25 July 2022: Textbook Updates

We have posted updates of the following topics:

Bladder, ureter & renal pelvis > Other nonneoplastic > Intestinal metaplasia
by Rugvedita Parakh, M.D.
Topic summary: Replacement of urothelium by benign colonic or small intestinal epithelium, with presence of mucin producing goblet cells. May coexist with cystitis glandularis, characterized by formation of glandular structures in lamina propria within von Brunn nests that have an innermost lining of columnar or cuboidal cells bound by transitional cells at periphery. Incidence increases with age; mean age of diagnosis 57 years (range 23 – 81 years). Long term follow up of intestinal metaplasia has confirmed a benign behavior. Treatment: May regress completely if pathogenic factor is removed.

Bone & joints > Osteomyelitis > Chronic osteomyelitis
by Mohammad Khurram Minhas, M.B.B.S., Nasir Ud Din, M.B.B.S.
Topic summary: Longstanding infection of bone lasting months to years; characterized by low grade inflammation and presence of dead bone or fistulous tract. Most common organism: Staphylococcus aureus; responsible for 80 – 90% of cases. Incidence is highest in adults, 41 – 50 years (29%); attributed partly to higher frequency of traumatic injury in this population. Diabetes is a poor prognostic factor in patients with chronic osteomyelitis; poor prognosis in patients with nutritional and systemic diseases. Treatment: antibiotic therapy; surgical therapy (debridement, saucerization, sequestrectomy, continuous intramedullary irrigation); may require myocutaneous flaps.

Chemistry, toxicology & urinalysis > Urine & renal function > Urine crystals & microscopy
by Archana Shetty, M.B.B.S., M.D.
Topic summary: Standard component of complete urinalysis. Urine analysis is the third major diagnostic screening test in the clinical laboratory, only preceded by serum / plasma chemistry profiles and complete blood count analysis. Indications for testing: helps diagnose kidney disease; urinary tract infection; cancers of urinary tract; reactions to medicines; prostate infection; liver disease; yeast, viral, parasitic infections. Automated urine analyzers enhance productivity and turnover in the laboratories by increasing the reproducibility and productivity / throughput. Urine reagent strips: analytes detected can be ascorbic acid, glucose, bilirubin, ketone (acetoacetic acid), specific gravity, blood, pH, protein, urobilinogen, nitrite and leukocytes.

Lymphoma & related disorders > Hodgkin lymphoma > CHL lymphocyte depleted
by Anna B. Owczarczyk, M.D., Ph.D., Lauren Smith, M.D.
Topic summary: Subtype of classic Hodgkin lymphoma (CHL) with numerous Reed-Sternberg cells and scant nonneoplastic background lymphocytes. Median age 30 – 40 years; male predominance. Predilection for subdiaphragmatic region (retroperitoneal lymph nodes, abdominal organs) and bone marrow. Unfavorable prognostic factors: advanced disease stage, advanced age, presence of B symptoms, 3 or more lymph node areas involved, large mediastinal mass, high ESR (erythrocyte sedimentation rate), HIV positive. Standard therapy: ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) with or without localized radiotherapy.

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