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Biomedical subjects

J F Silverman

Publications and source records attributed to J F Silverman.

At least 127 records · Page 7Linked to original sources
PubMed1989

Fine-needle aspiration cytology of breast masses in pregnant and lactating women.

Eleven pregnant women with breast masses that arose during pregnancy or in the postpartum period underwent fine-needle aspiration biopsies. Cytologic examination demonstrated a spectrum of morphologic features, including (1) a pattern of dissociated epithelial cells stripped of their cytoplasm along with small clusters of cells having a frayed secretory type of cytoplasm; (2) larger epithelial groups with nuclear pleomorphism, prominent irregular nucleoli, and abundant vacuolated cytoplasm; (3) cellular smears, often with an inflammatory background and proteinaceous debris; and (4) microtissue fragments showing features of lobular hyperplasia. This article illustrates the clinical utility of fine-needle aspiration biopsy in evaluating breast masses in pregnant and lactating women and discusses the potential hazards for a false-positive diagnosis of malignancy in these patients.

Adenofibroma↗
PubMed1989

Fine-needle aspiration cytology of postirradiation sarcomas, including angiosarcoma, with immunocytochemical confirmation.

Postirradiation sarcomas are an unusual but well-recognized late effect of cancer therapy. In this article, a fine-needle aspiration (FNA) series of four cases is presented. There were three female patients and one male patient, with an age range of 28-55 yr (mean, 41). Two of the patients were irradiated for uterine cervical carcinoma while the other two received irradiation for malignant lymphoma. The time interval to the development of the postirradiation sarcoma ranged from 10 to greater than 20 yr. There were a postirradiation synovial sarcoma of the buttock region, malignant fibrous histiocytoma of the bone (femur), and rhabdomyosarcoma and angiosarcoma of the retroperitoneum. A spectrum of cytologic findings was encountered, reflecting the specific types of sarcomas. Immunocytochemical studies performed on the aspirated material from the angiosarcoma demonstrated the utility of immunoperoxidase stains for ULEX europaeus agglutinin-1 (UEA-1) and, to a lesser degree, factor VIII-related antigen antibody, confirming the vascular nature of this malignancy. The FNA findings from all four cases demonstrated cytologic features that allowed recognition of this unusual complication of irradiation treatment. This article confirms the utility of FNA cytology in following patients with previous malignancies and differentiating a postirradiation sarcoma from recurrent carcinoma.

Adult↗
PubMed1989

Significance of giant cells in fine-needle aspiration biopsies of benign and malignant lesions of the pancreas.

The cytologic results of 44 consecutive fine-needle aspiration (FNA) biopsies of the pancreas are reported. The series consisted of 27 women and 17 men with an age range of 31-89 yr (mean, 61.5). Excluding insufficient cases, the sensitivity of the procedure was 88%, specificity was 100%, positive predicative value (PV) was 100%, negative PV was 69%, and efficiency of the test was 90%. There were 29 true-positive, four false-negative, and nine true-negative diagnoses. Two specimens were insufficient for diagnosis. Giant cells of varying types were seen in both the malignant and benign cases. Two of the benign cases demonstrated rare multinucleated foreign body-type giant cells, most likely representing the changes seen in pancreatitis. In 13 malignant cases, multinucleated tumor cells were present, while six additional cases had multinucleated benign histiocytes reflecting the associated pancreatitis. Two malignant cases each had tumor giant cells and benign multinucleated histiocytes. Three of the malignant cases had numerous multinucleated tumor giant cells arranged in a dissociative fashion with evidence of cytophagocytosis consistent with a pleomorphic giant-cell carcinoma of the pancreas. One additional case demonstrated numerous multinucleated osteoclastic-like cells consistent with an osteoclastic tumor of the pancreas. This article documents the accuracy of FNA biopsy of the pancreas and notes that giant cells of varying types can be found in pancreatic FNA biopsies. Appreciation of the various types of giant cells in pancreatic FNA biopsy is important for diagnostic accuracy and prognosis.

Adult↗
PubMed1989

Gastric ulcer healing after laser treatment in dogs.

Endoscopic laser photocoagulation of ulcers is increasingly used to produce hemostasis in patients who are actively bleeding or in patients with stigmata of recent hemorrhage. Little information is available describing ulcer healing rates after laser treatments. The aim of this study was to compare the healing rates of gastric ulcers treated with laser energy (Nd:YAG) with untreated ulcers in dogs. Two standard gastric ulcers (12-14 mm diameter) were created in each dog stomach using an ulcer maker (Quinton) under endoscopic guidance and one was randomly selected for laser treatment (L), while the other served as control (C). Ten laser spots were applied circumferentially around the ulcer crater with a mean energy of 595 J per ulcer. Ten dogs were studied; four of which were sacrificed after one week and six after two weeks. Healing of treated ulcers was compared with that of control ulcers and expressed as a percentage of the initial ulcer surface. Histologic injury and reepithelialization were scored by two pathologists unaware of the treatment. Laser-treated ulcers healed significantly slower than untreated ulcers at one week (53% L vs 94% C, P less than 0.05) and histologic injury was greater in ulcers treated with laser photocoagulation. At two weeks, only 82% of the laser-treated ulcer surface was healed in comparison with 94% (P less than 0.05) healing in untreated ulcers, although the mean histologic injury score was not different at two weeks. Reepithelialization was decreased both at one week (11% L vs 71% C, P less than 0.01) and at two weeks (75% L vs 100% C, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Absence of luminal intrinsic factor after gastric bypass surgery for morbid obesity.

Abnormally low serum cobalamin levels (less than 180 pg/ml) have been observed in 154 of 429 patients (36%) at an average of 22 months (range 3-64 months) after gastric bypass surgery for morbid obesity. Twenty-four patients underwent a Schilling test and retrograde endoscopy of the bypassed gastric segment to determine the presence of intrinsic factor (IF) in gastric aspirates and in mucosal biopsies at 22 +/- 4 months after surgery. Five patients had a normal cobalamin level (405 +/- 44 pg/ml), and gastric juice intrinsic factor was present in three of them (11 +/- 7 ng/ml). Nineteen patients had a low cobalamin level (113 +/- 8 pg/ml), and gastric juice IF was found in only two subjects of this group (10 ng/ml each). Basal gastric juice IF concentration of healthy control subjects was 24 +/- 5 ng/ml. Schilling test results were normal in all five patients of the first group and in only nine patients of the group with cobalamin deficiency after surgery. To assess whether IF was present within the parietal cells of subjects with absent luminal IF, we studied gastric biopsy material of 14 patients using a well-characterized indirect immunoperoxidase method. IF was identified in fundic mucosal biopsy specimens of all 14 patients with absent gastric juice IF. We conclude that cobalamin deficiency occurs in a significant number of patients after gastric bypass and is associated with absence of gastric juice IF. We propose that this abnormality might be caused by inadequate secretion of IF from the bypassed stomach.

Adult↗
PubMed1989

Immunohistochemical study of uterine stromal sarcoma and rhabdomyosarcoma.

The cytoplasmic filament composition of two pure high-grade endometrial stromal sarcomas and five pure endometrial rhabdomyosarcomas was studied using the immunoperoxidase avidin-biotin method. Ultrastructural correlates were performed on the same tissues. While four of the seven tumors presented as high-grade undifferentiated neoplasms, they were readily categorized on the basis of immunocytochemical findings in which the five rhabdomyosarcomas were positive for muscle-specific actin (HHF 35) and the two stromal sarcomas were positive for vimentin only. Ultrastructure on the HHF 35-positive cases showed the presence of thick filaments and Z-band material, whereas the other tumors showed no cytoplasmic differentiation. Muscle-type actin differs stromal cells, and is useful when used in conjunction with a panel of antibodies in the categorization of undifferentiated endometrial sarcomas.

Biomarkers, Tumor↗
PubMed1989

The impact of fine-needle aspiration biopsy on a diagnostic electron microscopy laboratory.

We retrospectively reviewed the number and types of diagnostic electron microscopic specimens from a 4 1/2-year period. During this period, the number of fine-needle aspirate biopsy specimens processed increased in a linear fashion, from a relatively uncommon occurrence to the current level of activity, in which fine-needle aspiration specimens now represent 40% to 50% of the nonrenal diagnostic material examined by electron microscopy. This study documents the increasing importance of fine-needle aspirate-type specimens in the everyday operation of a diagnostic electron microscopy facility.

Biopsy, Needle↗
PubMed1988

Fine-needle aspiration cytology of mesenchymal tumors of the breast.

This report describes the fine-needle aspiration (FNA) cytologic findings of 15 cases of sarcomas involving the breast out of a combined series of 2,064 breast FNA biopsies, including 580 malignancies, thereby accounting for 2.6% of all the malignant breast tumors. The series consisted of 14 women and one man with a mean age of 48.4 yr (range, 29-63). There were eight cases of cystosarcoma phyllodes, including one malignant cystosarcoma phyllodes. Three benign cystosarcoma phyllodes had a significant concomitant atypical epithelial hyperplasia, which lead to a misdiagnosis of carcinoma in two of the cases. The third case was correctly identified as recurrent cystosarcoma phyllodes. In retrospect, features suggestive for cystosarcoma phyllodes and unusual for breast carcinoma include increased numbers of naked nuclei and hypercellular stromal fragments. Sarcomatous patterns in our four metaplastic carcinomas included chondrosarcoma (two cases), malignant fibrous histiocytoma (MFH) (one case), and fibrosarcoma (one case). Two additional pure primary MFHs (both of which had electron microscopic confirmation) and one metastatic fibrosarcoma to the breast were encountered. Recognition of unusual cytologic patterns for breast carcinoma should suggest the possibility of a primary or metastatic sarcoma to the breast. Potential pitfalls for misdiagnosis include the presence of atypical epithelial hyperplasia in some cases of cystosarcoma phyllodes, along with occasional cases having patterns indistinguishable from a fibroadenoma. The pleomorphic and bizarre cellular features can suggest the diagnosis of metaplastic and pure sarcomas of the breast, although the potential exists for confusion with very poorly differentiated carcinoma. FNA diagnosis of sarcomatous lesions of the breast is essential in order to insure proper surgical treatment.

Adult↗
PubMed1988

Fine-needle aspiration cytology of pulmonary carcinosarcoma with immunocytochemical and ultrastructural observations.

The cytologic, immunocytochemical, and ultrastructural features of a pulmonary carcinosarcoma diagnosed by fine-needle aspiration biopsy are presented. Both malignant epithelial groups and bizarre spindle-shaped cells arranged in loose groups, microtissue fragments and in a dissociate fashion showed dual immunoperoxidase staining with cytokeratins and vimentin. Although the immunocytochemical staining pattern is typical of this neoplasm, it does not allow differentiation in all cases from the more common primary large-cell undifferentiated carcinoma, which can also show dual staining for cytokeratin and vimentin. However, the presence of poorly differentiated epithelial groupings associated with a malignant mesenchymal component set in a myxoid stroma should suggest the correct diagnosis. Cytologically, differentiating carcinosarcoma, a poorly differentiated malignancy showing dual staining for cytokeratin and vimentin, from a large-cell carcinoma is important, since the former may pursue a more indolent clinical course.

Biopsy, Needle↗
PubMed1988

Clinical utility of fine needle aspiration in the diagnosis and management of neuroblastoma.

Eleven fine needle aspiration (FNA) biopsies were performed in five children with neuroblastoma, including one patient with peripheral neuroectodermal tumor of the thoracopulmonary region (Askin tumor). Cytologic features in conjunction with immunocytochemistry and electron microscopy on the aspirated material enabled us to make a primary diagnosis in four of the five patients and diagnose local recurrence and metastatic disease in three patients. There were no false-positive or false-negative cytologic diagnoses; therefore, diagnostic accuracy was 100%. FNA is an extremely useful technique for the primary diagnosis and management of neuroblastoma and excludes other small cell malignancies of children. The results of this study and literature review demonstrate that FNA cytology coupled with ancillary techniques of immunocytochemistry and electron microscopy is a rapid, safe, minimally invasive procedure which can aid in the diagnosis and management of patients with neuroblastoma without resorting to more aggressive diagnostic procedures in selective cases.

Biopsy, Needle↗
PubMed1988

Accelerated coronary vascular disease in the heart transplant patient: coronary arteriographic findings.

Annual coronary arteriograms have been obtained from all heart transplant recipients at Stanford University Medical Center since 1969. Angiographic lesions in 81 transplant patients exhibiting coronary vascular disease were classified into three categories: type A, discrete or tubular stenoses; type B, diffuse concentric narrowing; and type C, narrowed irregular vessels with occluded branches. The 81 arteriograms showing transplant coronary vascular disease were contrasted with 32 from nontransplant patients with coronary artery disease analyzed in a similar fashion. The nontransplant angiograms showed 178 lesions, all of type A (discrete or tubular) morphology, 75% of which were located in primary epicardial coronary vessels and 25% in secondary branch vessels. In the patients with transplant coronary vascular disease, 349 (76%) of 461 lesions were type A: 57% in primary vessels, 42% in secondary branches and 1.4% in tertiary branches. Of the 112 type B and C lesions (diffuse narrowing, tapering and obliteration), 25% were in primary vessels, 44% in secondary vessels and 31% in tertiary branches (p less than 0.05 for patients with transplant coronary vascular disease versus patients with nontransplant coronary artery disease). Total vessel occlusion was found in proximal or middle vessel segments in 96% and distally in 4% of patients with "ordinary" coronary artery disease versus 49% distally in patients with transplant coronary disease (p less than 0.002). In the presence of total vessel occlusion, collateral vessels were poor or absent in 92% of transplant versus 7% of nontransplant patients with coronary disease (p less than 0.002). Therefore, coronary artery disease in transplant patients represents a mixture of typical atheromatous lesions and unique transplant-related progressive distal obliterative disease that occurs without collateral vessel development.

Cardiac Catheterization↗
PubMed1988

Physician-generated cost containment in transurethral prostatectomy.

Cost containment need not be imposed on physicians by government, insurance companies and hospital administrators. Decreases in hospital cost can be achieved voluntarily by physicians without sacrificing quality of care, especially for common procedures with relatively homogeneous patient populations, such as transurethral prostatectomy. Variations in existing practice were identified and shared, and optimal scientific practice was discussed at 5 meetings of the division of urology during a 16-month period. Strict guidelines were not developed; surgeons were encouraged to apply cost-related knowledge individually. Resource use was measured before, during and after the intervention. A total of 356 transurethral prostatectomies was studied. There were significant decreases in preoperative and postoperative length of stay, specific ordering practices and total hospital charges. University faculty differed from community urologists and individual surgeons varied considerably. Suggestions for scientific cost management in prostatectomy are presented.

California↗
PubMed1988

Fine-needle aspiration biopsy of pleomorphic (giant cell) carcinoma of the pancreas. Cytologic, immunocytochemical, and ultrastructural findings.

Four cases of pleomorphic (giant cell) carcinoma (PGC) of the pancreas, diagnosed by fine-needle aspiration biopsy, are presented. Ancillary immunocytochemical studies were also performed on the smears (four cases) and cell blocks (three cases), along with ultrastructural (electron microscopic) examination of the aspirated specimen (two cases). Three of the four patients were elderly (age range: 44-65 years), and all had large pancreatic masses. A spectrum of cytomorphologic features was encountered, including poorly cohesive bizarre mononuclear cells, many multinucleated tumor giant cells, and associated malignant spindle cells. Prominent cellular cannibalism and cytophagocytosis also were seen. Immunoperoxidase studies demonstrated dual staining of the malignant cells for cytokeratin and vimentin in two cases and exclusive staining for vimentin in the remaining two cases. Ultrastructural examination demonstrated epithelial features in both cases studied. One of the cases demonstrated intracytoplasmic whorled bundles of intermediate filaments, corresponding to pale eosinophilic globular material, appreciated both in the Diff-Quik- and Papanicolaou-stained smears and staining with positive results for vimentin. The immunocytochemical studies suggest that the coexpression of vimentin and cytokeratin within the cells is consistent with a pleomorphic malignancy of epithelial origin. It is speculated that the staining of two of the cases exclusively for vimentin can be seen in either epithelial malignancies with sarcomatoid transformation or, less likely, a pure sarcoma of the pancreas.

Adult↗
PubMed1988

Cutaneous malignant melanoma in a black patient with neurofibromatosis (von Recklinghausen's disease).

A unique case of a cutaneous malignant melanoma arising in a black man with a familial history of neurofibromatosis (von Recklinghausen's disease) is reported. Although neurofibromatosis is believed to be a disorder of neural crest origin that is associated with a number of different malignancies, a definite association of malignant melanoma with neurofibromatosis has not been reported. The presence of a malignant melanoma arising on the trunk of a black man suggests an association of cutaneous malignant melanoma and neurofibromatosis--a malignancy and genodermatosis, respectively--of ultimate neural crest origin.

Adult↗
PubMed1987

The use of immunoperoxidase panels for the cytologic diagnosis of malignancy in serous effusions.

The diagnostic value of an immunoperoxidase panel composed of antisera to carcinoembryonic antigen (CEA), epithelial membrane antigens (EMA), and high- and low-molecular-weight cytokeratins was evaluated on 39 consecutive pleural and peritoneal fluid specimens and correlated with routine cytologic and histochemical studies. The cases were classified into two groups: malignant (epithelial and small-cell undifferentiated carcinomas) and benign effusions. We found that the CEA and EMA antisera identified 91% and 100% of the epithelial malignancies, respectively. Mucin stains were positive in only 41% (mucicarmine) and 59% (Alcian blue) of these cases. The battery of cytokeratin markers identified malignant cells from 45%-100% of the cases but showed considerable positive staining of mesothelial cells. A selective review of the literature is presented along with recommendations for technical improvement in immunoperoxidase studies. We believe that an immunoperoxidase panel can be of considerable value in the cytologic diagnosis of epithelial malignancies in effusions. The panel composed of CEA and EMA can prove helpful in a routine cytology practice. Although the cytokeratin marker identified malignant cells, the concomitant immunostaining of mesothelial cells limits its utility. The commercially available panel can be a potential aid in improving the accuracy of serous fluid cytologic examination by decreasing both false-positive and false-negative diagnoses and thereby helping to prevent delays in diagnosis and treatment.

Ascitic Fluid↗
PubMed1987

Intensive care for the elderly: outcome of elective and nonelective admissions.

Survival, quality of life, and need for continuing medical care were evaluated for 134 elderly patients admitted to the intensive care units (ICU) at Stanford University Hospital and for a control group. Of the patient group, 57.5% were admitted to the ICU following elective surgery; 42.5% were emergency surgical and medical patients. Hospital mortality was 3.9% for elective and 22.8% for nonelective patients; 18-month mortality was 13.0% and 47.4%, respectively. Fifty-nine patients (60.8% of survivors) completed follow-up questionnaires. Subjective and objective quality of life was good. Quality of life was slightly worse for ICU survivors than for controls; elective and nonelective patients did not differ significantly. Although the cost of ICU hospitalization was high, additional medical care was not excessive. Nonelective patients required more continuing care than elective patients, and both groups required more than controls.

Activities of Daily Living↗
PubMed1987

Clinical and laboratory correlates of accelerated coronary artery disease in the cardiac transplant patient.

Accelerated coronary disease in the cardiac allograft (TxCAD) is a major complication affecting long-term survival of heart transplant patients. Since the transplanted heart remains denervated, the first sign of TxCAD may be silent myocardial infarction or sudden death. The prevalence of this disease has been unaltered since the advent of cyclosporine immunosuppression. Serial annual coronary arteriograms in 132 patients undergoing transplantation after 1979 at Stanford revealed 44 patients who developed TxCAD (33%). Multiple variables, including patient lipid profile, extent of donor and recipient tissue match, age of recipient and donor, number of rejection episodes, prednisone dose, and fasting blood sugar were examined in relation to occurrence of TxCAD. Donor age was greater among the 44 patients developing TxCAD that in the 88 patients who did not develop coronary artery disease (23.5 +/- 5.8 vs 21.3 +/- 5.7 years, p less than .05). The fasting plasma triglyceride level 1 year after transplantation was 236.0 +/- 246.3 mg% in the patients with TxCAD vs 170.1 +/- 108.2 mg% in those without TxCAD (p less than .05). No other indexes, including number of rejection episodes during first posttransplant year, number of HL-A mismatches, level of maintenance steroids, fasting blood sugar, and cholesterol subfractions identified patients who developed TxCAD. We conclude that TxCAD has limited correlation with the clinical and laboratory factors analyzed. Higher donor age and elevated plasma triglycerides may be significant predisposing factors for the development of TxCAD.

Adult↗