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Biomedical subjects

L D True

Publications and source records attributed to L D True.

At least 55 records · Page 3Linked to original sources
PubMed1992

Recurrent prostate cancer despite undetectable prostate specific antigen.

Serum prostate specific antigen (PSA) is a sensitive tumor marker following definitive therapy for adenocarcinoma of the prostate. Detectable levels of PSA after radical prostatectomy indicate residual and/or recurrent cancer. Therefore, we were surprised to document recurrent cancer following radical retropubic prostatectomy in a man who had undetectable serum PSA levels. This observation suggests that careful clinical monitoring remains essential after definitive therapy, since rare patients may have recurrent and/or residual carcinoma despite undetectable levels of PSA.

Adenocarcinoma↗
PubMed1990

The usefulness of the level of the muscularis mucosae in the staging of invasive transitional cell carcinoma of the urinary bladder.

The initial biopsy specimens from 50 patients with high-grade invasive transitional cell carcinoma of the urinary bladder were evaluated for depth of invasion. Stages were assigned according to the following system: T1A, invasion of connective tissue superficial to the level of the muscularis mucosae; T1B, invasion to the level of the muscularis mucosae; T1C, invasion through the level of the muscularis mucosae but superficial to the muscularis propria; and B, invasion into the muscularis propria. Follow-up from the Yale Tumor Registry at a median time of 4.6 years showed that tumors invasive to levels T1A and T1B had a 75% 5-year survival, but tumors invasive through the level of the muscularis mucosae but apparently superficial to the muscularis propria (level T1C) had an 11% 5-year survival, which was comparable with the survival of patients with tumors invasive of the muscularis propria. This study suggests the prognostic importance of assessing the depth of invasion in initial biopsy specimens, even when the specimens lack a muscularis propria.

Adult↗
PubMed1990

Clinical and pathological characteristics of hepatotoxicity associated with occupational exposure to dimethylformamide.

The clinical characteristics, laboratory results, and liver biopsy findings of seven workers with toxic liver injury associated with exposure to several solvents, including substantial levels of the widely used solvent dimethylformamide, are presented. Three patients had short exposure (less than 3 months), four long exposure (greater than 1 year). Among those with brief exposure, symptoms included anorexia, abdominal pain, and disulfiram-type reaction. Aminotransferases were markedly elevated with the ratio of alanine aminotransferase to aspartate aminotransferase always greater than 1. Liver biopsy showed focal hepatocellular necrosis and microvesicular steatosis with prominence of smooth endoplasmic reticulum, complex lysosomes, and pleomorphic mitochondria with crystalline inclusions. Among workers with long exposure, symptoms were minimal and enzyme elevations modest. Biopsies showed macrovesicular steatosis, pleomorphic mitochondria without crystalloids, and prominent smooth endoplasmic reticulum, but no evidence of persisting acute injury or fibrosis. Abnormal aminotransferases in both groups may persist for months after removal from exposure, but progression to cirrhosis in continually exposed workers was not observed. We conclude that exposure of these workers to solvents, chiefly dimethylformamide, may result in two variants of toxic liver injury with subtle clinical, laboratory, and morphological features. This may be readily overlooked if occupational history and biopsy histology are not carefully evaluated.

Adult↗
PubMed1990

Malignant rhabdoid tumor of the kidney in an adult.

We report a case of rhabdoid tumor of the kidney in a 32-year-old white woman. This highly malignant tumor has been reported previously only in the pediatric age group. The clinical and pathological findings are discussed, and the literature is reviewed.

Adult↗
PubMed1989

Small cell carcinoma of the bladder. Report of five cases with immunohistochemistry and review of the literature with evaluation of prognosis according to stage.

Five cases of small cell carcinoma (SCC) of the bladder are reported with pathologic and immunohistochemical findings and clinical follow-up. Sixteen additional cases reported in the literature are studied and staged according to depth of tumor infiltration of the bladder wall. In our series of five cases and those reviewed from the literature, survival appeared to be dependent on stage of the tumor, analogous to the more common transitional cell carcinoma (TCC). We report two of five patients with the longest recorded follow-up times in the literature who are alive with no evidence of disease at 4 and 6 years. Contrary to the belief that SCC of the bladder is an aggressive, rapidly disseminating tumor similar to SCC of the lung, our findings support the notion that this is a potentially curable neoplasm with a prognosis that appears to be dependent on stage and surgical resectability.

Aged↗
PubMed1989

Immunohistochemistry of capillary hemangioblastoma. Immunoperoxidase-labeled antibody staining resolves the differential diagnosis with metastatic renal cell carcinoma, but does not explain the histogenesis of the capillary hemangioblastoma.

We used a battery of antigens to determine whether immunohistochemistry can (a) contribute to resolving the histogenesis of the stromal component of the capillary hemangioblastoma, and (b) answer cases of difficult pathologic differential diagnosis with metastatic clear cell carcinoma. The stromal cells of the capillary hemangioblastoma are antigenically polymorphous and may express immunoreactive erythropoietin, renin, keratin, Leu M1, Leu 7, actin, neuron-specific enolase, S100 protein, and glial fibrillary acidic protein. However, the use of epithelial membrane antigen allows certain histopathologic distinction between capillary hemangioblastoma and metastatic clear cell carcinoma.

Adenocarcinoma↗
PubMed1989

Pelvic trophoblastic implants after laparoscopic removal of a tubal pregnancy.

Laparoscopic removal of ectopic gestations is becoming increasingly popular. We present a case in which an early, unruptured ampullary ectopic pregnancy was identified clinically, removed during laparoscopy, and subsequently confirmed by pathology. The patient later presented with pain and with rising titers of beta-hCG. Laparotomy demonstrated multiple pelvic implants of trophoblastic tissue.

Adult↗
PubMed1988

Investigation of Doppler waveforms in porcine renal allografts: Doppler-pathologic correlation.

A porcine model was devised to investigate Doppler waveforms in dysfunctional renal allografts. NIH miniature pigs served as allografts donors and recipients. Renal transplantation was effected into the recipient pelvis while the left normotopic kidney was subjected to warm ischemia in order to induce acute tubular necrosis (ATN). Doppler demonstration of allograft arterial occlusion in six animals was confirmed at surgery. Increased pulsatility of intrarenal arterial signals constituted evidence of vascular rejection in two animals. Biopsies confirmed the diagnosis in both cases. Histologic changes of ATN were identified in two native kidneys subjected to ischemia. No waveform or pulsatility alterations were observed in these animals. The porcine model provides for the investigation of allograft Doppler waveforms in a controlled setting with free access to biopsy and operative pathologic correlation.

Animals↗
PubMed1988

Spermatocytic seminoma of testis with sarcomatous transformation. A report of five cases.

Five cases of spermatocytic seminoma of the testis associated with a sarcomatous component, one of them of rhabdomyosarcomatous type, are presented. No recognizable teratomatous structures were identified in any of the cases. The presence of the sarcomatous elements transformed the usually innocuous spermatocytic seminoma into a highly aggressive neoplasm, which led to the patients' death in at least two cases. The sarcomatous elements may represent a nonseminomatous germ cell component, but we prefer to view them as an expression of anaplastic transformation of the tumors, analogous to that seen in tumors in other organs.

Adult↗
PubMed1988

Unusual causes of increased vascular impedance in renal transplants: duplex Doppler evaluation.

Duplex Doppler ultrasound (US) examination of the renal vasculature has proved valuable in assessing the kidney transplant. The normal renal allograft exhibits low-impedance arterial inflow similar to that seen in the normotopic kidney. The authors and others previously reported that a high vascular impedance, defined as either a pulsatility index (PI) greater than 1.8 or a resistive index greater than 0.9, indicates acute vascular rejection (AVR). Although AVR remains the most common cause of increased PI, the authors noted ten episodes among 180 serially followed-up transplants in which abnormal waveforms were clearly not due to rejection. Four other causes of increased vascular impedance are reported, including renal vein obstruction, severe acute tubular necrosis, pyelonephritis, and extrarenal compression of the graft. These new causes only slightly decrease the specificity of high vascular impedance for rejection. Furthermore, the cause can usually be recognized from the clinical history or other US findings.

Acute Kidney Injury↗
PubMed1988

Origin of granules in granular cell tumor. Intracellular myelin formation with autodigestion.

Eight cases of granular cell tumor were stained with Luxol fast blue to look for the presence of myelin. Luxol fast blue-positive granules were present in all cases. One case was studied ultrastructurally. It showed evidence of origin of granules as infoldings of cell membrane by a process similar to myelin formation around axons. These infoldings subsequently appear to be phagocytosed by lysosomes, resulting in the typical granules of the granular cell tumor.

Abdominal Muscles↗