DOCSLIB.ORG

Health and Safety at Necropsy J L Burton

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Health and Safety at Necropsy J L Burton 254 REVIEW J Clin Pathol: first published as 10.1136/jcp.56.4.254 on 1 April 2003. Downloaded from Health and safety at necropsy J L Burton ............................................................................................................................. J Clin Pathol 2003;56:254–260 The postmortem room is a source of potential hazards cution; and finally (but rarely) poisoning, as a and risks, not only to the pathologist and anatomical result of chemicals and/or radiation. Conse- quently, this review discusses the “high risk” (of pathology technician, but also to visitors to the mortuary infection) necropsy, dangerous foreign objects, and those handling the body after necropsy. Postmortem and the contaminated body. First, however, it is staff have a legal responsibility to make themselves useful to consider the nature of risks and hazards. aware of, and to minimise, these dangers. This review RISKS AND HAZARDS focuses specifically on those hazards and risks Although these terms are often used interchange- associated with the necropsy of infected patients, with ably, they are not synonymous in the context of foreign objects present in the body, and with bodies health and safety. The danger of injury posed by a slippery floor, the sharp corner of a table, the that have been contaminated by chemicals or blade of a knife or saw, or the point of a needle radioactive sources. represents a hazard. In contrast, the chance of .......................................................................... acquiring a blood borne infection such as hepati- tis B virus (HBV) or human immunodeficiency virus (HIV) from a sharps injury represents a “Quidquid agis, prudenter agas, et respice risk.13 21 finem.” (Whatever you do, do cautiously, Pathogens may be acquired by inhalation (of and look to the end.) Anon. aerosols), ingestion, direct inoculation, entry though pre-existing breaks in the skin, and “The chapter of knowledge is very short, through the mucous membranes of the eyes, but the chapter of accidents is a very long nose, and mouth. Any procedure that may result one.” Lord Chesterfield, 1694–1773. in infection through one of these routes consti- tutes a hazard.21 he mortuary can be a dangerous place. Most http://jcp.bmj.com/ dangerous in this environment is the indi- THE HIGH RISK (OF INFECTION) Tvidual who is ignorant of, or who ignores, the NECROPSY potential hazards at necropsy. Such people are a Occupationally acquired infections, particularly liability to themselves, colleagues working in the “hazard group 3” risk infections, can have a dev- 26 27 mortuary (pathologists and anatomical patho- astating impact on the health care worker. logy technicians (who have the highest rate of Knowledge of the risks of infection is therefore 1 essential. Accidental exposures to high risk necropsy related morbidity )), visitors to the mor- on September 29, 2021 by guest. Protected copyright. tuary (clinical staff and students), and those pathogens are uncommon but not infrequent, 28 29 involved in handling the body (relatives, funeral and many could be prevented. directors,23 embalmers,45 and crematoria staff), or material derived from it (laboratory workers3) “The decline in mortuary acquired after necropsy. The decline in mortuary acquired infections such as tuberculosis and blood infections such as tuberculosis and blood borne borne hepatitis in the past 25 years can be hepatitis in the past 25 years can be largely attrib- largely attributed to the increased uted to the increased awareness and adoption of awareness and adoption of safe working 6–9 safe working practices. practices” There is a considerable body of literature and legislation pertaining to the design and provision The high risk necropsy can be defined as the of a safe working environment10 11 and safe work- 12–20 “postmortem examination of a deceased person ing practices within the mortuary. It is not my who has had, or is likely to have had, a serious intention to focus on this, because such general infectious disease that can be transmitted to principles have been discussed in detail 21–23 those present at the necropsy, thereby causing ....................... elsewhere. Neither will I discuss general them serious illness and/or premature death”.30 aspects of laboratory health and safety, such as The principal biological risks faced by mortuary Correspondence to: handwashing, how to handle sharps, or the Dr J L Burton, Academic prohibitions on eating, drinking, smoking, and Unit of Pathology, E-Floor Medical School, Beech Hill the application of cosmetics that apply in the ................................................. Road, Sheffield S10 2RX, mortuary. Instead, this review will focus on Abbreviations: UK; [email protected] specific dangers faced at necropsy. Such dangers CI, confidence interval; HBV, hepatitis B virus; HCV, hepatitis C virus; HIV, human include: the acquisition of “category 3” risk immunodeficiency virus; OR, adjusted odds ratio; TSE, Accepted for publication 24 25 16 October 2002 pathogens ; injuries (with the concomitant transmissible spongiform encephalopathy; v-CJD, variant ....................... dangers of haemorrhage and sepsis) and electro- Creutzfeldt-Jakob disease www.jclinpath.com Health and safety at necropsy 255 workers are the infections caused by Mycobacterium tuberculosis, staff caring for a patient who died of unsuspected tuberculo- the blood borne hepatitides, HIV, and agents responsible for sis showed a skin test conversion, whereas all five non-reactors J Clin Pathol: first published as 10.1136/jcp.56.4.254 on 1 April 2003. Downloaded from transmissible spongiform encephalopathies (TSE), such as present at the necropsy converted from negative to positive variant Creutzfeldt-Jakob disease (v-CJD).3 All of these and two of these developed positive sputum cultures.40 Kantor pathogens retain their infectivity after death.31–35 et al observed a similar preponderance of nosocomial infection Such diseases are frequently asymptomatic and may be among postmortem workers.34 present without morphological evidence at necropsy.34 The social stigma attached to those in groups at high risk of Human immunodeficiency virus acquiring such infections means that both the clinical team The necropsy is a valuable investigation in patients who have and the mortuary staff (including the pathologist) may be died from AIDS because it permits clinicopathological follow unaware of the risk associated with the necropsy.36–38 For up, elucidation of the descriptive clinical pathology and epide- example, it is estimated that there are more than 11 000 cases miology of HIV disease, validation of endpoints in clinical of undiagnosed HIV infection in the UK.39 The presence of trials, assessment of drug efficacy and toxicity, accumulation such pathogens may not become known until after the gross of tissue for further research, and medical education.53 HIV examination.34 40 This becomes less worrisome if all staff in the serophobia has been documented among staff working in mortuary regard every necropsy as a potential source of these mortuaries handling high risk cases since the 1980s,53–57 pathogens, regardless of whether or not an infection has been although there is no evidence that HIV is readily acquired in documented in the medical notes, and irrespective of whether the mortuary. Consequently, it is difficult to justify refusal to the patient is known to belong to a high risk group. This is undertake necropsies on patients with such infections.53 58 especially prudent in medicolegal cases, where the pathologist Indeed, Gottfried57 has suggested that “those individuals who often has to rely on the brief non-medical notes provided by remain unwilling to expose themselves to high risk patients or the coroner’s officer.41 specimens, even after expert counselling, should be advised to Let us consider first the risks of acquiring such pathogens at seek a change of career”. However, pathologists (and other necropsy, before discussing strategies for reducing such risks. mortuary workers) should not undertake such cases if they are themselves immunosuppressed (and hence at risk of Mycobacterium tuberculosis acquiring opportunistic pathogens from such cases),53 have It has long been known that staff working in the mortuary are uncovered wounds, weeping skin lesions, or other at risk of occupational infection with M tuberculosis. The litera- dermatitides.58 ture abounds with reported cases of acquired pulmonary40 42–46 47 Most health care workers found to be HIV seropositive have and cutaneous infection. Indeed, René Laennec (1781–1826; a history of behavioural (male homosexual contact or inventor of the stethoscope) died of the disease, having 59 48 intravenous drug use) or transfusional exposure. Occupa- acquired it from the dissection of tuberculous cadavers. tional exposure to HIV is uncommon,60 61 and the overall risk of Xavier Bichat (1771–1802), regarded as the “Father of Histol- seroconversion after contact with HIV positive blood is low ogy” and performer of some 600 necropsies in the year of his 28 29 62 63 49 (seroconversion rate, 0–0.42%). Most documented death, also succumbed to the disease. cases of HIV seroconversion after occupational exposure Pulmonary tuberculosis accounts for approximately 90% of occurred after needlestick injuries (the most common source cases and is acquired by inhalation of aerosols or dried of exposure20 28 64). The estimated HIV transmission rate after a material.43 Cutaneous infection (“prosector’s paronychia”, single percutaneous
Load more

Recommended publications
  • Tuberculosis Verrucosa Cutis Presenting As an Annular Hyperkeratotic Plaque
    CONTINUING MEDICAL EDUCATION Tuberculosis Verrucosa Cutis Presenting as an Annular Hyperkeratotic Plaque Shahbaz A. Janjua, MD; Amor Khachemoune, MD, CWS; Sabrina Guillen, MD GOAL To understand cutaneous tuberculosis to better manage patients with the condition OBJECTIVES Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Recognize the morphologic features of cutaneous tuberculosis. 2. Describe the histopathologic characteristics of cutaneous tuberculosis. 3. Explain the treatment options for cutaneous tuberculosis. CME Test on page 320. This article has been peer reviewed and approved Einstein College of Medicine is accredited by by Michael Fisher, MD, Professor of Medicine, the ACCME to provide continuing medical edu- Albert Einstein College of Medicine. Review date: cation for physicians. October 2006. Albert Einstein College of Medicine designates This activity has been planned and imple- this educational activity for a maximum of 1 AMA mented in accordance with the Essential Areas PRA Category 1 CreditTM. Physicians should only and Policies of the Accreditation Council for claim credit commensurate with the extent of their Continuing Medical Education through the participation in the activity. joint sponsorship of Albert Einstein College of This activity has been planned and produced in Medicine and Quadrant HealthCom, Inc. Albert accordance with ACCME Essentials. Drs. Janjua, Khachemoune, and Guillen report no conflict of interest. The authors discuss off-label use of ethambutol, isoniazid, pyrazinamide, and rifampicin. Dr. Fisher reports no conflict of interest. Tuberculosis verrucosa cutis (TVC) is a form evolving cell-mediated immunity. TVC usually of cutaneous tuberculosis that results from acci- begins as a solitary papulonodule following a dental inoculation of Mycobacterium tuberculosis trivial injury or trauma on one of the extremi- in a previously infected or sensitized individ- ties that soon acquires a scaly and verrucous ual with a moderate to high degree of slowly surface.
    [Show full text]
  • History of the Department of Anatomy and Cell Biology I: Beginnings to Stevenson
    History of the Department of Anatomy and Cell Biology I: Beginnings to Stevenson 1. Introduction As the oldest of the Basic Science Departments in McGill’s faculty of Medicine, our Anatomy department has played a prominent role in the history of the medical school. This work examines the long history of our department in terms of its two primary missions: research and teaching. Our department goals have always been to continuously extend the frontiers of knowledge in the field of Anatomy and to pass on of that knowledge to new generations of students. In recent years, the addition of “Cell Biology” to our departmental name reflects the broadening of our research focus to investigate the structure and function of organs, tissues, cells and even molecules. The past century has seen spectacular achievements in these fields, and yet the deeper we probe, the more we realize how much more remains to be understood. In terms of teaching, the discipline of Anatomy has always been central to the education of students in Medicine, Dentistry and other health related disciplines. In recent times, with an ever- increasing realization of the importance of science as a basis for medical practice, the training of science undergraduate and graduate students has formed a prominent additional part of our mission. This work describes the often fascinating individuals who played a role in our department’s development and the conditions in which they worked. All major departmental faculty members are listed in chronological order with the dates of their stay in the department listed in brackets. Other members are listed in an appendix.
    [Show full text]
  • Newsletter HPS 2016 March
    Newsletter February 2016 History of Pathology Society Officers President: Stephen A. Geller Trustees: President-Elect: James Wright Florabel Mullick (2013-2016) Past President: David N. Louis Gaetano Thiene (2015-2018) Secretary-Treasurer: Santo V. Nicosia Robert H. Young (2015-2018) Past Secretary-Treasurer: Allan Tucker History of Pathology Society Meeting Sunday, March 12, 2016, 3:30-5:30 p.m. CC 602-604 Washington State Convention Center, Seattle, WA, USA United States and Canadian Academy of Pathology Meeting Beginnings Moderator: Stephen A. Geller Weill Cornell Medical College, New York, NY, US Introductory Remarks 3:30 Stephen A. Geller, Weill Cornell Medical College, New York, NY, US Time-Travelling to the Origins of Lung Cancer 3:35 Anthony A. Gal, Emory University School of Medicine, Atlanta, GA Alfred’s Morgagni Klemperer Crohn Disease 4:05 Stephen A. Geller, Weill Cornell Medical College, New York, NY, US How Neuropathological Observations Have Determined the Treatment of Neurological Disease: A Historical Perspective 4:35 Harry Vinters. David Geffen School of Medicine, University of California, Los Angeles, CA 5:05 Business Meeting TIME TRAVELLING TO THE ORIGINS OF LUNG CANCER Faculty Disclosures: None Anthony A. Gal, M.D. Professor Emeritus Emory University School of Medicine, Atlanta, Georgia LUNG CANCER IN THE EARLY 21st CENTURY TIME TRAVELING • Global epidemic • Charles Dickens: A Christmas Carol (1843) • Most common cause of cancer-related death in M & F • H.G. Wells: The Time Machine (1895) • Survival stage and histology
    [Show full text]
  • Department of Pathology
    DEPARTMENT OF PATHOLOGY 2017 – 2018 HOUSESTAFF HANDBOOK 300 Pasteur Drive, L235 Stanford, CA 94305 http://pathology.stanford.edu 1 Please use the bookmarks as the Table of Contents 2 Training in Pathology at Stanford Overview The Department of Pathology at Stanford University Medical Center seeks to train outstanding candidates for academic, private practice and other leadership positions in pathology. We offer residency training in Anatomic Pathology (AP), Clinical Pathology (CP), and combined AP and CP (AP/CP). The overall goal of our program is to provide in-depth, flexible training, in all aspects of pathology, leading to board certification in AP, CP or AP/CP. We also offer accredited clinical fellowships in Blood Banking/Transfusion Medicine, Breast Pathology, Cytopathology, Dermatopathology, Gastrointestinal Pathology, Gynecologic Pathology, Hematopathology, Neuropathology, Microbiology, Molecular Genetic Pathology, and Surgical Pathology. Combined AP/Neuropathology is also offered, but must be discussed with the Program Directors and appropriate Fellowship Directors prior to pursuing these training avenues. Trainee Selection All eligible applicants will be considered for training in the Pathology Department at Stanford. Applicants must have one of the following qualifications to be eligible for consideration: ● Graduates of medical schools in the United States and Canada accredited by the Liaison Committee on Medical Education (LCME) ● Graduates of colleges of osteopathic medicine in the United States accredited by the American Osteopathic Association (AOA) ● Graduates of medical schools outside the United States and Canada who have received a currently valid certificate from the Educational Commission for Foreign Medical Graduates or have a full and unrestricted license to practice medicine in a U.S.
    [Show full text]
  • Rudolf Virchow (1821-1902): Founder of Cellular Pathology and Pioneer of Oncology
    Journal of BUON 9: 331-336, 2004 © 2004 Zerbinis Medical Publications. Printed in Greece HISTORY OF ONCOLOGY Rudolf Virchow (1821-1902): Founder of Cellular Pathology and Pioneer of Oncology G. Androutsos Institute of History of Medicine, University Claude Bernard, Lyon, France Summary as the founder of Cellular Pathology. He contributed great- ly to the study of tumors, leukemia, hygiene, and sanitation. Rudolf Virchow, distinguished pathologist, physical anthropologist, and statesman, was probably the most dis- Key words: cellular pathology, oncology, physical anthro- tinguished German pathologist of his age, and is regarded pology, Virchow The rise of modern medicine and surgery is in- Berlin on 5 September 1902. A landowners’s son, he extricably linked with the career of Rudolf Ludwig Carl proved to have an enormous capacity for learning. Virchow, one of the greatest figures in the evolution of Before starting medical studies at the renowned Kai- pathology and a dominant figure in European medicine ser Wilhelm Institute in Berlin, he had mastered during the second half of the 19th century. French, English, Hebrew and Italian, as well as the classics and Arabic poetry! In Berlin he met two great Life and career teachers, the physiologist Johannes Müller (1801- 1858) and the clinician who named the disease “he- Virchow (Figure 1) was born on 13 October mophilia”, Johann Schönlein (1793-1864). They per- 1821 at Schivelbein, Pomerania, Germany; he died in suaded him to enter research, and he graduated in 1843 with a dissertation on rheumatic illnesses [1]. Appointed to a minor post at the Charité, in 1845 he gave one of the two first independent de- Figure 1.
    [Show full text]
  • A Symposium in Honour of The
    J Clin Pathol: first published as 10.1136/jcp.11.6.463 on 1 November 1958. Downloaded from J. cliii. Path. (1958), 11, 463. A SYMPOSIUM IN HONOUR OF THE CENTENARY OF VIRCHOW'S "CELLULAR PATHOLOGY9" (1858-1958) At the instigation of the Council of the Association of Clinical Pathologists the Editorial Board decided to devote this issue of the Journal to the publication of this Symposium on the pathology of the cell, which was held at the Royal College of Surgeons on October 2, 1958, to commemorate the centenary of the publication of Virchow's classical volume. Participants of different interests in the cell were invited to contribute, and consequently it is hoped that in this issue readers will receive a wide and stimulating survey of the developments and the newer knowledge on the fundamental aspects of the physiology andpathology of the cell now being pursued. 1858 BY SIR ROY CAMERON, F.R.S. From University College Hospital, Medical School, London copyright. " For my part I am ready for anything, at a dom from long and devastating wars. Popula- time when asphalt, India rubber, railroads, and tions expanded as wealth and comfort increased steam are changing the ground we walk on, the in some communities; in others, condemned to style of overcoats and distances." So remarks one ignorance, poverty, and despair, they were fos- of Balzac's characters in his Deputy from Arcis tered by better medical knowledge, and the break- as he curtly dismisses the 1830s. It was a time of down of old customs and restrictions, early transition from the splendours and miseries of the marriage, and the like.
    [Show full text]
  • Autopsy Protocol
    140 Part 4 Records and Reports Section 404.3 Case Files Regardless of whether you develop investigative protocols it is incumbent upon you to maintain as thorough and organized set of investigative files as possible. The investigative files should include but not be restricted to the following: all reports, investigator's notes, sketches and death scene photographs, reports of autopsy and laboratory analyses of evidence, copies of all forms completed by the coroner to include chain-of-custody forms and laboratory request forms. The major objective is to maintain as complete and proper file as possible. Section 501 Autopsy Protocol Section 501.1 Overview.............................................................................................................................. 115 Section 501.2 Ordering an Autopsy............................................................................................................ 115 Section 501.3 Autopsy Protocol.................................................................................................................. 117 Section 501.1 Overview Coroners may find the following definition of forensic pathology useful to their work. Forensic pathology is the branch of medical practice that produces evidence useful in the criminal justice administration, public health and public safety. Under this definition are three key elements: Cause of Death, Manner of Death and Mechanism of Death. The cause of death related to the disease, injury or abnormality that alone or together in some combination
    [Show full text]
  • Alfred's Morgagni Klemperer Crohn Disease ACCME/Disclosure
    4/8/2016 Alfred’s Morgagni Klemperer ACCME/Disclosure Crohn Disease Stephen A. Geller, M.D. Dr. Geller has nothing to disclose Weill Cornell Medical College, New York David Geffen School of Medicine, UCLA Uilcerating mucosal inflammation Transmural inflammation Mural thickening Serositis Adhesions Sinus tracts Fistula formation Mulder et al: A tale of two diseases: The History of inflammatory bowel disease. J Crohn’s Colitis 2014;8:341‐348. 1 4/8/2016 Regional Ileitis 1932 Oppenheimer Crohn Ginzburg Burrill B. Crohn, M.D. (1884‐1983) The first case of Crohn disease … ?? Aretaeus (Ἀρεταῖος) of Cappodocia (Καππάδοξ) –1st C C.E. 2 4/8/2016 Asser: Life of King Alfred City of London Bristol cathedral Alfred the Great (849‐899) Winchester Craig G. Alfred the Great: a diagnosis. J Roy Soc Med 1991;84:303‐305. De Abditis Morborum Causis, 1507 Attacks of diarrhea for decades, fever (The Hidden Causes of Disease) and rectal abscesses 1642 – bloody diarrhea, fever, abdominal pain, perianal abscess or fistula XCV. 1643 –autopsy showed ulcerated small and “ … gripes in the intestines, called by the large bowel, perianal abscess or fistula, Greeks dysenteria … apt to ulcerate the cavitary lesion of lung lining of the intestines and thus the excrement comes down bloodstained and mucous …” XCV. Similar symptoms and also wasting and death with “entrails … internally eroded.” Antonio Benivieni (1443‐1502) Louis XIII of France (1601‐1643) 1991 3 4/8/2016 June 5, 1944 Dwight David Eisenhower (1890‐1969) 34th President of the United States New York Times, June 10, 1956 Giovanni Battista Morgagni (1682‐1771) Some of Morgagni’s contributions 1682 –born, Forli Italy, comfortable circumstances angina pectoris, coronary atherosclerosis, vegetative endocarditis, aneurysm, 1701 –University of Bologna M.D.
    [Show full text]
  • A Review of the Techniques and Guidelines in Adult Autopsies Anu Sasidharan1*, Nadia M
    Saudi Journal of Medicine Abbreviated Key Title: Saudi J Med ISSN 2518-3389 (Print) |ISSN 2518-3397 (Online) Scholars Middle East Publishers, Dubai, United Arab Emirates Journal homepage: http://scholarsmepub.com/sjm/ Review Article A Review of the Techniques and Guidelines in Adult Autopsies Anu Sasidharan1*, Nadia M. Al-Kandary2 1Associate Professor & Unit Head of Forensic Pathology, Department of Forensic Medicine & Toxicology, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India 2Head of Forensic Pathology Section, Forensic Medicine Department, General Department of Criminal Evidence, Kuwait DOI: 10.36348/sjm.2019.v04i12.006 | Received: 18.12.2019 | Accepted: 25.12.2019 | Published: 26.12.2019 *Corresponding author: Dr. Anu Sasidharan Abstract A medico-legal autopsy on an adult if performed completely and systematically, with a reasonable uniformity and clarity can help in the betterment of outcomes while providing justice. The pre-requisites prior to an autopsy, and a thorough external examination are very important before moving on with the internal examination. In many situations a proper external examination will be sufficient to give a medico-legal report; if done methodically. There are four types of skin incisions employed in a medico-legal autopsy to examine three body cavities. The internal examination can be done using four dissection techniques as outlined in the existing literature. Examination of brain, heart, neck structures, spinal column and genitalia are very important and requires an organized approach in order to not to miss salient findings. Finally, while closure of the cadaver the doctors must bear a very important fact in mind that the body on the table was once housed by a living being and hence s/he must be treated with the same respect and dignity as one would expect him/herself to be treated by others.
    [Show full text]
  • Notes on the Medical History of Vienna: Part II (Conclusion)
    NOTES ON THE MEDICAL HISTORY OF VIENNA By HORACE MARSHALL KORNS, M.D. IOWA CITY, IOWA PART II (Conclusion) * The first vaccination on the Euro- collection of valuable books, which was pean continent was performed in incorporated with the Hofbibliothek Vienna, on April 30, 1799, by Sani- after his death, bears witness to his deep tatsreferent Pascal Josef von Ferro, who interest in medicine and natural sci- used his own children for the experi- ence, and he was a no less diligent stu- ment. Ten days later, on May 10, 1799, dent of music and languages. Jean de Carro (1770-1857) inoculated Harrach’s patients were all indigent, his son with lymph obtained from the and, inasmuch as most of them were pustule on the arm of Ferro’s daughter. also incurables who had been given up Ferro was too much occupied with his by other physicians, his radiant per- official duties to pursue the matter fur- sonality and innumerable charities were ther, and it fell to the young and en- his most efficacious therapeutic weap- thusiastic de Carro, who reported 200 ons. K. F. Burdach, an eminent con- inoculations in his celebrated book temporary anatomist, said: (1801) , and extended his activities in I met him often, surrounded by a group behalf of vaccination throughout Aus- of incurables and grateful convalescents, tria, Germany, Turkey and India. He and saw with what admirable simplicity refused the 1000 guineas offered him for he bore himself towards these poor peo- his work in India, whereupon Jenner ple. In 1809 he devoted himself unceas- sent him a lock of his hair, and a silver ingly to the care of the French and Aus- snuffbox with the inscription, “ Jenner trian soldiers in Vienna, until he himself to Jean de Carro.” De Carro was a contracted typhus.
    [Show full text]
  • Extensive Multifocal Tuberculosis Verrucosa Cutis in a Young Child
    Medical Practice and Review Vol. 2(6), pp. 60-65, November 2011 Available online http://www.academicjournals.org/MPR ISSN 2I41-2596 ©2011 Academic Journals Case Report Extensive multifocal tuberculosis verrucosa cutis in a young child Muhammad Hasibur Rahman 1* and Nazma Parvin Ansari 2 1Department of Dermatology and VD Community Based Medical College, Bangladesh. 2Department of Pathology of Dermatology and VD Community Based Medical College, Bangladesh. Accepted 22 September, 2011 Although there has been increasing number of tuberculosis cases throughout the world, but multifocal cutaneous tuberculosis accounts to be a very rare manifestation. An interesting study report inform us of one such case of multifocal tuberculosis verrucosa cutis in a 12-year old male child encountered with a typical presentation alike in the absence of any primary tuberculous focus and extensive involvement. Key words: Multifocal, tuberculosis verrucosa cutis (TVC), young child. INTRODUCTION Tuberculosis an ancient early century malady caused by observed to persist in the upper and mid-dermis, Mycobacterium tuberculosis . In recent times cutaneous sometimes perforating through the epidermis. The num- tuberculosis constitutes only a small proportion of extra ber of acid-fast bacilli found is consistently scanty. The pulmonary tuberculosis. Tuberculosis verrucosa cutis tuberculin test is however strongly positive. (TVC) is also recognized as warty tuberculosis (Wolff and Tappeiner, 1999), anatomist's wart or prosector's wart and is characterized by the presence of verrucous CASE REPORT plaque-like lesions. It is naturally is initiated due to direct inoculation of the organism into the skin of a previously A 12-year old male child is presented with multiple well infected patient.
    [Show full text]
  • GLOSSARY of HISTOLOGICAL & MICRO-ANATOMICAL TERMS
    GLOSSARY of HISTOLOGICAL & MICRO-ANATOMICAL TERMS Abbreviations: ( ) plural form in brackets • A. Arabic abb. abbreviation • c. circa (= about) • F. French adj. adjective • G. Greek • Ge. German cf. compare • L. Latin dim. diminutive • NA. Nomina anatomica q.v. which see • OF. Old French A-band abb. of anisotropic band G. anisos = unequal + tropos = turning; meaning having not equal properties in every direction; transverse bands in living skeletal muscle which rotate the plane of polarised light, cf. I-band. Abbé, Ernst. 1840-1905. German physicist; mathematical analysis of optics as a basis for constructing better microscopes; devised oil immersion lens; Abbé condenser. absorption L. absorbere = to suck up. acervulus L. = sand, gritty; brain sand (cf. psammoma body). acetylcholine an ester of choline found in many tissue, synapses & neuromuscular junctions, where it is a neural transmitter. acetylcholinesterase enzyme at motor end-plate responsible for rapid destruction of acetylcholine, a neurotransmitter. acidophilic adj. L. acidus = sour + G. philein = to love; affinity for an acidic dye, such as eosin staining cytoplasmic proteins. acinus (-i) L. = a juicy berry, a grape; applied to small, rounded terminal secretory units of compound exocrine glands that have a small lumen (adj. acinar). acrosome G. akron = extremity + soma = body; head of spermatozoon. actin polymer protein filament found in the intracellular cytoskeleton, particularly in the thin (I-) bands of striated muscle. adenohypophysis G. ade = an acorn + hypophyses = an undergrowth; anterior lobe of hypophysis (cf. pituitary). adenoid G. " + -oeides = in form of; in the form of a gland, glandular; the pharyngeal tonsil. adipocyte L. adeps = fat (of an animal) + G. kytos = a container; cells responsible for storage and metabolism of lipids, found in white fat and brown fat.
    [Show full text]