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Biomedical subjects

E L Barnes

Publications and source records attributed to E L Barnes.

At least 37 records · Page 2Linked to original sources
PubMed1986

Pulmonary hypertension in the CREST syndrome variant of systemic sclerosis.

Pulmonary hypertension (PHT) occurred in 59 (9%) of 673 systemic sclerosis patients seen between 1963 and 1983. In 30 patients, all with the CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasias), the pulmonary hypertension was isolated, i.e., independent of other pulmonary or cardiac conditions. In 20 patients, isolated PHT was demonstrated by cardiac catheterization. All had normal or only mildly decreased lung volumes, and mild or no pulmonary interstitial fibrosis on chest roentgenogram. In comparison with 287 CREST syndrome patients without PHT, these 20 patients had markedly reduced diffusing capacity for carbon monoxide (DLCO) (mean 39% of predicted normal). In 6 patients, the low DLCO antedated clinical evidence of PHT by 1-6 years. At autopsy there was marked intimal fibrosis with hyalinization and smooth muscle hypertrophy in the small- and medium-sized arteries, without significant parenchymal fibrosis or inflammation. Patients with isolated PHT did not respond favorably to vasodilators and had a very poor prognosis, with a 2-year cumulative survival rate of 40%. A DLCO less than 45% of predicted in the absence of pulmonary interstitial fibrosis may be an important predictor of the subsequent development of isolated PHT.

Calcinosis↗
PubMed1986

Extraparotid Warthin's tumor.

Papillary cystadenoma lymphomatosum (Warthin's tumor) is a benign, slowly growing tumor found almost exclusively in the parotid gland or periparotid lymph nodes. Our experience with 14 cases of extraparotid Warthin's tumor (EPWT) over 22 years is presented. All cases occurred in extraparotid lymph nodes and represented 8.0% of 176 Warthin's tumors accessioned during this time. Fourteen cases of EPWT occurred in 13 patients (seven men and six women) between 41 and 77 years old. Three of the 13 patients (23%) had associated Warthin's tumor of the parotid gland. One of these patients also had a metachronous EPWT presented as a contralateral cervical mass. EPWT was discovered incidentally in six patients (46%) undergoing neck dissections for malignancies of the head and neck. Four patients (31%) presented with clinically evident solitary cervical masses. The embryologic basis for such findings is discussed. EPWT is adequately managed by conservative excision.

Adenolymphoma↗
PubMed1985

Cervical lymph node metastases. Incidence and implications of extracapsular carcinoma.

The incidence and prognostic significance of extracapsular spread (ECS) of tumor in cervical lymphatics was investigated. The surgical specimens from 349 patients treated for squamous cell carcinoma by radical neck dissection between 1978 and 1982 have been examined retrospectively. Follow-up data were available relative to recurrence rate, site of recurrence, and disease-free intervals. Fifty-nine percent of the patients with N1 cervical metastases had ECS. Patients were classified according to the histopathologic findings in the radical neck dissection specimens. The three groups identified were patients with normal nodes, patients with no ECS, and patients with ECS. The histopathologic evidence of ECS was associated with a statistically significant reduction in survival when compared with patients without ECS. The disease-free interval between treatment and the development of recurrent disease was shorter for patients with ECS than for patients with no ECS.

Carcinoma, Squamous Cell↗
PubMed1984

Primary carcinoma of Stensen's duct: recognition and management with literature review.

Primary carcinoma of Stensen's duct is a rare neoplasm with only 15 cases reported in the English literature since 1927. The authors present a recent additional patient and discuss their criteria for the determination of true primary ductal lesions based upon clinical presentation, operative findings, and tumor histology. This method of selection, most particularly involving electron microscopy in the reported case, is necessary to define whether the lesion originates from the ductal epithelium. All previously reported cases were reviewed, together with the actual pathologic slides in four available cases. Only ten were retained as primary ductal lesions. Most important, this analysis clarifies the natural history of these neoplasms and reinforces a recent theory of histogenesis of salivary gland tumors. In light of these findings, a rational treatment plan can be suggested.

Adult↗
PubMed1983

Clinical and serologic study of Sjögren's syndrome in patients with progressive systemic sclerosis.

Fifty-eight patients with progressive systemic sclerosis (PSS) were evaluated clinically and by biopsy of the minor salivary glands of the lips for the presence of Sjögren's syndrome. Clinical findings included dry eyes in 38%, dry mouth in 32%, parotid enlargement in 4%, and an abnormal Schirmer's test in 34%. Histologic changes in lip biopsies included lymphocytic infiltrates characteristic of Sjögren's syndrome in 17 individuals (29%). In 19 (33%) there was periglandular and intraglandular fibrosis (PSS-fibrosis) without significant inflammation, an alteration characteristic of PSS per se. In the remaining 22 patients (38%) with PSS, no abnormality was found. Of those with PSS and Sjögren's syndrome, 53% had serum antibodies to SS-A and/or SS-B, while only 1 patient with a normal biopsy had either of these antibodies. Anti-SS-A and anti-SS-B were not detected in patients with glandular fibrosis alone. The mortality rate of the PSS-fibrosis group was higher due to a variety of severe internal manifestations related to PSS. Antibodies to SS-A and SS-B are useful serologic markers of the presence of Sjögren's syndrome in patients with PSS.

Adolescent↗
PubMed1983

Scleredema adultorum of Buschke: a clinical, pathologic, and cell culture study of two patients.

Two patients with scleredema of Buschke are presented. The second patient developed scleredema after a febrile drug reaction. Biopsies of both involved and uninvolved skin were obtained for histologic examination and cell culture studies. Immunofluorescent studies of the biopsy specimens revealed staining with IgG, IgM and C3 at the dermal-epidermal junction in the involved skin of the first patient. This has not been previously reported. Cell culture studies revealed that fibroblasts from the involved skin produced more glycosaminoglycans (GAG) than uninvolved skin and most of the GAG produced was hyaluronic acid. Possible pathogenic mechanisms for this unusual condition are discussed.

Biopsy↗
PubMed1981

The extracapsular spread of tumors in cervical node metastasis.

Extracapsular spread (ECS) of lymph node metastases is believed to be an indicator of poor prognosis. In general, it has been thought that ECS was limited to large "fixed" nodes. To test the validity of the assumption that nodes less than 3 cm in diameter do not have ECS, the specimens from 177 radical neck dissections were reviewed retrospectively with regard to ECS. Sixty-five percent of the nodes that were 2.9 cm or less in diameter were found to demonstrate ECS. We found no substantial difference in the number of patients who had no histologic disease in their necks when compared with a second group of patients who had metastasis confined to the lymph node. The patients whose lesions had ECS had statistically significantly reduced numbers of survivors. Other factors, eg, tumor differentiation and the number of malignant nodes, had no prognostic importance. The impact of ECS on staging, the reporting of retrospective reviews, and therapy are discussed.

Carcinoma, Squamous Cell↗
PubMed1981

Management of inverted papilloma of the nose and paranasal sinuses.

Inverted papilloma of the nose and paranasal sinuses is a neoplastic growth of epithelium which inverts into the underlying stroma rather than proliferating outward from the surface. These neoplasms probably arise from the area of the lateral nasal wall. Inverted papilloma is characterized by its: A. capacity to destroy; B. tendency to recur; and C. association with malignancy. During the past decade, we have come to understand better the histologic, biologic, and anatomic features of this tumor. More studies focusing on inverted papilloma have been published in recent years, and the authors of these reports have advocated more aggressive surgical procedures in the management of this tumor. The application of the technique of lateral rhinotomy and en bloc excision of the lateral nasal wall has dramatically decreased the recurrence rate while providing the patient with quite acceptable cosmetic and functional results. The surgical approach to inverted papilloma associated with squamous cell carcinoma varies with the extent of disease; but a good cure rate, especially with localized tumors, may be achieved with aggressive surgery combined with radiation therapy in these cases. We present a series of 19 patients with inverted papilloma. In 6 of these 19 patients, squamous cell carcinoma was associated with the inverted papilloma; 13 of the patients with inverted papilloma and 3 of the patients with an associated malignancy underwent lateral rhinotomy with en bloc excision of the lateral nasal wall. The tumor did not recur in these patients. The rationale for this surgery, as well as the details of these patient's case histories, form the basis of this report.

Adult↗
PubMed1979

The pathologic assessment of primary hyperparathyroidism and its impact on therapy. A prospective evaluation of 50 cases with oil-red-O stain.

Normal and abnormal parathyroid glands removed surgically from 50 consecutive patients with primary hyperparathyroidism were studied by means of hematoxylin and eosin and oil-red-O stains. This was done to establish the incidence of the different pathological entities in our patient material, and to evaluate the role of the oil-red-O stain in the diagnostic histopathological process. The oil-red-O stain distinctly separates abnormally hyperfunctioning from normal or suppressed parathyroid tissue. Therefore, it is a valuable tool in the pathologic evaluation of patients with hyperparathyroidism. Chief cell adenomas were the most frequent lesions (88%), while diffuse hyperplasia was seen less commonly (10%) and carcinoma infrequently (2%). These findings justify a surgically conservative approach as the most desirable in managing patients with primary hyperparathyroidism.

Adenoma↗
PubMed1979

Hepatic adenoma associated with portasystemic shunting in a young woman.

The development of a hepatic adenoma is described in a young female of reproductive age who had documented portasystemic shunting and hyperestrogenemia. The intrinsic hyperestrogenemia and the increased hepatic arterial blood flow, both of which occurred as a result of the portasystemic shunting secondary to portal venous obstruction, may have been important factors in the development of her hepatic tumor. We would postulate that prolonged endogenous hyperestrogenemia, like exogenous sex steroids, may predispose to hepatic adenoma formation.

Adult↗
PubMed1978

Serum gastrin levels in the differential diagnosis of recurrent peptic ulceration due to retained gastric antrum.

If recurrent peptic ulceration follows partial gastrectomy with Billroth II reconstruction, retained antrum on the duodenal stump may be the culprit. Moderate hypergastrinemia and a high basal acid output (BAO) to maximal acid output (MAO) ratio on gastric analysis should alert the clinician. Careful filling of the afferent loop on barium meal or technetium 99m scanning may verify the diagnosis. The secretin provocative test may be helpful in distinguishing retained antrum from the Zollinger-Ellison syndrome by eliciting a decrease in serum gastrin levels in patients with retained antrum and an increase in serum gastrin levels in patients with Zollinger-Ellison syndrome.

Aged↗
PubMed1977

Sjögren's syndrome in progressive systemic sclerosis.

Thirty-five consecutive patients with progressive systemic sclerosis were prospectively evaluated for evidence of Sjögren's syndrome. Six of the 35 (17%) were judged to have the disorder. This is a higher prevalence than in most reports, but much lower than that recently reportedly by Alarcón-Segovia and associates (7). An additional 17 of the 35 patients (48%) had significant fibrosis in the absence of sufficient mononuclear cell infiltrates to confirm the diagnosis of Sjögren's syndrome. This group had particularly aggressive scleroderma with serious visceral features, and five died after a short duration of illness. No significant abnormalities were found in biopsies from six patients with the mixed connective tissue disease syndrome, five with Raynaud's phenomenon alone, or in 29 autopsy control subjects who had no evidence of connective tissue disease. Fibrosis in the absence of mononuclear infiltration in minor salivary glands of patients with progressive systemic sclerosis indicates a poor prognosis.

Adult↗
PubMed1976

Metastasis of malignant melanoma of the nasal mucosa to the small intestine.

Malignant melanoma of the mucous membranes is rare and has a very poor prognosis. When localized in the nose, the tumor becomes apparent late in the course of the disease with nasal obstruction and epistaxis. Distant metastases are uncommon, but any organ of the body can be involved. A case of a malignant melanoma of the nasal mucosa with metastasis to the small intestine is presented, and the natural history of the metastatic disease is discussed.

Aged↗
PubMed1975

Necrotizing sialometaplasia. Report of a case.

Necrotizing sialometaplasia occurred in a 46-year-old woman. This is an uncommon benign disease that typically begins with an ulcerated lesion on the hard palate and surrounding tissues. Clinical and microscopic findings show obvious similarity with a malignant neoplasm. Necrotizing sialometapiasis is a benign minor salivary gland disease. It is important since it may easily be confused with squamous cell carcinoma and mucoepidermoid carcinoma.

Carcinoma↗
PubMedDate not supplied

Squamous cell carcinoma arising in Hashimoto's thyroiditis.

The case of a 76-year-old white woman with squamous cell carcinoma of the thyroid gland arising in a background of Hashimoto's thyroiditis is presented. Squamous cell carcinoma of the thyroid gland is a very rare and aggressive tumor, and only a few cases are reported as arising in Hashimoto's thyroiditis. Although Hashimoto's thyroiditis alone does not necessarily predispose patients to malignancy, the finding of a prominent nodule in such a patient should suggest the possibility of malignancy, and an aggressive search and treatment regimen, including surgical intervention, should be pursued.

Aged↗