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Biomedical subjects

M D Weaver

Publications and source records attributed to M D Weaver.

10 recordsLinked to original sources

Fostering self-help on an inpatient unit.

A self-help movement for people with chronic mental illness is growing but is not as advanced as the system of self-help for the chemically dependent. Barriers to organized self-help among those with chronic mental illness include stigma, denial, and the debilitating effects of the illnesses themselves. The authors developed a coping group on a 12-bed psychiatric unit to address these problems. The group was designed to strengthen ties with a local self-help club and to foster the idea that people with chronic mental illness can have a positive impact on the course of their illness. Mental health consumers who were successfully coping with their illnesses were guest speakers and role models for group members. The coping group, which was well received by participants, stimulated research questions and suggested potential modifications of clinical practice. In recent years, a mental health consumer movement has gathered momentum. Individuals who have been receiving psychiatric services are now clamoring for a more active role. There are currently several national consumer organizations that are growing in power and visibility. Some self-help groups, like Recovery Inc., are primarily therapy groups concerned with personal growth. Others, like the National Mental Health Consumers Association, are involved in supporting research and empowerment through political action as well as focusing on mutual-aid groups.

Adaptation, Psychological

Thoracolumbar compression fractures presenting with an acute ileus.

Corticosteroids are commonly used in the treatment of connective tissue diseases such as systemic lupus erythematosus. Although they are usually efficacious, osteoporosis leading to spine compression fractures is not uncommon. In this case report, we describe an elderly patient with systemic lupus erythematosus on long-term corticosteroid therapy who presented with symptoms of acute abdomen with minimal low back symptoms. No intraabdominal process was found by abdominal studies and exploratory laparotomy. Increased lower back symptoms led to further skeletal spine studies, which initially demonstrated a compression fracture at the twelfth thoracic (T12) vertebra. Later, a T8 and a fourth lumbar (L4) compression fracture were also found. Her abdominal and lower back symptoms resolved on conservative therapy. Although the rate of these occurrences are unknown, compression spine fractures should be considered in elderly patients presenting with acute abdomen after being on long-term corticosteroid therapy.

Aged

Tetralogy of Fallot associated with uncommon lesions.

A patient presented with a a unique combination of cardiovascular abnormalities: tetralogy of Fallot, absent pulmonary valve, stenosis of peripheral pulmonary arteries, and partial anomalous pulmonary venous connection to the azygos vein. The salient aspects and associated lesion of each of these abnormalities are described.

Abnormalities, Multiple

Total anomalous pulmonary venous connection to the left vertical vein. A plain-film sign useful in early diagnosis.

Total anomalous pulmonary venous connection to the left vertical vein often may be recognized on the plain postero-anterior chest radiograph by the characteristic supracardiac shadow. This "snowman sign" is useful in older patients but rarely is apparent in infancy. In such young patients the authors have discovered a density anterior to the trachea on the lateral chest radiograph. This finding is present prior to the appearance of the snowman sign and should prove useful in the early diagnosis of this anomaly, facilitating prompt, appropriate treatment. Five representative cases are tabulated and developmental and clinical aspects are reviewed.

Child

Malignant thymic neoplasms: diagnosis by fine-needle aspiration biopsy with histologic, immunocytochemical, and ultrastructural confirmation.

Two cases of malignant thymic neoplasms diagnosed by transthoracic fine-needle aspiration (FNA) biopsy under fluoroscopic and computerized axial tomography (CT) guidance with histologic, immunocytochemical, and ultrastructural confirmation are presented. The clinical and cytomorphologic features of the first case were typical of a malignant thymoma. A characteristic biphasic cell population of benign epithelial cells and mature lymphocytes was seen in Diff-Quik- and Papanicolaou-stained smears from the anterior mediastinal mass and the paravertebral metastasis and was confirmed by histologic examination. Immunoperoxidase studies for T and B cell subsets demonstrated lymphocytes with the thymic lymphocyte phenotype (Leu 6). Electron microscopic (EM) examination revealed epithelial cells with desmosomal attachments, tonofilaments, and extended cell processes along with mature lymphocytes. FNA biopsy of the second case demonstrated features of a thymic carcinoma. Individually scattered and loosely clustered small groups of markedly anaplastic and pleomorphic large cells were seen both in the Diff-Quik- and Papanicolaou-stained smears. EM performed on the FNA specimen demonstrated the poorly differentiated epithelial nature of the malignancy. The mediastinal mass was partially resected and demonstrated an undifferentiated carcinoma staining positively for low-molecular-weight cytokeratin. Ultrastructure demonstrated cell attachments and relationships consistent with carcinoma. The lack of a lung or other extrapulmonary primary tumor was consistent with a thymic carcinoma. These cases demonstrate the value of performing EM and immunocytochemistry on material obtained by fine-needle aspiration, which can aid in establishing the correct diagnosis and facilitate the clinical management of patients with malignant thymic neoplasms.

Adult

Fine needle aspiration cytology of renal infarcts. Cytomorphologic findings and potential diagnostic pitfalls in two cases.

The fine needle aspiration (FNA) cytologic features of two cases of renal infarction are presented. Both patients did not have a classic clinical history for infarction, and the radiologic findings were suggestive of neoplasia. In one of our cases, necrotic glomeruli and tubules were present, which suggested the correct diagnosis of renal infarction and permitted appropriate early treatment. In the other case, groups of atypical renal tubular cells undergoing repair secondary to the infarction was misinterpreted as renal cell carcinoma. This case illustrates that renal infarction, like pulmonary infarction, can be a potential pitfall for a false-positive cytologic diagnosis of malignancy in FNA biopsy. A conservative approach is warranted when there is scanty cellularity and atypical cells having features of a repairlike reaction are present.

Adult

Fine needle aspiration cytology of pulmonary infarct.

The cytologic features of a pulmonary infarct diagnosed by fine needle aspiration (FNA) cytology are reported in a 54-year-old white man with a prior history of renal transplant surgery. Although the diagnosis of pulmonary embolus was unsuspected, FNA cytology suggested the correct diagnosis, which was confirmed by subsequent radiologic studies. This is believed to be the first reported case of pulmonary infarct diagnosed by FNA cytology. Cytologic features of the entity are discussed along with potential sources for a false-positive diagnosis of malignancy.

Biopsy, Needle

Fine needle aspiration cytology of tuberculosis of the lumbar vertebrae (Pott's disease).

The cytomorphologic features of tuberculosis of the lumbar vertebra having a granulomatous pattern diagnosed by fine needle aspiration (FNA) biopsy are reported in a 72-year-old woman with a prior history of malignant lymphoma treated by chemotherapy. Cytologic examination revealed microtissue fragments of cohesive cells, including epithelioid histiocytes and scattered, multinucleated Langhans-type giant cells. This is believed to be the first reported case of vertebral tuberculosis (Pott's disease) diagnosed by FNA cytology and confirmed by culture of the aspirate material. This case illustrates the value of FNA cytology in the diagnosis of nonneoplastic skeletal lesions and confirms the value of FNA biopsy the early detection of infectious processes in patients with malignancy.

Aged

Aspiration biopsy cytology of malignant schwannoma metastatic to the lung.

The aspiration biopsy cytologic features of a malignant schwannoma metastatic to the lung in a 39-year-old black female with von Recklinghausen's disease are reported. Cytologic features of malignant sarcomas having a spindle-cell pattern are described along with a discussion of the cytologic differential diagnosis. This is believed to be the first reported case of a malignant schwannoma involving the lung diagnosed by aspiration cytology and demonstrates the usefulness of the technique in evaluating patients with metastatic sarcomas.

Adult