Acquired supravalvular pulmonary artery stenosis after coronary artery bypass grafting.
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Aged↗
Biomedical subjects
D M Evans
Publications and source records attributed to D M Evans.
Reporting cervical intra-epithelial neoplasia (CIN): intra- and interpathologist variation and factors associated with disagreement.
Eight histopathologists, based at different hospitals, who had previously examined 100 consecutive colposcopic cervical biopsies were circulated with the results of the initial study. The slides were then 'reblinded' and re-examined by the pathologists who, as before, assigned them into one of six diagnostic categories. The degree of interpathologist agreement for the seven observers who returned usable responses was characterized by kappa statistics and compared to the corresponding figures for the same observers from the previous study. Although some of the observers showed significant alterations in their diagnostic practices there was persistent poor agreement for CIN 1 and 2, mediocre agreement for CIN 3 and excellent agreement for invasive carcinoma. Intra-observer agreement was consistently better than inter-observer agreement for each of the diagnostic categories. Significant differences were found among observers in the degree of intra-observer variability. The 20 cases in which there was most disagreement were re-examined by one of the authors who compared these with 20 biopsies which caused little disagreement. Disagreement was considered to be associated with florid papilloma-virus changes, basal cell hyperplasia and severe inflammation in varying combinations. On the basis of these findings we suggest changes in the terminology of CIN lesions.
Carcinoma in Situ↗
Angiolymphoid hyperplasia with eosinophilia associated with tetanus toxoid vaccination.
Three cases of angiolymphoid hyperplasia with eosinophilia are reported at the site of tetanus toxoid vaccination. All presented as nodules on the upper arm, a known adverse effect of the vaccine following superficial inoculation. Histologically the nodules showed numerous small and medium sized vessels, some lined by hyperplastic endothelial cells with perivascular lymphocytic cuffing and an inflammatory infiltrate of plasma cells, eosinophils and scattered mast cells. Lymphoid follicles replete with germinal centres were identified in the dermis and subcutaneous tissue. Immunostaining revealed a polytypic lymphoplasmacytic infiltrate and a curious IgE reticulated pattern within the germinal centres, a feature described in both Kimura's disease and angiolymphoid hyperplasia. The present study suggests that atopic reaction to tetanus toxoid may be an aetiological factor in some cases of angiolymphoid hyperplasia.
Adult↗
Observer variation in histopathological diagnosis and grading of cervical intraepithelial neoplasia.
To assess the variability among histopathologists in diagnosing and grading cervical intraepithelial neoplasia eight experienced histopathologists based at different hospitals examined the same set of 100 consecutive colposcopic cervical biopsy specimens and assigned them into one of six diagnostic categories. These were normal squamous epithelium, non-neoplastic squamous proliferations, cervical intraepithelial neoplasia grades I, II, and III, and other. The histopathologists were given currently accepted criteria for diagnosing and grading cervical intraepithelial neoplasia and asked to mark their degree of confidence about their decision on a visual linear analogue scale provided. The degree of agreement between the histopathologists was characterised by kappa statistics, which showed an overall poor agreement (unweighted kappa 0.358). Agreement between observers was excellent for invasive lesions, moderately good for cervical intraepithelial neoplasia grade III, and poor for cervical intraepithelial neoplasia grades I and II (unweighted kappa 0.832, 0.496, 0.172, and 0.175, respectively); the kappa value for all grades of cervical intraepithelial neoplasia taken together was 0.660. The most important source of disagreement lay in the distinction of reactive squamous proliferations from cervical intraepithelial neoplasia grade I. The histopathologists were confident in diagnosing cervical intraepithelial neoplasia grade III and invasive carcinoma (other) but not as confident in diagnosing cervical intraepithelial neoplasia grades I and II and glandular atypia (other). Experienced histopathologists show considerable interobserver variability in grading cervical intraepithelial neoplasia and more importantly in distinguishing between reactive squamous proliferations and cervical intraepithelial neoplasia grade I. It is suggested that the three grade division of cervical intraepithelial neoplasia should be abandoned and a borderline category introduced that entails follow up without treatment.
Biopsy↗
Membrane anchoring of heparan sulfate proteoglycans by phosphatidylinositol and kinetics of synthesis of peripheral and detergent-solubilized proteoglycans in Schwann cells.
Previous studies have shown that Schwann cells synthesize both peripheral and integral hydrophobic cell surface heparan sulfate proteoglycans (HSPGs). The experiments reported here were undertaken to investigate the mode of attachment of these proteins to the cell surface and their potential interrelationship. The binding of the hydrophobic HSPGs to membranes appears to be via covalently linked phosphatidylinositol based on the observation that incubation of the detergent-solubilized protein with purified phosphatidylinositol-specific phospholipase C significantly reduces the ability of the HSPGs to associate with phospholipid vesicles in a reconstitution assay. The peripherally associated HSPGs were released from the cells by incubation in the presence of heparin (10 mg/ml), 10 mM phytic acid (inositol hexaphosphate), or 2 M NaCl. These treatments also solubilized basement membrane HSPGs synthesized by the Schwann cells. These data suggest that the peripheral HSPGs are bound to the surface by electrostatic interactions. The peripheral and hydrophobic HSPGs were identical in overall size, net charge, length of glycosaminoglycan chains, and patterns of N-sulfation. To determine whether the peripheral HSPGs were derived from the membrane-bound form by cleavage of the membrane anchor, we examined the kinetics of synthesis and degradation of the two forms of HSPGs. The results obtained indicated the existence of two pools of detergent-solubilized HSPG with fast (t1/2 = 6 h) and slow (t1/2 = 55 h) turnover kinetics. The data were consistent with a model in which the peripheral HSPGs were derived from the slowly turning over pool of detergent-solubilized HSPGs.
Animals↗
The temperature sensitivity of the Sabin type 3 vaccine strain of poliovirus: molecular and structural effects of a mutation in the capsid protein VP3.
The growth of the Sabin strain of type 3 poliovirus is reduced at high temperatures compared to that of its virulent precursor strain Leon. Recombinant viruses have been generated from infectious cDNA clones and demonstrate that the temperature-sensitive (ts) phenotype is mainly attributable to a difference in residue 91 of the virion protein VP3. Examination of non-ts mutants derived in vitro or in vivo reveals the existence of second site mutations some of which are clearly able to suppress the ts phenotype. The location of residue 91 of VP3, and of a number of candidate suppressor mutations, in the atomic structure of the virion suggests that the ts phenotype may result in destabilization of the particle and that the suppressors may function by stabilizing specific interfaces. It is not yet clear whether the ts phenotype is expressed at the level of the particle or in the form of defects in assembly or uncoating of the virion, or all three.
Amino Acid Sequence↗
Genetic basis of attenuation of the Sabin type 3 oral poliovirus vaccine.
The poliovirus type 3 Sabin oral poliovirus vaccine strain P3/Leon/12a1b differs in nucleotide sequence from its neurovirulent progenitor P3/Leon/37 by just 10 point mutations. The contribution of each mutation to the attenuation phenotype of the vaccine strain was determined by the construction of a series of recombinant viruses from infectious cDNA clones. The neurovirulence testing of recombinant viruses indicated that the attenuation phenotype is determined by just two point mutations: a C to U in the noncoding region at position 472 and a C to U at nucleotide 2034 which results in a serine-to-phenylalanine amino acid substitution in the structural protein VP3.
Amino Acid Sequence↗
The utility of intraoperative cholangiography with acute cholecystitis.
An increasingly important subset of patients with biliary tract disease are those with acute cholecystitis. The indications for both routine or selective intraoperative cholangiography (IOC) during elective cholecystectomy may not be appropriate for this group. The utility of IOC in the presence of acute cholecystitis was examined. The medical records of 223 patients with histologically confirmed acute cholecystitis were reviewed. Clinical and laboratory criteria included age, sex, white blood cell count (WBC), serum bilirubin and alkaline phosphatase levels. In 52 (23%) patients, IOC was not attempted and was technically unsuccessful in 15 (7%) patients. IOC was successful in 156 (70%) patients and, of these, six (4%) had a false-positive examination. The remainder are divided into two groups. Group 1 (131 patients) had true-negative IOC, whereas Group 2 (19 patients) had true-positive IOC as evidenced by stone recovery upon surgical exploration. When comparing Group 2 with Group 1, the mean preoperative laboratory values are higher; these differences do not reach statistical significance. Further, within Group 2, five (26%) patients did not demonstrate any clinical or laboratory elevations suggestive of common duct pathology. Thus, in acute cholecystitis, laboratory criteria do not appear to discriminate between the presence or absence of choledocholithiasis. IOC is advocated as an integral component of the operative procedure.
Acute Disease↗
Step-advancement island flap for fingertip reconstruction.
An island flap is described for fingertip reconstruction, based on one neurovascular bundle. The design incorporates the stepladder principle, which ensures the provision of ample skin with full tactile sensibility in the required position, without the risk of longitudinal volar scarring and with good nail support when necessary. Fourteen such repairs have been carried out with satisfactory results and no complications.
Amputation, Traumatic↗
Segmental splenectomy using the ultrasonic surgical aspirator.
The technique described seems to significantly decrease blood loss in segmental splenectomy. Resection of the damaged splenic segments offers the potential advantage of reducing rebleeding and secondary hemorrhage from sites of repaired lacerations. Also, the viable splenic fragment that is left behind may afford protection from postsplenectomy sepsis. The ultrasonic surgical aspirator seems well suited for the purpose of segmental splenectomy in both the trauma and staging laparotomy setting.
Humans↗
Changing concepts of deep venous thrombosis of the upper extremity--report of a series and review of the literature.
Deep venous thrombosis (DVT) of the upper extremity has recently been recognized as being more common than previously reported (probably because of the increasingly frequent use of subclavian venous access). A retrospective review of patients in whom subclavian or axillary DVT had developed in the past 6 years (1980 to 1986) was conducted at the Akron General Medical Center. The major cause identified was related to subclavian venous catheterization, which accounted for 39% of all instances of subclavian and axillary DVT. Our results are correlated with a review of the literature. In our review of studies in which subclavian venous catheterizations were prospectively examined with use of objective means of diagnosis, we found that 28% of all subclavian catheterizations had venous thrombosis develop, often subclinically. This is not an innocuous disease, as suggested in the past; in our series 12% of upper-extremity DVT had pulmonary embolization (PE). In reviewing the recent literature, we found an average 12.4% incidence of PE, which often occurs during anticoagulation treatment. Diagnostic modalities are discussed and treatment regimens are reviewed along with an extensive literature review.
Arm↗
Diagnostic discriminants of thyroid cancer.
One hundred ten consecutive patients with histologically proved thyroid carcinoma were studied in relation to cell type, age, sex, presence of metastases, and results of thyroid scintiscanning and ultrasonography. Forty-four percent of these patients presented with a normally functioning, or warm, nodule on scintiscan. Nineteen percent presented with ultrasonographic findings of a cystic lesion. The physiologic circumstances that explain these findings have been discussed. On the basis of this study, as well as other reported series, it is concluded that both scintiscanning and ultrasonography are not reliable discriminants in the diagnosis of thyroid cancer.
Diagnosis, Differential↗
Studies on the attenuation of the Sabin type 3 oral polio vaccine.
The genetic basis of attenuation of the poliovirus type 3 vaccine strain P3/Leon 12a1b has been investigated by comparing the nucleotide sequence of this strain with that of its neurovirulent progenitor P3/Leon/37 and by constructing recombinants between these two viruses using infectious cDNAs. Preliminary results suggest that attenuation is caused by just two point mutations, one occurring in the 5' non-coding region and the other causing an amino acid change in coat protein VP3.
Base Sequence↗
Synovial chondromatosis presenting with peripheral nerve compression--a report of two cases.
We report two cases of synovial chondromatosis presenting with peripheral nerve compression syndromes involving respectively the median nerve at the wrist and the posterior interosseous nerve at the elbow. Only one previous instance of nerve compression due to this condition has been described, involving the ulnar nerve at the elbow. In one of our cases the disease process was at an early stage in its natural history and in the other at an advanced stage. The occurrence of nerve compression was related to the site rather than the stage of the disease. Full recovery followed local excision with decompression of the peripheral nerve involved.
Aged↗
Use of an abdominal rotation flap for inguinal lymph node dissection.
In order to reduce the incidence of skin edge necrosis following dissection of the inguinal lymph nodes, an abdominal rotation flap has been used to help with closure. This allows excision of the most vulnerable skin, and closure without tension. Our experience in 13 groin dissections is presented, with skin edge necrosis in one patient (7.6%). This is compared with previously reported series and the reasons for the precarious blood supply to the skin following groin dissection are discussed.
Adult↗
Management of women with abnormal cervical smears: supplement to terminology in gynaecological cytopathology.
Recommendations are made for the management of patients with abnormal cervical smears. Colposcopic examination is indicated for persistent mild and moderate dyskaryosis, as well as for severe dyskaryosis.
Colposcopy↗
The role of bone and liver scans in surveying patients with breast cancer for metastatic disease.
The objective of this study is to correlate the presence of bone and liver metastases in patients with breast cancer with respect to the results of bone and liver scans, axillary nodal status, and serum alkaline phosphatase levels. One hundred ninety-seven patients with breast cancer treated by modified radical mastectomy between the years 1978 and 1981 were studied. Fifty-nine (30%) of the total group had distant metastases during the course of observation of 60 to 96 months; of 35 patients in whom bone metastases developed, 30 had normal preoperative bone scan results. Of 21 patients who had liver metastases, 19 had normal preoperative liver scans. Nineteen (70%) of the 27 patients with abnormal bone scans had normal alkaline phosphatase levels. Seven (63%) of the 11 patients who had abnormal liver scans had a normal alkaline phosphatase. The study supports the concept that preoperative bone and liver scans are ineffective indicators of metastatic involvement. Selection of patients for screening by bone and liver scans according to alkaline phosphatase determinations was not supported by this study. The appropriate use of bone scans for screening in patients with breast carcinoma is suggested as a follow-up device in patients with positive lymph nodes.
Alkaline Phosphatase↗