Biomedical subjects
B J Ferguson
Publications and source records attributed to B J Ferguson.
Exit site infections in CAPD patients wearing tight clothes.
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Sex steroid receptor distribution in the human larynx and laryngeal carcinoma.
Previous reports of estrogen receptor (ER) and progesterone receptor (PgR) in the human larynx and laryngeal carcinoma have relied on ligand-binding techniques using cytosol from tissue homogenates. These methods obscure the contribution of different tissue components to total receptor content. Recently developed, highly specific monoclonal antibodies to human ER and PgR were able to discern the presence of ER and PgR at the cellular level in 12 specimens of normal laryngeal tissue and eight laryngeal squamous cell carcinomas. Localization of ER and PgR was observed in the nuclei of vocalis muscle. No evidence of ER or PgR was found in epithelial components of the normal larynges or in laryngeal carcinomas. These results extend previous findings in lower primates and rodents to the human larynx and clarify previously reported receptor analyses of laryngeal carcinomas.
Pathologic quiz case 2. Chordoma.
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Pathologic quiz case 2. Infected oncocytic cyst.
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Pathologic quiz case 1. Giant cell arteritis (temporal arteritis, cranial arteritis).
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Hard palate reconstruction in maxillectomy.
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Spontaneous CSF otorrhea from tegmen and posterior fossa defects.
Spontaneous cerebrospinal otorrhea (SCSFO) from tegmen or posterior fossa defects is uncommon. Twenty-nine cases have been detailed in the literature to date. We report an additional four cases from three patients. This group of 33 cases of SCSFO from tegmen or posterior fossa defects is characterized by certain clinical features. These patients are usually older adults (mean age 48 years, range 8 months to 80 years). Aural fullness with a serous appearing middle ear effusion, or clear otorrhea, often subsequent to tube myringotomy, are the usual initial symptoms. Meningitis was the initial manifestation in eight patients (24%), and ultimately occurred in an additional four patients (12%). The pathophysiologic basis for SCSFO from tegmen defects is discussed. Methods for diagnosing and treating CSF otorrhea from tegmen defects are reviewed.
Mechanisms of cholesteatoma formation following stapedectomy.
Poststapedectomy cholesteatoma is uncommon. We report a patient with bilateral cholesteatomas, each following an initially successful stapedectomy for conductive hearing loss due to stapedial fixation from otosclerosis. A revision right stapedectomy done in 1972 was complicated 4 years later by prosthesis extrusion and cholesteatoma. An extensive left cholesteatoma occurred 7 years after stapedectomy in 1977 and required a radical mastoidectomy. The etiology of poststapedectomy cholesteatoma in this patient was probably chronic eustachian tube dysfunction and negative middle ear pressures. The initial right cholesteatoma occurred following prosthesis extrusion, which is presumed to have been the portal of entry of squamous epithelium into the middle ear. The later-occurring left poststapedectomy cholesteatoma represented progression of an attic retraction pocket. Both of these complications were likely secondary to negative middle ear pressure. In addition to eustachian tube dysfunction, other proposed etiologies for poststapedectomy cholesteatoma formation include prosthesis extrusion independent of negative middle ear pressure, unrecognized presence of squamous epithelium in an oval window fat graft, an inverted tympanomeatal flap due to improper positioning, and a marginal perforation from a disrupted anulus. Poststapedectomy cholesteatoma is a rare phenomenon, but does occur. The preoperative exclusion of patients with eustachian tube dysfunction and proper surgical techniques should reduce this complication.
An ultrastructural analysis of breast carcinoma presenting as isolated axillary adenopathy.
Metastatic adenocarcinoma in the axillary lymph nodes of a female patient often originates from a primary tumor in the ipsilateral breast. Mastectomy may be recommended if adenocarcinoma is found in the axillary nodes even when the primary tumor is not clinically detectable. In these circumstances, the recommendation for mastectomy should be based on the firm histologic diagnosis of adenocarcinoma. In the present report, five female patients are discussed who presented with axillary lymphadenopathy without clinically evident breast masses or mammographic evidence of malignancy. Axillary lymph node biopsies, performed in each patient, were inconclusive after conventional light microscopic examination. Electron microscopy established the diagnosis of adenocarcinoma. These findings were complemented by sex steroid analyses of the tumors where possible. Each patient underwent ipsilateral mastectomy, and in each specimen an occult breast carcinoma was found. The necessity of making a precise tissue diagnosis in all cases of metastatic cancer from an unknown primary is stressed, and special techniques to accomplish this must be considered preoperatively. This is particularly important in the female patient with metastatic breast carcinoma in an isolated axillary lymph node, since ipsilateral mastectomy may be curative.
Immunoglobulin localization in benign and malignant lesions of the human mammary gland.
Using direct imunofluorescence, lesions from 266 human breast specimens were studied for the presence of IgA, IgM, or IgG localization. The lesions included benign elements from 66 subcutaneous mastectomy specimens in which the absence of simultaneous breast malignancy was documented, primary breast carcinomas from 153 mastectomy specimens, and 47 biopsies containing metastatic breast cancer. A statistically significant association of IgA and IgM with benign lesions was contrasted to the association of IgG with malignant lesions. In both primary and metastatic lesions, IgG localization was associated with estrogen-receptor-poor primary cancers as compared with estrogen-receptor-rich primary cancers. Among primary breast cancer patients, IgG localization in the tumor correlated with relative lymphopenia. A shorter disease-free interval was noted in association with IgG localization among the metastatic breast lesions. No statistically significant association between stage of disease and immunoglobulin presence was demonstrable. Moderate-to-severe intraductal epithelial hyperplasias were more often associated with immunoglobulin G localization that were other benign lesions.
Modified radical mastectomy with immediate reconstruction for carcinoma of the breast.
Fifty patients undergoing immediate reconstruction of the breast following modified radical mastectomy for carcinoma were characterized by their clinical findings and the pathologic features of their tumors. Evidence of nipple--areolar involvement by tumor was noted in five patients. This high incidence mitigates against nipple--areolar transplantation. In ten patients the breast contained multifocal tumor or intraductal carcinoma away from the primary tumor, thus emphasizing the importance of careful evaluation of the total tissue specimens. Four patients have had recurrence of tumor. The detection of the recurrence was not hindered by the presence of the prosthesis. In these four patients immediate reconstruction of the breast did not appear to adversely affect the natural history of the breast cancer. We suggest that when appropriate and thorough surgical extirpation followed by reconstruction is undertaken as a team effort among the general and plastic surgeons, pathologist and clinical psychologist, the optimal clinical and cosmetic results may be achieved. However, conclusive statements regarding the long-term implications of immediate reconstruction awaits additional follow-up.
Fibrous dysplasia of the paranasal sinuses.
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Quantitative analysis of microdebriders used in endoscopic sinus surgery.
PURPOSE: To develop a standardized in vitro model for evaluating efficacy of the microdebriders and to assess whether differences in efficacy exist among available microdebriders. Microdebriders combine suction of tissue with amputation by a hollow rotating cutter. Several models are available, and they are increasingly popular in endoscopic sinus surgery. MATERIALS AND METHODS: Seven microdebriders were tested by using a standardized soft tissue model (standard fresh raw oysters excluding muscle) and a firm tissue model (standard fresh raw oyster muscle). Efficacy was measured in grams of tissue aspirated per minute. Models to simulate lamina papyracea (eggshell) and dura (egg sac) were also tested with each microdebrider. RESULTS: Statistically significant differences in soft tissue aspiration were found between most microdebriders ranging from the Xomed (Jacksonville, FL) Straight Shot/4.0-mm blade (147 g/min); the ESSential Shaver (Smith & Nephew, Memphis, TN)/4.0-mm blade (99 g/min), the Linvatec (Largo, FL)/4.2-mm blade and Dyonics (Burscheid, Germany)/3.5-mm blade and Wizard Plus/4.0-mm blade (range 43 to 46 g/min), followed by the Hummer II (Stryker, Santa Clara, CA) 4.0-mm blade (22.5 g/min), and finally the Xomed Wizard Plus/3.5-mm blade at 16 g/min. The Xomed Straight Shot/4.0 blade was statistically superior to all other microdebriders in efficiency of aspiration in the firm tissue model. All microdebriders were able to abrade a "bony" spicule and intact "dura," whereas none could abrade intact "bone." CONCLUSIONS: Significant differences exist among the various microdebriders in this standardized model of efficiency of aspiration. Additional clinical factors including cost, safety, ease of use, and adaptability should also be considered in the choice of a microdebrider.
Adjunctive hyperbaric oxygen for treatment of rhinocerebral mucormycosis.
The therapy of rhinocerebral mucormycosis includes aggressive surgical debridement, administration of high-dose amphotericin B, and control of underlying predisposing conditions, especially diabetes and immunosuppression or immunodeficiency. Hyperbaric oxygen suppresses fungal growth in vitro and has theoretical value in treating mucormycosis because it reduces the tissue hypoxia and acidosis that accompany vascular invasion by the fungus. In a retrospective review of patients at Duke University Medical Center with rhinocerebral mucormycosis, six patients were treated with hyperbaric oxygen and seven cases (involving six patients) were treated without hyperbaric oxygen. All patients received surgical debridement and amphotericin B. Two of six patients receiving hyperbaric oxygen therapy died, and four of seven patients not receiving hyperbaric oxygen therapy died. Adverse effects from hyperbaric oxygen were minimal. Because mucormycosis occurs infrequently, this retrospective review involved a small number of patients. Despite this limitation, adjunctive hyperbaric oxygen appears to be a promising clinical modality for the treatment of rhinocerebral mucormycosis and warrants further investigation.
Papillary carcinoma in a thyroglossal duct cyst: CT findings.
A case of papillary carcinoma arising in a thyroglossal duct cyst is presented. The cystic mass may have a variable anatomic location: intralingual, suprahyoid, thyrohyoid, and suprasternal, along the course of the embryologic descent of the thyroid gland. Computed tomography allows characterization and precise identification of the extent of the lesion prior to surgical resection.
Hyperbaric oxygen therapy for laryngeal radionecrosis.
Radionecrosis of the larynx is a debilitating disease associated with pain, dysphagia, respiratory obstruction, and, in some cases, the need for laryngectomy. Persistent poor wound healing can lead to death. A series of eight patients with advanced (grades III and IV, Chandler classification) radionecrosis of the larynx treated with adjunctive hyperbaric oxygen therapy is presented. Signs and symptoms of radionecrosis were dramatically ameliorated in seven of eight patients, while one patient, despite subjective improvement, eventually required laryngectomy. There were no deaths. These results are compared to previous series on radionecrosis of the larynx in which hyperbaric oxygen was not used. This series indicates that hyperbaric oxygen therapy is a useful and effective adjunctive treatment modality in the management of laryngeal radionecrosis.