmic DCM. Hypertensive cardiomyopathies were found in 13% of cases, 12% congenital heart disease, 2% pericardial disease, and 1% idiopathic pulmonary arterial hypertension (IPAH). Table 3 presents the etiologies of CI by age group (Figure 1).


CI is a global public health problem. In Chad, we do not have epidemiological data on this pathology. In this study the mean age was 40.21 21.30 years and more than half of our patients were under 50 years of age. Several authors in Sub-Saharan Africa have found similar results [12] [13] [14] . In the West, according to the Framingham Cohort study, the average age was 70 [15] . This difference in the average age with the West, is related to the lack of medical coverage and the reduced life expectancy at home. The leading cardiovascular risk


factors in our study were high blood pressure, obesity, diabetes, alcohol and renal dysfunction. The same risk factors have been found in most studies in both developed and Sub-Saharan Africa [16] [17] . Our patients often presented with a global CI chart (61%) because of the delayed diagnosis related to difficulties in access to health care and the lack of specialists. This clinical presentation was noted by several authors in Sub-Saharan Africa [14] [18] [19] . The etiologies of CI in this study were dominated by non-ischemic causes. Rheumatic valvulopathy were the main causes (48%), followed by DCM (22%) and hypertensive cardiomyopathy (13%). Ischemic cardiomyopathy was found only in 4% of cases. These results are consistent with most of the study series in Sub-Saharan Africa, where these 3 etiologies account for more than 65% of the causes of CI [13] [14] [19] [20] [21] . In the West, Ischemic heart disease is the most common etiology of CI. However, in Africa, Hypertensive cardiomyopathy is predominant [16] [22] . In a recent systematic review and meta-analysis of 22 African studies (1999-2017) 10098 patients; Hypertensive heart disease was the most common cause of CI (39.2%), followed by Cardiomyopathy (21.4%) and Rheumatic heart disease (14.1%) [23] . Ischemic heart disease was rare (7.2%) [23] . The size of our sample was not representative to assert the rarity of ischemic heart disease in Ndjamena, Chad. Further studies will be needed to provide an answer to this trend. However, according to age groups, our study revealed a clear predominance of Rheumatic heart disease and Congenital heart disease in children and young adults (


The sample size of our study is not significant enough to reach formal conclusions. In this study, we did not include the therapeutic and evolutionary aspect of the patients which could have given us an idea about the overall care of the patients. Therefore, further studies are needed in the future with larger samples to better describe this pathology.


100 Cases in Clinical Pathology presents 100 clinical scenarios commonly seen by medical students and junior doctors in the emergency department, outpatient clinic, or in general practice in which an understanding of the underlying clinical pathology is central to arriving at the correct diagnosis. A succinct summary of the patient's history, examination, and initial investigations?histopathology, chemical pathology, haematology, microbiology, and clinical immunology as appropriate?is followed by questions on each case, with particular emphasis on the interpretation of the results and the arrival at a clinicopathologic diagnosis. The answer includes a detailed discussion on each topic, providing an essential revision aid as well as a practical guide for students and junior doctors.


m21-2. In a separate case, A 35-year-old man who received kidney transplantation was being treated with cyclosporine, azathioprine, and high doses of corticosteroids. While on this regimen, the patient began to experience headaches and became lethargic. A clinical diagnosis of meningoencephalitis was made. He died 7 days later. Autopsy showed a gelatinous meningeal exudate, and on sectioning of the brain, multiple small cyst-like areas were seen. Microscopic examination showed areas containing rounded structures with a prominent capsule that stained brightly with mucicarmine.


Pathology is the study of the nature, origin, progress, and cause of disease. It studies the processes involved of disease, whether by the naked eye, microscopically, or on a molecular level. Pathology addresses four components of disease: cause/etiology, mechanisms of development (pathogenesis), structural alterations of cells (morphologic changes), and the consequences of changes (clinical manifestations). Pathology is further separated into divisions, based on either the system being studied or the focus of the examination.


The Department of Pathology and Laboratory Medicine at the UC Health University of Cincinnati Medical Center is devoted to excellence in patient care by providing a full range of professional and technical services to the UC Health System. The department has an illustrious history of involvement in undergraduate medical and postgraduate education, pathology service and the acquisition of new knowledge related to human disease. The department offers fully accredited residency training programs in anatomic and clinical pathology.


In an academic environment of teaching and research, these services encompass anatomic and clinical pathology, and they serve to promote pathology as a discipline integral to the delivery of health care.


Anatomic pathology includes autopsy pathology, cytopathology and surgical pathology, to include subspecialization in genitourinary (GU), breast, gynecologic, gastrointestinal, hepatobiliary, pancreatic, endocrine, pulmonary, cardiovascular, neuromuscular, renal and head/neck pathology. 041b061a72


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