Search PubMed⌕ Search

Biomedical subjects

J H Crosby

Publications and source records attributed to J H Crosby.

17 recordsLinked to original sources
PubMed1992

Complex cryptococcal empyema.

Cryptococcus neoformans continues to present diagnostic and treatment challenges in patients with underlying malignant neoplasms. Cryptococcal empyema is a relatively rare complication of cryptococcal disease. It is important to distinguish whether uncontrolled malignancy or cryptococcal infection is responsible for the effusion. We used traditional diagnostic approaches, bronchoscopy and transthoracic fine needle aspiration, to verify the presence of the organism but continued to have treatment failure until adequate drainage was established.

Cryptococcosis↗
PubMed1992

Cytology and DNA flow cytometry of peritoneal washings in gynecologic patients.

Peritoneal washing cytology, widely used in the management of gynecologic malignancy, entails several difficulties in interpretation. Quantitative DNA analysis by flow cytometry (FCM) holds promise as a more objective method fo diagnosis of malignancy. We performed traditional cytologic examination and single-parameter FCM DNA analysis on peritoneal washings from 136 gynecologic laparotomies, compared these results with the final pathologic findings, and analyzed sources of error. A total of 50 laparotomies were performed for benign disease. Another 86 were performed for cervical, endometrial, and ovarian carcinomas and various other cancers. In the benign group, cytology had one false suspicious but no false positive results, and FCM showed only diploid cells. In the cancer cases, cytology had five suspicious and 13 positive results and one false negative from laboratory error. On review, 16 washings contained confirmed cancer cells. FCM, performed in 13 of these cases, was diploid in 10 and aneuploid in only 3. In six of the diploid cases, visual cell counts showed that tumor cells were present in concentrations of 2.5% or less of total cells. In the remaining four diploid cases, a second DNA determination was obtained by FCM of nuclei retrieved from paraffin blocks of the tumors. These nuclei were diploid by FCM in three of the tumors and aneuploid in only one. Single-parameter DNA FCM was too insensitive to be helpful in our material.

DNA↗
PubMed1991

Self reported snoring and daytime sleepiness in men aged 35-65 years.

BACKGROUND: It has been suggested that snoring alone, without conventional sleep apnoea or hypopnoea, may disrupt sleep and produce substantial daytime hypersomnolence. This study addresses this potential relationship. METHOD: Eight hundred and fifty men, aged 35-65 years, drawn from one general practice were visited at home and asked a range of questions potentially related to sleepiness, snoring, and sleep apnoea; these included inquiries about alcohol and cigarette consumption, nasal stuffiness, shift work, hypnotic or other drug use, and medical diagnoses. In addition, measurements of height, weight, and overnight arterial oxygen saturation were made. The relation between snoring and sleepiness, with allowance made for potentially confounding variables, including sleep apnoea, was assessed by multiple logistic regression. RESULTS: Positive answers to all questions about sleepiness were correlated significantly with self reported snoring. After potentially confounding variables and any sleep apnoea had been controlled for, positive answers to four questions about inappropriate drowsiness or sleepiness were independently related to snoring. For example, the odds ratio of admitting to "having almost had two or more car accidents while driving due to sleepiness" was 5.8 (95% confidence intervals: 2.7-12.5) in an "often" snorer. CONCLUSIONS: Although epidemiological associations such as this do not prove a causal relation, the study suggests that snoring (without classical sleep apnoea) may sometimes reduce sleep quality sufficiently to produce substantial daytime drowsiness.

Adult↗
PubMed1991

Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men.

One thousand and one men, aged 35-65 years, were identified from the age-sex register of one group general practice. Over four years 900 men were visited at home and asked questions about symptoms potentially related to sleep apnoea and snoring. Height, weight, neck circumference, resting arterial oxygen saturation (SaO2), and spirometric values were also determined. All night oximetry was then performed at home and the tracing analysed for the number of dips in SaO2 of more than 4%. Subjects with more than five dips of 4% SaO2 or more per hour were invited for sleep laboratory polysomnography. Seventeen per cent of the men admitted to snoring "often." Multiple linear regression techniques identified and ranked neck circumference (r2 = 7.2%), cigarette consumption (r2 = 3.4%), and nasal stuffiness (r2 = 2%) as the only significant independent predictors of snoring. Together these account for at least a sixfold variation in the likelihood of being an "often" snorer. Forty six subjects (5%) had greater than 4% SaO2 dip rates of over five an hour and 31 of these had full sleep studies. Three subjects had clinically obvious and severe symptomatic obstructive sleep apnoea, giving a prevalence of three per 1001 men (0.3%; 95% confidence interval 0.07-0.9%). Eighteen men had obstructive sleep apnoea only when supine and in 10 the cause of the SaO2 dipping on the original home tracing was not elucidated. The greater than 4% SaO2 dip rates correlated with the history of snoring. Multiple linear regression techniques identified and ranked neck circumference (r2 = 7.9%), alcohol consumption (r2 = 3.7%), age (r2 = 1%) and obesity (r2 = 1%) as the only significant independent predictors of the rate of overnight hypoxic dipping. This study shows that snoring in this randomly selected population correlates best with neck size, smoking, and nasal stuffiness. Obstructive sleep apnoea, defined by nocturnal hypoxaemia, correlates best with neck size and alcohol, and less so with age and general obesity.

Adult↗
PubMed1990

Relation between systemic hypertension and sleep hypoxaemia or snoring: analysis in 748 men drawn from general practice.

OBJECTIVE: To establish whether a history of snoring or the degree of overnight hypoxaemia is an important independent predictor of systemic blood pressure. DESIGN: Prospective community based study of blood pressure in relation to overnight oxygen saturation, height, weight, and a questionnaire assessment of snoring, smoking, and alcohol consumption. Analysis was by multiple linear regression techniques and analysis of variance. SETTING: Small town outside Oxford, served by one group general practice of four partners. All measurements were made at home. SUBJECTS: The names of 836 men aged 35-65 were drawn at random from the general practitioners' age and sex register and the men then asked to participate; 752 (90%) agreed. MAIN OUTCOME MEASURES: Systolic, mean, and diastolic blood pressures and their association with age, obesity, alcohol consumption, cigarette consumption, snoring, and overnight hypoxaemia. RESULTS: Though systemic blood pressure correlated significantly with overnight hypoxaemia, this was due to the cross correlation with age, obesity, and alcohol consumption. No independent predictive effect of overnight hypoxaemia was found. Snoring was correlated with systemic blood pressure but not significantly so and also was not an independent predictor once age, obesity, and alcohol consumption had been allowed for. CONCLUSIONS: It is unlikely that snoring and sleep hypoxaemia from occult sleep apnoea are important causes of diurnal systemic hypertension when compared with age, obesity, and alcohol consumption. The increased prevalence of cardiovascular complications reported in snorers may be due to the confounding variable of obesity or to nocturnal rises in blood pressure that are not reflected in the daytime figures.

Adult↗
PubMed1989

Fine-needle aspiration of subcutaneous phaeohyphomycosis caused by Wangiella dermatitidis.

Two cases of subcutaneous phaeohyphomycosis, first recognized by fine-needle aspiration (FNA), were confirmed with culture, excision, and histologic study. Both patients had debilitating medical problems and a solitary mass on the left leg. Pigmented hyphae and other fungal elements, numerous in both aspirates, assumed a variety of forms that did not permit specific identification. Culture grew Wangiella dermatitidis in both cases. FNA also yielded purulent exudate, multinucleated giant cells, and, in one case, epithelioid histiocytes. Both excised lesions were abscesses, with associated granulomatous inflammation, fibrosis, and plant splinters. Fungi in sections resembled those seen in the aspirates.

Biopsy, Needle↗
PubMed1989

Malignant fibrous histiocytoma and malignant melanoma: the role of immunohistochemistry and electron microscopy in the differential diagnosis.

Malignant fibrous histiocytoma (MFH) and malignant melanoma (MM) occur together often in the differential diagnosis of poorly differentiated neoplasms. They differ, however, in their biologic behavior and recommended treatment. Investigators have therefore explored a variety of special techniques, including electron microscopy (EM) and immunoperoxidase (IP), to classify these tumors accurately and to separate them from each other. To determine the usefulness of IP and EM in the classification of these tumors, we applied a Fontana-Masson stain and IP probes for vimentin, alpha-1-antitrypsin (alpha-1-A), human melanoma black (HMB)-45, and S-100 protein to twelve MMs and nine MFHs, all of which had available EM studies. Three of twelve MMs were amelanotic. All tumors contained vimentin. Eight of twelve MMs and six of nine MFHs contained alpha-1-A. Ten of twelve MMs and no MFHs contained HMB-45. Eleven of twelve MMs and, surprisingly, two of nine tumors classified by light and EM as MFHs contained S-100 protein. When problems arose with either IP negativity or potentially misleading cross-reactivity, careful EM study allowed definitive classification.

Adult↗
PubMed1989

Fine-needle aspiration of inguinal lymph nodes in gynecologic practice.

Palpable inguinal lymph nodes are a common finding in gynecologic patients. Assessment of such nodes is especially important in the clinical staging of pelvic cancers. To determine the accuracy, safety, and usefulness of fine-needle aspiration in this setting, we retrospectively reviewed pathologic and clinical data from 62 consecutive aspirates of inguinal lymph nodes in 48 gynecologic patients, of whom 42 had cancer. Aspirates from 37 patients yielded diagnostic material. Aspirated tumor cells consistently reflected the primary tumor histology. Tumors included carcinomas of the vulva, vagina, and cervix, and carcinomas and mixed mesodermal cancers of the corpus and ovary. Node excision and clinical observations provided adequate follow-up for 19 positive and 15 negative aspirates, and identified no false positives and two false negatives. The role of fine-needle aspiration varied with the tumor type and stage. It provided the first microscopic diagnosis of cancer in six patients and the first diagnosis of metastasis in six others. Decisions concerning surgery, radiation ports, and chemotherapy frequently depended on the results of fine-needle aspiration. There were no complications from the procedure. Fine-needle aspiration is an accurate, safe, and useful method for assessing clinically suspicious inguinal nodes.

Biopsy, Needle↗
PubMed1986

Risk factors for bladder cancer in a cohort exposed to aromatic amines.

Occupational and nonoccupational risk factors for bladder cancer were analyzed in a cohort of 1385 workers with known exposure to a potent bladder carcinogen, beta-naphthylamine. Bladder cancer was approximately seven times (95% confidence interval [CI] = 3.9, 12.4) more likely in exposed rather than nonexposed individuals, yet, otherwise, the groups were generally similar in other exogenous or hereditary risk factors. A total of 13 cases of bladder cancer were identified. After the first year of a screening program involving 380 members of the cohort, 9 of the 13 cases of bladder cancer and 36 persons with atypical bladder cytology, histology, or pathology were compared with 335 noncases for distributions of different variables. Occupational variables were significant in a multivariate model that controlled for age, cigarette smoking history, and source of drinking water. The estimated odds ratio for the association for bladder cancer and the duration of employment, when controlling of these other variables, is 4.3 (95% CI = 1.8, 10.3). In addition to the occupational factors, age was significant in the multivariate analysis. Other potential risk factors, such as consumption of coffee or artificial sweeteners, use of phenacetin, or decreased use of vitamin A were not found to be significantly different in cases and noncases.

1-Naphthylamine↗
PubMed1986

Diagnosis of thoracic splenosis by tru-cut needle biopsy.

We present a case of thoracic splenosis diagnosed by tru-cut needle biopsy, which yielded histologically normal splenic tissue. This is the first report of a diagnosis of thoracic splenosis by needle biopsy. The patient had a history characteristic of thoracic splenosis. Autotransplanted splenic tissue functions and may provide some defense against serious infections. A conservative approach to diagnosis offers the advantages of preserving splenic tissue and avoiding thoracotomy.

Biopsy, Needle↗
PubMed1986

Embryonal rhabdomyosarcoma in ascitic fluid. Immunocytochemical and DNA flow cytometric study.

We report the case of an 18-year-old woman who had a small-cell malignant neoplasm of the left paranasal sinuses and who, 18 months later, developed malignant ascites. Immunoperoxidase stains of the ascitic fluid cells and, subsequently, the original tumor, identified it as embryonal rhabdomyosarcoma. Flow cytometric DNA analysis of the ascitic fluid demonstrated an aneuploid cell population that was also present in the paraffin-embedded tissue on which the original diagnosis had been made.

Adolescent↗
PubMed1985

Transthoracic fine-needle aspiration. Experience in a cancer center.

The authors summarize 5 years' experience with transthoracic fine-needle aspiration (TFNA) in 180 patients. Aspirated tumors tended to be large and peripheral. A large pneumothorax was seen after 4.3% of aspirations, and various minor complications followed another 23.3%. Emphysema was a significant risk factor for complications. Follow-up confirmed 151 cancers, with a wide variety of origins and histologic types. In the diagnosis of cancer, TFNA cytology had a specificity of 100% and a sensitivity of 82%. Positive TFNA findings usually provided the earliest microscopic diagnosis of cancer or of cancer stage.

Adolescent↗
PubMed1985

Risk assessment of a cohort exposed to aromatic amines. Initial results.

A cohort of 1,385 workers potentially exposed to carcinogenic amines was evaluated to determine the extent of its risk for bladder cancer. The cumulative incidence of bladder cancer was determined from death certificates, from interviews with community urologists, and from a screening program. A total of 13 confirmed cases of bladder cancer were identified at the conclusion of the first year of study. The entire cohort has approximately a fourfold excess risk of bladder cancer; however, black workers with more than 10 years of employment had a risk ratio of 111 (based on three cases). The onset of disease occurred, on the average, 15 years earlier in these black workers than in the general U.S. population. The cumulative incidence of bladder cancer increased with the duration of employment, ranging from 0.4% for workers with five or fewer years of employment to 36% for those with greater than 20 years. No significant differences were found between cases and noncases for cigarette smoking, coffee drinking, use of artificial sweeteners, or prior employment in high-risk occupations. More cases of bladder cancer are expected in this cohort because many members have not yet achieved the average latency found for the confirmed cases.

Adolescent↗
PubMed1975

Herpetic tracheobronchitis. Cytologic and virologic detection.

Tracheobronchitis due to herpes simplex virus is a well-recognized finding in cases of burns, debilitation, or immunosuppression. Nearly all reported cases have been diagnosed at necropsy despite the possibility for clinical detection of such infections by exfoliative cytological studies, virus isolation and identification, or both. The present report details the cytologic and virologic diagnosis of herpetic tracheobronchitis in a patient with carcinoma of the lung and alcoholic fatty liver. Respiratory cells with herpetic infection cytologically showed less tendency to multinucleation than the characteristic herpes-infected cells of squamous epithelium, which may be a source of diagnostic confusion.

Aged↗
PubMedDate not supplied

Transthoracic fine needle aspiration of primary and metastatic sarcomas.

Sarcomas, excluding lymphomas, are relatively uncommon targets of transthoracic fine needle aspiration. This paper presents a series of 11 adult patients with a variety of histologically documented sarcomas that were positive on transthoracic fine needle aspiration. Most tumors were metastatic from extrathoracic primary sites. We summarize the cytologic appearances of the aspirates and the clinical roles of fine needle aspiration in this setting. The aspirates resembled the corresponding histologic sections in cellular morphology. Nine different histologic types of sarcomas therefore produced a wide variety of cytologic appearances. Two findings, though not specific for sarcomas, were common and are suggested as clues to the recognition of sarcomas: (1) poor cohesion of cells and (2) numerous spindle cells. Transthoracic fine needle aspiration confirmed a strongly suspected clinical diagnosis in 7 cases, and it clarified a more obscure clinical diagnosis in 4 cases. Suggestions are presented for differential diagnosis.

Adult↗
PubMedDate not supplied

Cytologic detection of urothelial cancer and other abnormalities in a cohort of workers exposed to aromatic amines.

A total of 541 members of a cohort at increased risk for occupational bladder cancer underwent a 33-month program of screening with urine cytology. Selected workers received further urologic study with cystoscopy and bladder biopsies. Eight workers had positive or suspicious cytologic findings. Only one of the eight had a prior history of bladder cancer. Biopsies showed invasive carcinoma and/or nonpapillary carcinoma in situ in five workers in this group, severe atypia in one, and no significant abnormality in two. Of 56 workers who had atypical cytologic findings, 16 had bladder biopsies, which showed atypia of flat urothelium in 11, nonpapillary carcinoma in situ in one, noninfiltrating papillary carcinoma in one, and no significant abnormality in three. The cytologic detection of urothelial abnormalities often required more than a single specimen. Since the cohort in this study may develop more bladder cancers with the passage of time, continued follow-up is indicated.

Adult↗