Vol 52 No 4 2011


Vol 52 No 4 2011

Pathology in Spain

The Royal National Academy of Medicine Madrid

Santiago Ramón y Cajal

William (Bill) Gardner

Jack Strong

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<INTERNATIONAL PATHOLOGY (ISSN 0020-8205) published quarterly by the International Academy of Pathology. Circulation 23,000 worldwide. IAP WEBSITE http://www.iaphomepage.org PRESIDENT Kristin Henry Imperial College London at Charing Cross Hospital Fulham Palace Road, London W6 8RF UK Email: k.henry@imperial.ac.uk SECRETARY David F. Hardwick University of British Columbia Faculty of Medicine E-mail: iap.secretary@ubc.ca TREASURER Jack P. Strong Boyd Professor Louisiana State University Medical Center New Orleans, USA E-mail: jstron@lsubc.edu EDITOR Robin A. Cooke Mayne Medical School, University of Queensland and Pathology Queensland Brisbane, Australia E-mail: cooker@ozemail.com.au DESIGN Luke Perkins Graphics Brisbane, Australia Email: l.perkins@bigpond.com Vol 52 No 4 2011 The 25th Congress of the Spanish Society of Anatomical Pathology – Spanish Division of the International Academy of Pathology was held in the city of Zaragoza, Spain from May 18 – 21, 2011 in association with the 20th Congress of the Spanish Society of Cytology and the 1st Congress of the Spanish Society of Forensic Pathology. A strategic goal of the Congress was the strengthening of international bonds amongst histopathologists, cytopathologists, forensic pathologists, clinicians, biologists, veterinarians, residents, technicians, patients’ associations, and the industry. With that purpose in mind, the event had a global flavour. It attracted about 1,000 delegates coming not only from Spain but also from Portugal, virtually all Latin American countries, the United States, Italy, the United Kingdom, Belgium, Canada, Australia, and China. For the first time in SEAP-IAP history, pathology technicians fully participated in the congress, which included numerous teaching activities specifically addressed to them. Another novelty worth mentioning was the digital display of all posters presented, with complete exclusion of paper support in poster sessions. There were 93 platform presentations and 490 posters. Drs Enrique de Alava, Javier Saenz de Santamaria, and Paz Suarez-Mier chaired the committee handling platforms and posters. Plenary slide seminars by Drs John R Goldblum and Saul Suster on Wednesday May 18 and by Drs Jaime Prat and John KC Chan on Saturday May 21 marked the beginning and ending points of scientific activities. Widely acclaimed plenary lectures were delivered by Drs Sergio Serrano, Christopher D M Fletcher, Juan Rosai, Javier Pardo (Pio del Rio Hortega Award), Francisco Nogales, and Antonio Cardesa (Santiago Ramon y Cajal Award). The ubiquitous work of Drs Robin A Cooke and Marcial Garcia-Rojo was especially acknowledged and the enforced unfortunate absence of Dr Florabel Mullick was particularly regretted. Pathology in Spain Finally, the closing business meeting witnessed my presentation of the new SEAP-IAP bylaws and concluded with the inauguration of Dr Ricardo Gonzalez-Campora as SEAP-IA President for the period 2011-2015. It was decided that Cadiz, a charming Atlantic town at the southern tip of Spain, will harbor the 2013 Congress. Aurelio Ariza, Executive President of the Congress Historical background The Conference was held in a very modern Convention Centre which is one of the buildings preserved from the 2008 World Expo buildings. The Expo site is on the Northern side of the River Ebro. There are a number of ultra modern hotels within easy walking distance of the Convention Centre. Zaragoza lies between the cities of Madrid and Barcelona and is connected to them by a high speed rail service that runs hourly. It is the 5th largest city in Spain with a population of about 700,000. It was the site of a World Expo in 2008 which had the theme – Water and Sustainable Development. It was chosen by the Romans as a site for an Executive Committee of the Spanish Society of AP – IAP L to R David Hardisson (Secretary), Ricardo Gonzalez-Campora (President elect), Aurelio Ariza (President), Joan Carles Ferreres (Treasurer), Teresa Ribalta (former Treasurer) Continued page 3 2 Above: Rio Hortega lecturer: Francisco Javier Pardo Mindán from the Clinical University of Navarra, Pamplona. He spoke on Leonardo da Vinci Below: Telepathology session. Front row: Josep Antoni Bombí (Barcelona), avier Pardo Mindán (Navarra), unknown, Jaime Sánchez (Guadalajara). Second row: Isabel Guerra Merino (1st left), (Vitoria), The other names are not known. Last row, standing: J. Ernesto Moro Rodríguez (Madrid), Fidel Fernández (Santander), Felix Pablo Arce Mateos (Santander), unknown, unknown, Máximo Fraga (Santiago de Compostela). Left: Digital pathology session. Front row; Marcial Garcia Rojo, Antonio Félix Conde Martín, Anna Colomer, Second row: Unkown lady, Carlos Gallego, Marcial Garcia Morillo, Third row; Luis Gonçalves, J. Ernesto Moro Rodríguez, José Santos Salas Valién, Unknown man, unknown man. Last rows: Scientists: Javier Diaz Moya, Martin Gomez Rodriguez, Jonathan Horan, unknown lady, Alberto Gamez Zapata, technician, Francisco Podadera, unknown man. Right: The two authors of a poster that was submitted online and at the Conference is viewed on a computer screen. Each screen takes 10 posters. The list of those on each screen is on the front screen. Touching the poster you want to see brings it up almost immediately. Below: John Chan and Jaime Prat preparing for the final Seminar of the Conference that was presented on Saturday morning. Above: At the poster viewing - Francisco Javier Quelpo who won a poster prize Right: Young pathologists from Navarro - Maria Zelaya, Adriana Yague, Francisco Quelpo, Sofia Alonso Left: History of Pathology in Spain speakers: Horacio Oliva Aldamiz (University Autonoma of Madrid), Santiago Ramon y Cajal, (Hospital Vall d’Hebron, Barcelona, Spain), Juan Domingo Toledo y Ugarte (University of the Basque Country), Francisco José Martinez Tello (Universitario 12 de Octobre, Madrid), José Antonio Giménez Mas (Hospital Miguel Servet de Zaragoza). Below left: Advisory Committee of the Spanish Society of AP - IAP: Standing (L to R) Josep M Corominas, Josep Lloreta, Cristina Terradez, Diego MartinezParra, Rosario Granados, Jose Luis Villar, Inmaculada Matanzas, David Hardisson, Santiago Nieto, Emilio Mayayo, Socorro Montalban. Sitting (L to R) Manuel Atienzar, Carmen Gonzalez-Vela, Jose Santos Salas, Aurelio Ariza, Amalia Fernandez, Joan Carles Ferreres, Eva Musulen Below: Attendees and speakers - Infectious Diseases Pathology. Emelio Mayoyo the moderator centre front. Right: President Aurelio Ariza at work with the new logo of the Society. administrative centre because of its strategic position in the Iberian Peninsula on the River Ebro which provided them with a good water supply. The Romans built a fortified camp and surrounded it with a defensive stone wall. They ruled the area for 400 years after 25 BC. The subsequent invaders, mainly the Goths from central Europe used some of the stones to build structures for themselves. Some of these stones can still be seen in the present buildings, and parts of the original wall still exist. A well preserved Roman amphitheatre was uncovered in the ‘old’ city in 1978 during the excavations needed to construct an apartment building. The Moors (Arabs) from North Africa invaded Spain, and from 714 to 1118 Zaragoza was an Islamic Arab Sultanate. After this time the city became the capital of the Christian Kingdom of Aragon, but as was the case with the Romans, their influence remained in some of the buildings that were preserved and used by the subsequent rulers. At the North Eastern end of the large square in the centre of the old city (the Plaza del Pilar) there is a large mediaeval cathedral (The Basilica of Our Lady of the Pillar). At the South Eastern end there is another cathedral, La Seo, the Cathedral of San Salvador (the Saviour). This has a mixture of various architectural styles, particularly Moorish and Romanesque. The Moorish architecture is preserved in the Northern wall of the Cathedral. The remainder of the building which is mainly of Romanesque architecture was built over an existing mosque during the 12th century. In front of La Seo there is a monument to Goya, one of the famous artists who lived and worked in Zaragoza. Another building from Moorish times is the Aljaferia Palace (or castle) built in the 11th century. This is where the Parliament of the Province of Aragon has its meetings. Presidents of the Societies attending the Conference In addition to the presidents of the three organizing societies (Aurelio Ariza for SEAP-IAP, Dr Ernesto Garcia-Ureta for SEC, and Dr Joaquin Lucena for SEPAF), in attendance were Dr Juan Rosai, congress honorary president, Dr Jose Antonio Gimenez-Mas, president of the local advisory committee, Dr Emilio Alba, president of the Spanish Society of Medical Oncology (SEOM), Dr Isabel Oriol, president of the Spanish Association against Cancer (AECC), Dr Claude Cuvelier, IAP vice president for Europe, Drs Eduardo Santini-Araujo and Marcelo Franco, IAP vice presidents for Latin America, Dr Michael Wells, president of the European Society of Pathology (ESP), Dr Fatima Carneiro, president-elect of the ESP, Dr Rui Henrique, president of the Portuguese Society of Pathology, Dr Fernando Soares, president of the Latin American Society of Pathology (SLAP), Dr Fernando Miziara, president of the Latin American Society of Cytopathology (SLAC), Dr Maria Merino, president of the Latin American Pathology Foundation (LAPF), Dr Laureado Ortega, president of the Central American Association of Pathology (ACAP), Dr Israel Borrajero, president of the IAP Cuban Division, Dr Reynaldo Falcon, president of the Anatomic Pathology Federation of the Mexican Republic, and Dr Fernando Brenes, president of the Costa Rican Pathology Association, among others. Left: Opening slide seminar Saul Suster, Santiago Ramon y Cajal, John Goldblum. Below: Roman amphitheatre uncovered in 1978 to build apartments. Above: Zaragoza: Goya monument in front of the Cathedral of San Salvador (La Seo). Zaragoza: Basilica of Our Lady of the Pillar on the South bank of the Ebro River. Below left: Zaragoza: Aljaferia Castle (Palace) built in the 11th century by the Moors. It is now the meeting place for the Parliament of the Province of Aragon. Below: The cathedral of La Seo in the old city has a mixture of architecture that reflects the history of the city. Along the North wall can be seen the Moorish and Romanesque architectures. 4 This is the most famous name in medicine in Spain. In fact, accounts of Spanish Medicine are labelled History before Cajal and after Cajal. The founders of the medical dynasty of Cajal were Justo Ramón, a rural doctor and Professor of Anatomy in the University of Zaragoza and his wife Antonia Cajal. Justo insisted that his two sons, Santiago and Pedro become doctors. Santiago was more interested in painting, and for some years he resisted his father’s wish that he study medicine. Ultimately he agreed to this, provided that he was allowed to take lessons in Art as well as in Medicine. He became interested in the microscopic anatomy of the Nervous System and adopted the silver nitrate staining method introduced by the Italian Anatomist, Camillo Golgi. He then began to draw the nerve cells that he saw in his histological preparations. By combining his skills in drawing and in anatomy he showed that each nerve cell was an entity that related to adjacent cells by contiguity (not continuity) thanks to small contacts between their processes. Then the nerve impulse was transmitted to other cells in a polarized way, from their dendrites towards the soma, and from this structure towards other cells through their axons and their fine collateral filaments. In his studies he made thousands of drawings. In 1906 he was awarded a Nobel Prize in Physiology or Medicine for his contributions to the understanding of the anatomy of the nervous system and the innervation of organs. In the late 20th century one of the observations he made in 1893 on the innervation of the gut received special attention. In some of his drawings he illustrated the plexuses of Meissner and Auerbach in the gut. He also recognised some fine filaments that did not belong to either of these systems. He called these the Interstitial cells. It was found that the Gastrointestinal Stromal Tumour (GIST) one of the less common tumours of the gut arises from these ‘Interstitial cells of Cajal.’ His nerve sections were made using different staining techniques. However, one of the most used, at least at the beginning of his studies, was the Golgi impregnation: small solid pieces of nervous tissue were hardened in potassium dichromate for several days (4-7) and then soaked for a couple of days in a weak silver nitrate solution. The stained pieces were then embedded in large beeswax blocks. At first he cut thick freehand sections from the blocks using a ‘cut throat’ razor. Later on he employed a sliding microtome. As well as his interest in the microanatomy of the nervous system he also made oil paintings of other anatomical sites. The Museum in the Cajal Institute of Neuroscience Research has some of these paintings including one of the anatomy of the head and neck, and one that shows the exposed abdominal contents. He became interested in photography soon after it Santiago Ramón y Cajal (1852 – 1934) Above: Santiago Ramon y Cajal in 1906, the year in which he won the Nobel Prize. Left: Cajal’s textbook on the microscopic anatomy of the nervous system published in 1911. Below: At left is a drawing of the cell in the gut that Cajal recognised as being different from the cells of Meissner and Auerbach. It was thinner than them and he called it the Interstital cell. At right is a normal stomach stained with CD117 immunostain which stains the Interstitial cells. The microscopic section on the bottom right is one of Cajal’s thick section, silver stained preparations from which he made his drawings of the nerve cells in the body. Above: Oil paintings by Santiago Ramon y Cajal Below: Cajal Institute of Bioscientific Research Far left: Cajal’s Nobel Laureat certificate Below: Top row from left; Julian Sanz-Ibañez, the 5th Director, Pedro Ramon y Cajal, Francisco Tello, the 2nd Director. (Pedro was the brother of Santiago). Bottom row: Julian Sanz-Ortega, grandson of the 5th Director; Santiago Ramon y Cajal, great grandson of Pedro; Francisco José Martinez Tello, great grandson of the 2nd Director. Photos from the Cajal Institute are reproduced by courtesy of the Cajal Legacy. Instituto Cajal (CSIC) Madrid, Spain. Continued page 6 5 This Academy was established by King Philip 5th in 1734. The headquarters building in Madrid was constructed in 1913. It is situated in a street beside the Opera House in the centre of the old city. (Arrieta Street 12, 28013, Madrid, Spain) The Academy consists of 50 members, each of whom is eminent in their sphere of learning. 40 of them are medical doctors, and the rest are from 6 other scientific professions related to Medicine such as veterinarians, pharmacists or sanitary engineers. Each member has a numbered chair in the lecture theatre. There is currently one female member. New members are appointed when an existing member dies. The Office bearers of the Academy are a Chairman, a Vice President and a Secretary. In the Academy building there is a lavishly decorated lecture theatre with a capacity for approximately 300 people. At the front of the theatre there is an elevated table for the President and officials. The Academicians sit in their chairs below the bench and beyond this there are seats for visitors on the floor level and also in a balcony. Every Tuesday during the academic year, guest lecturers are invited to speak to the Academicians and visitors. The Presidential table is flanked by a flag of the King on the right and one of the Academy on continued page 6 The Royal National Academy of Medicine Madrid Above: National Academy of Medicine: Presidential table with the Curator, Jose Manuel Perez, Robin Cooke and Julina Sanz. Portrait of King Henry 5th and on the right the flag of the Academy and on the left the flag of the King. Left: National Academy of Medicine: Presidential table with some of the chairs for the Academicians in the foreground. Above: National Academy of Medicine lecture theatre. Far left: One of the smaller, ornately decorated function rooms called the Blue Room. The painting is of vaccination and is on loan from the Prado Museum. Left: Carved on the wooden Presidential table are the coats of arms of the Crown on the left and the Academy on the right. Below: National Academy of Medicine in Madrid built in 1913.



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