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Biomedical subjects

G W Moore

Publications and source records attributed to G W Moore.

At least 73 records · Page 4Linked to original sources
PubMed1989

The pulmonary vasculature in meconium aspiration.

Some studies have suggested that pulmonary hypertension in the newborn with meconium aspiration can be attributed to a primary prenatal increase in pulmonary arterial musculature; but this concept has been controversial. To examine this question, we reviewed 62 infants autopsied at The Johns Hopkins Hospital, 24 of whom demonstrated meconium aspiration, 20 with meconium staining but no aspiration, and 18 with abruptio placentae without meconium aspiration or staining. Clinical and pathologic features were evaluated and cross-sectional arterial medial area was determined at the junction of the conducting and respiratory airways in nondistended lungs. No significant difference in arterial medial area was found between infants with meconium aspiration and those with meconium staining only or abruptio placentae. In addition, circumferentially muscularized intraacinar arteries were present in all infants with meconium aspiration and abruptio placentae, and all but one infant with meconium staining alone. Comparison of lungs with and without arterial injection and fixation in distention showed that injection does not uniformly distend vessels and that formalin distention may remove or mask meconium. The study suggests that meconium aspiration and its complications, not primary structural arterial changes, account for pulmonary hypertension in infants with meconium aspiration.

Arterioles↗
PubMed1989

Pulmonary disease associated with pleural "asbestos" plaques.

The diagnosis of asbestos-related pulmonary disease is frequently based in part on the identification of pleural plaques; however, postmortem observations have suggested that pleural plaques may occur without associated pulmonary disease. To examine this issue, we compared the pulmonary parenchymal pathology in 93 patients with pleural plaques to 93 control patients matched for age, race, and sex, all autopsied at The Johns Hopkins Hospital between Jan 1, 1981 and March 31, 1986. Pulmonary sections were graded without knowledge of the patient's group for peribronchiolar fibrosis, other types of fibrosis, emphysema, and pleural changes. Correlations were found between the presence of pleural plaques and peribronchiolar fibrosis (p less than 0.001), alveolar fibrosis (p less than 0.05), large scars (p less than 0.02), scar-related emphysema (p less than 0.02), and pleural thickening (p less than 0.005). A history of smoking was also associated with pleural plaques (p less than 0.05). Interstitial fibrosis was not significantly different between the two groups. Peribronchiolar fibrosis was neither universally nor exclusively present in patients with pleural plaques, being found in 49 (53 percent) of 93 subjects with and 36 (39 percent) of 93 subjects without plaques. The results suggest that caution must be exercised in extrapolating from the identification of pleural plaques to a diagnosis of asbestos-related pulmonary disease.

Adult↗
PubMed1989

Racial differences in the etiology of dementia and frequency of Alzheimer lesions in the brain.

Empirical observations suggest a preponderance of cases of sporadic Alzheimer's disease among whites relative to blacks. If true, this might indicate a genetic basis for non-familial Alzheimer's disease. Among 6,000 consecutive autopsies performed at The Johns Hopkins Hospital, 242 adults with dementia were identified. The 98 consultation cases were excluded from the data analysis because of potential selection bias. Among the remaining 144 cases, the proportions of whites and blacks were similar, yet the frequency of Alzheimer's disease was 2.6 times higher among whites (P = 0.001), dementia due to Parkinson's disease was more frequent among whites (P = 0.05), and the frequencies of multi-infarct dementia and dementia due to chronic ethanol abuse were higher among blacks (P = 0.004 and P = 0.007, respectively). Moreover, in brains from neurologically intact controls, incidental histologic lesions of Alzheimer's disease were observed more frequently in whites than blacks (P = 0.01). These findings provide a strong argument in favor of genetic transmission of sporadic Alzheimer's disease.

Aged↗
PubMed1988

Altered metastatic behavior of small cell carcinoma of the lung after chemotherapy and radiation.

Heterogeneity of malignant neoplasms is a recognized phenomenon now, but the implications of this with respect to the responsiveness of carcinomas to different modes of therapy are not known. To examine this question, we reviewed the clinical and pathologic features of 85 autopsied patients with small cell carcinoma of the lung. Patients who were treated with chemotherapy plus radiation survived significantly longer than all other patients (P less than 0.005), but there were no significant differences in the mean number of metastatic sites or overall tumor burden at autopsy. Patients who were treated with chemotherapy only had significantly more frequent (P less than 0.05) and more extensive (P less than 0.005) metastases to the leptomeninges, more frequent metastases to other sites within the lungs (P less than 0.05), and less frequent metastases to the adrenal glands (P less than 0.01) and pancreas (P less than 0.05). The patients who were treated with radiation only had more extensive metastases to the adrenal glands (P less than 0.005), and more frequent metastases to the pancreas (P less than 0.001), colon (P less than 0.01), and cerebral white matter (P less than 0.05). The patients who were treated with both chemotherapy and radiation had more frequent and more extensive metastases to the gastrointestinal tract (P less than 0.05) and serosal surfaces (P less than 0.01), but not to any site within the central nervous system (CNS). The latter suggests that prophylactic treatment of the CNS may not be necessary to prolong survival when patients are treated with both chemotherapy and radiation. The results also suggest that although chemotherapy and radiation may prolong survival in patients with small cell carcinoma of the lung, these forms of treatment change the biologic behavior of the tumors by eliminating certain clones that are distinguishable by their metastatic patterns.

Autopsy↗
PubMed1988

Computer ranking of the sequence of appearance of 40 features of the brain and related structures in staged human embryos during the seventh week of development.

The sequence of events in the development of the brain in human embryos, already published for stages 8-17, is here continued for stages 18 and 19. With the aid of a computerized bubble-sort algorithm, 58 individual embryos were ranked in ascending order of the features present. The increasing structural complexity provided 40 new features in these two stages. The chief characteristics of stage 18 (approximately 44 postovulatory days) are rapidly growing basal nuclei; appearance of the extraventricular bulge of the cerebellum (flocculus), of the superior cerebellar peduncle, and of follicles in the epiphysis cerebri; and the presence of vomeronasal organ and ganglion, of the bucconasal membrane, and of isolated semicircular ducts. The main features of stage 19 (approximately 48 days) are the cochlear nuclei, the ganglion of the nervus terminalis, nuclei of the prosencephalic septum, the appearance of the subcommissural organ, the presence of villi in the choroid plexuses of the fourth and lateral ventricles, and the stria medullaris thalami.

Brain↗
PubMed1988

Influence of age on the metastatic behavior of breast carcinoma.

The effects of aging on the biologic behavior of malignant neoplasms are poorly understood. To examine the question of a possible age effect on the metastatic behavior of tumors, we reviewed the clinical histories, autopsy protocols, and histologic slides of 187 patients with metastatic breast carcinoma who were subjected to complete autopsy at The Johns Hopkins Hospital. Patients were categorized in four groups according to the age of onset of breast carcinoma: group I had 12 young patients (less than 40 years old); group II had 41 patients, 40 to 46 years old, considered to be premenopausal; group II had 89 patients, 47 to 60 years old, considered to be early postmenopausal; and group IV had 45 patients over 60 years old, considered to be late postmenopausal. Group II patients survived about 50% longer than group III or IV patients (p less than 0.05), and groups I, II, and III patients had significantly greater numbers of metastases than group IV patients (p less than 0.05). There was a progressive decline in the frequencies of metastases in several locations as a function of age, such that group I and II patients had significantly more frequent metastases to the central nervous system (p less than 0.05), endocrine organs (p less than 0.01), ovary (p less than 0.05), pancreas (p less than 0.01), and gastrointestinal tract (p less than 0.05) than patients in group III or IV. These differences in number and distribution of metastases were not explainable on the basis of survival, therapy, or initial stage of disease. The results suggest that the process of aging may influence the metastatic behavior of breast carcinoma; hormonal and metabolic factors may be implicated.

Aging↗
PubMed1988

Development of the coronary arteries in the embryonic human heart.

It is not known why the coronary arteries almost always originate only from the right and left aortic sinuses of Valsalva, since the structure and conditions appear to be the same for all six sinuses of the embryonic great arteries. We sought a possible mechanical explanation for the phenomenon by studying the development of the coronary vasculature in 351 staged, serially sectioned human embryos of Carnegie stages 9 through 23 from the Carnegie Embryological Collection. A plexus of blind epicardial capillaries appears on the heart in Carnegie stage 14 or 15 and acquires a coronary sinus connection in stage 15, 16, or 17. The connection of the proximal coronary arteries to the aorta does not appear until stage 18. We found no histologic features of the cardiac nerves or any other component of the tissues to account for the consistent origin of coronary arteries from the right and left aortic sinuses of Valsalva. However, serial section reconstructions showed that the two sinuses where coronary arteries develop acquire a positive transverse curvature and a negative longitudinal curvature, i.e., a catenoidal or saddle-shaped configuration, before the appearance of the coronary arteries. The four noncoronary sinuses also have a positive transverse curvature, but longitudinally, in contrast, they have a positive curvature or are straight. The results suggest that the coronary arteries originate from those sinuses of Valsalva where wall tension is increased by a catenoidal configuration.

Capillaries↗
PubMed1988

Growth and asymmetry of the human liver during the embryonic period.

Previous studies had suggested that the development of asymmetry in the human liver could occur as a consequence of the earlier developing asymmetry of the heart and that the preferential right-sidedness of hepatic volume was secondary to favored venous return on the right. To examine this question we reconstructed the liver from serial histologic sections of human embryos in the Carnegie Embryological Collection of stages 11 through 23. Photomicrographs of embryo sections were projected, traced into the digitizing pad on an image analyzer microcomputer, and the liver volume and relative volumes to right and left of the median plane of the body calculated. The 38 embryos studied represent each Carnegie stage, sectioned in transverse, frontal, or sagittal (except stage 11) planes. The liver appears in stage 11 and grows to over 90 mm3 at stage 23, as the embryo enlarges from 3 to 30 mm crown-rump length (CRL). A significantly greater proportion of the liver was found on the right of the median plane in all embryos from stage 11 onward (p less than 0.001). Volume in mm3 is given by the semilogarithmic regression formulas volume = 1.49 x 10(-6)e0.826 stage, or volume = 0.0177 e0.333 CRL. Insignificant variation from the average proportion of 57.8% (SE +/- 0.8%, range 51-70%) on the right of the median plane was present throughout the embryonic period. The observation that the liver is right-sided from its first appearance is not well explained by properties of the vascular pattern. The explanation for this intrinsic hepatic asymmetry remains obscure.

Embryonic and Fetal Development↗
PubMed1988

Arrested rotation of the outflow tract may explain tetralogy of Fallot and transposition of the great arteries.

In a previous study we investigated the rapidly changing spatial relationship of the junction of the outflow tract and great arteries in normal human embryos of Carnegie stages 15 through 19. The results suggested that the malformation complexes tetralogy of Fallot and transposition of the great arteries could be accounted for as arrests in the progression of this process of rotation. To further study this question we reviewed hearts obtained at autopsy: 28 were normal, 16 had tetralogy of Fallot, and 27 had transposition of the great arteries. The angle of the aortic to pulmonary valve axis relative to the inferior surface of the heart, as viewed from apex to base, was measured from postmortem radiographs. For normal hearts the angle was 72 degrees +/- 3 SE, 48 degrees +/- 5 for tetralogy of Fallot, and 333 degrees +/- 3 for transposition of the great arteries. Although direct comparison of hearts and embryos is difficult because of the different methods of determining angles, the valve positions in normal hearts were most similar to stage 19 embryos. Likewise, hearts with tetralogy of Fallot and transposition of the great arteries resembled stages 18 and 15, respectively. The results of the two studies are consistent with the hypothesis that tetralogy of Fallot and transposition of the great arteries arise as a result of arrests in the normal rotation of the region of the junction of the outflow tract and the great arteries.

Heart↗
PubMed1988

Integrated pathology reporting, indexing, and retrieval system using natural language diagnoses.

Pathology computer systems are making increasing use of natural language diagnoses. The Johns Hopkins Medical Institutions integrated pathology reporting system, a commercial product with extensive, locally added enhancements, covers all information management functions within autopsy and surgical pathology divisions and has on-line linkages to clinical laboratory reports and the medical library's Mini-MEDLINE system. All diagnoses are written in natural language, using a word processor and spelling checker. A security system with personal passwords and different levels of access for different staff members allows reports to be signed out with an electronic signature. The system produces financial reports, overdue case reports, and Boolean searches of the database. Our experience with 128,790 consecutively entered pathology reports suggests that the greater precision of natural language diagnoses makes them the most suitable vehicle for follow-up, retrieval, and systems development functions in pathology.

Artificial Intelligence↗
PubMed1987

Computer ranking of the sequence of appearance of 73 features of the brain and related structures in staged human embryos during the sixth week of development.

The sequence of events in the development of the brain in human embryos, already published for stages 8-15, is here continued for stages 16 and 17. With the aid of a computerized bubble-sort algorithm, 71 individual embryos were ranked in ascending order of the features present. Whereas these numbered 100 in the previous study, the increasing structural complexity gave 27 new features in the two stages now under investigation. The chief characteristics of stage 16 (approximately 37 postovulatory days) are protruding basal nuclei, the caudal olfactory elevation (olfactory tubercle), the tectobulbar tracts, and ascending fibers to the cerebellum. The main features of stage 17 (approximately 41 postovulatory days) are the cortical nucleus of the amygdaloid body, an intermediate layer in the tectum mesencephali, the posterior commissure, and the habenulo-interpeduncular tract. In addition, a typical feature at stage 17 is the crescentic shape of the lens cavity.

Brain↗
PubMed1987

Partial gastrectomy: a risk factor for carcinoma of the pancreas?

Recent reports suggest an increased risk of cancer of the pancreas after partial gastrectomy. We investigated this putative relationship by performing a case-control study on autopsy subjects. Our findings suggest a three-fold risk of pancreatic carcinoma in postgastrectomy patients. Increased production of carcinogens in the gastric remnant, excretion of the carcinogens by the liver into the bile, and subsequent bile reflux into the pancreatic duct is proposed as a working hypothesis for pancreatic carcinogenesis. This study illustrates the usefulness of autopsy series as an instrument for checking a straightforward hypothesis before designing more extensive and expensive studies. Moreover, efficient use of autopsy data was accomplished by computerized data base retrieval of autopsy records, emphasizing that this method of record retrieval is an important precondition for prospective studies.

Adenocarcinoma↗
PubMed1987

Myocardial injury in patients with aortic stenosis.

Clinical studies of patients with aortic stenosis suggest that left ventricular myocardial injury is frequent. To examine the morphologic basis of this observation, we studied 32 patients with isolated aortic stenosis, no cardiac surgery, and hearts studied at autopsy after postmortem arteriography and fixation in distension. The patients were 46-87 years old (average 69), and 21 (66%) were male. Calcific aortic stenosis was present in 19 hearts, 12 had congenital bicuspid aortic valve, and 1 had rheumatic aortic stenosis. In 19 hearts there was moderate or marked coronary atherosclerosis, and 12 hearts had 17 myocardial infarcts. However, among 13 hearts with no or mild coronary atherosclerosis, 9 had either subendocardial myocardial contraction band necrosis, a lesion occurring when periods of no perfusion are followed by reflow, or focal replacement fibrosis. In 13 hearts there was subendocardial vacuolization of myocytes, an alteration produced by ischemia, that was not accounted for by coronary artery disease. Our results are consistent with clinical observations and show that ischemic myocardial injury may be associated with isolated aortic stenosis in the absence of coronary artery obstruction. The contraction band necrosis and vacuolated myocytes suggest that both episodic and sustained reductions of subendocardial blood flow occur in the presence of aortic stenosis.

Aged↗
PubMed1987

The progression of morphologic changes in bronchopulmonary dysplasia.

Review of published reports shows confusion regarding the pathologic sequelae of neonatal respiratory distress. To examine this problem the authors studied histologic slides of lung from 46 patients so diagnosed listed in the autopsy files of The Johns Hopkins Hospital. Two distinct morphologic patterns emerged. In 26 patients (Group 1) there were varying sized areas of interstitial fibrosis with associated distortion of air spaces. The process was nonspecific and closely resembled the interstitial fibrosis of varying etiologies found in adults. This lesion appears to correspond to most descriptions of bronchopulmonary dysplasia. A second process predominated in 10 patients (Group 3). There were normal conducting bronchi, marked uniform enlargement of distal air spaces, and little or no interstitial fibrosis. In 10 patients (Group 2) both lesions coexisted. To gain further insight into the morphology of these disorders, the authors reconstructed serial histologic sections of lung from three infants of varying sizes with normal lungs and infants of varying ages with bronchopulmonary dysplasia. The results confirmed the observations made on routine histologic sections by showing interstitial fibrosis in the early stages of bronchopulmonary dysplasia and a reduced number of very large terminal air spaces without interstitial fibrosis in the late stages. There were no obvious differences in the clinical courses of infants with the different morphologic stages; but Group 1 patients averaged 39 days of age, Group 2 lived 142 days, and Group 3 survived 277 days. It seems probable that early bronchopulmonary dysplasia is simply the healing of alveolar wall injury of whatever cause, most commonly hyaline membrane disease of the newborn; and that in the later phases of repair, with continuing growth, there is a thinning of airway walls, but a failure of alveolar development. Recognition of these two pathologically different patterns is important for further studies of the pathogenesis of bronchopulmonary dysplasia.

Age Factors↗
PubMed1986

Metastatic behavior of prostate cancer. Cluster analysis of patterns with respect to estrogen treatment.

The responsiveness of prostate cancer to treatment with estrogen has been recognized for over 40 years, but whether the effect is mediated by diminished tumor growth or reduction in metastatic spread is not known. To answer this question the authors reviewed the clinical and pathologic features of 89 patients with metastatic prostate cancer after autopsy. Sixty-three percent of the patients studied were black. Patients treated with estrogen survived somewhat longer (0.05 less than P less than 0.10), but they had significantly greater numbers of metastatic sites (P less than 0.001) and greater overall tumor burden (P less than 0.001), with significantly increased frequencies of metastases to the liver, adrenal gland, bone, lymph nodes, large bowel, lungs, serosal surfaces, ureters, and central nervous system (CNS) (all P less than 0.05 or lower) compared with patients who had not been treated with estrogen. However, patients not treated with estrogen more frequently died from other causes (P less than 0.001). When the patients who died from other causes were excluded from the data analysis, there were no significant differences in the number of metastatic sites between patients who received estrogen therapy and those who did not, and the only remaining significant difference in the distribution of metastases was that patients who received estrogen treatment had more frequent metastases to the adrenal cortex and CNS (P less than 0.05). These observations were corroborated by cluster analysis of the metastatic patterns. Cluster analysis also identified a subset of predominantly (67%) black patients who developed distant metastases without much local spread of tumor. This suggests that tumor behavior in this group was less predictable than for the other patients in whom disease appeared to progress from Stage A to Stage D as expected. The authors conclude that estrogen therapy may prolong survival by slowing the rate of tumor growth rather than by inhibiting the metastatic progression of prostate cancer or destroying selective populations of tumor cells.

Adenocarcinoma↗