Beginnende Demenz und Fahreignung

Physiological changes, but most of all diseases, affect driving ability in old age, whereby cognitive and mental performance plays an important part. Impaired health and feeling of unease while driving are the main reasons for driving cessation in the elderly. The causes of crashes and crash development show typical features compared to younger drivers. In the assessment of accident frequency and crash risk, sophisticated analyses are necessary. A person with moderate to severe dementia is certainly no longer fit to drive, whereas driving ability may be maintained in mild dementia for some time. In part 2, comprehensive information on the practice of assessment and judgement of driving ability is provided.     

t(X;14)(p11.4;q32.33) is recurrent in marginal zone lymphoma and up-regulates GPR34

Genetic events underlying pathogenesis of nodal and extranodal marginal zone lymphoma are not completely understood. We report here a novel t(X;14)(p11.4;q32.33) identified in 4 lymphoma cases: 2 with a mucosa-associated lymphoid tissue lymphoma, one with a nodal marginal zone lymphoma and one with gastric diffuse large B-cell lymphoma. In all cases, lymphoma evolved from a previous auto-immune disorder. Fluorescence in situ hybridization and molecular studies showed that t(X;14), which is mediated by immunoglobulin heavy chain locus, targets the GPR34 gene at Xp11.4. Upregulation of GPR34 mRNA and aberrant expression of GPR34 protein has been demonstrated in 3 presented cases by quantitative real-time polymerase chain reaction and immunohistochemistry, respectively. GPR34 belongs to the largest family of cell surface molecules involved in signal transmission that play important roles in many physiological and pathological processes, including tumorigenesis. Although functional consequences of t(X;14) have not been identified, our studies suggest that up-regulated GPR34 activate neither nuclear factor-κB nor ELK-related tyrosine kinase.     

A practical approach to vascular pathology in pulmonary hypertension

Pulmonary hypertension (PH) is the common physiological denominator in an otherwise heterogeneous disease. While pulmonary hypertension itself is not a pathologists' diagnosis, various patterns of pulmonary vasculopathy may be recognized in pulmonary hypertension. These patterns of vasculopathy are at the basis of classification, as they point towards (groups of) risk factors and aetiology. However, as surgical lung biopsy is a high risk procedure in PH, the role for histopathological evaluation is now mainly in retrospective evaluation on explanted lung or tissue obtained at autopsy, taking clinical work-up, including haemodynamic parameters and HRCT imaging, into account. Such multidisciplinary evaluation and classification may help assess the prognosis, including risk of recurrence in a transplant, and possible risk of PH in family members. More generally, systematic evaluation may identify clues as to pathogenesis and may help to fill the knowledge gap between histopathology and non-invasive diagnostic procedures such as imaging. This will hopefully eventually lead to a patho-physiologic rationale for classification, and to improved treatment strategies. This review aims to offer some practical guidelines for pathologists, pointing out pitfalls along the way.