Biomedical subjects
Publications and source records attributed to H Johnson.
Sarcomas of the external genitalia are rare. The first known case of leiomyosarcoma of the scrotum is reported, and its treatment described. Long-term follow-up is documented and the world literature is reviewed.
Steroid hormone receptors were studied in 42 patients with primary, recurrent or metastatic breast cancer in cryostat frozen section and imprint preparations. The ligands, 17 B-estradiol-6-carboxymethyloxine-bovine serum album fluorescein isothiocyanate (FITC-BSA estradiol) and hydroxyprogesterone-hemisuccinate bovine serum album tetramethylrhodamine isothiocyanate (TMRITC-BSA progesterone) were used in the fluorescent cytochemical method. Results were compared with standard dextran-coated charcoal (DCC) biochemical assay. Overall, significant correlation between biochemical values and cytochemical fluorescence results was found. However, the imprint results were more sensitive and more specific than the frozen section results. A statistically significant difference (P less than 0.05) was observed between touch preparation material and frozen section specimens by the fluorescent method.
The estrogen receptor (ER) status of breast cancer is important as an indicator of prognosis and in the selection of patients for endocrine therapy. Biochemical techniques (estrogen receptor analysis [ERA]) are conventionally used to determine ER; however, they have limitations and disadvantages. In this study a monoclonal antibody to ER (estrogen receptor-immunochemical assay [ERICA]) was used to detect the presence of ER on cytologic and frozen tissue specimens of breast cancers and was compared with the dextran-coated charcoal assay. One hundred two breast cancers were studied. Ninety-four specimens were studied by ERA and ERICA; in eight patients in whom tissue was insufficient for ERA, ERICA alone was performed. ERICA correlated remarkably well with ERA: 94% sensitivity, 89% specificity, and 93% accuracy. In the eight patients in whom ERA could not be performed, ERICA was successfully applied to obtain information regarding receptor status. There was uniform agreement between frozen-sectioned tissues and cytologic smears. The results suggest that immunocytochemical determination of ER is a valuable adjunct and/or alternative to the biochemical method for determination of the ER status of breast cancers.
Three hundred ninety-five patients with colon cancer were identified from a community hospital tumor registry and the sites of their primary tumors determined. Two defined anatomical sites (right and sigmoid colons) and two regional anatomical areas (proximal colon including splenic flexure and distal colon) were used to tabulate the location of primary tumors. Patients were categorized into racial subgroups. Significant differences were found in the occurrence of primary tumors. Of all colonic cancers in whites, 50.9% developed in the sigmoid colon compared with 36.6% in blacks (P = 0.0047). Of all colonic cancers in blacks, 35.3% developed in the right colon vs 24.5% in whites (P = 0.02). Biological variables probably determine the differences. Black females and white males depicted age-incidence data that varied from expectations.
The occurrence of nodular renal blastema and renal dysplasia was determined in a retrospective study of 75 cases of congenital obstructive uropathy. Nodular renal blastema was present in 3 upper pole nephrectomy specimens removed as a consequence of nonfunction owing to ectopic ureterocele; none was dysplastic. A more differentiated type of nodular renal blastema was present in 3 other total nephrectomy specimens, bilateral involvement in a case of posterior urethral valves and unilateral nodular renal blastema associated with ureteral atresia. This subset of differentiated nodular renal blastema was associated with renal dysplasia.
Although nonoperative management is the standard initial treatment in children with splenic injury, this therapeutic option has been exercised infrequently in adults. Over the past two years we have hospitalized and observed 11 hemodynamically stable adults with splenic trauma and no other significant injury. Ten patients sustained blunt trauma localized to the left upper quadrant, and one patient was stabbed in the left flank. Eight patients were normotensive on hospital arrival, while three had an initial systolic blood pressure of 90 to 98 mm Hg. All patients remained normotensive after receiving 2 liters of crystalloid fluid IV. Nine patients had an initial hemoglobin level of 11.1 to 14.0 gm/dl, and two a level of less than 10 gm/dl. Liver-spleen scan done in ten patients yielded true-positive results in eight, false-positive results in one, and false-negative results in one. In the 11th patient, a celiac arteriogram showed a splenic defect. Three patients had laparotomy 27 to 43 hours after hospitalization, owing to a decreasing hemoglobin concentration; one required partial splenectomy. Eight patients were successfully managed nonoperatively; only one required blood transfusion, and all tolerated oral alimentation by the second hospital day. All patients were discharged by the 12th hospital day. Nonoperative management can be successfully applied to adults with isolated splenic trauma.
Aspirin is generally regarded as a cause of gastric ulcer but the role of non-steroidal anti-inflammatory agents and paracetamol in the aetiology of peptic ulcer is unclear. To investigate this we conducted a case control study of 180 matched pairs of peptic ulcer patients and controls obtained from surgical and dermatology outpatient clinics. There were 95 gastric ulcer and 85 duodenal ulcer patients. A statistically and clinically association (relative risk = 5) was found between the regular use of non-steroidal anti-inflammatory agents and gastric ulcer. There was also evidence of positive associations between gastric ulcer and aspirin containing preparations with or without non-steroidal anti-inflammatory agents. By contrast, duodenal ulcer was unrelated to these drugs. Too few patients used paracetamol for any conclusion to be drawn on its role.
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We studied 299 consecutive male 28-day survivors of unstable angina or myocardial infarction aged under 60 years to examine the relationship between social class and initial risk factors, change in risk-factors at one year follow-up, return to work, and 3-year mortality. There was a significant correlation between smoking on admission and social class, with 80% of lower and 31% of upper classes being current smokers. Daily cigarette consumption among smokers was significantly higher in lower-class patients. Lower-class patients also had a significantly higher weekly alcohol intake. Although the proportion of hypertensives did not vary with social class, mean in-hospital blood pressure was higher in lower-class patients. Social class bore no relationship to amount of leisure exercise, serum cholesterol or degree of overweight. There was a 90% 1-year return to work overall, and while there was no relationship between social class and eventual re-employment, lower-class patients took significantly longer to return to work. There were highly significant associations between social class and successful smoking cessation, increase in leisure exercise and weight reduction over the first year after discharge. There was no significant association between social class and 3-year mortality.
Interposition of a segment of terminal ileum into the proximal jejunum has been shown to cause weight loss and hypertrophy of the pancreas and intestines of rats. To further evaluate the potential of ileal interposition as an anti-obesity procedure, weight loss, liver histology and intestinal morphology were studied in normal adult mongrel dogs. A 40 to 45-cm segment of distal ileum was transposed isoperistaltically on its vascular pedicle to the proximal jejunum (n = 14). Control dogs (n = 4) underwent transection and reanastomosis without interposition. Interposition resulted in a mean weight loss of 3.9 kg or 16 percent of body weight, over a 12-week period compared to a mean gain of 2.6 kg (11 percent of preop.) in the controls (P less than 0.025). Liver histology (n = 3) showed minimal fatty infiltration in one dog. Grossly, the transposed ileal segment did not show any consistent elongation or thickening of the bowel wall. Microscopically, there was complete jejunalization of the mucosa of the ileal segment which was indistinguishable histologically from the adjacent jejunal mucosa. Because of the variability of the weight response (-8.6 to +0.9 kg), further studies are required to evaluate the potential of this experimental procedure to achieve weight loss.
The tumor registry of a community hospital has been reviewed, and 60 patients with untreated colon and rectal cancer have been identified. Thirty-four patients were black and 26 patients were white. Sixty-five percent of black patients had specified colonic lesions primarily distributed in the right colon and proximal to the splenic flexure. Sixty-three percent of white patients had specified lesions localized to the sigmoid colon. The patients had disease in local, regional, and disseminated stages, and lethality was associated with all stages. Forty-eight percent of patients expired in less than 30 days after presenting to the hospital, and two-thirds expired between 1 and 2 months of presentation. Only two patients survived more than 1 year. These data suggest that untreated colorectal cancer will be nearly uniformly fatal early in all patients who go untreated.
One hundred patients admitted to coronary care with unstable angina were followed for a period of 1 year. A conservative approach to treatment was adopted. Routine beta blockers, calcium antagonists, and anticoagulants were not employed. Patients with persistent pain following admission were treated with nitrates only and with symptomatic treatment. One death and nine nonfatal infarctions occurred within the first 28 days after admission. A total of eight deaths, 14 nonfatal infarctions, and three readmissions for unstable angina occurred during the follow-up period of 1 year. Of the various initial factors studied, persistence of pain and the magnitude and extent of ECG ST-T changes were the only predictors of an unfavorable outcome. Non-smokers and those with a previous history of angina on effort had a significantly higher incidence of persistence of pain. The withdrawal of beta blockers on admission and the late administration of beta blockers to those with persistent pain did not appear to influence outcome.
Cytosine arabinoside is known to cause severe gastrointestinal side effects in an already very ill patient population. Three cases are reviewed in which apparent surgical peritonitis was managed conservatively, with very careful clinical monitoring. Two of the patients recovered completely, and one died of systemic fungal infection. No patient had a surgically remediable condition, and all were extremely poor surgical risks. A review of our experience and the literature leads us to recommend careful conservative management in patients receiving cytosine arabinoside who appear to have a "surgical abdomen," but in whom a definitive surgical diagnosis cannot be made.
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The pre-B phenotype of childhood acute lymphoblastic leukemia, in which the mu immunoglobulin molecule is expressed in the cytoplasm of the blast cells, has been shown to have independent prognostic significance. Patients with this phenotype of the disease tend to have a poorer outcome on contemporary treatment regimens than do those with the other B-precursor phenotypes. For these clinical studies, the detection of the pre-B phenotype has depended upon fluorescent-microscope based techniques. A flow-cytometry based technique for the detection of the cytoplasmic mu immunoglobulin molecule is presented here and the results compared in detail with those of fluorescent microscopy. The results show that the two techniques are equivalent. The flow cytometry method has the advantage of a standardized control, is less labor intensive, and is observer-independent.
To determine whether serum beta 2-microglobulin values could be useful as a tumor marker in patients with soft tissue sarcomas, 31 preoperative sera stored in our serum bank were assayed by radioimmunoassay for beta 2-microglobulin levels. Sera were selected from patients known to have large bulky tumors, but no evidence of other major systemic disorders. Thirty-one sera of sex and age matched controls were assayed for comparison. The laboratory range for normal serum beta 2-microglobulin values was 1.1-2.4 mg/l. Our control patients had values ranging from 0.7-1.7 mg/l. Values in tumor patients ranged from 0.7-2.5 mg/l. No markedly elevated values were observed in any single patient. Four age groups, 20-29, 30-39, 40-49, and 50-59 years, revealed no significant differences. This observation differs from previously reported data. Serum beta 2-microglobulin appears to have no value as a tumor marker in patients with soft tissue sarcomas. We were unable to substantiate findings by others that there is a significant increase in values of normal subjects corresponding to advancing age.
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