Biomedical subjects
Publications and source records attributed to J Linder.
We report a 34-yr-old patient with multiple endocrine neoplasia 2B and achalasia of the cardia who was successfully treated with pneumatic dilation. The various gastrointestinal manifestations of this syndrome are discussed.
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Nuclear matrix proteins are a group of recently described proteins that are thought to be cell-type specific. Using a monoclonal antibody (NM 200.4; Matritech, Cambridge, MA) generated against nuclear matrix proteins isolated from a human breast carcinoma cell line, we examined frozen tissue sections from 30 breast carcinomas, and a variety of normal tissues to determine the antibody specificity, and to assess the relationship with the staining pattern and tumor type and hormone receptor status. Most breast carcinomas marked with the antibody, but stromal and vascular endothelial cells in the tissues surrounding these lesions also marked focally. Marking of vascular endothelium in a variety of benign tissues, renal tubular epithelium, and occasionally uterine smooth muscle cells was also observed. Normal breast tissue from 4 patients without breast cancer did not react. Studies on breast tumors revealed that 15/20 invasive ductal, 3/4 in situ ductal, 3/3 medullary, 2/2 invasive lobular, and 1/1 colloid carcinomas marked with this antibody. Image analysis revealed that the staining intensity of medullary carcinoma was twice that found in invasive ductal carcinoma (avg pixel density 76.6 vs. 30.1; P < 0.05). Invasive lobular and in situ ductal carcinoma also expressed higher staining intensities than invasive ductal carcinoma, but these differences were not significant. Invasive ductal carcinomas had heterogeneity in staining intensity (avg. pixel intensity range: 0-94 units). Tumors with multiple aneuploid populations had significantly higher stain intensity values than either diploid lesions or lesions containing a single aneuploid population (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
The isolation of Aspergillus fumigatus from airway secretions from patients with cystic fibrosis (CF) is common and usually denotes asymptomatic colonization or allergic broncho-pulmonary aspergillosis (ABPA). A 12-year-old boy with CF acutely developed moderately severe symptoms of unremitting cough, fever, dyspnea, weight loss, and cyanosis. Chest radiographs demonstrated widespread unilateral infiltrates and volume loss. By bronchoscopy tenacious mucous plugs were seen occluding the left lower lobe bronchus. Cultures from sputum and sequential bronchoalveolar lavage grew Aspergillus fumigatus, but other significant criteria for diagnosing ABPA were lacking. No improvement was seen with a 3 week course of systemic corticosteroid and antibiotic therapy. Treatment with amphotericin B and short-term mechanical ventilation resulted in rapid resolution of all symptoms. This form of endobronchial aspergillosis has not been described previously.
A major problem in pancreas transplantation is the lack of a reliable method for the early detection of rejection. Over a 32-month period, we performed 61 combined pancreas-kidney transplants with pancreaticoduodenocystostomy. All patients received quadruple immunosuppression with OKT3 induction. Urine cytologic monitoring was performed on Papanicolaou-stained membrane filters for cell counts and cytocentrifuge preparations for HLA-DR antigen staining. The final diagnosis of rejection was based on clinical criteria, a rise in serum creatinine, histopathology, and hypoamylasuria. Cytologic features of acute rejection included hypercellularity with lymphocyturia, increased numbers of epithelial cells and positive antibody staining for HLA-DR antigen. A total of 36 definite acute rejection episodes occurred in 28 patients, with 19 confirmed by histopathology. Satisfactory urine cytologic specimens were available in 28 rejection episodes and corroborated the diagnosis in 21 cases, for a sensitivity of 75% compared with 75% and 50% with serum creatinine and urine amylase, respectively. When the urine cytologic score was combined with HLA-DR antigen staining, sensitivity improved to 93%. Thirteen false-positive diagnoses occurred in the remaining 1444 urine cytologic specimens available for evaluation, for a specificity for rejection of 99%. The positive predictive value of cell counts was 62% and negative predictive value was 99%. Patient survival is 98.4%, kidney allograft survival is 96.7%, and pancreas allograft survival is 93.4% after a mean follow-up of 15 months. Only 2 immunologic graft losses occurred (1 kidney, 1 pancreas). In conclusion, urine cytologic monitoring shows promise as a simple, reliable, and noninvasive method to detect rejection after combined pancreas-kidney transplantation with bladder drainage. Prospective studies are needed to assess the role of urine cytologic monitoring after solitary pancreas transplantation.
Both peripheral and central glucocorticoid sensitivity was examined in patients with Alzheimer's disease (AD; n = 13), glucocorticoid-treated patients (n = 8), healthy elderly controls (n = 10) and young controls (n = 9). We performed glucocorticoid receptor-mediated skin vasoconstrictor responses to clobetasol and low-dose dexamethasone suppression tests. Patients with AD showed skin blanching at a significantly higher clobetasol concentration than did healthy elderly controls (p = 0.002). There was no difference in skin blanching between patients with AD and patients treated with corticosteroids. Patients with AD had significantly higher post-dexamethasone serum cortisol levels than healthy elderly (p = 0.01). No association was found between skin blanching and dexamethasone suppressibility. Thus patients with AD have apparently independent reductions in both central nervous system and peripheral glucocorticoid sensitivity. These results predict an increase in glucocorticoid secretion in some patients, which might accelerate neuronal degeneration in the absence of features of overexposure to glucocorticoids in peripheral tissues.
LTB provokes a systemic immune response and exerts adjuvant effects on mucosal immune responses to unrelated antigens. The binding and uptake of fluorescein-labelled LTB in the normal villus epithelium was compared to that in Peyer's patch dome epithelium in mouse intestine. LTB was bound by the GM1-receptor and taken up extensively by both tissues, indicating that not only the Peyer's patches but also the normal villus epithelium play a significant role in the transport of orally administered antigens. These results were supported by transport studies in the human intestinal epithelial cell line Caco-2 using 125I-LTB. After 2 h incubation, 5.1 +/- 0.1% and 5.9 +/- 0.1% of the added radioactivity was transported in the apical to basolateral and basolateral to apical direction, respectively. Less than 1% of the transported radioactivity was immunoprecipitated with anti-LTB antiserum indicating that LTB was extensively degraded during the transport. The results suggest that normal enterocytes play a significant role in the binding, uptake and transport of orally administered LTB.
STUDY OBJECTIVE: To evaluate the efficacy, safety and tolerability of intravenous (i.v.) isosorbide dinitrate (ISDN) administered as a bolus in the treatment of cardiogenic acute pulmonary edema (CAPE). DESIGN: Clinical, prospective, open, noncontrolled trial. SETTING: Emergency room. PATIENTS AND INTERVENTIONS: Twenty two patients (15 male and 7 female), aged 54 to 80 years (68.4 +/- 6.4) with severe respiratory distress consistent with CAPE were included. The cause of CAPE was chronic ischemic cardiopathy in 13 patients, acute myocardial infarction in four, hypertensive cardiopathy in three and mitral valve disease in two. Patients were excluded from the study because of shock or systolic blood pressure equal or lower than 100 mmHg, severe aortic stenosis, hypertrophic cardiomyopathy and non-cardiogenic pulmonary edema. All patients were placed in the sitting position and received oxygen. Initial therapy consisted of an i.v. bolus of 5 to 10 mg of ISDN. Clinical data were recorded at admission and after 5, 10, 15 and 30 minutes. A new i.v. bolus of ISDN and/or another drug was administered at 5 minutes, when necessary. RESULTS: Fifteen patients treated exclusively with ISDN (in three a second i.v. bolus was necessary) improved markedly. In the remaining seven patients that needed other drugs, the improvement was not so impressive. The mean total dose of i.v. ISDN was 10.34 +/- 3.48 mg. Although all data showed a trend towards improvement, just the following were statistically significant (p < 0.05): pH increased from 7.26 +/- 0.13 to 7.32 +/- 0.9, systolic blood pressure decreased from 192.7 +/- 34.8 mmHg to 155.0 +/- 24.4 mmHg (-19%) and diastolic blood pressure decreased 110.5 +/- 12.7 mmHg to 93.2 +/- 9.1 mmHg (-16%). CONCLUSIONS: In this trial, iv ISDN administered as a bolus in doses ranging from 5 to 20 mg, was effective and safe as a first line agent in the treatment of CAPE. No serious adverse reaction were reported.
We describe four cases of primary hyperaldosteronism whose initial presentation was a moderate hypertension. Serum potassium and plasmatic aldosterone values were high although plasmatic renin levels were normal. The captopril test (Lyons version), abdominal CT and iodocholesterol (NP-59) scan proved useful to exclude essential hypertension. A good therapeutical results was achieved in all cases by unilateral adrenalectomy. After surgery, diagnosis was confirmed in all cases by histological studies. At one year follow-up, all patients were asymptomatic, with no hypertension without therapeutic and the serum potassium and plasmatic aldosterone and renin values were normal.
UNLABELLED: Fever in the first days of acute myocardial infarction (AMI) is a very common clinical feature, being its prognostic value unquestionable. As infarction area reduction implies a less important fever reaction in the first days of AMI, we believe that thrombolytic therapy would result in a decline of body temperature of patients so treated. That is why we tried to identify such a correlation, and demonstrate the value of normal body temperature as indicative of reperfusion. We studied retrospectively 68 patients (10 F and 58 M, 57.1 +/- 9.6 years) survivors of AMI (I-II KK classes), with (TT) or without (NT) thrombolytic therapy. In NT group, there was an axillary temperature (AX T) higher than 37 degrees C at the first 24 hours in 21 patients (62%); TT group only had 10 patients (30%) with AX T over 37 degrees C (p < 0.01). NT group CK mean peak was 856 +/- 610 U.I./l in patients having AX T > 37 degrees C, and 436 +/- 233 U.I./l when AX T was < or = 37 degrees C (p < 0.05); in TT group there was no difference between CK peak means when AX T was > or < or = 37 degrees C (1508 +/- 1210 U.I./l vs 1406 +/- 1149 U.I./l, respectively) (NA). We established statistic difference between AX T of 15 patients which CK peak was reached after 10 hours over onset of AMI (37.59 +/- 0.36 degrees C) and those (19 p) with CK peak before 10 hours (37.17 +/- 0.60 degrees C) (p < 0.05). NT group presented then more febrile patients than did TT group. CONCLUSIONS: in NT group there was a positive relation between AX T and CK peak level; AX T > 37 degrees C was less frequent in TT group and was as much light when CK peak was more precocious. These results suggest that in thrombolytic treated patients the absence of fever in the first 48 hours may constitute one more coronary reperfusion criterion.
This is a report of an acute myocardial infarction complicated with rupture of the free wall of the left ventricle. Some comments concerning diagnosis and therapy are added, with emphasis in the correct communication of community hospitals with the centers of cardiac surgery.
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In physical chemistry, the most unique and dramatic reactions occur at the interface between different phases of matter. An analogy can be drawn between this observation and the interface that currently exists between the traditional practice of cytopathology and the technologies discussed in this editorial. It is natural to be excited about new technologies. They offer the potential to improve our diagnostic ability, to save time, and to expand the range of cytopathology services. Our enthusiasm for new technology should be tempered by the inherent appeal of cytopathology--its relative simplicity. Cytologic diagnoses are possible with a glass slide, extracts of tree bark, and a well-trained observer. This can be rapid and tremendously cost effective, not only identifying the type of abnormality, but often providing prognostic information. New technology, while offering additional information, may not be cost effective, or may not offer more information than is available by traditional methods. Whether or not to accept new technologies is the choice of cytotechnologists and cytopathologists. It is the goal of the Editorial Board of Diagnostic Cytopathology that this be a well-informed choice. The current and coming issues of Diagnostic Cytopathology will describe technological advances in the Focus on Technology section of the journal. We trust that you will find this information useful in your evaluation of new technology.
Machine-aided screening of cervical Papanicolaou (Pap) smears is being pursued in response to a cytotechnologist shortage and a perception that computer-aided screening may improve human screening. Several different commercial efforts are underway to automate either the processing of cervical specimens or the screening of Pap smears and nongynecologic specimens. The technical approaches used by these manufacturers are varied and include traditional algorithmic computers, expert systems, and neural networks, alone or in combination. Alternatives to cell smears on glass slides are also being studied, in which monolayer cell preparations facilitate the analysis of the cells. It is not possible to suggest what approach to automation in cytology is preferred at this time. Preliminary studies of different systems suggest several of them may have sensitivity to detect intraepithelial abnormalities in excess of 95%. It is likely that these technologies will significantly aid the analysis of cytologic specimens.
OBJECTIVE: To clarify the association between treatment of affective psychiatric disorders with lithium, and the development of secondary hyperparathyroidism. DESIGN: Retrospective review of medical records, 1973-89. SUBJECTS: 17 patients with affective psychiatric disorders who were treated with lithium (n = 6) or with tricyclic antidepressant, or neuroleptic, drugs (n = 11) all of whom were operated on for hyperparathyroidism. MAIN OUTCOME MEASURE: Duration of lithium therapy and parathyroid histology. RESULTS: Parathyroid hyperplasia was present in 5 patients who had taken lithium during a median period of 13 years. A parathyroid adenoma was found in one patient treated with lithium for three years. Ten of the 11 patients who had been treated with tricyclic antidepressant, or neuroleptic drugs had a parathyroid adenoma and the remaining one had an adenoma as an underlying cause of hyperparathyroidism. CONCLUSION: Hyperparathyroidism in patients who have undergone long term treatment with lithium is associated with parathyroid hyperplasia. This indicates that lithium may exert a chronic stimulus that results in secondary hyperparathyroidism.
We report coexistent collagenous colitis and collagenous sprue in a 62-year-old woman with diarrhea. Investigations suggested malabsorption, and small intestinal biopsies demonstrated a flattened mucosa with subepithelial collagen deposition. Colonic biopsies also showed a thickened subepithelial collagen band as well as a striking lamina propria inflammatory cell infiltrate. Symptomatic remission was induced with a gluten/lactose-free diet, oral prednisone, and sulfasalazine and has been maintained with gluten restriction alone. Repeat biopsies after 2 months demonstrated restoration of normal small intestinal and colonic collagen bands; only a chronic inflammatory cell infiltrate (consistent with microscopic/lymphocytic colitis) persisted in colonic biopsies. We propose that, in this instance, collagenous enterocolitis represented a diffuse manifestation of gluten sensitivity.
In a retrospective study of fifty cases of gastrostomy insertion performed operatively (OG) or using a percutaneous endoscopic approach (PEG), complication rates were 74 percent (nineteen adults) and 76 percent (seventeen children) in the OG group, and 86 percent (fourteen adults) in the PEG group. While most complications were minor, major ones were usually related to the underlying disease and the general condition of the patient.