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Biomedical subjects

G W Moore

Publications and source records attributed to G W Moore.

At least 127 records · Page 7Linked to original sources
PubMed1983

Nonrandom distribution of metastases in neuroblastic tumors.

Metastatic behavior of neuroblastic tumors was analyzed to determine whether the secondary distribution of tumor was random, or whether the pattern of metastases was predictable and related to tumor type. The authors reviewed the 64 patients subjected to complete autopsy who had metastases from a neuroblastoma, retinoblastoma, medulloblastoma, or pinealoblastoma. The organ and tissue distribution of metastases was recorded in relation to location of primary tumor, type of therapy, survival, and presence of central nervous system metastases. Data were analyzed using chi-square contingency tables, correlation coefficients, and cluster analysis. The results indicate that: (1) the development of central nervous system metastases from neuroblastoma correlates with the pattern of extracentral nervous system metastases; (2) the pattern of tumor metastases is altered by chemotherapy and/or radiation; and (3) regardless of the site of origin, neuroblastic tumors behave in a uniform manner with a nonrandom metastatic distribution in particular tissues within the central nervous system. Cluster analysis demonstrated patterns of neuroblastoma tumor metastases which were consistent with both Hutchison and Pepper syndromes. The findings suggest that a random distribution, as might be secondary to blood flow, does not account for metastatic patterns, but rather that there are preferential patterns of growth, possibly reflecting trophic tendencies in neoplasms.

Adolescent↗
PubMed1983

Giardiasis causing urticaria in a child.

We report an association between giardiasis and chronic urticaria and review the few previous cases in the literature. An unusual aspect of our case was the intensification of the urticarial response with antiprotozoal chemotherapy. We discuss the clinical features in terms of the limited current knowledge concerning immunologic mechanisms in giardiasis and the antigenic structure of Giardia lamblia.

Child, Preschool↗
PubMed1983

Role of the vagus nerve and its recurrent laryngeal branch in the development of the human ductus arteriosus.

The reason that the normal ductus arteriosus has a muscular media, contrasting with the elastic lamellar structure of the adjacent great arteries, is unknown. We examined the hypothesis that the anatomic relationship of the ductus arteriosus to the vagus and recurrent laryngeal nerves during early development might be of importance in influencing ductal morphology. Normal human embryos from the Carnegie Embryological Collection and embryos and fetuses from the Hopkins Pathology Collection were studied microscopically, by reconstructions made from serial histologic sections, or by gross dissection. At Carnegie stage 16 the recurrent laryngeal nerves pass medially from the vagus nerve to the laryngeal area and are caudal to the bilaterally symmetric sixth aortic arches. By stage 18 the right sixth aortic arch has disappeared and the left sixth aortic arch is in a more caudal position relative to the larynx. The left vagus nerve and its recurrent laryngeal branch form a sling supporting the distal (or ductus arteriosus component) of the left sixth aortic arch. In subsequent development there is greater relative separation of the larynx and ductus arteriosus. The media of the ductus arteriosus beneath the supporting nerves is thinner and has less elastic fiber formation than the elastic lamellar media of the adjacent aortic arches. The study shows that the vagus and recurrent laryngeal nerves are in a position to provide mechanical support to the ductus arteriosus during its development and that the morphology of the media of the supported ductus arteriosus differs from that of the adjacent unsupported aortic arches. It is suggested that this local mechanical support may be the reason that the normal ductus arteriosus differentiates as a muscular artery and is therefore able to obliterate its lumen in postnatal life. Without such support the ductal media could develop the abundant elastic fibers characteristic of the normal unsupported aorta and pulmonary trunk and become an abnormal, persistently patent ductus arteriosus.

Ductus Arteriosus↗
PubMed1983

Asplenia and polysplenia malformation complexes explained by abnormal embryonic body curvature.

Asplenia and polysplenia malformation complexes characteristically have severe cardiovascular defects and visceral heterotaxy. We examined the hypothesis that the conditions may arise from an altered timing of development of embryonic body curvature: delayed in asplenia, accelerated in polysplenia. The morphologic features of the 25 patients with asplenia and 15 with polysplenia autopsied at The Johns Hopkins Hospital were determined. The time of appearance of various morphologic features and the evolution of body curvature was studied in 351 staged serially sectioned human embryos of The Carnegie Embryological Collection. All asplenia patients had severe atrioventricular canal malformations. Bilateral trilobed lungs were found in 12 patients. The polysplenia patients had severe interatrial septal defects in 10 patients; but ventricular septal defects in only six. Bilateral bilobed lungs were seen in five patients. Comparison of the time of appearance of anatomic structures in normal embryos with the observed malformations suggest that asplenia and polysplenia complexes originate in stages 13 to 15. The observations are consistent with the concept that the malformations in asplenia and polysplenia can be explained by minor alterations in the sequence of development of embryonic body curvature relative to organ maturation.

Adult↗
PubMed1983

Right ventricular infarction: role of the moderator band artery in determining infarct size.

We studied 19 patients with proximal right coronary artery occlusions associated with acute myocardial infarcts less than 30 days old. Right ventricular infarct size, determined as a percentage of right ventricular surface area, ranged from 0% to 29%. Correlation of 24 variables measuring infarct size, chamber size and coronary artery disease failed to demonstrate a significant correlation with the extent of right ventricular infarction. However, estimates of the degree of obstruction to potential collateral flow into the right coronary arterial system from the left anterior descending coronary artery, especially through the moderator band artery, showed a significant positive correlation with infarct size (p less than 0.02). Among the five patients with massive (greater than 25%) right ventricular infarction, four had significant (greater than 75%) obstruction of the left anterior descending system, resulting in potentially impaired collateral blood flow; the other patient had normal coronary arteries and embolic occlusion of the proximal right coronary artery with contraction band necrosis. The study suggests that collateral flow to the right ventricular myocardium, especially through the moderator band artery, protects against massive infarction in the presence of proximal right coronary artery occlusion.

Adult↗
PubMed1983

Patterned distribution of metastases from malignant melanoma in humans.

Malignant melanoma has an unpredictable clinical course in terms of metastatic behavior, and further understanding might lead to improved therapeutic intervention with immune agents or antagonists. To determine whether metastases show patterns or are randomly distributed, we analyzed the distributions of metastases in the 56 patients with metastatic malignant melanoma, subjected to complete autopsy at The Johns Hopkins Hospital, using parametric statistics and cluster analysis. Variables examined included age, race, sex, location of primary tumor, length of survival, mode of therapy, histology of tumor, location of metastases, and extent of tumor infiltration at each metastatic site. The results indicate that the distributions of metastases from malignant melanoma are patterned such that significant positive correlations (p less than 0.05 or better) were observed among various tissues and organs. We identified several aggregations with respect to the distributions of metastases: (a) central nervous system; (b) mesodermal; (c) endocrine; (d) reticuloendothelial; and (e) foregut. Organs and tissues comprising each aggregation were interrelated by their similar developmental origins or functions. A very highly significant negative correlation between central nervous system and hepatic metastases (p less than 0.001) was also demonstrated by cluster analysis. We concluded that the distributions of metastases from malignant melanoma are not random; the patterns of metastases may be related to the embryological derivation of tissues involved.

Adult↗
PubMed1982

Unusual cardiac malformations in splenogonadal fusion-peromelia syndrome: relationship to normal development.

A male newborn infant, studied at autopsy, showed continuous splenogonadal fusion and severe peromelia associated with an unusual, possibly unique, cardiac malformation complex. The cardiac lesions included multiple right ventricular diverticula, tricuspid atresia, mitral to semilunar valve discontinuity, and absent muscular outflow tract septum. Tabulation of the time of appearance of relevant anatomic features in 351 normal human embryos of Carnegie stages 9 through 23 showed that the teratogenic influence in the present case probably occurred by stages 16-17. The nature and distribution of lesions observed suggest that proliferating undifferentiated mesenchyme was the target of the unknown injury.

Gestational Age↗
PubMed1982

Catenoidal shape of the interventricular septum in idiopathic hypertrophic subaortic stenosis: two dimensional echocardiographic confirmation.

A catenoid is a curved surface with the property of net zero curvature at all points. Morphologic observations have suggested that the interventricular septum in idiopathic hypertrophic subaortic stenosis has a catenoid shape, (that is, concave to the left in the transverse plane and convex to the left in the sagittal plane). To determine if such a septal configuration is present in living patients, six patients with clinically diagnosed idiopathic hypertrophic subaortic stenosis were studied with phased array two dimensional echocardiography, and left ventricular wall segment curvature, thickness and motion were compared with values in six patients with left ventricular hypertrophy secondary to long-standing systemic hypertension, and in six normal subjects. A curvature thickness index was determined from the echocardiographic image for systole and diastole as: curvature thickness index equals segment thickness times the sum of curvatures in the transverse and sagittal planes. In all six patients with idiopathic hypertrophic subaortic stenosis the septum had a catenoidal configuration and showed significantly less (p less than 0.05) septal change in the curvature thickness index during the cardiac cycle than it did in the control groups. In contrast, the left ventricular free wall had significantly greater (p less than 0.05) change of curvature thickness index over the cardiac cycle in patients with idiopathic hypertrophic subaortic stenosis. The hyperkinetic free wall motion seemed to account in part for systolic anterior motion of the anterior mitral leaflet as part of the displacement of the entire mitral apparatus. The catenoid shape of the septum observed in idiopathic hypertrophic subaortic stenosis may account for asymmetric hypertrophy and septal immobility, because a ventricular segment with net zero curvature would develop internal tension but have isometric contraction.

Adolescent↗
PubMed1982

Gonadal morphology in patients receiving chemotherapy for leukemia. Evidence for reproductive potential and against a testicular tumor sanctuary.

To evaluate the possible reproductive potential in patients who receive chemotherapy for leukemia, we reviewed the gonadal histologic findings at autopsy in 183 treated leukemic patients and in 183 age- and sex-matched control subjects. The 103 male leukemic patients had significantly reduced spermatogenic activity and tubular fertility index and increased interstitial fibrosis as compared with control subjects (p less than 0.001). The 80 females had marked reduction of secondary follicles (p less than 0.001). These lesions showed no predilection for grouping by sexual maturity or by leukemia diagnosis. There was no correlation with the type of chemotherapy or time since last dose of any antileukemic agent. Despite these extensive pathologic changes, there was histologic evidence of residual reproductive potential--a tubular fertility index greater than zero in 65 percent of males and intact primary follicles in 81 percent of premenopausal females. Testicular leukemia was present in 25 percent of males; all of the patients with testicular leukemia had additional foci of leukemia in other organs. The study shows histologic evidence of possible reproductive potential in treated leukemic patients of both sexes and does not support the concept of the testis as a tumor sanctuary in leukemia.

Adolescent↗
PubMed1982

Correlation of intraventricular pressures at catheterization with postmortem ventricular curvature-thickness indexes in human hearts with aortic valve dysfunction.

It has been proposed that the pressure-producing activity of the ventricular wall segments, left and right free walls, and interventricular septum can be characterized by a curvature-thickness index (CTI) derived from the Laplace relation. Thirty patients with isolated aortic valve disease were examined clinically by cardiac catheterization and at autopsy after coronary arteriography and fixation of the heart in distention. The CTI for each segment was determined from wall thickness on postmortem radiographs, which is considered to represent tension in the Laplace relation, and from curvatures. The left ventricular shape was determined as the ratio of maximal diameter to chamber length. Segment CTIs were compared with peak systolic pressure in the respective chamber or with right and left ventricular pressure differences for the septum. A significant correlation was found between peak pressure and the CTI for ventricular free walls (r = 0.933, P less than 0.001), which was not improved by including ventricular distention as a predictor in a multivariate linear regression analysis. The left ventricular diameter-to-length ratio varied from 0.63 to 0.83 (average 0.74) and showed no significant differences related to type of aortic valve dysfunction. The results suggest that the CTI could serve as a useful index for evaluation of interventricular pressure and might be applicable to noninvasive diagnostic methods as well as postmortem studies.

Adolescent↗
PubMed1982

Morphologic evidence for coronary artery spasm in eclampsia.

Vascular spasm has been considered to be an important component of the eclamptic state. If this abnormal vascular reactivity affects the coronary arteries in eclampsia, one might expect to find areas of myocardial contraction band necrosis, a lesion secondary to coronary reflow after periods of no flow. We reviewed the cardiac findings in the 34 patients with fatal eclampsia (hypertension, edema, proteinuria, and convulsions without evident cause) autopsied at The Johns Hopkins Hospital since 1899, and compared each with the next pregnant or puerperal nontoxemic autopsied patient. The eclamptic patients were 15-45 years old (average 27 years). Convulsions began antepartum in 21 patients, intrapartum in eight, and postpartum in five. The hearts weighed 200-407 g (average 312 g). One heart had rheumatic valvular disease and one had myocarditis. Histologic study of heart sections showed the presence of contraction band necrosis in 12 cases (35%). The control cases included two patients with rheumatic valvular disease, two with endocarditis, two with myocarditis, two with pericarditis, and one with leukemic infiltration. Only one control patient (3%) had contraction band necrosis (p less than 0.001). The frequent occurrence of myocardial contraction band necrosis suggests that coronary artery spasm may be common in patients who die with eclampsia.

Adolescent↗
PubMed1982

Pulmonary artery atherosclerosis: correlation with systemic atherosclerosis and hypertensive pulmonary vascular disease.

Atherosclerosis of the pulmonary arteries is a common autopsy finding and is associated with a variety of clinical conditions. To delineate the morphologic changes associated with pulmonary artery atherosclerosis, autopsies of 337 consecutive adults (greater than 15 years of age) were studied. For each, 35 features were studied, including age, coronary vascular disease, cardiac chamber hypertrophy and dilation, pulmonary artery and aortic atherosclerosis, and pulmonary thromboemboli and emphysema. These were compared using correlation coefficients and forward and backward stepwise regression procedures for selected variables. Pulmonary artery atherosclerosis correlated significantly with age, right ventricular dilation and hypertrophy, pulmonary emphysema, and aortic atherosclerosis. Regional evaluations of systemic and pulmonary atherosclerosis showed highly significant internal correlations. In the ligamentum arteriosum, the intensity of atherosclerosis over the aortic insertion correlated with the severity of a similar atheroma at the pulmonary artery insertion. With the multiple-regression procedure, pulmonary artery atherosclerosis was a significant predictor of aortic atherosclerosis, right ventricular hypertrophy, and pulmonary embolization. Our study shows that pulmonary embolization. Our study shows that pulmonary embolization. Our study shows that pulmonary artery atherosclerosis is accelerated in patients with atherosclerosis of the systemic arteries and the pathologic lesions associated with hypertensive pulmonary vascular disease.

Adolescent↗
PubMed1981

Coronary artery bypass grafts in 109 autopsied patients. Statistical analysis of graft and anastomosis patency and regional myocardial injury.

The natural history of coronary artery bypass grafts (CABGs) is poorly understood. In 109 hearts with CABGs, examined after postmortem coronary arteriography and fixation in distention from patients autopsied at The Johns Hopkins Hospital, we studied the 236 grafted coronary arteries for graft and anastomosis patency and operative myocardial injury in the distribution of the distal anastomosis. Of the 30 patients who died at operation, 71 of 72 (99%) had patent grafts; of 61 who died within one month, 120 of 131 (92%) had patent grafts; and of 18 who died one to 70 months after surgery 20 of 33 (61%) had patent grafts. The distal anastomosis site was open in 184 of 211 (87%) patent grafts but in only 13 of 25 (52%) nonpatent grafts. Regional contraction-band necrosis was found in 83 of 184 (45%) with patent graft and distal anastomosis, but in only 11 of 52 (21%) that were closed. Five closed distal anastomoses, but none that were open, had coagulation necrosis. Since the introduction of cold potassium chloride cardioplegia, significantly less regional contraction-band necrosis (19 of 79) (24%) was found than before (80 of 157) (51%). The results of this study show less CABG patency in long-term survivors; association of regional contraction-band necrosis with patent grafts and of coagulation necrosis with closed grafts; and less operative myocardial injury with current surgical technique.

Angina Pectoris↗