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Biomedical subjects

J S Meyer

Publications and source records attributed to J S Meyer.

At least 19 recordsLinked to original sources
PubMed1996

The impact of stage and histology on the long-term clinical course of 163,808 patients with breast carcinoma.

BACKGROUND: Stage and histologic type have a significant impact on the long term clinical course of breast carcinoma. Clinical course is governed by two components: likelihood of cure and medial tumor-related survival time among uncured patients. Estimates of these components can be derived only by using survival models that incorporate cured fraction as a specific parameter. METHODS: The prognostic value of stage and histologic type was determined for 163,808 patients with breast carcinoma using the log normal and log logit cure-based survival models. Follow-up ranged from 1 month to 19 years and was obtained from the SEER Program. RESULTS: In approximate terms, ductal carcinoma was diagnosed in 70% of the patients, with estimate cured fractions of 2/3 and 1/3 for local and regional disease, respectively. Estimates of medial survival times for uncured patients were 10 and 5 years. Findings were similar for patients with tumor of miscellaneous histologic types. For patients with medullary carcinoma were 82% and 50%, with median survival times of 6 and 4 years. For patients with mucinous, lobular, and ductolobular carcinomas, parametric analysis gave inconsistent estimates of cured fraction, but findings suggested unusually long tumor-related survival times. CONCLUSIONS: Cured-based parametric survival models offer valuable insight into the impact of stage and histology on the clinical course of breast cancer.

Breast Neoplasms↗
PubMed1996

Rates of growth of human neoplasms: Part II.

Part I of this study [Spratt JS, Meyer JS, Spratt JA: J Surg Oncol 60:137-146, 1995] reviewed the early reports of investigators, predominantly mathematical biologists and statisticians considering the mathematical laws that would describe the growth of a neoplasm. Included were cytokinetic measurements of the mitotic index, thymidine labeling index, bromodeoxy-uridine labeling index, and the relation of these indices to the potential tumor volume doubling time. The actual doubling time of benign and malignant colonic neoplasms were reported. This second part provides the cumulative observations on the actual doubling times of pulmonary metastases, primary pulmonary cancers, skeletal sarcomas, melanomas, a chemodectoma, tumors of maxillary antrum, testicular cancers, prostate cancer, and the relation between the accumulation of multiple primary cancers and growth rates. The most complete data set is for breast cancer concluding that the cancer growth curve is a decelerating curve with great natural variance. Understanding of the rates of growth of human cancers is essential for understanding the spectrum of cancer behavior observed clinically.

Bone Neoplasms↗
PubMed1996

Langerhans' cell histiocytosis of the spine in children.

Between May 1972 and December 1991, 58 children were seen in the authors' institution for treatment of Langerhans' cell histiocytosis. Of these, 15 children (7 males, 8 females) had biopsy-proven Langerhans' cell histiocytosis with vertebral involvement. The average age at presentation was 6.4 years (range, 0.2-13.3 years). At presentation, 8 patients had involvement of a single vertebra and 4 had involvement of multiple vertebrae. Nine patients had extraspinal skeletal involvement. Two patients had visceral involvement. Currently, 13 patients have had >2 years followup (average, 8.9 years; range, 2-21 years). None of these patients had clinical evidence of disease at the latest encounter. This group of patients with Langerhans' cell histiocytosis with vertebral involvement has fared well. Most patients have had involvement of multiple vertebrae and many have had extraspinal bony involvement as well. There was a great deal of variability in the extent of collapse and reconstitution of vertebral height, and the amount of reconstitution did not correlate with patient age.

Adolescent↗
PubMed1996

Prospective study of vascular events and cerebral perfusional changes following transient ischemic attacks.

A prospective case-control study was carried out to clarify associations of cerebral transient ischemic attacks (TIAs) and other stroke risk factors with progression and exacerbation of cardiovascular and cerebrovascular disorders; 243 neurologically normal controls and 123 TIA patients without prior history of stroke were followed up for a mean interval of 4.4 years of TIA patients, 26 (21%) developed other events (excluding recurrent TIAs); 10 died of vascular causes (8.1%). Of controls, 44 (18%) developed events; 13 died of vascular causes (5.4%) and 3 from cancer. TIA patients were at 2.3 times greater risk than normal controls for stroke or death from vascular causes. They were predominantly male with significantly higher associations of risk factors for stroke, including hypertension, heart disease, diabetes mellitus, smoking, hyperlipidemia, alcohol consumption, and limited education. Controls developing vascular events compared with controls who did not were older, more frequently male, and with greater incidences of heart disease. TIA patients had lower rates of cerebral perfusion compared with controls that persisted throughout the study, with similar rates of decline related to aging among both groups. Among TIA patients, stroke risk factors were more prevalent than among controls. The longer their duration, the greater the incidence and the more rapid the rate of severe, often fatal cardiovascular complications.

Age Factors↗
PubMed1996

Magnetic resonance imaging of skewfoot.

Magnetic resonance imaging was used to visualize the ossified and unossified portions of the bones and soft tissues of the feet in order to evaluate the tarsometatarsal anatomy in sixteen children, three months to six years old (mean, fifteen months old), who were seen in the orthopaedic clinic with a suspected diagnosis of skewfoot. Twenty-seven feet were clinically abnormal and five were normal. Of the abnormal feet, twenty-six had a radiographic diagnosis of skewfoot and one, of simple metatarsus adductus. Of the skewfeet, seven had a talocalcaneal angle of 45 degrees or more as measured on the lateral radiograph and six had a talocalcaneal angle of 45 degrees or more as measured on the anterior radiograph. Valgus deformity of the hindfoot was not apparent on clinical examination in any of the children. The talocalcaneal angles measured on the magnetic resonance images corresponded poorly with those measured on the radiographs, possibly because it is not possible to simulate weight-bearing during magnetic resonance imaging or because the effect of partial volume averaging on thin sections. However, magnetic resonance imaging demonstrated the shapes of the bones and the positions of the unossified portions of the bones. Magnetic resonance imaging showed lateral subluxation of the navicular in twenty-four skewfeet, plantar subluxation in ten, and medial subluxation of the first metatarsal on the medial cuneiform in twenty-five. The alignment of the lateral margin of the calcaneus and cuboid on the magnetic resonance images was normal in all patients. Magnetic resonance imaging has the unique ability to show the cartilaginous and ossified portions of the developing bones of the foot.

Child↗
PubMed1996

Characterization and localization of [125I]RTI-55-labeled cocaine binding sites in fetal and adult rat brain.

The present studies examined the characteristics of fetal (gestational day 20) and adult rat brain cocaine recognition sites labeled with the potent cocaine congener [125I]RTI-55 [3 beta-(4-iodophenyl)-tropane-2 beta-carboxylic acid methyl ester]. Saturation analyses of [125I]RTI-55 binding to membrane fractions from both fetal and adult whole-brain yielded curvilinear Scatchard plots that were resolved by nonlinear curve-fitting into high- and low-affinity components. Mean Kd values were 0.13 nM and 12 nM for fetal brain high- and low-affinity sites, respectively, compared to 0.26 and 18 nM for adult brain. The Kd for high-affinity binding was significantly different between the groups, suggesting a possible developmental change in the properties of [125I]RTI-55 binding sites. Drug displacement studies with various monoamine uptake inhibitors indicated that at a 10 pM concentration of [125I]RTI-55, almost all binding to fetal brain membranes could be accounted for by interaction with the serotonin (5-HT) and (to a lesser extent) dopamine (DA) transporters. This conclusion was supported by autoradiographic studies of both adult and fetal brain, demonstrating a predominance of [125I]RTI-55 binding in areas with high densities of 5-HT and/or DA uptake sites. The present results are in accordance with our previous demonstration of [3H]cocaine binding sites in fetal brain (Meyer et al., 1993) and further suggest that [125I]RTI-55 should be a useful ligand for assessing the effects of prenatal cocaine exposure on the subsequent development of cocaine recognition sites on the DA and 5-HT transporters.

Animals↗
PubMed1995

Proliferative rate by S-phase measurement may affect cure of breast carcinoma.

BACKGROUND: Standard, nonparametric statistical methods measure the interaction of covariates with survival rate or relative risk. Conversely, parametric methods measure the interaction of covariates with the two cardinal features of malignant potential: the likelihood of cure and the median time to relapse among uncured patients. METHODS: The authors performed parametric analysis on data from 810 patients with breast cancer using relapse as the survival end point. Prognostic covariates included lymph node status, tumor size, patient age, nuclear size, S-phase by thymidine or bromodeoxy-uridine labeling, and type of adjuvant therapy (chemotherapy, radiation, or hormone therapy). Also included was the cross-product term (labeling index X chemotherapy). RESULTS: Multivariate analysis revealed that: likelihood of cure was associated positively with labeling index X chemotherapy and associated negatively with lymph node status, tumor size, and patient age; and time to relapse was associated negatively with node status, nuclear size, and labeling index. CONCLUSION: The associations of labeling index and chemotherapy with the clinical course suggest that rapidly dividing tumors have a high likelihood of cure, especially with adjuvant chemotherapy, but those not cured may have early relapse.

Adult↗
PubMed1995

Rates of growth of human solid neoplasms: Part I.

The purpose of this article is to consolidate data collected from a variety of sources that have permitted calculations of the rates of growth of human neoplasms. These sources include Fischel State Cancer Hospital (Columbia, MO); Mallinckrodt Institute of Radiology, (St. Louis, MO); Roentgen Diagnostic Institute, Allmanna Sjukhuset (Malmo, Sweden); University of Louisville (Louisville, Kentucky); University of Heidelberg (Heidelberg, Germany); and St. Luke's Hospital (St. Louis, MO). Included in the data are laboratory measurements of cell replication rates. All gross measurements were made either on imaging studies or with a centimeter scale for surface or palpable neoplasms. Data have been reported for breast and pulmonary cancers and metastases of many types, melanomas, skeletal sarcomas, benign and malignant colonic neoplasms, and isolated cases of less frequent neoplasms. Related cytokinetic measurements by tritriated thymidine labelling, bromodeoxyuridine labelling, S-phase fraction from DNA flow cytometric analysis, and mitotic indices are discussed. The various mathematical formulae applicable to the analysis of the collected data and the determination of rates and patterns of growth are included. Also considered are the clinical implications of these data and the importance of ever better knowledge on the cytokinetics of human cancer. Prior studies on the evolution of insight into this field are cited and discussed. The authors conclude that a more accurate quantification of the growth rates of human cancer is essential for understanding the biological variance of human cancers seen clinically.

Breast Neoplasms↗
PubMed1995

Langerhans cell histiocytosis: presentation and evolution of radiologic findings with clinical correlation.

Radiologic images and medical records of 42 children with Langerhans cell histiocytosis (LCH) (histiocytosis X) were reviewed to evaluate the presentation of the disease and the evolution of the radiologic findings. There were 26 male and 16 female patients aged 3 months to 18 years. Twenty-two patients presented with localized disease; 20 presented with multifocal disease. Four patients developed diabetes insipidus. Two patients had organ dysfunction. The radiologic findings were largely due to destructive bone lesions; 83% of the patients had at least one affected bone. Isolated soft-tissue masses, interstitial lung disease, and central nervous system abnormalities were also seen. Of patients in whom results of appropriate follow-up were available, 91% showed improvement in their lesions, 43% developed new lesions, and 92% had good clinical outcomes. LCH is usually a self-limited disease with a varied clinical and radiologic presentation. The prognosis is generally poor in children with organ dysfunction. In the absence of organ dysfunction, children with either localized or multifocal LCH have an excellent prognosis.

Adolescent↗
PubMed1995

Prospective CT confirms differences between vascular and Alzheimer's dementia.

BACKGROUND AND PURPOSE: Cognitive test performances were correlated prospectively with changes in cerebral CT measurements of atrophy, infarct volume, ventricular enlargement, local tissue density, and local perfusion to contrast annual rates of changes among patients with ischemic vascular dementia (IVD) or dementia of the Alzheimer type (DAT). METHODS: The cerebral atrophic index (ATI; ratio of cerebrospinal fluid or infarcted brain to intracranial volume), infarct volume ratio, ventricular volume ratio (VVR; ventricular volume/intracranial volume), cortical and subcortical gray and white matter local perfusion (local cerebral blood flow [LCBF]), and local Hounsfield unit (HU) density were measured concurrently and compared longitudinally with Cognitive Capacity Screening Examinations (CCSE) scores among 24 treated IVD (age, 68.2 +/- 9.7 years; follow-up, 42 +/- 27 months) and 24 DAT patients (age, 74.2 +/- 6.2 years; follow-up, 30 +/- 19 months). RESULTS: IVD annual changes were as follows: CCSE, +1.2 +/- 5.9; ATI, +2.1%/y; VVR, +3.2%/y; and LCBF in the subcortical basal ganglia, -0.74 mL.100 g-1.min-1.y-1 (-1.8%/y). DAT annual changes were as follows: CCSE, -1.8/y; ATI, +8.1%/y; VVR, +9.6%/y; cortical LCBF, -2.0 mL.100 g-1.min-1.y-1 (-5.2%/y); LCBF in the basal ganglia, -3.0 mL.100 g-1.min-1.y-1 (-6.7%/y); white matter LCBF, -0.75 mL.100 g-1.min-1.y-1 (-4.1%/y); and all cortical tissue densities, -0.83 HU/y (-2.1%/y). In IVD, multiple regression analyses correlated cognitive changes directly with (1) recurrent silent infarctions and (2) bidirectional changes of perfusions within frontal white matter, thalamus, and internal capsules. In DAT, cognitive declines correlated with cerebral atrophy and cortical hypoperfusion related to frontotemporal and parietal cortical polioaraiosis (decreased gray matter tissue densities). CONCLUSIONS: In IVD, recurrent strokes were not observed clinically during risk factor control, and antiplatelet therapy and cognitive impairments improved or stabilized. In DAT, cognitive performance relentlessly declined. Ischemic pathogenesis for vascular dementia is supported by the following: (1) cognitive declines correlate directly with recurrent "silent" strokes, and (2) bidirectional cognitive changes correlate directly with frontal white matter, thalamic, and internal capsular perfusional changes.

Aged↗
PubMed1995

Lack of postmenopausal estrogen replacement therapy and the risk of dementia.

Estrogen replacement therapy (ERT) and associated risks for ischemic vascular dementia (IVD) and dementia of the Alzheimer's type (DAT) among postmenopausal women were investigated by determining whether ERT was differently distributed among control subjects than among subjects with dementia. Subjects included 93 with probable DAT, 65 with probable IVD, and 148 normal control subjects. The proportion of control subjects on ERT was almost 2:1, and this ratio holds for both dementia groups. Logistic regression suggests lack of ERT is associated with increased risk for dementia among elderly women. ERT may eventually prove to be a useful prophylactic agent for reducing risk of DAT and IVD among postmenopausal women.

Aged↗
PubMed1995

Cerebral density and perfusion measured among heart disease patients with and without stroke.

This investigation was designed to clarify the chronic effects of cardiogenic emboli on cerebral perfusion and tissue densities within remaining noninfarcted brain. Local cerebral perfusion and tissue densities were measured by xenon-contrasted CT scanning and compared by cross-sectional designs among normal volunteers without heart disease (Group C, n = 44), normal volunteers with heart disease (Group N, n = 20), patients with heart disease and lacunar infarctions (Group L, n = 31) and patients with heart disease associated with cardiogenic cerebral embolism (Group E, n = 12). In Group E, remaining cortical and subcortical gray and white matter perfusion were reduced compared to Groups C and N (p = 0.01), but did not differ from Group L, who had similar profiles of risk factor for stroke. In Group E, perfusion was reduced within the thalamus ipsilateral to cortical infarctions (p < 0.05). There were no differences in remaining tissue densities between Groups E and L. It is concluded that reduced cerebral perfusion in noninfarcted regions among patients with cardiogenic emboli appears to be related to atherosclerosis of small cerebral vessels in a similar manner to patients with lacunes, but thalamo-cortical disconnections also contribute to cerebral hypoperfusion.

Adult↗
PubMed1994

Cognitive declines correlate with decreased cortical volume and perfusion in dementia of Alzheimer type.

Cerebral CT changes are correlated with cognitive declines among 18 patients with probable dementia of Alzheimer type (DAT) (7 men, 11 women, mean age 75.4 years) and are compared for control purposes with similar measures among 18 age-matched normal volunteers (8 men, 10 women, mean age 73.7 years). Mean follow-up intervals are 28.6 months for DAT and 27.0 months for controls. For DAT, annual rates for ventricular volume enlargement are +9.2% and for cortical atrophy are -2.1%. Annual reductions in regional cerebral perfusions per 100 g brain/min, are: total cortex -1.1 ml, frontal -1.2 ml, temporal and parietal -0.9 ml, basal ganglia -1.6 ml, thalamus -2.5 ml, total white matter -0.6 ml, frontal white matter -0.7 ml. At entry evaluation, compared to normals, DAT patients had reduced CT densities in white matter, but not in cortex. Nevertheless, cortical CT densities declined progressively at annual rates of -0.72 Hounsfield units (HU), but remained constant in white matter. Annual point score declines for Cognitive Capacity Screening Examinations were -2.0 and for Mini Mental State: -2.8. Controls showed no cognitive change. Multiple regression analyses correlate cognitive declines with: (1) reductions in perfusion within parietal cortex (p = 0.015), (2) decreases in cortical volume (p = 0.019), and (3) decreases in HU within subcortical gray matter (p = 0.007).

Aged↗
PubMed1994

S-phase fraction and nuclear size in long term prognosis of patients with breast cancer.

BACKGROUND: S-phase fraction (SPF) predicts the prognosis of patients with breast cancer independently of tumor size, axillary metastasis, estrogen receptor (ER) and progesterone receptor (PgR), and patient age. Whether SPF is best measured by DNA labeling index (SPF-LI) or by flow cytometry (SPF-Flow) and what is the relative efficacy of SPF versus histopathologic characteristics for prognosis have remained unanswered questions. METHODS: The authors studied 845 women with Stages I-II disease classification for years 1975-1990 with end results data, who were treated surgically with axillary lymph node dissection by an in vitro DNA labeling index protocol with tritiated thymidine or 5-bromo-2'-deoxyuridine and whose SPF was measured microscopically. Nuclear size was estimated with a calibrated optical grid as less than 11 microns, 11-14 microns, or greater than 14 microns. DNA flow cytometry was performed on fresh or paraffin embedded tissue; ER and PgR were performed by cytosol assay. Kaplan-Meier survival plots and multivariate analysis were used for comparisons. RESULTS: Tumor size, axillary lymph nodal status, SPF-LI, nuclear size, and ER all related strongly to breast cancer specific survival and relapse free survival. PgR was less effective. Lymph node status and tumor size predicted long term survival; differences for other variables largely disappeared by 10 years. By multivariate analysis, axillary lymph node status, tumor size, and ER were independently prognostic for disease specific, relapse free survival. A strong trend was found for nuclear size. PgR, DNA ploidy, and SPF did not contribute to prognosis independently. Nuclear size was the strongest independent predictor in patients with negative axillary lymph nodes. CONCLUSIONS: The number of positive axillary lymph nodes, tumor size, ER, and nuclear size were the strongest predictors of prognosis for patients with breast cancer. Only tumor size and lymph node status predicted the long term risk of metastasis.

Aged↗
PubMed1994

High proliferative rates demonstrated by bromodeoxyuridine labeling index in breast carcinomas with p53 overexpression.

The protein p53 is a product of a suppressor oncogene. Mutations occurring in 13-15% of breast carcinomas are associated with p53 stainability within nuclei and progression of the tumor. We determined the extent to which p53 abnormality was associated with proliferation by measuring p53 immunohistochemically with a polyclonal antibody and monoclonal PAb1801 in invasive carcinomas of known S-phase fraction (SPF) assessed histologically by bromodeoxyuridine incorporation. Results with the two antibodies always agreed. One of 20 low, 2/18 midrange, and 9/17 high SPF carcinomas were positive for p53. P53 positivity was also related to other indicators of aggressiveness including size of primary tumor, nuclear and nucleolar size, and estrogen and progesterone receptor content, but relationships between p53 and vascular invasion and lymph node metastasis were not found. We conclude that nuclear p53 accumulation is more closely related to proliferation than to invasion and metastasis, and that it identifies some but not all breast carcinomas with high proliferative indices.

Breast Neoplasms↗
PubMed1994

CT changes associated with normal aging of the human brain.

CT was used to measure changes in cerebral gray and white matter tissue densities associated with normal aging, using a cross-sectional design, in order to provide normative data for comparisons with abnormal aging such as dementias of Alzheimer's and vascular types. Cerebral compartmental densities were measured using plain CT, and their perfusion values were recorded during stable xenon inhalation (CT-CBF), among 81 neurologically and cognitively normal volunteers of different ages. Results led to the conclusion that cortical gray matter tissue densities progressively decline (polio-araiosis) after age 60. Cortical polio-araiosis is coupled with regional hypoperfusion but not with cortical atrophy. It is speculated that the cortical hypodensity identified by CT imaging parallels declines in cortical synaptic density, as reported from autopsy studies using anti-synaptophysin staining of cerebral cortex obtained from normal people above and below age 60. The coupling of cortical hypoperfusion with polio-araiosis is believed to reflect age-related reductions of cortical metabolic demands as reported by PET. During normal aging leuko-araiosis correlates directly with cortical atrophy, suggesting that anterograde axonal degeneration resulting from cortical neuronal dearborization play a role in its causation.

Adult↗
PubMed1994

Magnetic resonance imaging of airway obstruction resulting from vascular anomalies.

Accurate diagnosis is important in the evaluation of airway disorders of infants and children. Today, multiple imaging techniques are available to evaluate the pediatric airway. We performed magnetic resonance (MR) imaging of the airway in 16 infants and children with symptoms of airway obstruction. Fourteen of 16 patients symptoms were related to compression of the airway by vascular structure. MR imaging was useful in the diagnosis and management of these patients without the need for more invasive procedures.

Aorta↗