Biomedical subjects
Publications and source records attributed to H Y Choi.
A case of primary oat cell carcinoma of the esophagus is presented. Clinical, radiological, and pathological findings in our case and those reported earlier were reviewed. Primary oat cell carcinoma of the esophagus should be suspected in patients with symptoms of dysphagia, radiating pain to the back with bulky mass on the esophagogram, and diffuse metastasis.
Estrone sulfate sulfohydrolase (estrogen sulfatase) activity was solubilized by treatment with Triton X-100 from 105,000 g pellets of guinea pig uterus, testis and brain, as well as from rat liver and human placenta. The solubilized forms were subjected to chromatofocusing in the fast protein liquid chromatography (FPLC) system and on conventional columns packed in our laboratory. The guinea pig tissue pattern was complex. Uterus showed peaks of activity with apparent pI's of 9.11 and 7.6; testis contained 3 peaks with pI's of 9.18, 8.7 and 7.5; brain possessed peaks with pI's of 9.28 and 8.6. In each case the major activity peak was that with pI greater than 9. Rat liver activity chromatofocused as a single peak of apparent pI = 6.87 and the human placental enzyme also showed a single, though broad, peak, of pI = 6.57. This suggests not only that the guinea pig enzyme(s) differs markedly from those of rat liver and human placenta, but that there may be qualitative differences between the forms in the three guinea pig tissues. Chromatofocusing behaviour was not independent of the specific exchange resins and ampholytes utilized. The recovered enzyme activity was fairly stable and it seems that chromatofocusing could be a useful step in purification of the guinea pig enzyme(s), particularly the main form possessing a pI greater than 9.
Nonepidermoid cancers of the larynx appear with consistency in large series of laryngeal tumors. We reviewed 1135 laryngeal cancers seen over a 24-year period at Thomas Jefferson University Hospital and found a 1.7% incidence. This is similar to several other large series. These patients are presented in terms of their sex, age, race, clinical presentations, therapies, and outcomes, and a review of these unusual tumors is given. The recognition of such lesions is important because many require different therapies and have different prognoses than their squamous cell counterparts. The relatively infrequent occurrence of these tumors makes the availability of controlled clinical studies extremely difficult.
This is a case report of a patient believed to be the first reported case of pulmonary metastases from follicular carcinoma of the thyroid undergoing transformation to anaplastic carcinoma proven by serial biopsies.
An exacerbation of idiopathic inflammatory bowel disease associated with the appearance of cytomegalovirus nuclear inclusion bodies in the colon was observed in two patients. In one, improvement in the colitis after withdrawal of corticosteroids suggested cytomegalovirus as the cause of the exacerbation. A review of the 16 reported cases of inflammatory bowel disease with cytomegalovirus superinfection of the colon indicates a high mortality rate (seven of 16), a frequent association with toxic dilatation of the colon, and a clinical course sufficiently severe to require colectomy in 10 of 16 patients. For exacerbations of inflammatory bowel disease associated with evidence of cytomegalovirus infection of the colon which are refractory to medical management withdrawal of corticosteroids and other immunosuppressive therapy should be considered. If necessary, early colectomy may be an appropriate alternative.
Basal cell hyperplasia of the prostate is a rare, benign lesion that often has been misdiagnosed as adenocarcinoma. Thirteen cases of basal cell hyperplasia were reviewed. All of the patients were over 60 years of age (range 63-83) and all had benign prostatic hypertrophy in addition to basal cell hyperplasia. Histologic features consisted of nests of uniform small cells with scant cytoplasm forming solid nests and acinar structures. Some foci had nodular configurations and most were located within larger nodules of "typical" glandular hyperplasia. In some instances there was a merging of the two types of hyperplasia. There was neither nuclear atypia nor pleomorphism, and the adjacent stroma was hyperplastic. Small elongated cells with desmosomes and nonspecific, dense bodies were seen on electron microscopic studies of formalin-fixed material. The architectural and cytologic features of the basal cell proliferations were not those of carcinoma. However, synchronously, two patients demonstrated foci of prostate carcinoma unrelated to the basal cell hyperplasia.
Transrectal sonography of the normal prostate demonstrates a gland that has low-level homogeneous echoes. Benign and malignant prostatic disease causes disruption of this normal texture. A prospective study was performed to determine the ability of ultrasound to detect focal defects accurately. The specific histologic diagnoses of the lesions were obtained by ultrasonically guided transperineal biopsy or prostatic resection. Acoustic characterization following pathologic evaluation demonstrated certain echogenic features to be highly suggestive of benign disease. These include hyperechoic lesions that are bright and thick, foci with shadowing, and, although uncommon, purely hypoechoic areas. Although in some instances differentiation of disease processes is difficult, this analysis suggests that in certain lesions, accurate prediction of benign and malignant disease can be made. At present, there is still enough overlap that biopsies are usually required.
As periodic evaluation of the causes of death in cancer patients may provide guidelines for further research on supportive care in cancer, the authors studied autopsy records of 144 mammary-cancer patients from the past ten years. The causes of death were analyzed and compared for the first and second five-year periods. During the first five-year period (65 cases), death was caused by the malignant process itself in 70.8% of the patients, by infection in 10.8% and by hemorrhage in 7.7%. During the second five-year period (79 cases), the malignant process itself was still the most frequent cause of death but in only 47.4% of the patients, and deaths due to infections (23.7%) and hemorrhages (9.2%) were relatively more frequent, without noticeable changes in the patients' survival times. These findings may be related to the more aggressive methods of treatment applied in recent years. The metastases to the organs tended to be massive, and except for the lymph nodes, the lung was the organ most frequently involved by tumors (60%), followed by bone (54%), liver (54%), adrenal gland (36%), pleura (36%) and brain (26%). As the chance of life-threatening infections is great in mammary cancer, the early detection and treatment of infections in mammary-cancer patients could become an important factor in prolonging the survival of these patients.
A high incidence of opportunistic fungal infections among cancer patients has been a pressing problem confronting clinicians. The fungal infections in 3,278 consecutive autopsies at Thomas Jefferson University Hospital during a ten-year period (1966-1975) were studied. There were 1,204 (36.7%) cancer patients; 85 (7.1%) of these patients had concomitant fungal infections. The incidence was 9.3% during the last five-year period; 5.1% during the first five-year period. Candidiasis was the most frequent fungal infection (52.2%) among these patients, followed by aspergillosis (31.1%), mucormycosis, cryptococcosis, histoplasmosis and nocardiosis. The leukemias and lymphomas were the most frequent malignancies associated with fungal infections. However, in this study, unlike others, the incidences of fungal infection in patients with some solid tumors were also high, especially those in patients with cancers of the colon and pancreas.
The postmortem injection study demonstrated that the main blood supply to each quadrant of the competent diaphragma sellae appears to come from the following vessels: posterior quadrant, inferior hypophyseal arteries; right and left marginal quadrant, tributaries of the intracavernous portion of the carotid artery; anterior marginal quadrant, anterior capsular arteries. When the diaphragm is incomplete or absent the inferior hypophyseal arteries are the main source of blood supply. Microscopic analysis of the vascular bed in the diaphragma sellae reveals that there are fine arterial filaments mostly in the superior layer, while venules are situated in the inferior part of the diaphragm.
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Six cases of gastric remnant cancer that occurred many years after Billroth II gastrectomy and gastrojejunostomy for benign disease are reported. They are classified as intestinal type and gastric type on the basis of their morphologic appearance. Their cytologic and histologic features are tabulated along with a summary of the clinical histories. Emphasis is placed on the possible high risk for patients with Billroth II procedures of developing cancer 10 to 25 years after surgery. Endoscopic follow-up including cytologic study is essential to diagnose gastric remnant cancer in its early stage to secure a better prognosis.
A case of a gastric ulcer with epithelial atypia following hepatic arterial infusion chemotherapy (mitomycin C and 5-fluoro-2'-deoxyuridine) for a metastatic carcinoid tumor in the liver was observed. The gastric ulcer was endoscopically detected about 2 months after the initiation of the hepatic arterial infusion chemotherapy. The gastric epithelial atypia was severe enough to cause erroneous cytologic interpretation of the smear as a carcinoma. The cytologic and histologic appearance of chemotherapy-induced epithelial atypia is described with special emphasis on possible diagnostic pitfalls in gastric cytology.
In the Orient, faces are usually wide and short. This physical characteristic is often undesirable in many Asian cultures. Consequently, reduction malarplasty is one of the most common aesthetic procedures performed in the Orient. Previously described techniques for malar reduction such as intraoral chiseling or the burring-down of the zygomatic body and arch often result in minimal invasiveness, with no external scarring. However, they are less effective techniques. Other techniques, such as osteotomy and repositioning of a prominent malar complex by means of a coronal approach also proved fallible, by often resulting in a prominent, visible scar. Furthermore, a combined approach, using both the intraoral and the external (preauricular or sideburn) routes, often results not only in an external scar, but also in possible facial nerve (frontotemporal branch) damage. Thus, we performed a true intraoral osteotomy and reduction malarplasty through upper buccal sulcus incisions, resulting in minimal tissue damage without external scarring. Aesthetic facial contouring surgery has been performed in increasing numbers over the past decade, especially for malar and mandibular angle protrusion. The prominence of the malar area varies according to differences in the inherited bony structure. Essentially, Orientals are mesocephalic, whereas Caucasians are dolichocephalic; the face is wider and shorter in the former than in the latter. An even greater prominence of the zygoma among Orientals, which causes the face to be wider and shorter, is widely regarded as an unattractive feature in the Oriental culture [1,2]. In contrast, a flat cheek bone in Caucasians makes the face appear masculine, in addition to making the nasal and chin prominences more noticeable. Of the previously described techniques for malar reduction, shaving and contouring by the intraoral approach, without the external approach [1,4] is often less effective due to the limitations of shaving. Likewise, osteotomy and repositioning of a prominent malar complex by the coronal approach can result in an extensive visible scar [2,5,6,12]. Additionally, the combined approach by means of the intraoral and external (preauricular or temporal, sideburn) routes [4,7] can result in an external scar and the distinct possibility of facial nerve damage [8]. Therefore, our team created a simple and effective way of conducting a true intraoral osteotomy and reduction malarplasty without external scarring and the instigation of facial nerve damage.