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Biomedical subjects

P Heitz

Publications and source records attributed to P Heitz.

At least 19 recordsLinked to original sources
PubMed1995

[Prospective therapy study in differentiated thyroid carcinoma].

Controversy still exists regarding the appropriate treatment for differentiated thyroid carcinoma, i.e. the extent of surgery and the usefulness of prophylactic 131I thyroid ablation. However, the debate is nowadays confined to those patients who may be categorized as having a favorable prognosis with respect to tumor-related death or serious recurrence, and the point of discussion is essentially the optimal treatment to prevent curable recurrences. From the literature it may be deduced that patients with a node negative papillary tumor of stage I and II in the age-related TNM classification system, and patients with a minimally invasive follicular carcinoma, have an excellent prognosis with respect to survival and recurrence. In a prospective study during a 20-year period from one surgical and one pathological institution 136 consecutive patients were treated. Patients with an incidental pT1 N0 tumor, or with a stage I or II node negative papillary carcinoma, or with a minimally invasive follicular carcinoma respectively, had a reduced extent of treatment. This consisted in resection for the concomitant benign goiter (7%), hemithyroidectomy (32%), or total thyroidectomy without 131I ablation (18%). All other patients, including those with a node positive tumor in stage I or II, had total thyroidectomy and 131I ablation (43%). Patients with a multifocal tumor had total thyroidectomy with or without 131I ablation. Hemi- or total thyroidectomy was technically carried out by capsular dissection with identification of the parathyroids, as introduced by Kocher and Halsted. Peritracheal and -laryngeal nodes were regularly searched for, and functional neck dissection was done in node positive tumors. Total thyroidectomy was carried out by completion thyroidectomy in 29 (35%) of the 83 patients. 5 patients (7%) with papillary carcinoma, all in stage III or IV, and 5 patients (8%) with follicular carcinoma, all with a high degree of capsular angio-invasion, died from the tumor 6 months to 16 years after diagnosis. A further patient with a high degree follicular carcinoma is alive with residual disease. All these patients with an unfavorable course underwent total thyroidectomy and 131I ablation as initial therapy. Two patients with papillary carcinoma had a presumptively curable recurrence, namely, a node recurrence in a pT1 N1 tumor (following total thyroidectomy and radio-iodine ablation), and a contralateral recurrence after hemithyroidectomy in a pT2 N0 tumor in a young patient. In sum, in no case with an unfavorable course was a radical therapy omitted initially, and less than total thyroidectomy with 131I ablation (n = 77 [57%]) led to a (curable) recurrence in only one instance (1.3%).(ABSTRACT TRUNCATED AT 400 WORDS)

Adenocarcinoma, Follicular↗
PubMed1991

Frequent detection of Epstein-Barr virus DNA by the polymerase chain reaction in lymph node biopsies from patients with Hodgkin's disease without genomic evidence of B- or T-cell clonality.

This study of 52 Swiss patients with Hodgkin's disease (HD), including 17 cases with a high content of Sternberg-Reed (SR) and Hodgkin (H) cells, was performed to determine the percentage of cases harboring Epstein-Barr virus (EBV) DNA and/or clonal rearrangements of Ig and T-cell antigen receptor (TcR) genes in diagnostic lymph node biopsies. Special attention was drawn to the heavily infiltrated cases to detect a possible relationship between clonality and EBV DNA identification. EBV DNA was detected by the polymerase chain reaction (PCR) using three different sets of specific primers. The viral origin of the amplification products was confirmed by hybridization with a radiolabeled internal probe or demonstration of a specific Sma I restriction site. Genomic rearrangement of Ig and TcR genes was studied by Southern blot analysis. EBV DNA was identified by PCR in 38 of 48 cases (79%). Clonal rearrangements were identified in only 4 of 52 cases (Ig genes) and were independent of the degree of infiltration by SR cells and the presence of EBV DNA. The absence of EBV DNA in three cases with numerous SR cells (only one of them showed clonal rearrangement) and the presence of only a few viral copies in four further cases with numerous SR cells (semiquantitative analysis of viral DNA by PCR was performed in 26 EBV-positive cases) suggests that this virus is modulating rather than an etiologic agent in a considerable proportion of HD cases.

B-Lymphocytes↗
PubMed1990

Morphological and immunohistochemical investigations of the utriculus prostaticus from the fetal period up to adulthood.

We investigated the utriculus prostaticus from the fetal period up to adulthood in 148 prostates. During the second half of gestation the utriculus had a simple tubular or a cystic form and was lined with metaplastic squamous epithelium which showed immunohistochemical positivity for different keratins, carcinoembryonic antigen, and peanut agglutinin binding sites. After birth, alveolar outgrowths of the utriculus developed. After puberty, the utriculus had become a complicated and variable structure. The epithelium no longer differed from that of the prostate glands either morphologically or immunohistochemically. Within the epithelium numerous endocrine cells were found containing neuron-specific enolase, chromogranin, and serotonin. The utriculus and ejaculatory ducts were embedded in a fibrous stroma with, after birth, numerous plexus-like blood vessels. This fibrous zone was peripherally bordered by a layer of smooth muscle. There was no evidence for a function of the utriculus differing from that of the prostate glands. Since the epithelium of both structures is identical immunohistochemically, the epithelium of the sinus urogenitalis most likely particpates in the lining of the utriculus during embryogenesis.

Adolescent↗
PubMed1987

Escape of the response to a long-acting somatostatin analogue (SMS 201-995) in patients with VIPoma.

Two patients with severe secretory diarrhea due to metastatic vasoactive intestinal peptidoma were treated with a synthetic somatostatin analogue in an attempt to control the patients' vasoactive intestinal peptide-related symptoms. In both patients, a good initial response to this treatment could be demonstrated; not only did diarrhea subside but there was also a dramatic fall in vasoactive intestinal peptide plasma levels. However, after 11 and 4 days respectively, diarrhea recurred accompanied by a rise in vasoactive intestinal peptide plasma levels. In fact, under treatment with the somatostatin analogue and with natural somatostatin, a significant rebound state was observed regarding diarrhea as well as vasoactive intestinal peptide levels, which caused considerable difficulty in the clinical management in 1 patient. This patient had to undergo surgery. In the second patient, the responsiveness to somatostatin analogue returned a few days after discontinuation of the treatment, lasting, however, for a short period only. The possible mechanism of this escape and rebound with somatostatin treatment is discussed.

Adenoma, Islet Cell↗
PubMed1983

Morphologic patterns and diagnostic criteria of VIP-producing endocrine tumors. A histologic, histochemical, ultrastructural, and biochemical study of 32 cases.

Thirty-two tumors (31 pancreatic and one jejunal) all associated with severe watery diarrhea, increased VIP levels in blood and most with hypokalemia, were investigated. The VIP content of tumor tissue ranged from 23 to 15,000 pmol/g. VIP immunoreactive cells were detected histochemically in 24 of 28 tumors investigated, PP immunoreactive cells in 11 of 28 tumors, hCG (alpha chain) immunoreactive cells in 12 of 25 tumors, and neuron specific enolase (NSE) immunoreactive cells in 24 of 26 tumors (the 2 negative results were due to inadequate fixation). All cases showed light microscopic features of epithelial endocrine tumors. Electron microscopy demonstrated a prevalence of agranular, poorly granulated and a minority of well granulated cells. Most secretory granules were round, small (150+/- 30 nm diameter) and of moderate electron density, resembling those of the so-called D1 cells. By electron immunocytochemistry, PP was directly localized in a subpopulation of relatively larger granules (154 +/- 22 nm core diameter) showing closely applied membranes. VIP-storing granules, directly identified only in the jejunal tumor, appear to correspond to a subpopulation of slightly smaller P-type granules (126 +/- 37 nm core diameter) showing a narrow, clear halo. The origin, behavior, and diagnostic criteria of VIPomas are discussed.

Adult↗
PubMed1981

[The diagnostic value of T- and B-rosette formation and the unspecific acid esterase in the differential diagnosis of acute and chronic leukemia].

The diagnostic significance of acid non-specific alpha-naphthyl-acetate (ANAE) and of rosette formation of leukemic cells with sheep and mouse erythrocytes was studied in 8 patients with acute myeloic leukemia (AML), in 4 patients with acute lymphatic leukemia (ALL) and in 14 patients with chronic lymphatic leukemia (CLL). ANAE showed typical diffuse cytoplasmic activity in all cases of AML. The enzyme activity was granular in both of the lymphoid malignancies, T-ALL and B-CLL, allowing differentiation from AML but not between B- and T-leukemia cells. Rosette formation with mouse erythrocytes (ME) was diagnostic in all 14 cases of CLL and superior to labeling of surface immunoglobulin (8 of 14 cases positive). ME-rosette forming myeloblasts were detected in 2 of 4 evaluated cases of AML. Rosette formation with sheep erythrocytes (SE), including cytological evaluation of rosette-forming cells, was diagnostic in all cases of ALL (= T-ALL). In 6 of 9 patients with AML, however, rosette formation with SE was observed in a few cells, including myeloblasts with Auer rods. The occurrence of blasts in myeloic leukemia carrying lymphoid cell markers is discussed in the light of recent findings, according to which lymphoblastoid cells may arise in the course of myeloic leukemia requiring antileukemic treatment different from that of AML.

Animals↗
PubMed1981

Gastroduodenitis and peptic ulcer in a rural Liberian community. An endoscopic prospective study.

In a prospective study on a Liberian rubber plantation lasting over 12 months, 79 consecutive patients with recurrent epigastric pain as well as 15 controls without evidence of gastrointestinal disease were endoscoped with a fiberoptic instrument. Peptic ulcers were found in 7 (9%) of the 79 patients; 3 were in the prepyloric antrum and 4 in the duodenal bulb. The incidence of symptomatic peptic ulcer disease estimated from the data was 0.15 per 1000 population per year. Histology revealed superficial gastritis in 34, atrophic gastritis in 23 and duodenitis in 23 of the patients and in 3, 2 and 1 respectively of the control group. The differences observed between patients and controls were statistically significant for the stomach (p less than 0.01) but not for the duodenum. No correlation was found between the presence of histological gastritis and either dietary and social habits or the presence of intestinal parasites.

Adolescent↗
PubMed1978

Adrenoleukodystrophy. Preliminary report of a connatal case. Light- and electron microscopical, immunohistochemical and biochemical findings.

This is the first description of a connatal case of adrenoleukodystrophy. The clinical picture consisted of severe psychomotor retardation, convulsions and hypsarrhythmia, but no obvious signs of adrenal insufficiency. Pathologically, the adrenals were small. The entire cortex was largely replaced by large round cells. Ultrastructurally, some cells in the adrenal cortex contained inclusions with electron-lucent clefts surrounded by a membrane. The anterior pituitary lobe could be demonstrated to have produced ACTH. The central nervous system showed extensive zones of demyelination in the brainstem, the cerebellum and the right-sided capsula interna. In the demyelinated areas there was sudanophilic breakdown and an intense gliosis. Ongoing demyelination could also be demonstrated by the chemical analysis. In the gray matter there waere micropolygyria of the insular cortex and swollen nerve cells in the nucleus arcuatus. Ultrastructure revealed the type of inclusions in the microglia of the same type as in the adrenals, and a different type of inclusions in unidentifiable cells, possibly neurons. These latter inclusions consisted of loosely stacked lamellar material. The findings are interpreted as further evidence of storage taking place in this disease.

Adrenal Cortex↗
PubMed1978

The endocrine pancreas in chronic pancreatitis. Immunocytochemical and ultrastructural studies.

The endocrine pancreatic tissue from patients with severe primary chronic pancreatitis (n=6). secondary chronic pancreatitis due to duct obstruction by carcinoma (n=6) and non-diabetic, non-pancreatitic controls (n=4) was studied qualitatively and quantitatively using specific immunocytochemistry and electron microscopy. Grouping of variously sized islets in the sclerotic tissue (sclerosis islets), islet neoformation by ductuloinsular proliferation, and intrainsular fibrosis were the main qualitative findings. Immunocytochemical quantitation of the distribution of insulin (B), glucagon (A), somatostatin (D) and pancreatic polypeptide (PP) producing cells revealed a significant relative increase in the number of A cells and a decrease in the number of B cells of the sclerosis islets in primary chronic pancreatitis ((B-44.1+/-9.3%:A-38.3+/-2.4%:D-8.6+/-5.1%:PP-4.6+/-4.1%) as well as in secondary chronic pancreatitis B-38.0+/-14.3%:A-38.4+/-19.0%:D-9.1+/-5.8%:PP-14.5+/-23.4%) compared with controls (B-71.1+/-8.1%:A-24.3+/-5.5%:D-8.0+/-2.8%:PP-0.5+/-0.4%). The number of PP cells was significantly increased in primary chronic pancreatitis only. It is suggested that scarring of the exocrine pancreas affects islet composition, probably by impairment of the local circulation and of glucose diffusion, thus leading to reduction of the number and glucose sensitivity of B cells. The hyperplasia of A and PP cells appears to be a secondary phenomenon due to the loss of B cells.

Adult↗
PubMed1978

[Pathophysiology and surgery of the parathyroid glands].

The treatment of primary hyperparathyroidism consists in a teamwork between the physician, pathologist and surgeon. The endocrinologist must be able to motivate the surgeon to perform an often tedious exploration of the neck, while the pathologist may influence the tactics of surgery by his analysis of the frozen sections. The surgeon needs much experience, a sound knowledge of anatomy, a good surgical technique and enough time and leisure for the operation.

Adenoma↗