Anatomical Pathology

Background and aims Occult hepatitis B virus infection (OBI) poses a challenge to the safety of blood donation. The prevalence of OBI is not well documented in Indonesia, although this information in such an endemic country is needed. This study was aimed to evaluate the prevalence of occult hepatitis B in blood donors from two cities of Indonesia, and to study the genetic variation and its effect on the predicted antigenicity of HBsAg. Methods Serum samples of 309 regular blood donors negative for HBsAg were tested for anti-HBs and anti-HBc. Hepatitis B virus (HBV) DNA isolated from anti-HBc-positive samples were analyzed by polymerase chain reaction, cloned and sequenced. Antigenic properties of identified HBsAg mutants were predicted by calculation of the antigenic index. Results Of the 309 HBsAg-negative samples, anti-HBc was positive in 134 (43.4%) and HBV DNA was detected in 25 (8.1%). Seven of the viremic samples had nucleotide substitutions (A521G, A551T, C582T, and A562G) in the S gene, causing amino acid mutations (T123A, M133L, and T143M) in the ‘a’ determinant of HBsAg that resulted in changes in the predicted antigenicity. Conclusions OBI was detected in blood donors’ samples in Indonesia. Anti-HBc was shown to be a better screening parameter than HBsAg, however, it might result in the loss of donors particularly in endemic countries. HBsAg detection failure in this study might be due to mutations altering the protein antigenicity and/or the low-level carriage of HBV.

Inefficiencies in mitochondrial respiration mainly affecting complex I and IV activities, occur with increasing age and have been suggested as a possible etiological factor in age-related neurodegenerative diseases. It has been suggested that this finding may be explained by an accumulation of mtDNA mutations. We hypothesise that some polymorphic mitochondrial genomes encode less efficient respiratory protein subunits and are therefore less tolerant of acquired mutations. If this hypothesis is correct, individuals with 'less efficient' mtDNA genotypes may be predisposed both to more rapid biological aging and to neurodegenerative disease. In this study we investigate the substantial nigra mtDNA composition from 4 elderly individuals (2 non-parkinsonian and 2 with idiopathic Parkinson's disease) to determine whether there is sufficient polymorphism to account for different possible respiratory efficiencies. Tbe mitochon-

Understanding the pathobiology of mitochondrial (mt) DNA diseases involves both characterization of the effects of individual mutations on respiratory function and elucidation of the changes in mutation load and distribution (energy mosaicism) over serial cell generations. Whether a given mutation is stably maintained, or increases or decreases with cell growth, is one of the determinants as to whether a particular tissue will be affected by oxidative phosphorylation failure. In this study, we correlated mt genotype with biochemical phenotype in myoblasts from patients with pathogenic mtDNA mutations. The dominant process detected was a progressive elimination of mutant mtDNA genomes concomitant with an improvement in respiratory chain activity, suggesting that energetically normal cells have a growth advantage over those with a high mutation load. We propose that this elimination is by biased distribution of wild-type mtDNA to daughter cells, and that a similar mechanism could operate in vivo and contribute to both the clinical expression of mt disease and the maintenance of a predominantly wild-type mt genome pool across generations.

Understanding the pathobiology of mitochondrial (mt) DNA diseases involves both characterization of the effects of individual mutations on respiratory function and elucidation of the changes in mutation load and distribution (energy mosaicism) over serial cell generations. Whether a given mutation is stably maintained, or increases or decreases with cell growth, is one of the determinants as to whether a particular tissue will be affected by oxidative phosphorylation failure. In this study, we correlated mt genotype with biochemical phenotype in myoblasts from patients with pathogenic mtDNA mutations. The dominant process detected was a progressive elimination of mutant mtDNA genomes concomitant with an improvement in respiratory chain activity, suggesting that energetically normal cells have a growth advantage over those with a high mutation load. We propose that this elimination is by biased distribution of wild-type mtDNA to daughter cells, and that a similar mechanism could operate in vivo and contribute to both the clinical expression of mt disease and the maintenance of a predominantly wild-type mt genome pool across generations.

Since its development in the late 1980's, the polymerase chain reaction (PCR) has revolutionised molecular genetic studies. It has provided direct access to genetic material in quantities sufficient for meaningful analyses to be performed. Adaptations to the basic technique have resulted in a wide range of applications from basic gene amplification to the estimation of DNA species quantities within cells. The study of human mitochondrial genetics is but one of the many disciplines to benefit from the rapid ascension of PCR based technology. In this communication we outline several uses of the PCR technique in the detection, quantification and characterisation of human mitochondrial genetic defects. The data presented in this communication highlight the versatility and applicability of PCR not only to mitochondrial research but to other disciplines of medical research. © 1997 Elsevier Science B. V.

Hasil: Uji Fisher's exact menunjukkan ekspresi positif p53 berhubungan dengan diameter tumor <5 cm meskipun tidak berhubungan dengan jumlah mitosis. Tipe histologi sinoviosarkoma tidak berhubungan dengan ekspresi p53 maupun mitosis. Melalui FISH diperoleh hanya 7/19 kasus mengalami translokasi gen SYT.

Hepatoid carcinoma is a special type of extrahepatic tumor associated with hepatic differentiation, and has the morphological and functional features of hepatocellular carcinoma. Hepatoid carcinoma of the gallbladder is very rarely reported in the literature. We report a case of hepatoid carcinoma of the gallbladder in a 71-year-old female who presented with abdominal pain and was rst diagnosed as cholelithiasis with cholecystitis. The microscopic findings of the gallbladder after cholecystectomy showed an area of tumor with poligonal cells, eosinophilic cytoplasm, distinct cell borders, round vesicular nuclei and prominent nucleoli, arranged in trabecular pattern resembling hepatocellular carcinoma intermingled with areas of adenocarcinoma or cholangiocarcinoma. The specimen from the pancreas also showed the same type of tumor cells. Histochemically, some of tumor cells were positive for Victoria Blue, Stein, and PAS. The immunohistochemistry for alpha-fetoprotein (AFP) showed strong intra cytoplasmic positivity, both in tumor cells with hepatic differentiation and tumor cells with bile duct epithelium differentiation. Based on these findings, this case was diagnosed as hepatoid carcinoma of the gallbladder with metastasis to the pancreas. This is the rst case that has been reported in our department.

Background: Heating process with autoclave is one of limb salvage modalities that are widely used. but the results are not satisfying, due to mechanical bone fragility. However, considering this treatment modality is widely accepted in terms of financial, religion and sociocultural aspects, we conducted a on study rats treated with resection and reconstruction with autoclave heating method to assess bone healing by sequential radiology, histopathologic osteoblasts count, and bone morphogenetic protein (BMP).Methods: Thirty six Sprague-Dawley rats were divided into two groups with one group being the autoclave group and others served as control group. In both groups, the tibial diaphysis was extracted en bloc for 7 mm. All groups were kept for 8 weeks and treated under the same condition except the autoclave group, where the extracted bones were put into autoclave at 134°C for 15 minutes and refixed again with k-wire. We performed radiological examination at 5th and 8th week using La...

Telah dilakukan penelitian tentang efek pemberian kombinasi testosteron undekanoat (TU) yang merupakan androgen dengan masa aktif lama dan depo medroksiprogesteron asetat (DMPA) dalam penekanan konsentrasi sperma tikus secara in vivo melalui peningkatan aktivitas protein caspase 3 sel spermatogenik. Tikus Sprague Dawley dewasa diberi TU 2,5 mg+DMPA 1,25 mg yang telah diketahui mempercepat pengurangan produksi testosteron oleh testes dan menimbulkan azoospermia dalam 12 minggu. Sel sperma yang positif caspase 3 meningkat dibandingkan dengan kontrol setelah 6 minggu penyuntikan dan tetap meningkat sampai 60 minggu. Immunohistokimia caspase 3 memperlihatkan bahwa spermatosit lebih banyak yang positif caspase 3. Aktifitas ekspresi caspase-3 berlokasi pada bagian inti sel germinal baik pada testis kontrol maupun pada perlakuan. Immunohistokimia juga memperlihatkan adanya peningkatan ekspresi yang signifikan dari caspase 3 pada inti sel germinal selama pemberian TU+DMPA pada tikus (453,90±84,88 sel/200 tubulus seminiferus). Kemudian, kandungan caspase 3 meningkat secara signifikan pada inti sel germinal seperti spermatogonia, spermatosit, dan spermatid. Sehubungan dengan itu, hasil ini dapat menyimpulkan bahwa azoospermia terjadi karena adanya pengurangan testosteron intratestikular yang berhubungan dengan ekspresi caspase 3 dan diduga bahwa peningkatan ekspresi caspase 3 pada inti mungkin terlibat dalam penurunan produksi sperma.

Delayed union, nonunion, and mechanical failure is still problems encountered in limb salvage surgery (LSS) using extracorporeal irradiation (ECI). This study aimed to determine whether bone marrow mesenchymal stem cells (MSC) and recombinant human bone morphogenetic protein-2 (rhBMP-2) improve hostgraft union after osteotomy and also increase its mechanical strength. Thirty Sprague Dawley rats were randomly divided into five groups. Group I (control) underwent LSS using ECI method with 150 Gy single doses. Similar procedures were applied to other groups. Group II received hydroxyapatite (HA) scaffold. Group III received HA scaffold and MSC. Group IV received HA scaffold and rhBMP-2. Group V received HA scaffolds, MSC, and rhBMP-2. Radiograph were taken at week-2, 4, 6, and 8; serum alkaline phosphatase and osteocalcin were measured at week-2 and 4. Histopathological evaluation and biomechanical study was done at week-8. The highest radiological score was found in group IV and V Sim...

Hepatoid carcinoma is a special type of extrahepatic tumor associated with hepatic differentiation, and has the morphological and functional features of hepatocellular carcinoma. Hepatoid carcinoma of the gallbladder is very rarely reported in the literature. We report a case of hepatoid carcinoma of the gallbladder in a 71-year-old female who presented with abdominal pain and was first diagnosed as cholelithiasis with cholecystitis. The microscopic findings of the gallbladder after cholecystectomy showed an area of tumor with polygonal cells, eosinophilic cytoplasm, distinct cell borders, round vesicular nuclei and prominent nucleoli, arranged in trabecular pattern resembling hepatocellular carcinoma intermingled with areas of adenocarcinoma or cholangiocarcinoma. The specimen from the pancreas also showed the same type of tumor cells. Histochemically, some of tumor cells were positive for Victoria Blue, Stein, and PAS. The immunohistochemistry for alpha-fetoprotein (AFP) showed st...

to investigate the safety and effectiveness of dose TU+DMPA hormones in developing potential male contraceptives. suppression of rat sperm concentration through increased apoptotic germ cells by in vivo administration of a long-acting androgen composed of a combination of testosterone undecanoate (TU) and depot medroxyprogesterone acetate (DMPA) was performed. Adult Sprague-Dawley rats received 2.5 mg TU every 6 week and 1.25 mg DMPA every 12 week for 60 week, a regimen known to rapidly reduce testosterone production by the testes and produce azoospermia within 12 week. Sperm concentration data were log transformed before analysis. Results are expressed as the mean±SEM. ANOVA, followed by post hoc test was used to determine differences across time and phase. T test was employed to determine differences between two groups. apoptosis revealed significant increase in apoptotic germ cells (80% when rats were administered with TU+DMPA. Apoptotic germ cells can be found in several spermat...

BackgroundCardiopulmonary bypass during tetralogy of Fallot corrective surgery is associated with oxidative stress, and contributes to peri-operative problems. Curcumin has been known as a potent scavenger of reactive oxygen species, which enhances the activity of antioxidants and suppresses phosphorylation of transcription factors involved in inflamation and apoptosis.ObjectivesTo evaluate the effects of curcumin as an antioxidant by evaluating the concentrations of malondialdehyde and glutathione, activity of nuclear factor-kappa B, c-Jun N-terminal kinase, caspase-3, and post-operative clinical outcomes.MethodsTetralogy of Fallot patients for corrective surgery were randomised to receive curcumin (45 mg/day) or placebo orally for 14 days before surgery. Malondialdehyde and glutathione concentrations were evaluated during the pre-ischaemia, ischaemia, re-perfusion phases, and 6 hours after aortic clamping-off. Nuclear factor-kappa B, c-Jun N-terminal kinase, and caspase-3, taken f...

Introduction. Burns edema is considered to be natural following thermal injury, due to increase of capillary permeability. Till now it is believed influenced by histamine as early inflammatory mediator; to be subsided in 72hr post burned. In clinical setting, massive edema referred to a big issue in critical burns and might be found in 168hr post burned. More often this edema followed by third space syndrome, which is fatal. Method. We run a study focused on endothelial lining histomorphology, which is aimed to find out endothelial disintegration of the vessels in burned– and non–burned area of critical– and non–critical burns as well, which were obtained in &gt;8hr to 24hr of hospital presentation. Samples with H&E stained were examined and confirmed with transmission electron microscopic study. Result. Severe endothelial lining derangement was found in the vessels of burned area and non– burned area in critical burn. And this derangement was found also in the vessels of burned are...

The incidence rate of dengue hemorrhagic fever in North Sumatera Province remains high. Socio-demographic and socio-cultural factors, as well as knowledge, attitudes, practices and environmental factors, influence incidence of dengue hemorrhagic fever. For effective control measures, effort should be concentrated on the disease risk factors. The objective of this study was to determine the risk factors for dengue hemorrhagic fever incidence based on their socio-demographic and socio-cultural factors, as well as knowledge, attitudes, practices and environmental factors and to determine whether the characteristics of caregivers influence the risk of dengue hemorrhagic fever. The study was designed as a case cohort study. The total number of study recruits was 682 at a case: sub-cohort ratio of 1:1 and all subjects were selected via purposeful and systematic sampling. Data analysis was performed using simple and multiple logistic regressions with α at 5% to determine the predictors of dengue hemorrhagic fever incidence in North Sumatera Province. The results of the study revealed that history of dengue hemorrhagic fever in the family, travel history of family members, frequency of garbage disposal and source of drinking water were the determinant factors for dengue hemorrhagic fever incidence in North Sumatera Province. Moreover, education and knowledge regarding dengue achieved through the involvement of caregivers played an important role in reducing the incidence of dengue hemorrhagic fever. Based on these findings, it is recommended to enhance health promotion regarding dengue prevention in the community.

Pulmonary metastasis rarely originates from a benign tumour, but may occur from giant-cell tumours of bone (GCT). It occurs most frequently in recurrent cases and may result in poor outcomes. We report a case with pulmonary metastases from huge ulcerated recurrent GCT at distal ulna, from diagnostic to limb salvage surgery procedure. Five months after surgery, unfortunately he passed away due to pulmonary metastases.

Excessive hepatocyte apoptosis induced by bile acid accumulation occurred in severe obstructive jaundice, and impair the liver secretion function. The objective of this study is to determine whether the inhibition of bile acid accumulation through bile duct decompression affect the excessive hepatocyte apoptosis and caused improvement the liver secretion functions on human model. In this study we use a before and after study on severe obstructive jaundice patients due to extra hepatic bile duct tumor was decompressed. Bile duct decompression was performed as a model of the role of inhibition of bile acid accumulation inhibition bile acid accumulation and excessive hepatocyte apoptosis. Bile acid and marker of liver secretion functions were serially measured. Liver biopsy pre and post decompression was performed for Hepatocyte apoptosis pathologic examination by TUNEL fluorescing, which measured by 2 people in double blinded system. Total bile acid, and liver secretion functions were measured by automated chemistry analyzer. The result of this study shows that twenty one severe obstructive jaundice patients were included. After decompression the hepatocyte apoptosis index decreased from an average of 53.1 (SD 105) to 11.7 (SD 13.6) (p < 0.05). Average of bile acid serum decreased from 96.4 (SD 53.8) to 19.9 (SD 39.5) until 13.0 (SD 12.6) μmol/L (p < 0.05) Total bilirubin decreased from 20.0 (SD 8.9) to 13.3 (SD 5.0) until 6.2 (SD 4.0) mg/dL (p < 0.05), while the phosphates alkaline (ALP) and γ-glutamil transpeptidase (γ-GT) activities also decreased significantly. In conclusion, bile acids accumulation and excessive hepatocyte apoptosis through bile duct decompression improve the liver secretion functions by inhibition mechanism.

Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant genetic disorder and characterized by postnatal progressive heterotopic ossification of the connective tissue. There are difficulties in diagnosing FOP, thus delayed or misdiagnosis and mismanagement is common. 3D printers have now become widely available and inexpensive, and can be used to rapidly produce life-size models based on CT scans of an individual patient. The availability of patient specific, accurate and detailed models of complex acetabular fractures can aid planning of surgical management on a patient specific basis. We present the diagnosis and surgical management of a 9-year old Indonesian girl with FOP. She presented with extensive involvement of cervical spine and both shoulders. Total excision of occipito-cervico-lumbar and paravertebral ossification and also exostoses at bilateral shoulder was done. At three years follow up, she had local recurrence with similar range of movement of the shou...

BACKGROUND: Plasma cell neoplasm (PCN) is a neoplastic plasma cell proliferation which includes solitary bone plasmacytoma (SBP), extramedullary plasmacytoma (EMP) and multiple myeloma (MM). Bartl classifies the degrees of PCN as low, intermediate and high. The aim of this study is to find the correlation between tumor suppressor gene p53 (TP53) expression and Ki-67 proliferation with Bartl malignancy degree of PCN. Therefore earlier PCN diagnostic method to prevent the development of PCN into MM can be found.METHODS: Thirty-two PCN cases were classified into three groups based on Bartl’s degrees of malignancy. TP53 and Ki-67 immunohistochemical staining were performed on samples and the percentage of positivity was evaluated.RESULTS: The Bartl’s low degree of malignancy was found in 10 MM cases (31.2%), intermediate degree in  5 SBP cases (15.6%) and high in 2 SBP and EMP cases (6.2%). TP53 expression was obtainable at 4% of low, 16% of intermediate and 10% of high degree. There wa...