Ruth M. Graham, D.Sc. (Hon.), B.S. (1917-1978).
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Cell Biology↗
Biomedical subjects
B Naylor
Publications and source records attributed to B Naylor.
Clinical outcome in aggressively treated meningeal carcinomatosis.
OBJECTIVE: To critically evaluate the clinical outcome of patients with cytologically proved meningeal carcinomatosis and to identify factors associated with an improved outcome. DESIGN: A consecutive series of patients was identified from a cytopathology data base. The study period was from 1985 to 1990. Case records and results of radiologic investigations were reviewed; all patients were followed up until their deaths. SETTING: University hospital with a cancer center. PATIENTS: Thirty-six consecutive patients with cytologically proved meningeal carcinomatosis. Patients with lymphoma or leukemia were excluded. INTERVENTIONS: External beam radiation therapy, intrathecal chemotherapy via a ventricular catheter, and intravenous chemotherapy. MAIN OUTCOME MEASURES: Clinical assessment and survival. RESULTS: Symptoms improved in 15% of 33 treated patients. Response to treatment had no clear relationship with the age, site of involvement, or tumor type. Median survival for treated patients was only 9 weeks. Patients who received more than five intrareservoir chemotherapy treatments had a median survival of 23 weeks. Median survival for patients with breast carcinoma who received intravenous chemotherapy was 20 weeks, significantly better than that of patients not receiving intravenous chemotherapy. CONCLUSIONS: Survival is poor despite aggressive treatment. Intravenous chemotherapy may improve survival in patients with chemoresponsive primary tumors and deserves further study.
Adult↗
Serum albumin and CA125 are powerful predictors of survival in epithelial ovarian cancer.
OBJECTIVE: To assess the prognostic significance of presentation serum albumin, clinical stage and CA125 levels in ovarian cancer. DESIGN: Retrospective analysis of data using a Cox proportional hazards model. SETTING: A district general hospital oncology unit. SUBJECTS: One hundred and fourteen consecutive patients with epithelial ovarian cancer. INTERVENTIONS: Cytotoxic chemotherapy and surgery. MAIN OUTCOME MEASURE: Survival. RESULTS: A linear increase in risk was observed with high log CA125 (P < 0.0001) and with low albumin (P < 0.0001). In late stage patients (III and IV) albumin is the best predictor of survival (P = 0.0006). The presence of ascites, blood transfusion, type of surgery or chemotherapy did not improve the predictive model. CONCLUSIONS: CA125 and albumin can be used to identify prognostic subgroups independently of stage. Albumin alone can also be used as a predictor of survival. A simple classification of patients into three groups based on serum albumin of 41 g/l or more, 35 to 40 g/l and 34 g/l or less provides a clear separation of survival curves in the present group of patients.
Adult↗
Analysis of the tumorigenic potential of common marmoset lymphoblastoid cells expressing a constitutively activated c-myc gene.
The respective roles of Epstein-Barr virus (EBV) and c-myc in the pathogenesis of endemic Burkitt's lymphoma (BL) are unclear. In order to help resolve the question whether constitutive expression of the c-myc gene in an EBV-immortalised B cell is sufficient to induce a tumorigenic phenotype, B cells from a common marmoset (Callithrix jacchus) were immortalised with EBV, transfected with a constitutively activated c-myc gene and inoculated into the host animals. Despite the cell line transfected with c-myc displaying enhanced growth characteristics, in vitro and in vivo experiments demonstrated that this was not sufficient to induce a tumorigenic phenotype. This supports our previous findings with EBV-immortalised human B cells transfected with an activated c-myc gene (Hotchin et al., 1990).
Animals↗
Cytomegalovirus infection of the cervix detected by cytology and histology: a report of five cases.
We present four cases of cytomegalovirus (CMV) infection detected by cervical cytology of asymptomatic young women. One patient who had undergone bone marrow transplantation was immunosuppressed, but no factors predisposing to CMV infection were identified in the other three patients. A cervical biopsy specimen from a fifth patient, who was also asymptomatic, demonstrated the locus of CMV infection to be in endocervical gland cells. Immunocytochemical and polymerase chain reaction studies on this biopsy specimen confirmed that the histological changes were caused by CMV. The finding of CMV-infected cells in cervical cytological or biopsy specimens is a rarity. Our observations in asymptomatic, non-immunocompromised women suggest their presence is an incidental finding, unlikely to have any clinical significance.
Adult↗
Rapidly fatal necrotising fasciitis caused by Streptococcus pyogenes.
AIMS: To describe the morbid anatomical and bacteriological features in a series of five cases of rapidly fatal Streptococcus pyogenes necrotising fasciitis. METHODS: Post mortem and bacteriological examinations were made of five patients dying within 48 hours from rapidly fatal necrotising fasciitis. RESULTS: All five cases died rapidly from a toxic Streptococcus toxin syndrome as a result of developing necrotising fasciitis following trivial injury. CONCLUSIONS: Necrotising fasciitis caused by Streptococcus pyogenes infection can be rapidly fatal. This is probably the result of a toxic shock syndrome. Rapid, early diagnosis and swift and probably empirical treatment is required to avoid a fatal outcome.
Adult↗
Postoperative apnea in infants.
This is a review of 127 neonates evaluated for postoperative apnea and bradycardia (A&B) after inguinal surgery. The patients could be divided into three groups based on postconceptional age (PCA) at operation. Ten of 29 patients operated on at PCA of 33 to 39 weeks developed episodes of A&B. Preoperative assessment was not reliable in their identification. In the second group of 54 patients at PCA 40 to 44 weeks, 8 developed A&B, whereas in the third group of 44 patients at PCA of 45 to 60 weeks 1 patient developed A&B. In the latter two groups preoperative assessment identified all patients at high risk. We conclude that after PCA of 40 weeks patients at risk for A&B can be identified preoperatively. Patients operated on up to 39 weeks PCA should all be observed in the hospital.
Age Factors↗
Cytological aspects of pleural, peritoneal and pericardial fluids from patients with systemic lupus erythematosus.
Serous effusions of nine of 33 patients with systemic lupus erythematosus contained lupus erythematosus (LE) cells, identifiable in Papanicolaou-stained smears, wet films stained with toluidine blue, and cell blocks stained with haematoxylin and eosin. Specimens in which LE cells were found contained at least a moderate number of polymorphonuclear neutrophilic leucocytes. Most specimens containing LE cells also contained cells that resembled LE cells (tart cells), which appeared to be small macrophages that had phagocytosed a non-homogenized nucleus of a cell that had undergone degeneration. In 34 years of cytologic practice we have recognized LE cells in serous effusions only from patients who were already diagnosed as having systemic lupus erythematosus.
Adolescent↗
Clinical outcome in aggressively treated meningeal gliomatosis.
We reviewed 11 consecutive patients with an antemortem cytologic diagnosis of meningeal gliomatosis. In three patients, meningeal gliomatosis was diagnosed before surgical resection of the glioma. Three of five patients with anaplastic astrocytoma and one with oligodendroglioma improved with treatment. Patients with glioblastoma multiforme did not respond and had a median survival from the diagnosis of meningeal gliomatosis of only 8 weeks. Meningeal gliomatosis can be an early finding in gliomas. Treatment response is probably related to tumor histology and grade.
Adolescent↗
Testicular lymphoma with pancreatitis.
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Humans↗
Radiographically guided fine-needle aspiration of nonpalpable breast lesions.
Radiographically guided fine-needle aspiration (X-FNA) in 215 nonpalpable, mammographically detected breast lesions was performed by means of a coordinate-grid localization system. Aspirates were categorized either into four cytologic groups or as simple cysts. Based on the most stringent cytologic criteria, the maximum sensitivity for detection of carcinoma was 97% and the specificity was 94%. However, according to these strict cytologic criteria, only 46% of aspirates contained representative material. Based on less stringent cytologic criteria, the maximum sensitivity was 68% and the specificity was 97%. Forty-one of 74 lesions proved to be malignant at biopsy. Thirty-four patients did not complete adequate mammographic follow-up. High sensitivity and specificity can be achieved with X-FNA. However, management decisions ultimately require integration of mammographic findings with cytologic results. Close cooperation among mammographer, surgeon, cytopathologist, and patient is mandatory for successful results.
Biopsy, Needle↗
Adrenal masses in oncologic patients: functional and morphologic evaluation.
The role of adrenocortical scintigraphy in the evaluation of unilateral adrenal masses detected with computed tomography (CT) in 28 oncologic patients with normal adrenal function was studied prospectively with the use of NP-59 (iodine-131-6-iodomethyl-19-norcholesterol). The diagnosis was proved by means of percutaneous fine-needle aspiration cytologic examination in 20 patients, surgical biopsy in one, and clinical and CT follow-up in seven. In 14 of the 28 patients, there was increased uptake of the NP-59 on the side of the adrenal mass detected at CT (concordant uptake). Thirteen of the 14 masses with concordant uptake were greater than 2 cm in diameter, and one was 1.5 cm; all were found to be adenomas. In 11 of 28 patients there was decreased uptake on the side of the mass detected at CT (discordant uptake). None of these 11 masses were adenomas; nine were metastases and two were adrenal cysts. Uptake was indeterminate (symmetric) in three patients, two of whom had adrenal adenomas and one an adrenal metastasis; each mass with indeterminate uptake was less than 2 cm in diameter.
Adosterol↗
CA 125 and survival in ovarian cancer: preliminary communication.
CA 125 is an epithelial membrane marker which can be detected in the serum of patients with ovarian cancer and which may reflect tumour burden. In a group of 42 patients, the level of this marker has also been shown to be significantly related to survival.
Antigens, Neoplasm↗
Tooth loss in 1535 treated periodontal patients.
Of 1535 treated recall patients surveyed over an average time of 12.9 years since treatment was completed, 1371 had lost no teeth from periodontal disease. The total number of teeth lost was 444, with the average tooth loss for the 1535 patients being 0.29. In the three full arch splinted cases, the loss rate was 14.67 teeth per patient. Patients treated without any excisional or flap surgical procedures made up 26.5% of those surveyed, whereas 73.5% had required various surgical procedures. No attempt was made to compare different pocket therapy procedures. Although many patients developed recurrent periodontal problems during recall, only 15.9% of the 1535 patients required surgical retreatment. Teeth that were originally given a doubtful prognosis often were responsible for recurrent problems and sometimes required extraction.
Aged↗
Fine needle aspiration cytology of the breast. An overview.
With the development of the Breast Care Center in the University of Michigan, we experienced over a 4-year period a 1,200% increase in the number of breast aspirates received annually in our cytopathology laboratory. During this period, as newcomers to breast aspiration cytology, we achieved an 81.4% positive diagnosis rate in 161 cases of breast cancer without any false positives. This article reviews our experience with fine-needle aspiration cytology of the breast with particular reference to (a) procurement of specimens, (b) cytopathology of benign lesions, (c) cytopathology of malignant lesions, and (d) advantages of the procedure.
Biopsy, Needle↗
Role of needle biopsy in the investigation of gynecologic malignancy.
Three methods were used to investigate and evaluate patients with primary and persistent/recurrent pelvic malignancy in the gynecologic oncology services at two medical centers. The 22-gauge Chiba needle was utilized with fluoroscopic guidance to perform fine needle aspiration (FNA) of pelvic and paraaortic lymph nodes that appeared abnormal on lymphangiography (LAG). The Tru-cut needle was used to obtain tissue samples from beneath the surface epithelium of the cervix, vaginal vault and parametrium. A disposable, hand-held syringe and 20-gauge needle were used to aspirate supraclavicular and inguinal lymph nodes and cul-de-sac nodules. One hundred thirty-eight patients were evaluated, with positive results in 66 (47.8%). Surgical exploration was used to further investigate 16 negative results that did not correlate with LAG and/or clinical presentation. The sensitivity and predictive value of a negative result for the three methods was Chiba needle FNA/LAG, 62.1% and 65.6%; Tru-cut needle biopsy, 94.4% and 93.5%; and hand-held syringe and needle, 87.5% and 66.7%, respectively. All three techniques proved to be safe, uncomplicated and rapid methods of assessing gynecologic tumor spread. Positive results from these techniques can often replace surgical exploration, with a considerable savings in patient morbidity and hospitalization, and permit additional treatment to proceed without delay. Negative results still require surgical validation.
Biopsy, Needle↗
Pneumocystis carinii pneumonia. Cytologic manifestations and rapid diagnosis in routinely prepared Papanicolaou-stained preparations.
In this study of 28 immunocompromised patients, it was found that Pneumocystis carinii pneumonia could be easily and reliably diagnosed by examination of routinely prepared, Papanicolaou-stained cellular samples obtained by bronchoalveolar lavage, bronchial brushing, and bronchial washing. The distinctive intra-alveolar exudate of pneumocystosis observed in lung biopsy specimens was readily discernible in all of the cellular samples that demonstrated P. carinii by special stains. The exudate was not present in any of the P. carinii-negative samples. Routinely prepared, Papanicolaou-stained cellular samples can be relied upon for the rapid diagnosis of P. carinii pneumonia.
Bronchi↗
Coexistent squamous cell carcinoma and adenocarcinoma of the uterine cervix.
The clinical and pathological features of 20 patients with coexistent squamous cell carcinoma and adenocarcinoma of the uterine cervix have been analyzed. Various combinations of in situ and invasive carcinomas were found. Located adjacent to each other and at times intermingling, these lesions probably originated from the subcolumnar reserve cells of the transformation zone. They are early lesions and may be precursors of adenosquamous and mucoepidermoid carcinomas of the cervix. The diagnosis of these double carcinomas depends upon being aware that the two entities may coexist in the same cervix. Treatment is conventional, and the prognosis is not worsened by the presence of the two types of neoplasms.
Adenocarcinoma↗