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Biomedical subjects

J F Southern

Publications and source records attributed to J F Southern.

65 records · Page 4Linked to original sources
PubMed1990

Lymphoid infiltrates of the stomach. Evaluation of histologic criteria for the diagnosis of low-grade gastric lymphoma on endoscopic biopsy specimens.

Low-grade gastric lymphomas may be difficult to distinguish from benign inflammatory infiltrates on endoscopic biopsy specimens. Recent reports have suggested that so-called lymphoepithelial lesions (infiltration of lymphocytes into glandular epithelium) are characteristic of primary gastric lymphomas. We evaluated the presence and prominence of lymphoepithelial lesions and other histologic criteria in 25 low-grade gastric lymphomas (21 primary) and 58 benign inflammatory infiltrates to evaluate their utility in distinguishing benign from malignant gastric lymphoid infiltrates. The following features were associated only with lymphomas: (a) prominent (2-3 +) lymphoepithelial lesions (eight of 24 versus none of 58; p less than .0001); (b) Dutcher bodies (three of 25 versus none of 58, p = .05); and (c) moderate cytologic atypia (nine of 25 versus none of 58, p less than .0001). One or more of these features was seen in 18 of 25 gastric lymphomas (72%). Features more often associated with, but not limited to, lymphomas were dense (2-3 +) lymphoid infiltrates (25 of 25 versus five of 58, p less than .0001), rare or questionable lymphoepithelial lesions (11 of 24 versus 17 of 58, p = .01), muscularis mucosae invasion (20 of 20 versus 20 of 47, p less than .0001), ulceration (12 of 24 versus five of 58, p less than .0001), and mild cytologic atypia (eight of 25 versus six of 58, p less than .005). Germinal centers, crypt abscesses, and reactive epithelial atypia were seen with equal frequency in both types of infiltrate. Acute inflammation (2-3 +) was associated more often with inflammatory infiltrates (two of 25 versus 27 of 58, p less than .001). Our results suggest that dense lymphoid infiltrates with either prominent lymphoepithelial lesions, moderate cytologic atypia, or Dutcher bodies are highly suggestive and may be diagnostic of lymphoma. This constellation of findings is present in about 70% of endoscopic biopsy specimens of low-grade gastric lymphoma. In addition, the majority of cases of primary low-grade gastric lymphoma have morphologic, immunophenotypic, and clinical features that justify their inclusion in the category of low-grade lymphomas of mucosa-associated lymphoid tissue, whereas a minority are examples of lymphomatous polyposis of the gastrointestinal tract (centrocytic lymphoma).

Adult↗
PubMed1989

Lymphedema, lymphocytic myocarditis, and sarcoidlike granulomatosis. Manifestations of Whipple's disease.

A patient with Whipple's disease presented with a long prodromal period characterized by granulomatous lymphadenitis and progressive lymphedema of the extremities. No gastrointestinal tract symptoms were present and a small bowel biopsy sample was normal. His clinical condition deteriorated with the onset of lymphocytic myocarditis. At autopsy, intestinal involvement with macrophages that stained positively with periodic acid-Schiff was limited primarily to the submucosa. Diffuse fibrous effacement of lymph nodes with afferent lymphangiectasia seemed to be the mechanism of diffuse lymphedema, protein-losing enteropathy, and hypoproteinemia. Whipple's disease, therefore, should be considered in the differential diagnosis of patients presenting with granulomatous disease, lymphocytic myocarditis, or unusual lymphedema.

Adult↗
PubMed1989

Aortoesophageal fistula arising as a complication of prolonged nasogastric tube placement.

Aortoesophageal fistula is a rare disorder that may result from many causes. In this report, we describe the unique case of a 71-year-old woman who developed an aortoesophageal fistula following prolonged placement of a nasogastric tube. The presence of dense fibrous adhesions between the aorta and esophagus may have facilitated the development of aortoesophageal fistula in this patient.

Aged↗
PubMed1989

Collagen fibril bundles: a branching assembly unit in tendon morphogenesis.

The assembly, deposition and organization of collagen fibril bundles and their composite fibrils were studied during morphogenesis of the chick embryo tendon using electron microscopy, serial sections and computer-assisted three-dimensional reconstruction techniques. The 14-day chick embryo is a stage when tendon architecture is being established and rapid changes in the mechanical properties occur between days 14 and 17 of development. Tendon matrix structure develops from discrete subunits, bundles of collagen fibrils. The bundles branch; undergo a gradual rotation over several micrometers; are intimately associated with the cellular elements of the developing tendon; and form arborizing networks within and among fascicles. The organization of discrete fibril segments into bundles, during the establishment of tendon architecture and function, where the segmental fibrillar components could interact with the interfibrillar matrix as well as with adjacent fibrils would contribute to the stabilization of this structure. The observed gradual rotation of the bundles would serve to stabilize the immature bundle through the physical twining of the composite fibrils while the extensive branching of the bundles observed at 14-days of development and their intimate association with the cellular elements would provide a higher order of structure stabilization.

Animals↗
PubMed1988

Relation between histological findings on early repeat right ventricular biopsy and ventricular function in patients with myocarditis.

Histological findings on repeat endomyocardial biopsy and changes in left ventricular ejection fraction early during immunosuppressive treatment were studied in 20 patients with documented myocarditis. All patients presented with heart failure of less than six months' duration and a left ventricular ejection fraction of less than or equal to 0.40. Repeat biopsy and assessment of ventricular function were performed at a mean (SEM) of 79 (17) days after the initial biopsy. At repeat biopsy eight patients had evidence of ongoing myocarditis and 12 showed resolved myocarditis. In eight (66%) of the 12 patients with resolved myocarditis ventricular function had improved significantly. Left ventricular ejection fraction also improved significantly in four of eight patients during treatment despite ongoing myocardial inflammation. Regardless of the histological findings on repeat biopsy, early improvement in ejection fraction was associated with an excellent long term prognosis--that is 83% survived for at least three years. Histological resolution of myocarditis during immunosuppressive treatment is not a prerequisite for improvement in ventricular function; and changes in left ventricular ejection fraction during the first three months of treatment are predictive of clinical outcome.

Adult↗
PubMed1988

Correlation between echocardiographic endocardial surface mapping of abnormal wall motion and pathologic infarct size in autopsied hearts.

We previously developed a cross-sectional echocardiographic technique for quantitatively mapping the endocardial surface of the left ventricle and on which regions of abnormal wall motion can be superimposed in their correct spatial distribution. This endocardial mapping technique (EMT) provides a measure of the left ventricular endocardial surface area (ESA in cm2), the area of abnormal wall motion (AWM in cm2), and the overall percent dysfunction (%AWM) as a measure of the functional "infarct size." To test this approach, we compared the EMT measurements with the actual endocardial surface area (in cm2) and pathologic infarct size (both percent infarct by volume and percent endocardial surface overlying infarct) measured at later autopsy in 20 adults (14 men, six women) ranging in age from 47 to 76 years (mean 64 +/- 9.6 years). The median interval from echocardiographic study to death was 19 days (range 1 to 269 days). Patients were divided into two groups based on the age of their infarcts at the time of death: (1) recent (infarct age less than 14 days; mean age 5.3 +/- 4.6 days) and (2) old (infarct age greater than 6 months; mean age 3.6 +/- 3 years). When the left ventricular endocardial surface area at autopsy was compared with the EMT-derived ESA, a close correlation was found (EMT area = 1.17 X autopsy area + 20.4; r = .94, p = .0001), with the systematic difference in the measurements accounted for by systolic arrest, loss of distending pressure, and specimen shrinkage. The echocardiographic measure of infarct size (%AWM) correlated well with the autopsy percent infarction by volume (%AWM = 1.1 X infarct volume + 5.5; r = .82, p = .0001). Similarly, a good correlation was found for the percent abnormal wall motion and the autopsy percent endocardial surface area overlying infarction (%AWM = 0.89 X infarct area - 0.9; r = .89, p = .0001). When the data were examined in relation to the age of the myocardial infarct, the echocardiographic %AWM appeared to overestimate the autopsy infarct size (by percent infarct volume) in the recent infarct group (n = 6), and underestimate the extent in the old infarct group (n = 13). The findings suggest that the EMT will provide a useful quantitative measure of left ventricular endocardial surface area and the extent of ischemic/infarct-related dysfunction.

Aged↗
PubMedDate not supplied

Antimyosin uptake and myofibrillarlysis in dilated cardiomyopathy.

BACKGROUND: Although antimyosin scintigraphy detects myocyte necrosis associated with myocarditis, it has also been reported to yield positive results in a large number of patients with clinical dilated cardiomyopathy without histologic evidence of myocarditis. The question to be resolved is whether this discordance represents false-positive results of antimyosin scans or whether antimyosin scintigraphy more accurately identifies the presence of myocyte necrosis than does endomyocardial biopsy testing. METHODS AND RESULTS: Forty patients with the acute onset of dilated cardiomyopathy (left ventricular ejection fraction < 45%; mean 27% +/- 11%) but no endomyocardial biopsy evidence of myocarditis, were identified from a consecutive series of 50 patients who had undergone indium 111 antimyosin antibody scintigraphy and endomyocardial biopsy for suspected myocarditis. The endomyocardial biopsy specimens were analyzed to identify features correlating with antimyosin uptake or improvement in left ventricular ejection fraction (LVEF) over time. Twenty-five patients showed left ventricular myocardial uptake of radiolabeled antimyosin antibody by both planar and tomographic imaging. The remaining 15 patients had no antimyosin uptake. Of the 25, 22 (88%) patients with positive findings on antimyosin scans had degenerated, myofibrillarlytic myocytes in their biopsy specimens. Of the 15 patients with negative findings on antimyosin scans, only 6 (40%) had similar myofibrillarlytic myocytes (chi 2 = 8.13; p < 0.0047). No other histological feature correlated with the antimyosin positivity. Stepwise multiple regression analysis was performed for identification of predictors of short-term improvement in LVEF. Patients with positive findings on antimyosin scans showed a trend toward improvement with time (F = 3.97; p > 0.05). None of the histologic features predicted improvement in the LVEF. However, the combination of positive findings on an antimyosin scan and myofibrillarlysis did correlate significantly with spontaneous improvement in ejection fraction (F = 4.53; 0.01; < p < 0.05). CONCLUSIONS: This study identifies myofibrillarlysis as a common pathologic alteration in patients with recent onset of dilated cardiomyopathy and positive findings on antimyosin scan, who lack right ventricular biopsy evidence of myocarditis. Because myofibrillarlytic cell population may represent a histologic spectrum of viable to necrotic myocytes, it appears that antimyosin uptake detects necrotic myofibrillarlytic myocytes that are not identified by light microscopy.

Adolescent↗
PubMedDate not supplied

Diagnostic accuracy of antimyosin scintigraphy in suspected myocarditis.

BACKGROUND: Radiolabeled antibody specific for cardiac myosin administered intravenously has been used to define noninvasively regions of myocardial necrosis. Inflammatory heart disorders such as myocarditis and heart transplant rejection demonstrate diffuse and often faint myocardial uptake of antimyosin antibody. This study was undertaken to evaluate the reproducibility and diagnostic accuracy of antimyosin antibody imaging for the detection of patients with suspected myocarditis. METHODS AND RESULTS: Fifty antimyosin scans, performed consecutively in patients with suspected myocarditis, were evaluated by one independent observer and two panels of observers. Antimyosin scan interpretations were compared with endomyocardial biopsy results and also with serial changes in left ventricular function. An independent observer (A) and a panel of five observers (A through E) interpreted the antimyosin scans as positive or negative on the basis of both planar images and tomographic reconstructions. Three of the five observers (A through C) again interpreted the scans but based interpretation only on planar images. Blinded random sequence evaluation of antimyosin scans based on the planar and tomographic interpretations revealed moderate agreement between the independent observer (A) and the group of observers (A through E) (kappa = 0.58). There was also moderate agreement between interpretations based on planar images alone and interpretations based on both planar and tomographic images (kappa [A through E]/[A through C] = 0.57; kappa [A through C]/A = 0.48). Comparison of antimyosin scan results with histologic evidence of myocarditis in endomyocardial biopsy specimens demonstrated that all scan results obtained from the individual or the panels of observers had a very high sensitivity (91% to 100%) and a high negative predictive value (93% to 100%). The specificity (31% to 44%) and positive predictive value (28% to 33%) were less impressive. We also compared the scan and biopsy results with the composite clinical standard of significant left ventricular functional improvement. Endomyocardial biopsy demonstrated poor sensitivity (35%) compared with antimyosin scans (82% to 94%) but had superior specificity (endomyocardial biopsy, 79%; antimyosin scan, 25% to 42%). The specificity of interpretations based on planar and tomographic interpretations (38% to 42%) was better than the planar images alone (25%). If reversible left ventricular dysfunction is considered clinical evidence of myocarditis, this study suggests that a negative endomyocardial biopsy significantly misses the presence of the disease. On the other hand, a negative antimyosin scan almost invariably excludes myocarditis. CONCLUSIONS: This study demonstrates a high degree of interobserver reproducibility of antimyosin interpretation. Comparison of the scintigraphic results with histologic and clinical standards indicates a high sensitivity of antimyosin scans for the detection of myocarditis. The antimyosin scan is also not likely to miss clinically or pathologically diagnosed myocarditis, in contrast to the endomyocardial biopsy, which missed clinically validated myocarditis 65% of time. The combination of high sensitivity and negative predictive value suggests that antimyosin scintigraphy may be an effective screening procedure for obviating biopsies in patients with suspected myocarditis.

Anti-Inflammatory Agents↗
PubMedDate not supplied

Cytologic diagnosis of pancreatic cystic lesions. A prospective study of 28 percutaneous aspirates.

PURPOSE: To prospectively evaluate fine needle aspiration biopsy (FNAB) of pancreatic cystic lesions. STUDY DESIGN: We performed a blind, prospective study on percutaneous aspirates from 28 radiographically identified cysts, including 6 inflammatory cysts (5 pseudocysts and 1 abscess), 4 serous cystadenomas, 1 cystic islet cell tumor, 5 mucinous cystic neoplasms, 6 mucinous cystadenocarcinomas and 6 nonpancreatic cysts. RESULTS: Four of six (67%) cystadenocarcinomas were identified as malignant, and the other two, which lacked sufficient morphologic criteria for malignancy, as consistent with mucinous cystic neoplasm. Two of five mucinous cystic neoplasms were correctly classified. One, which contained atypical cells, did not appear to be mucinous on the ThinPrep, and one, which lacked an epithelial component, was suggested because of the presence of mucin in the background. The fifth one contained inflammatory cells only. One of four serous cystadenomas produced a diagnostic specimen. FNAB of the cystic islet cell tumor was nondiagnostic. Five of six inflammatory cysts (83%) were correctly diagnosed, whereas one case produced an acellular, nondiagnostic specimen. Six of 28 (23%) cases were nonpancreatic cysts, aspirated under the presumption that they were pancreatic cysts based on radiologic studies: only one case, a papillary cystadenocarcinoma of the stomach, was correctly diagnosed; the other five cases were nondiagnostic, and in two of these the assumption that the cysts were pancreatic in origin precluded an accurate classification. CONCLUSION: FNAB of pancreatic cystic lesions can differentiate mucinous from nonmucinous pancreatic cysts and provide definitive evidence of malignancy. In some cases, serous cystadenomas can be diagnosed. Pseudocysts can be suspected on the basis of an inflammatory smear lacking both epithelial cells and background mucin, but this finding is not specific. Nonpancreatic lesions constitute a significant percentage of cases aspirated as pancreatic cysts and present a major pitfall in cytologic interpretation.

Biopsy, Needle↗