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H D Appelman

Publications and source records attributed to H D Appelman.

At least 73 records · Page 4Linked to original sources
PubMed1987

Quantification of IgG-containing plasma cells as an adjunct to histopathology in distinguishing acute self-limited colitis from active idiopathic inflammatory bowel disease.

ASLC is clinically and endoscopically similar to active idiopathic IBD, especially ulcerative colitis. While several histopathologic criteria have been described which are useful in distinguishing these conditions, the diagnosis can still be difficult. In this study, we review the use of immunofluorescence on formalin-fixed paraffin-embedded biopsies from patients with ASLC. While tissues from active IBD have a striking increase in the number of IgG- and a lesser increase in the IgA- and IgM-containing plasma cells in the lamina propria, tissues from ASLC have normal numbers of IgG-containing cells with only a slight increase in IgA- and IgM-containing cells. The use of immunofluorescence on these tissues can provide quantifiable information which may be a helpful diagnostic adjunct in distinguishing these alternatives if histopathologic evaluation is equivocal.

Colitis↗
PubMed1987

A study of the correlation between endoscopic and histological diagnoses in gastroduodenitis.

Serial histological specimens from 14 patients with the endoscopic diagnosis of erosive gastritis and/or duodenitis were examined for correlation between endoscopic and histological findings. All patients were symptomatic outpatients without history of alcoholism or usage of aspirin or nonsteroidal antiinflammatory drugs. After the initial diagnosis, the patients underwent follow-up endoscopy until healing of erosions at 1, 4, and 8 wk. Pairs of biopsies from the gastric fundus, body, and antrum, and the duodenum were obtained at each endoscopy. Agreement between histological and endoscopic findings occurred in only 56% of the 161 sites studied. The best correlation occurred in the duodenum when there was endoscopic disease (89%) and was worst in the stomach at all sites regardless of endoscopic findings (46%). A normal histology in the face of abnormal endoscopic changes was seen in only 16% of all biopsies. Histological inflammation occurred in 27% of all biopsies with a normal endoscopic appearance and in 55% of the normal endoscopic areas in the stomach. Histological appearances at each biopsy site remained constant in individual patients throughout the study. The specific histological findings, such as activity and severity, did not correlate with the endoscopic severity of inflammation or with any specific endoscopic appearances, such as erosions, petechiae, or nodules. In conclusion, the histological and endoscopic findings in the stomach from patients with symptomatic erosive gastroduodenitis correlate poorly while good correlation occurs in the duodenum.

Adolescent↗
PubMed1987

Optimizing surgical management of symptomatic solitary hepatic cysts.

Four men and six women with symptomatic solitary hepatic cysts were encountered over an 11-year period. Average age was 49 years (range, 10 months to 67 years). Most common clinical features included right upper quadrant (RUQ) pain, a palpable RUQ mass and early postprandial satiety. Liver function studies were uniformly normal. Ultrasound and computerized tomography CT were virtually diagnostic alone or in combination. Eight patients had unilocular, simple cysts and two patients had multilocular complex cysts also designated as biliary cystadenomas. Cysts recurred in four patients treated surgically by needle aspiration, incision, and internal drainage or external catheter drainage. All four patients required reoperation, which included hepatic lobectomy in three patients and extensive unroofing in one patient. No cysts have recurred in six patients treated by extensive unroofing or excision of the cyst and none has required reoperation. One patient who underwent hepatic lobectomy for cyst recurrence after an inadequate primary procedure was found to have an unsuspected carcinoma in the cyst wall. The conclusion is that extensive unroofing of unilocular solitary hepatic cysts minimizes the likelihood of cyst recurrence and obviates the need for hepatic resection. Total cyst excision is indicated for all multiloculated cysts to avoid overlooking a biliary cystadenoma or for unilocular cysts if the biopsy specimen of the cyst wall demonstrates an unsuspected neoplasm.

Adult↗
PubMed1986

Smooth muscle tumors of the gastrointestinal tract. What we know now that Stout didn't know.

Arthur Purdy Stout and his co-workers, in several publications, raised two important issues concerning gut stromal tumors. First, they felt that all were of smooth muscle origin. Recent ultrastructural and immunohistochemical studies suggest that the component cells are basically undifferentiated, and there is only occasional emergence of smooth muscle features and, in some tumors, possibly features of other cell types as well, such as Schwann cells. Second, Stout felt that the high mitotic rate was the best predictor of malignancy, but he recognized that some tumors, even with low rates, could metastasize. Surprisingly, recent studies, even those covering large series, have done little to dispute these contentions. However, current data suggest that the diagnosis of malignancy can be made using multiple parameters, not all of which must be present in every sarcoma. These parameters include, in addition to mitotic rate, the size, gross invasion of adjacent organs, and cellularity, and all of these must be modified according to the location in the gut and the pattern of growth.

Anaplasia↗
PubMed1986

Adenocarcinoma of the distal esophagus and gastric cardia. Comparison of results of transhiatal esophagectomy and thoracoabdominal esophagogastrectomy.

Between 1965 and 1984, 72 patients underwent operation for adenocarcinoma of the distal esophagus or gastric cardia. A standard transthoracic esophagogastrectomy and esophagogastrostomy was performed in 43 and a transhiatal esophagectomy without thoracotomy and partial proximal gastrectomy was performed in 29. There was no significant difference between the two groups in age, sex, or TNM tumor staging. The perioperative complication rate was 86% in the esophagogastrectomy patients and 48% in the transhiatal esophagectomy patients (p less than 0.05). Mortality was higher in the esophagogastrectomy group (14%) than in the transhiatal esophagectomy group (7%). Average operative blood loss was greater in the esophagogastrectomy patients (2,510 versus 1,187 ml). Average postoperative hospitalization was longer for the esophagogastrectomy patients (22.2 days versus 12.3 days). Both differences are statistically significant (p less than 0.05). Late results, as evaluated by life-table analysis, showed no significant difference in survival between the two groups of patients. Because the morbidity and mortality rates of transhiatal esophagectomy are as low as or lower than those for esophagogastrectomy, late survival is as good, and palliation is superior (less suture-line tumor recurrence and reflux esophagitis), we believe that transhiatal esophagectomy is the preferred operative approach in patients with adenocarcinoma of the distal esophagus or gastric cardia.

Actuarial Analysis↗
PubMed1985

Hemorrhage into a hepatic adenoma and type Ia glycogen storage disease: a case report and review of the literature.

Older patients with type I glycogen storage disease (GSD) develop hepatic adenomas that may undergo malignant transformation. Despite their similarity to oral contraceptive-related hepatic tumors, only one previous report has even mentioned hemorrhage in GSD-related hepatic tumors. We recently followed a 20-year-old patient with type Ia GSD and a 10 cm focal defect in the left lobe of the liver; angiography suggested that this was a benign adenoma. At 22 years of age, after an acute symptomatic episode, repeat studies (ultrasonography and angiography) revealed a 2 cm increase in diameter of the hepatic mass. Imminent tumor rupture was of grave concern; thus the patient was admitted to the hospital and given 2 weeks of constant glucose administration by central venous line in the hope of improving her metabolic abnormalities. After resolution of the coagulopathy and metabolic disorders, the patient safely underwent surgical enucleation of the tumor. Pathologic examination of the tumor revealed that the patient had indeed hemorrhaged into a typical hepatic adenoma that had focuses of hepatocellular dysplasia. She has done well without evidence of tumor recurrence for 3 years since the operation. We conclude that hemorrhage and malignant transformation are potential complications of GSD-related hepatic adenomas. This conclusion underscores the importance of following these patients closely as they age. Nocturnal nasogastric feeding should be considered in the hope of preventing a tumor or inducing regression. Acute symptomatic attacks should be evaluated promptly for possible tumor hemorrhage.

Adenoma↗
PubMed1984

Correlation of histopathologic evidence of disease activity with the presence of immunoglobulin-containing cells in the colons of patients with inflammatory bowel disease.

Immunofluorescence of formalin-fixed, paraffin-embedded tissues was performed to study the plasma cell population in 114 colonic specimens from 58 patients. Correlation of the histopathologic stage of disease activity with the isotypes and numbers of immunoglobulin-containing cells in the lamina propria demonstrated highly significant (P less than 0.001) increases in the mean numbers of IgG- (18-fold), IgA- (twofold) and IgM- (sixfold) containing cells in specimens from patients with active inflammatory bowel disease as compared with control specimens. Increased numbers of immunoglobulin-containing cells were uncommon in inactive inflammatory bowel disease and in reactive mucosa. No deposition of immunoglobulin-containing immune complexes was found at any stage of disease activity. These findings suggest that immune complex-mediated damage does not play a major role in the epithelial damage in inflammatory bowel disease. In future studies, it will be of importance to determine whether the antibody from immunoglobulin-containing cells seen in patients with inflammatory bowel disease can effect damage via an antibody-dependent cell-mediated cytotoxicity mechanism.

Antigen-Antibody Complex↗
PubMed1984

Solitary solid stromal gastrointestinal tumors in von Recklinghausen's disease with minimal smooth muscle differentiation.

Neurofibromatosis (von Recklinghausen's disease) is occasionally associated with large, solid stromal tumors of the gastrointestinal tract. The authors examined by electron microscopy two such cases of cellular spindle cell neoplasms of the small bowel histologically that resembled leiomyomas, in an attempt to clarify the cell of origin of these lesions. Ultrastructurally, the tumor cells predominantly contained moderate to large numbers of intracellular filaments, small cell processes, discontinuous adherent dense basement-membrane-like material, and abundant intercellular collagen. Definite fusiform dense bodies or structures highly suggestive of them and pinocytotic vesicles were seen in rare cells of each lesion after viewing multiple blocks. While patients with neurofibromatosis are certainly at risk of developing gastrointestinal Schwann cell neoplasms, these two cases suggest that they are also at risk for developing poorly differentiated stromal tumors, resembling leiomyomas by light microscopy, which may show only characteristic cytoplasmic differentiation of smooth muscle cells after ultrastructural examination of many sections.

Cell Differentiation↗
PubMed1984

Pharmacologic interventions in acute mesenteric ischemia: improved survival with intravenous glucagon, methylprednisolone, and prostacyclin.

An experimental model of acute mesenteric ischemia following 85 minutes of superior mesenteric artery (SMA) occlusion in male Wistar rats was used in this investigation. Untreated control animals had a 48-hour survival rate of 38% (n = 26), whereas sham laparotomy resulted in a 100% 48-hour survival rate (n = 10). Study groups received intravenous infusions of normal saline solution (16.6 ml/kg/hr; n = 26) or similar volumes of normal saline solution with the addition of glucagon (1.6 micrograms/kg/min; n = 26), dopamine (3.2 micrograms/kg/min; n = 26), or prostacyclin (PGI2) (10.7 ng/kg/min; n = 26). Infusions were begun 15 minutes after initiating 85 minutes of SMA occlusion and were continued for a total of 90 minutes. Glucagon increased the 48-hour survival rate to 85%, significantly greater than both control survival (p less than 0.001) and normal saline solution group survival rates (p less than 0.025). Neither normal saline solution alone nor dopamine significantly increased the 48-hour survival rate, which was 54% in both groups. The PGI2 group survival rate, 65% at 48 hours, was significantly greater than the control rate (p less than 0.05), was not statistically different from the normal saline solution group survival rate, and was 20% less than the glucagon group survival rate, the latter difference approaching statistical significance (p = 0.10). Methylprednisolone (40 mg/kg; n = 26) administered as an intravenous bolus 15 minutes after initiating SMA occlusion significantly increased the 48-hour survival rate to 73% (p less than 0.01), whereas neither intravenous heparin (150 U/kg; n = 26) nor superoxide dismutase (11,900 U/kg; n = 26) were beneficial. Glucagon, methylprednisolone, and PGI2 improved the survival rate in this model of acute mesenteric ischemia.

Animals↗
PubMed1984

Clinical, epidemiologic, and morphologic comparison between adenocarcinomas arising in Barrett's esophageal mucosa and in the gastric cardia.

Forty-nine cases of surgically resected adenocarcinomas of the gastric cardia and 23 cases of resected adenocarcinomas arising in Barrett's columnar lined lower esophagus were compared histologically and clinically. Morphologically, the two groups were almost identical in terms of pattern of growth (expansile or infiltrative), degree of differentiation, and extent of spread at the time of operation. These similarities are not surprising, as the two carcinomas arise close to each other from almost identical mucosas. The major histologic difference was the finding of much more frequent dysplasia in the adjacent Barrett's mucosa than in the surrounding cardiac mucosa, probably a reflection of the larger surface area covered by Barrett's than by cardiac mucosa. The groups differed in certain epidemiologic parameters that possibly reflected independent carcinogenetic mechanisms. Thus, although the age ranges and median ages were the same, there was a higher male predisposition among the patients with cardiac carcinoma. In addition, patients with cardiac carcinoma had a significantly higher history of heavy smoking and history of alcohol intake, whereas those with Barrett's carcinoma were much more likely to have hiatal hernias.

Adenocarcinoma↗
PubMed1983

Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications.

Assessment of epithelial dysplasia in ulcerative colitis has been hindered by inconsistencies in and disagreements about nomenclature and interpretation. To resolve these issues, pathologists from ten institutions participated in three exchanges of multiple slides and, following each exchange, in discussions of the results. A classification system for the epithelial changes that occur in ulcerative colitis was developed, which should be applicable to other forms of inflammatory bowel disease as well. The classification makes use of standardized terminology, addresses specific problem areas, and offers practical solutions. The reproducibility of the system was studied by means of examinations of both inter- and intra-observer variations. The clinical implications of the findings were incorporated into suggestions for patient management. The basis of the classification is that the term "dysplasia" is reserved for epithelial changes that are unequivocally neoplastic and may therefore give rise directly to invasive carcinoma. Specimens are categorized as negative, indefinite, or positive for dysplasia. The negative category includes all inflammatory and regenerative lesions and indicates that only continued regular surveillance is required. The indefinite category is applied to epithelial changes that appear to exceed the limits of ordinary regeneration but are insufficient for an unequivocal diagnosis of dysplasia or are associated with other features that prevent such unequivocal diagnosis. Clinically, it indicates that early repeat biopsy is often required to assess the changes more accurately. The positive category is divided into two subcategories: 1) high-grade dysplasia, for which colectomy should be strongly considered after confirmation of the diagnosis, and 2) low-grade dysplasia, which also requires confirmation and early repeat biopsy or colectomy, depending on other findings.

Biopsy↗
PubMed1983

Noncirrhotic portal hypertension: differing patterns of disease in children and adults.

Of 440 patients who underwent operative portal decompression to control variceal hemorrhage, 25 (6%) had histologically verified noncirrhotic portal hypertension (NCPH). A review of these patients identified two distinct patterns of disease. Fourteen children with an average age of 8.5 years were treated with no deaths at operation. Occlusion of the portal vein (PV) was demonstrated preoperatively or intraoperatively in 10 children (71%). Follow-up for 12 to 207 months showed that no children died of a liver-related illness and only one child (7%) developed portal-systemic encephalopathy (PSE). In contrast, 11 adults with an average age of 56 years were treated with an operative mortality rate of 18%. Occlusion of the PV was demonstrated angiographically in four adults (35%). Of nine surviving adults who were followed for 12 to 164 months, five adults (56%) manifested PSE. Intraoperative liver biopsy specimens were analyzed by light microscopy in all cases. With the possible exception of sinusoidal fibrosis and dilatation of intrahepatic portal venous radicles, no histologic discriminators of adult forms versus childhood forms were identified regardless of the status of the PV. We conclude that age stratification in patients with NCPH may provide important prognostic data regarding survival rates and the incidence of PSE after portal-systemic shunting.

Adolescent↗
PubMed1982

Papillary adenoma of the lung with lamellar and electron dense granules. An ultrastructural study.

An unusual papillary adenoma in the periphery of the lung was resected in a 25-year-old woman. Examination of the tumor showed a noninfiltrating cellular neoplasms consisting of cuboidal to columnar epithelial cells with eosinophilic granular cytoplasm and without nuclear atypia. Ultrastructurally the tumor cells had microvilli, infrequent cell junctions, and cytoplasmic dense granules and whorled lamellar membrane membrane inclusions. These findings suggest that this benign pulmonary neoplasm has morphologic characteristics consistent with a Clara Cell and alveolar type II pneumocyte differentiation. Although tumors of similar types can be experimentally induced in mice, and the light microscopic features of similar human neoplasms have been described, this is the first report of the ultrastructural characteristics of a benign human lung tumor with morphologic features resembling Clara cell and alveolar type II pneumocytes.

Adult↗
PubMed1982

The histopathologic spectrum of acute self-limited colitis (acute infectious-type colitis).

Acute self-limited colitis (ASLC) is a self-limiting diarrheal illness which is often caused by known infectious agents (Campylobacter, Salmonella, and Shigella), but many cases are of unknown etiology. This report describes the histopathologic features of acute self-limited colitis as related to its natural history. The extent of inflammation and regeneration varies with the duration of the disease. In the peak activity stage (within 0-4 days of onset of bloody diarrhea) there is mucosal edema, cryptitis, crypt ulcers, and abscesses. At the time of resolution (within 6-9 days of onset of bloody diarrhea), regenerative features become apparent along with residual focal neutrophilic cryptitis. In the latter stages of resolution, along with some regenerative features, occasional crypts with transmigrating lymphocytes may be present. A rectal biopsy is diagnostic only in the early stages of the disease. Later in the course, the rectal biopsy from patients with ASLC may be nondiagnostic or may be confused with Crohn's disease due to the persistence of focal cryptitis. In our experience, the presence of crypt distortion and basal plasmacytosis are the two most useful criteria to differentiate chronic ulcerative colitis from ASLC.

Acute Disease↗
PubMed1981

Mesenteric angiopathy, intestinal gangrene, and midgut carcinoids.

Twenty-six cases of carcinoid-related mesenteric angiopathy and intestinal infarction (three from our institution and 23 previously reported cases) were reviewed. Twenty patients presented with acute abdominal findings, including peritonitis (13 cases), intestinal obstruction (five cases), and bleeding per rectum (two cases). Fifteen patients (75%) experienced antecedent symptoms of abdominal pain and/or diarrhea, averaging 2.5 years in duration. Twelve patients (46%) exhibited symptoms of carcinoid syndrome. Mesenteric angiography in three cases demonstrated encasement and segmental branch narrowing or occlusion of major mesenteric vessels. Eleven patients underwent resection and primary bowel anastomosis with an early survival rate of 91%. Four additional patients who underwent lesser surgical procedures and five patients who did not undergo operation all died. Elastic vascular sclerosis (EVS) was identified in 19 of 22 cases with available histologic material (86%). These changes were observed in proximity to as well as distant to the primary tumor. In general, the severity of EVS did not correlate with the likelihood of gut ischemia. Although not the sole cause of intestinal gangrene in patients with midgut carcinoids, EVS may contribute significantly to the evolution of these ischemic changes.

Adult↗
PubMed1981

Inflammatory cloacogenic polyp. A unique inflammatory lesion of the anal transitional zone.

This report describes the clinical and pathologic features of eight cases of an unusual inflammatory polyp arising from the transitional zone of the anus. This lesion has been designated as the inflammatory cloacogenic polyp. Rectal bleeding is the most common presenting clinical symptom. The polyp is usually located on the anterior wall of the anal canal. Morphologically, it is characterized by a tubulovillous pattern of growth, superficial ulceration, displaced groups of crypts into submucosa, and extension of chronically inflamed fibromuscular stroma into the lamina propria. Clinical and morphologic similarities with the solitary rectal ulcer syndrome suggests that prolapse of transitional zone mucosa may be important in its pathogenesis. Simple surgical resection appears to be the treatment of choice.

Adult↗
PubMed1980

Hepatic pathology as a determinant of prognosis after portal decompression.

The status of 124 patients who had liver biopsies and underwent portal decompression was analyzed and correlated with certain clinical features and hepatic histologic findings. Child risk class, the urgency of operation, the presence of many Mallory bodies, the presence of cirrhosis and the cause of portal hypertension as determined histologically were found to correlate with prognosis. The estimate of hepatic reserve by Child risk class system and the presence of many Mallory bodies were found to have an independent predictive value. The observed differences in prognosis determined by other factors may be accounted for by variations in hepatic reserve. The presence of few or many Mallory bodies appears to be a contraindication to urgent operative portal decompression because of an exceedingly high mortality rate. In addition, the presence of many Mallory bodies regardless of Child class appears to correlate with a poor diagnosis. Since Mallory bodies may occur in all Child risk classes, preoperative liver biopsy is recommended whenever feasible to better define the actual operative risk of any portal decompressive procedure.

Biopsy↗