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Biomedical subjects

C E Platz

Publications and source records attributed to C E Platz.

17 recordsLinked to original sources

Cytomegalovirus infection in a cyclosporine-treated burn patient: case report.

We report the case of a 45-year-old burned man (55% total body surface area full-thickness burn) who developed symptomatic cytomegalovirus infection during cyclosporine (CSA) therapy (3 mg/kg orally) for skin transplantation. During the sixth hospital week the patient developed signs compatible with CMV infection, and CMV was recovered from the urine and sputum. Examination of skin biopsy specimens from the transplanted cadaver allograft revealed inclusion bodies compatible with CMV infection, and CMV antigens were detected by immunohistochemical testing. The CMV infection of the skin was confirmed by recovery of infectious virus and by detection of CMV nucleic acids using in situ hybridization with a biotinylated HCMV DNA probe. Restriction enzyme analysis of a urine CMV isolate and two isolates from skin demonstrated differences in DNA patterns, suggesting that the patient was infected simultaneously with two different CMV strains.

Burns

A clinicopathologic study of orbital and adnexal non-Hodgkin's lymphoma.

An analysis of non-Hodgkin's lymphoma involving the orbital structures was performed at the University of Iowa between 1937 and 1975. Sixteen cases of primary orbital lymphoma were diagnosed. Histopathologic reclassification according to the Rappaport scheme and the clinical course of each histologic sub-category was described. There were 5 patients with reactive hyperplasia, 2 patients with well-differentiated lymphoid proliferation with Dutcher bodies which were also felt to be reactive, 3 patients with diffuse poorly differentiated lymphocytic lymphoma, 4 patients with nodular poorly differentiated lymphocytic lymphoma, and 2 patients with diffuse histiocytic lymphoma. It was concluded that the Rappaport classification is applicable to orbital lymphoid tumors and that those lymphomas which do present as primary tumors should be staged as one would stage the same histologic category of lymphoma presenting in other sites. Radiation therapy appears to be an effective treatment for local control; however, patients with primary orbital lymphoma should undergo observation for systemic disease similar to patients with lymphoma presenting in other sites. Excisional biopsy is recommended to facilitate precise classification.

Aged

Clinical usefulness and reproducibility of histologic subclassification of advanced diffuse histiocytic lymphoma.

Thirty-one patients with stage III and IV diffuse histiocytic lymphoma (DHL) were treated uniformly with cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP). The patients were subclassified independently by two hematopathologists into groups with predominantly large noncleaved cells (eight patients), predominantly large cleaved cells (seven patients), a mixture of large cleaved cells and large noncleaved cells (11 patients), tumors with the characteristics of immunoblastic sarcomas (two patients) and unclassified (three patients). The concurrence rate on applying the subclassification was 85 per cent. Survival in patients with large noncleaved cells was superior to that of the other patients as a group (p less than 0.001), and to that of those with large cleaved cells (p less than 0.05) and large cleaved and large noncleaved cells (p less than 0.025). All the patients with large noncleaved cells are alive and "off" therapy without evidence of progressive disease. This histologic subclassification seems to identify a subgroup of patients with advanced diffuse histiocytic lymphoma having large noncleaved cells who have an excellent prognosis when treated with CHOP.

Antineoplastic Agents

Smooth muscle within ovarian decidual nodules: a link to leiomyomatosis peritonealis disseminata?

Evidence is presented for the coexistence of smooth muscle and decidual cells in nodules on and within the ovarian tunica albuginea at term. Routine histologic techniques and electron microscopy have been employed in characterizing the morphology of the nodules. Recent literature concerning the frequency of ovarian decidualization during pregnancy is discussed with respect to the possible relationship of such decidualization to the histogenesis of leiomyomatosis peritonealis disseminata (LPD). The hypothesis that LPD may represent "disseminated fibrosing decidua" is discussed in light of finding collagen fibrils, secretory decidual cells, and smooth muscle cells in these nodules. It is concluded that the present case does not represent "fibrosing decidua." The authors agree with others who have proposed that the smooth muscle in ovarian decidua and LPD result from proliferation of stem cells which may reside in the subperitoneal stroma in association with ectopic endometrial stroma and which may respond to the hormones of pregnancy.

Decidua

Accuracy of lymphangiography in the diagnosis of paraaortic lymph node metastases from carcinoma of the cervix.

A study was undertaken to evaluate the use of lymphograms as a method of diagnosing cancer of the cervix metastatic to the paraaortic lymph nodes. Twenty-one patients underwent lymphograms, surgical biopsy, and histologic examination of the paraaortic nodes. The specificity of lymphangiographic examinations is not accurate enough to be of clinical significance in the detection of paraaortic lymph node metastasis from carcinoma of the cervix. Lymphangiography can be of assistance in locating suspicious lymph nodes. These nodes should then be biopsied. The final therapeutic decisions should be based on tissue diagnosis.

Aorta

Spinal accessory lymph nodes: a prospective study of metastatic involvement.

The traditional radical neck dissection involves excision of the spinal accessory nerve en bloc with the soft tissue of the posterior triangle in an effort ot remove completely all node-bearing tissue. The resultant decrease in range of motion of the involved extremity and subsequent pain have prompted some surgeons to seek alternatives. The purpose of this study is to review prospectively radical neck specimens with the specific intent of evaluating the frequency of metastatic involvement of the spinal accessory lymph nodes with head and neck malignancies. Fifty neck specimens were studied and the frequency of cancerous involvement of the spinal accessory nodes was not found to be significantly different from nodal involvement of the entire neck specimen. The location of accessory nerve involvement was predominantly in the proximal portion which is not within the posterior triangle. The results are further evaluated with the subsequent conclusion that preservation of the spinal accessory nerve cannot be justified on the basis of infrequent involvement with metastatic lymph nodes.

Accessory Nerve

Hematoma of liver: a lesion-mimicking hepatic neoplasm.

A plethora of case reports of women on birth control agents who present with hepatic masses and who are ultimately found to have liver neoplasms have overshadowed the clinicians' awareness of other possible diagnoses in patients who present in a similar fashion. Hematomas of the liver, secondary to vascular lesions induced by these agents, must be considered and preoperative attempts to make the diagnosis must be ensured by obtaining appropriate studies.

Adult

Multicentric colonic lymphoma complicating ulcerative colitis.

A 72-year-old female with ulcerative colitis of 30 years duration underwent total proctocolectomy for a cecal mass thought to be an adenocarcinoma. Pathologic examination of the colon revealed 22 tumors, all of which proved to be malignant lymphoma, histiocytic type. Thirteen cases of non-Hodgkins malignant lymphoma and 2 cases of Hodgkins disease of the colon arising in ulcerative colitis are reviewed and discussed.

Aged

Melanoma of skin of the breast: therapeutic considerations based on six cases.

Melanomas of the skin of the breast are uncommon lesions which are amenable to cure with standard mastectomy techniques, even when lymphatic spread has occurred. Of six patients treated at the University of Iowa, two have died of metastatic melanoma, one treated by wide excision and subsequent axillary dissection and the other by radical mastectomy initially. Of the remaining patients, one with positive axillary nodes at the time of mastectomy died 28 years following operation of unrelated causes, one with axillary nodes involved is 5 years without evidence of recurrence, and two who have been followed for less than 2 years, are without evidence of recurrent disease in spite of having had positive nodes at the time of initial treatment. All six patients had had pigmented lesions of the skin of the breast for many years, suggesting that such lesions in this location should be considered premalignant.

Adult

Laryngeal rhabdomyosarcoma.

Laryngeal rhabdomyosarcomas are very rare, extremely malignant tumors. Approximately half of the reported cases have occurred in children. Diagnosis may be difficult, and adequate biopsy material is crucial in the identification of these lesions. Unil recently, rhabdomyosarcomas carried a dismal prognosis; however, combined treatment with surgery, irradiation, and triple chemotherapy appears to have improved the outlook. This should probably be the treatment for laryngeal rhabdomyosarcomas, and was successfully used in the case reported herein.

Child

Desmoid tumors of the abdominal wall.

Four cases of desmiod tumors of the anterior abdominal wall recently treated at the University of Chicago Hospitals and Clinics are presented. From our experience we conclude: 1. Inadequate excision of desmoid tumors results in local recurrence. 2. Adequate excision of desmoid tumors ot the abdominal wall sometimes necessitates creation of an abdominal wall defect too large for primary closure. 3. Marlex mesh has been used successfully in reconstruction of the abdominal wall following adequate excision of desmoid tumors. 4. One patient (Case 4) with an abdominal wall desmoid tumor associated with familial polypisis and mesenteric fibromatosis has benefited greatly following wide excision of abdominal wall and reconstriction using Marlex mesh, despite the fact that the mesenteric fibrous tumor was unresectable.

Abdominal Neoplasms

Acute dilation of the colon in malignant lymphoma.

Acute dilatation of the colon with signs of systemic toxicity developed in an elderly man with malignant lymphoma. Although barium contrast X-rays taken previously were interpreted as consistent with granulomatous colitis, rectal biopsy had revealed features characteristic of malignant lymphoma, poorly differentiated lymphocytic type. Bone marrow and lymph nodes were also involved. The onset of dilatation was temporally related to therapy with opiates and anticholinergics, and the acute episode was resolved with nasogastric suction, intravenous fluids, albumin, and antibiotics.

Aged

Factors influencing local recurrence after abdominoperineal resection for cancer of the rectum and rectosigmoid.

One hundred and fifty-two patients who underwent abdominoperineal resection for cancer of the rectum and rectosigmoid are reviewed. Six physicians were selected to predict which of these patients would have a local recurrence. All information available at the end of the operation was duplicated and submitted to the observers. None of the physicians was able to predict local recurrence significantly better than random. There were 31 local recurrences, i.e. an incidence of 20-4 per cent. Low level of tumour in the rectum, local spread into perirectal fat or serosa, lymph node involvement and age below 60 years at time of operation were the only factors that were statistically related to local recurrence. The strategy for careful follow-up of patients at risk is outlined and a plea is made for a controlled trial of postoperative radiotherapy.

Age Factors

The radiographic manifestations of pseudolymphoma of the stomach.

Pseudolymphoma of the stomach is a benign proliferation of lymphoid tissue which can be mistaken histologically for malignant lymphoma. The etiology is unknown but in most cases it is believed to be a reaction to chronic peptic ulcer disease. The clinical records and radiographs of 18 patients with pseudolymphoma of the stomach were reviewed. The radiographic findings fell into 3 relatively distinct groups: tumor masses, enlarged gastric rugae, and well-defined benign-appearing ulcers. All but 2 cases demonstrated ulcers radiographically and all cases had ulcers or erosions on pathological examination.

Adolescent

Idiopathic midface lesions.

The term lethal midline granuloma has been used to describe a number of lesions which may present in the midface. A list of possible causes is presented and three entities, midline malignant reticulosis, Wegener's granulomatosis, and malignant lymphoma, are discussed in detail. The pathological descriptions, the clinical features, and the recommended forms of therapy are outlined. It is important to vigorously pursue the patient with a midline facial lesion until a definite tissue diagnosis is obtained. Multiple biopsies may be necessary because necrosis and nonspecific inflammatory changes may be present in various of these disease entities. The correct diagnosis is essential because the treatment of these disease is different: Wegener's granulomatosis responds best to chemotherapy, whereas midline malignant reticulosis and lymphoma should be treated with radiation therapy if they are localized. Despite conceptual variations, most recent authors believe that these three diseases exist as separate entities, and furthermore, recommend that the term lethal midline granuloma be either dropped from the lexicon or relegated to a descriptive clinical term to be used only until a more definitive diagnosis can be made.

Adolescent