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Biomedical subjects

H M Reiman

Publications and source records attributed to H M Reiman.

53 records · Page 3Linked to original sources

Retrorectal tumors. Mayo Clinic experience, 1960-1979.

One hundred twenty patients with primary retrorectal tumors (79 congenital, 14 neurogenic, 13 osseous, and 14 miscellaneous) had their initial treatment at the Mayo Clinic from 1960 to 1979. The mean age was 43 years (100 patients were adults). Female predominance was associated with congenital cysts (15:1) and male predominance with chordomas (5:1). Forty-three percent of the patients had malignant lesions. No dermoid cysts were found in this series. Diagnosis was made by digital examination or sacral radiographs in all patients. Computed tomography scan was the most important diagnostic method; the rate of positive findings was 100 percent in 20 patients. Approach to the tumor was posterior in 79 of 102 patients in whom resection was possible. Ten of 66 patients with benign tumors had recurrence. The five-year survival rate for patients with chordomas was 75 percent and for patients with other malignant lesions was 17 percent. Because preoperative biopsy can cause tumor spread, abscess, fecal fistula, or meningitis, it should not be performed if tumors are potentially resectable. Whenever possible, total resection should be done.

Adolescent↗

Comparison of needle biopsy with cytologic analysis for the evaluation of pleural effusion: analysis of 414 cases.

We retrospectively studied the results from thoracenteses and needle biopsies of the pleura performed in 414 patients with pleural effusions between 1973 and 1982. The final causes of effusion were malignant disease in 281 patients (67.9%) and nonmalignant disease in 133 (32.1%). The presence of pleural malignant disease was established by cytologic study in 162 patients (57.6%), by needle biopsy in 123 (43%), and by either cytologic analysis or biopsy in 182 (64.7%). In only 7.1% of the 281 patients with malignant pleural effusions did biopsy reveal malignant disease when the results of cytologic study were negative for malignant disease. Nearly half of the patients with lymphoma had lymphocytosis of the pleural fluid, but neither this finding nor the lymphocytic pleuritis noted on biopsy was diagnostic of lymphomatous involvement of the pleura. Among the patients with malignant mesothelioma, thoracotomy was necessary to confirm the diagnosis in 60.9%. In the patients with nonmalignant diseases, with the exception of six with tuberculous pleurisy, pleural biopsy was nondiagnostic even though the causes of pleural effusion were apparent from the clinical features. The causes of pleural effusion remained unknown in 82 patients (19.8%). Pleural biopsy failed to provide adequate tissue in 55 patients (13.3%). This study shows that cytologic analysis has a higher sensitivity (P less than 0.001) than needle biopsy for diagnosing malignant pleural effusions. The value of needle biopsy is limited in establishing the cause of pleural effusion that results from either malignant or nonmalignant disease, with the exception of tuberculous pleurisy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Cutaneous extraskeletal Ewing's sarcoma.

Extraskeletal Ewing's sarcoma has been recognized as being histologically indistinguishable from Ewing's sarcoma of bone. Although the occurrence of extraosseous Ewing's sarcoma in deep soft tissues has been well described, such cutaneous lesions are rare. We report the clinical history, histopathologic findings, and results of ultrastructural study of this rare variant occurring in a 12-year-old girl. She presented with a dermal and subcutaneous tumor of the left third toe, without osseous involvement. The lesion was composed of masses of round-oval cells, with perilobular fibrosis, focal hemorrhage, ill-defined pale cytoplasm containing glycogen, and absent pericellular reticulin. Ultrastructural study showed a monotonous cell population, with focal thickening of apposing membranes, high nuclear/cytoplasmic ratio, copious intracytoplasmic glycogen, and paucity of organelles except mitochondria. We present this case along with discussion of the literature and problems concerning differential diagnosis of small cell malignancies in the skin.

Bone Neoplasms↗

CT of soft-tissue neoplasms.

The computed tomographic scans (CT) of 84 patients with untreated soft-tissue neoplasms were studied, 75 with primary and nine with secondary lesions. Each scan was evaluated using several criteria: homogeneity and density, presence and type of calcification, presence of bony destruction, involvement of multiple muscle groups, definition of adjacent fat, border definition, and vessel or nerve involvement. CT demonstrated the lesion in all 84 patients and showed excellent anatomic detail in 64 of the 75 patients with primary neoplasms. CT did not differentiate vessel or nerve entrapment from neurovascular structures that were simply applied to the pseudocapsule of the tumor. Blurring of adjacent fat was an infrequent finding, but when it was present, the tumor was malignant. The CT findings were characteristic enough to suggest the histology of the neoplasm in only 13 lesions (nine lipomas, three hemangiomas, one neurofibroma). No malignant neoplasm had CT characteristics specific enough to differentiate it from any other malignant tumor. However, malignant neoplasms could be differentiated from benign neoplasms in 88% of the cases.

Adipose Tissue↗

Fibrosarcoma.

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Adult↗

Malignant peripheral nerve sheath tumors in childhood.

Malignant peripheral nerve sheath tumor (MPNST) is an uncommon sarcoma in the pediatric population; however, its presence should be considered in a child with an enlarging or painful soft-tissue mass. Diagnosis of this neoplasm depends on either the demonstration of its origin within a peripheral nerve or the association with a contiguous neurofibroma. We have identified 16 cases of MPNST involving children 16 years of age or less, which represent 12.8% of the total cases seen at the Mayo Clinic. Most of the lesions arose in children with von Recklinghausen's disease and were associated with a contiguous neurofibromatous component. The mean survival of patients who were known to have died of tumor was only 1.8 years. This sarcoma requires prompt aggressive therapy utilizing wide surgical excision. Because of the association of MPNST with von Recklinghausen's neurofibromatosis, a careful workup and family history should be obtained for the potential prognostic value and for the purpose of genetic counseling.

Adolescent↗

Extra-abdominal desmoid tumors.

One hundred and ninety-four patients with extra-abdominal desmoid tumors, most of them in the extremities, have been treated at the Mayo Clinic. One hundred and thirty-two patients (68 per cent) experienced a recurrence at an average of 1.4 years after the first treatment. A greater tendency for recurrence was evident in female patients, in patients who were more than thirty years old, in certain anatomical locations (especially the foot and calf), and most importantly after treatment by intralesional or marginal excision. In view of the excellent prognosis for survival, we recommend wide local excision when anatomically feasible or marginal excision and postoperative radiation therapy when function of the extremity would be severely compromised if excision with wide margins were done. A recurrent lesion that does not appear to be growing should be followed until evidence of growth of the lesion precipitates a secondary wide excision.

Adolescent↗

Proliferative potential of cells from normal human colon epithelium, adenomas, and carcinomas of the large bowel.

The proliferative potential of nonmalignant and malignant cells obtained from the human large bowel was assessed with a soft agar culture colony-forming technique and by flow cytometry to analyze cell cycle kinetics. No colony formation occurred with samples of normal human adult colon mucosa. The absence of colony formation in all but 1 of 24 evaluable colorectal adenomas suggested that malignancy of tissue in vivo is generally necessary for colony formation to occur in soft agar cultures. A high proliferative index (S + G2/M), as assessed by flow cytometry, was significantly associated with higher soft agar culture counts in a series of 25 colorectal carcinomas.

Adenoma↗

Intra-articular temperature: technique and reliability in an animal model.

To determine if reproducible and reliable measurements of intra-articular temperature could be performed in an animal model, surface and intra-articular measurements were studied in 30 rabbits. Anterior insertion of a thermometer probe into the joint cavity was found to be a reliable method for measuring intra-articular temperature in the rabbit knee. This method yielded temperatures with less than 0.1C variation in contralateral and serial determinations. Consistent differences in intra-articular temperatures were observed between normal knees and contralateral knees in which arthritis had been experimentally induced. Measurements of surface temperature and knee intra-articular temperature by a posterior approach, however, did not give consistent or reproducible values.

Animals↗

Primary embryonal carcinoma and choriocarcinoma of the mediastinum. A case report.

Primary germinal tumors of the mediastinum are very rare. We studied a 67-year-old man with a primary embryonal carcinoma and choriocarcinoma of the mediastinum. To our knowledge, this is the oldest patient described as having this lesion. The diagnosis of primary germinal tumor of the mediastinum should not be made unless the possibility of a primary testicular lesion has been eliminated by thorough clinical evaluation. The prognosis is very poor for patients with teratocarcinoma, embryonal carcinoma, or choriocarcinoma, despite aggressive therapy.

Aged↗

Association between the actual doubling times of primary breast cancer with histopathologic characteristics and Wolfe's parenchymal mammographic patterns.

This study identifies associations between the actual doubling time of primary mammary cancers with histopathologic characteristics and Wolfe's parenchymal mammographic patterns. Seventy microscopic criteria and Wolfe's mammographic parenchymal patterns were coded for 32 primary breast cancers on which actual volume doubling times were calculated from serial mammographic views of tumor nucleus shadows. Circumscribed cancer margin and papillary intraductal growth were associated with slow-growing breast cancers. More anaplastic nuclear grade was associated with faster-growing cancers. No association could be established between doubling time and parenchymal patterns as described by Wolfe.

Breast Neoplasms↗

Desmoplastic malignant melanoma: a case report.

A further case of desmoplastic malignant melanoma of the cheek is presented, bringing the total number of reported cases to 15. Its clinicopathological features and treatment are discussed.

Cheek↗

Migration and granulomatous reaction after periurethral injection of polytef (Teflon).

Although patients with urinary incontinence have been treated successfully by periurethral injection of polytef paste, this study in continent animals demonstrates migration of polytef particles from the injection site. We injected polytef paste periurethrally into female dogs and male monkeys. Particles were found at 50 to 70 days in pelvic nodes in six of seven animals and lungs in four of seven (the kidneys and brain were not studied); and at 10 1/2 months in pelvic nodes, lungs, and brain in seven of seven; kidneys in four of seven; and spleen in two of seven. X-ray microanalysis confirmed that the particles were polytef. At 10 1/2 months, polytef granulomas were found at all injection sites and some sites of distant migration. Since these granulomas signify chronic foreign-body reaction, we believe that until the long-term effects in humans are known, polytef paste should not be used in children or young adults with normal life expectancy.

Animals↗