Biomedical subjects
Publications and source records attributed to M C Anderson.
A BBC microcomputer was incorporated into a closed circuit television system while it was being used to show microscope slides. The computer generates screens of text that complement the demonstration of the microscopy. An additional feature is the capacity of the system to produce 35 mm transparencies.
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In direct RAST analyses of sera from 43 individuals with a history of cat allergy, 39.5% were positive to cat pelt, 37.5% to cat saliva, and 12% each to cat urine and serum. The cat pelt and saliva extracts contained allergen 1, but cat serum and cat urine collected by bladder puncture had no detectable levels of this allergen. A crossed immunoelectrophoresis/crossed radioimmunoelectrophoresis analysis failed to reveal any allergen in urine or serum that was not also present in the saliva or pelt preparations, although urine had two allergens not present in serum. When serum from a patient who was direct RAST positive to cat pelt, serum, saliva, and urine was tested by crossed radioimmunoelectrophoresis, it was determined that a total of six allergens were detectable in cat pelt, three in cat urine, and six in cat serum. Since cat serum contains no detectable cat allergen 1, it may be concluded that at least seven allergens derived from the cat are capable of binding to IgE antibody in humans.
A case history has been presented that reports a rare type III choledochal cyst (choledochocele) and describes the association of a choledochocele and recurrent acute pancreatitis. The most reliable diagnostic technique, as used in our patient and supported by our literature review, is endoscopic retrograde cholangiopancreatography. This case further supports surgical correction employing transduodenal sphincteroplasty. This procedure is highly recommended for management of the intramural choledochocele (type IIIc), especially when associated with recurrent pancreatitis. Finally, patients who present with recurrent pancreatitis without the usual historical or diagnostic findings of biliary tract or alcoholic disease should have a choledochocele included in the differential diagnosis.
Two cases of an unusual variant of the Stein-Leventhal syndrome and ovary are described and two similar reported cases reviewed. Clinically three of the patients had a delayed menarche followed by irregular periods and one had irregular menorrhagia. Pathologically all four had large firm nodular ovaries of 6-9 cm in diameter, showing a gross excess of stroma and distorted or fragmented atretic follicles with unusual granulosal cell persistence. Both grossly and microscopically, ovaries of this type are liable to be mistaken for tumours, but there is no good evidence that they are either neoplastic or pre-neoplastic.
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The preinvasive phase of squamous cell carcinoma of the cervix is a continuous spectrum of abnormal epithelium, which, for convenience of classification and as a guide to management, is customarily subdivided into three grades. The histological diagnosis of CIN, as well as the distinction between the grades, depends on a combination of features embracing aspects of differentiation, nuclear changes and mitotic activity. Grading of CIN is subjective. Generally, a minor degree of CIN would be expected to progress to a more severe form if not treated, but this progression does not seem to be inevitable; the more severe a CIN is at the time of diagnosis, the more likely it is that it will progress, both to a more severe degree of CIN and, eventually, to invasive carcinoma. Conversely, the more minor the degree of CIN at diagnosis, the more likely it is that it will regress. True figures are not available for the rate of progression from CIN to invasive carcinoma; it is sufficient to accept that the risk of progression probably occurs in a significant proportion of cases, if not the majority. Preclinical invasive carcinoma is divided into microinvasive carcinoma and occult invasive (Stage Ib) carcinoma. The definitions of these lesions have not yet been satisfactorily established; the term microinvasive carcinoma should define the maximum size of tumour which has virtually no metastatic potential and so may be treated in a conservative fashion. Invasive squamous cell carcinoma is classified histologically according to the cell type and the degree of differentiation, although it is debatable whether the cell type has any correlation with prognosis. Adenocarcinomas make up 5-10% of cervical cancers and a variety of histological types have been recognized. Adenocarcinoma in situ is being diagnosed with increasing frequency, often in association with squamous CIN. It seems apparent that AIS is a precursor of adenocarcinoma, but little is known about its natural history.
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Spontaneous rupture of the liver associated with pregnancy is a rare and very serious complication, usually occurring in association with eclampsia or preeclampsia. Survival has generally been dependent on early recognition of characteristic signs and symptoms and prompt surgical intervention. Even with surgery, maternal mortality approaches 40% and fetal mortality is even higher. The diagnosis can usually be firmly established based on the clinical and radiographic findings presented in this article. Reported is a patient with hepatic rupture successfully treated by transcatheter embolization of the hepatic artery. It is the authors' belief that if such a patient is clinically stable enough to undergo angiography, then transcatheter embolotherapy is a reasonable alternative to surgery.
Of the 24 samples of leiomyoma tissues examined 14 were shown to have aromatase activity in vitro. In contrast only 1 of 12 samples of myometrium had any demonstrable activity. Measurements of tissue oestrogen levels showed no correlation with the amount of aromatase activity although oestradiol levels were consistently higher in the tumour tissues compared with the normal myometrium.
Five monoclonal antibodies (Ca1, HMFG 1 and 2, 8.30.3 and 77.1) were used to study the distribution of antibody binding sites in cervical tissue with a view to identifying a marker which would distinguish between benign and malignant cervical epithelium. Both benign tissue (mature and immature metaplastic squamous epithelium, congenital transformation zone and glandular epithelium) and neoplastic tissue (cervical intraepithelial neoplasia, 1, 2 and 3 and invasive squamous cell carcinoma) were stained by these antibodies. Although immature metaplastic epithelium stained strongly with all the antibodies, the intensity and distribution of staining in general did not distinguish between benign and neoplastic conditions. All five antibodies, raised against three different antigens, stained cervical tissue in a similar way and thus were unsuitable for use as specific tumour markers in equivocal cases. Further studies on other tumour markers are indicated in view of the potential value of this approach.
The routine application of preoperative percutaneous transhepatic biliary drainage (PTBD) to patients who have obstructive jaundice has a significant effect on overall morbidity, mortality, and patient survival by allowing selective application of the most appropriate therapeutic modality. Surgical patients who undergo PTBD were compared with those for whom PTBD was not available. The surgical complication rate was 44% for those who did not undergo PTBD and 15% for those who did. The surgical procedure-related mortality rate was 30% for those who did not undergo PTBD and 12% for those who did. These differentials may have been due either to a beneficial effect of presurgical decompression or to the fact that only more favorable candidates were selected for operative internal bypass. There was an overall increase in length of survival following the application of PTBD, especially in those patients who were surgical candidates.
Erosion of adjacent organs occurred in 19 of 80 patients with pseudocysts of the pancreas (22%). A total of 26 organs were eroded. Thirteen patients had single organ erosion and six patients had two or more sites of involvement. The gastrointestinal tract was most frequently affected (stomach-seven, duodenum-five, duodenojejunal junction-two, colon-two). It is probable that many of these communications occur without detection and result in spontaneous internal drainage of the cyst. The surgical management of cystenteric fistulas is attended by a low morbidity and mortality. Urinary tract involvement occurred in two patients, both of whom recovered following correction of the communication and retrograde drainage of the pancreatic ducts. Eight patients developed erosion of adjacent major arteries and in six this resulted in major upper gastrointestinal hemorrhage. Two of these patients died as a direct consequence of the vascular erosion. Vascular involvement clearly represents a formidable complication in patients with pancreatic pseudocyst. This study illustrates the diverse complications that may develop when pseudocysts erode into adjacent organs. The risks appear to be greatest in cysts that develop in the course of chronic pancreatitis, in acute cysts associated with severe necrotizing pancreatitis, and when acute cysts are followed for prolonged intervals without surgical decompression.
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Washing the surface of live anesthesized cats with water results in a solution rich in allergen 1 and low in albumin. CIE and CRIE analysis showed the presence of at least seven antigens. All were shown to be immunologically identical to antigens that occur in pelt extracts and saliva. The only allergens that could be detected in surface washes were allergen 1 and albumin. The animals could be washed at monthly intervals to yield approximately the same quantity of allergen 1. This simple procedure could provide an excellent source of potent cat allergen extracts.
A total of 40 patients with pancreatitis had associated extrahepatic biliary obstruction. Eighteen had biliary-induced pancreatitis. Comprehensive correction of the biliary tract disease, including cholecystectomy, common duct exploration and, when indicated, transduodenal sphincteroplasty, resulted in a high recovery rate (83%) with no recurrence of pancreatitis. Twenty-two patients had chronic pancreatitis with involvement of the terminal biliary tract by a long tapering stenosis. Nineteen of these patients had chronic fibrocalcific pancreatitis secondary to chronic alcohol abuse. In five patients, the stenosis produced a high grade obstruction which required biliary bypass with choledochoduodenostomy (four) or cholecystoduodenostomy (one). The remaining 14 patients maintained patency of the biliary tract following correction of the underlying pancreatic pathology. The latter consisted of drainage (nine) or resection (five) of 14 associated pseudocysts (present in 64% of the 22 patients), combined with side-to-side pancreaticojejunostomy to decompress an obstruction of the major pancreatic duct. In assessing the degree of terminal bile duct stenosis, calibration of the duct with Bakes dilators or rubber catheters was a useful aid. Two of the 22 patients ultimately proved to have carcinomas, producing obstruction of the pancreatic duct in the head of the gland. Both were treated initially with choledochoduodenostomy. This possibility must be considered in the management of these patients.
A total of 107 women with abnormal cervical smears showing cytological changes consistent with cervical intraepithelial neoplasia (CIN) 1 or CIN 2 were kept under regular cytological, colposcopic, virological and serological surveillance for an average of 18 months (range 9 months-3 years). Regression of the cervical lesion was noted in 31 (29%) and progression to CIN 3 in nine women (8.4%). We found a positive correlation between the presence of type 2 antibody and progression of CIN 1 and 2 to CIN 3 and a negative association with the presence of type 1 antibody and suggest the antibody status of a woman with CIN 1 or CIN 2 may provide a useful basis for follow-up. We found no association between the outcome of the cervical lesion and active infection with herpes simplex or cytomegalovirus or any other infectious agent or sex-related factors.
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