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Biomedical subjects

R J Reed

Publications and source records attributed to R J Reed.

At least 19 recordsLinked to original sources
PubMed1992

Reduced mortality risk in alcoholics who achieve long-term abstinence.

OBJECTIVES: To determine if alcoholic men who achieved stable abstinence experienced fewer deaths than those who relapsed and to develop a model predictive of premature mortality. DESIGN: A cohort of alcoholic men recruited into a prospective study of neurocognitive effects of alcoholism was followed up from 1 through 11 years. A demographically equated group of nonalcoholic men was also followed up. Alcoholics were classified as stable abstainers or relapsers. SETTING: Alcoholics were patients or ex-patients from a Department of Veterans Affairs Alcoholism Treatment Program and/or members of local chapters of Alcoholics Anonymous. PARTICIPANTS: There were 234 alcoholic men who met the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, criteria for alcohol dependence. Follow-up status regarding relapse and mortality was obtained for 199 alcoholic subjects (85%). Of these, 101 had relapsed and 98 had abstained. Ninety-eight nonalcoholic controls equated for age, education, and sex also participated. Mortality status was obtained for 92 subjects in this group (94%). EXCLUSIONS: Major medical and psychiatric illness and history of nonalcoholic drug abuse. MAIN OUTCOME MEASURE: Death during a follow-up period of 1 through 11 years. Death was ascertained through the National Death Index, the California State Department of Health and Vital Statistics, the State Department of Motor Vehicles, and through personal contact with informants, relatives, and significant others of the subjects. RESULTS: There were 19 deaths among relapsed alcoholics compared with the expected number of 3.83 (99% confidence interval (CI), 9.64 to 33.38). Among abstinent alcoholics there were four deaths (expected = 3.21; 99% CI, 0.67 to 12.59). The standardized mortality ratio for relapsed alcoholics was 4.96, which significantly exceeded the expected ratio (P less than .001), whereas the standardized mortality ratio for abstinent alcoholics (1.25) was indistinguishable from the expected. Cox proportional hazards analysis was used to determine if any of several demographic, medical, cognitive, or drinking history variables (in addition to relapse) helped predict mortality among alcoholics. Only relapse was significantly related to increased mortality (chi 2 = 9.15, P = .003). CONCLUSIONS: Alcoholic men who achieve stable abstinence do not differ from nonalcoholic men in mortality experience; however, alcoholics who relapse die at a rate 4.96 times that of an age-, sex-, and race-matched representative sample from the US Bureau of the Census.

Alcoholism↗
PubMed1992

Compound (primordial) adnexal carcinoma arising in a systematized compound epithelial nevus.

A distinctive systematized epithelial nevus and associated multifocal carcinomas of the microcystic and sclerosing sweat duct type affected the lower extremities of a 9-year-old girl. The carcinomas were well differentiated and were both adenosyringomatous and microcystic. They qualify as microcystic and compound. In both the epithelial nevi and the carcinoma, primordial potentials are recapitulated.

Biopsy↗
PubMed1992

Long-term abstinent alcoholics have normal memory.

It is generally believed that many non-Korsakoff alcoholics have subtle defects in memory. To determine whether such defects vary as a function of length of abstinence (LOA), we performed extensive memory testing with: (1) recently detoxified (n = 31; LOA-29 days); (2) intermediate-term abstinent (n = 28; LOA = 1.9 years); (3) long-term abstinent (n = 32; LOA-7.0 years) alcoholics; and (4) nonalcoholic controls (n = 37). All subjects were matched on age and education. Alcoholics were matched on years of alcoholic drinking. Memory measures were divided into the following domains: verbal learning, verbal recall, visual learning, visual recall, and paired associate learning. A series of MANOVAs were conducted that revealed a significant relationship between visual learning and length of abstinence, and a significant interaction between age and length of abstinence on visual recall. Long-term abstinent subjects were not significantly different from controls on any test. We conclude that memory disturbance demonstrable among recently detoxified alcoholics in the early weeks of their abstinence is not evident in demographically matched long-term abstinent alcoholics with similar drinking histories.

Adult↗
PubMed1991

Histologic classification of the combined nevus. Analysis of the variable expression of melanocytic nevi.

The designation combined nevus gives recognition to mixed cytologic patterns. In the common variant, plump, pigmented spindle cells form fascicles among nests of ordinary nevus cells. In other variants, one or several cellular components that share cytologic features with either a blue nevus or a Spitz nevus are represented. Ninety-five cases, 49% of which were of the common type, were studied. Grossly, most of the lesions were darkly pigmented papules or nodules. The clinical diagnosis in three-fourths of the cases was nevus, blue nevus, or melanoma. Fifteen percent had concomitant histologic features of melanocytic dysplasia, and most of these lesions were of the common type. For the common variant, the cytologic features, pattern of apparent infiltration, and variable representation of the features of a premalignant melanocytic dysplasia often mislead a pathologist in interpreting and predicting biologic potential. In combined nevi, the phenotypic diversity and genetic lability of melanocytic nevus cells is manifested.

Adolescent↗
PubMed1990

Metastatic amelanotic melanoma simulating giant-cell tumor of bone.

A case of metastatic malignant melanoma simulating a giant cell tumor of bone is reported. This case typifies the diversity of expression of malignant melanoma. Osteoclast-like giant cells were present only in the femoral head metastasis and were not present in the primary lesion. The giant cell component may be reflective of an inherent and indiscriminant expression which may be seen in a variety of neoplastic bone lesions.

Diagnosis, Differential↗
PubMed1990

Minimal deviation melanoma (halo nevus variant).

Twenty-eight cases of minimal deviation melanoma (MDM) in the histologic setting of halo nevus formed the basis for this study. Requisites for this study included at least one of the following: a remnant of a halo nevus in a MDM; remnants of both MDM and halo nevus in a common melanoma; and a MDM of Spitz or dermal type, or MDM arising in premalignant dysplasia in which the vertical growth components manifested distinctive cytologic features and cytophilia for lymphocytes. Many of the lesions apparently represented neoplastic progressions involving a population of cells at the dermal-epidermal interface (accretive growth). Some of the lesions qualified as dermal variants and apparently represented neoplastic progressions in a dermal component (interstitial growth). Most examples of MDM in this study were borderline in size (less than 1.00 mm in vertical dimensions). The borderline MDM were interpreted as brief (and in some cases perhaps ephemeral) neoplastic interludes. For the 12 cases with follow-up, there have been no metastases or local recurrences.

Adolescent↗
PubMed1990

Actinic keratoacanthoma. Speculations on the nature of the lesion and the role of cellular immunity in its evolution.

The implications of cytologic atypia, patterns of growth, stromal refractoriness, and immune responses in actinic keratoacanthoma are examined here in a speculative manner with the following conclusion: keratoacanthoma is a generic designation for a spectrum of invasive, keratinocytic hyperplasias. In this context, hyperplasia may affect both genomically normal and abnormal keratinocytes. In keratoacanthoma, it does so indiscriminately. The universality of the process in which both benign and neoplastic clones are affected qualifies as immunostimulation. The affected keratinocytes, regardless of genomic characteristics, extend beyond their sustaining stroma into retinaculum and the basement membrane, as an immunologic barrier, is disrupted. Following a period in which the stroma and the immune response are refractory, one or more clones of keratinocytes are exposed to an immune response. For the adnexal contributions, the eventual encounter with the immune response is brief and short-lived. The fate of these genomically intact cells is predictable: complete regression is the inviolate pathway. For the genomically deranged populace, the results of the encounter are unpredictable and potentially manifold. The options, variably expressed, include regression, spatial progression (expansion in space), and neoplastic progression (expansion in the number and types of neoplastic clones). In some actinic keratoacanthomas, neoplastic clones are represented in either focal or extensive carcinomalike patterns from the inception of the hyperplasia. In them, a potential for neoplastic progressions is inherent. If autonomous, aggressive clones are selected in the progressions, the transition from universal hyperplasia (keratoacanthoma) to malignancy (carcinoma) is effected. In the transition, hyperplastic, genomically intact, follicular keratinocytes are not affected; actinically deranged keratinocytes are. The final pathway for an individual evolving lesion is unpredictable, but in some cases it leads to biologic carcinoma (carcinoma ex-keratoacanthoma).

Carcinoma, Squamous Cell↗
PubMed1989

Embolic and metastatic cardiac myxoma.

This paper presents a case of a cardiac myxoma with cutaneous emboli. The diagnosis of a cardiac lesion was anticipated after the histologic examination of a skin lesion. The first clue to the existence of a cardiac myxoma was a distinctive intravascular lesion of a dermal vessel. The clinical and pathologic features of cardiac myxoma are discussed. In addition, new evidence regarding the nature of a previously reported case of metastasizing cardiac myxoma is also presented.

Adult↗
PubMed1989

Fibroma of tendon sheath. A clinicopathologic study of 32 cases.

We report 32 cases of fibroma of tendon sheath. Most cases presented as a painless mass in the distal portion of an extremity. Ganglion cyst was the most frequent clinical diagnosis. The median patient age was 30.5 years, and 60% of the patients were male. Only one lesion is known to have recurred. The lesions, which averaged 1.5 cm, were light tan, firm, and nodular. Histologic features common to all lesions were (a) a predominantly fibrous matrix containing (b) fibroblast-like spindle cells. Elongated, slitlike spaces were observed in many lesions, and nine cases had areas closely resembling nodular fasciitis. Myofibroblasts and fibroblasts were observed in the three cases studied by electron microscopy. The histologic findings were similar to those previously described for fibroma of tendon sheath. Although slitlike spaces are present in most instances, this finding is not specific for fibroma of tendon sheath, nor is it invariably present. Fasciitis-like changes have been noted in previous series. Our findings, as well as those from prior studies, indicate that fibromas of tendon sheath are heterogeneous. The diagnosis is made only after other fibrous, nodular lesions of the extremities are excluded. Fasciitis-like lesions heretofore classified as fibroma of tendon sheath are more appropriately classified as tenosynovial counterparts of nodular fasciitis.

Adolescent↗
PubMed1989

Pigmented myomatous neurocristoma of the uterus.

A tumor of the myometrium composed of pigmented and nonpigmented melanocytes in a matrix of altered smooth-muscle cells is reported. Electron microscopy and immunohistochemical studies were used to identify the cellular constituents. The neurocristic components were arranged in patterns comparable with those in cellular blue nevus of the skin. Problems relating to histogenesis and to taxonomy are addressed using neurocristic dysplasias of the skin as models. It is believed that melanin production should not be the only criterion used to classify pigmented neurocristic dysplasias arising in extracutaneous mesenchyme. The designation pigmented myomatous neurocristoma is proposed as a suitable alternative to cellular blue nevus To our knowledge, no similar lesion has been reported previously.

Adult↗
PubMed1986

The spectrum of minimal deviation melanoma: a clinicopathologic study of 21 cases.

A retrospective study of 21 patients with the histopathologic diagnosis of minimal deviation melanoma (MDM; n = 18) and borderline melanoma (BM; n = 3) was undertaken to determine the prognosis for these patients compared with that for patients with other types of malignant melanoma. The findings indicate that the prognosis for these uncommon nevomelanocytic tumors is somewhat better than that for other malignant melanomas. Follow-up periods in this series ranged from 18 to 96 months (mean, 57 months). Primary lesions ranged in thickness from 1.6 to 10.4 mm. The histopathologic subtypes included the Spitz variant (nine patients), the spindle cell variant (six patients), the combined spindle and epithelioid cell type (three patients), and the small epithelioid cell type (three patients). Only two of the patients died of widespread metastatic disease. Comparison of the histologic and clinical prognostic indicators of mortality in patients who have malignant melanoma with the clinical and pathologic features seen in this series of 21 patients would appear to indicate a diminished tendency toward metastatic or recurrent disease in patients with MDM and BM.

Adolescent↗
PubMed1986

Duodenal gangliocytic paragangliomas: a study of 10 cases with immunocytochemical neuroendocrine markers.

Ten cases of duodenal paraganglioma were studied by conventional histologic and immunocytochemical techniques at both light and electron microscopic levels. Histologically, mixtures of epithelial, ganglion, and spindle cells were seen. In all of the cases immunoreactivity for neuron-specific enolase (NSE) and protein gene product (PGP) 9.5 was seen in each component. Pancreatic polypeptide immunoreactivity was detected in eight cases, mainly in epithelial cells. Somatostatin immunoreactivity was present in epithelial and ganglion cells in nine cases. In seven cases immunoreactivity for neurofilaments, a marker for neurons, was seen in ganglion and spindle cells. However, immunoreactivity for chromogranin, a protein found in endocrine storage granules, was found in only two cases, and the staining was confined to well-granulated epithelial cells. The spindle cells were immunostained only for neuronal markers, NSE and neurofilaments, and the glial marker S-100 protein.

Duodenal Neoplasms↗