Large calcified pleural-based mass in the left hemithorax.
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Calcinosis↗
Biomedical subjects
R R Miller
Publications and source records attributed to R R Miller.
Pulmonary sclerosing hemangioma: unusual cause of a solitary pulmonary nodule.
Pulmonary sclerosing hemangiomas are rare, benign neoplasms, which are usually solitary. The authors describe the computed tomography-pathological correlation in a case of pulmonary sclerosing hemangioma. Computed tomography demonstrated a smoothly marginated, homogeneously enhancing nodule, 1.5 cm in diameter. Pathologically the lesion was well circumscribed, soft and hemorrhagic on its cut surface. Microscopic examination revealed a sclerosing hemangioma, predominantly of the hemorrhagic type.
Adult↗
Chest-wall tumours.
Between August 1984 and October 1988, 7 women and 16 men underwent chest-wall resection. The 23 patients ranged in age from 17 to 79 years. Resection was done for benign lesions in 9 patients, for recurrent chest-wall sarcoma in 4 and for carcinoma involving the chest wall in 10. The number of ribs resected ranged from none to six. Prosthetic material was required for reconstruction in eight patients. There were no operative deaths and no flail segments developed postoperatively. Three patients have since died of metastatic disease, one has died of unrelated causes but with no residual disease and the remainder were alive and well at follow-up intervals ranging from 11 to 60 months. Aggressive resection, including a wide margin of healthy tissue, provides the best chance for recurrence-free survival for patients with many types of chest-wall tumour. Resection can be performed with low morbidity and satisfactory cosmetic results.
Adolescent↗
Pathologic findings in total esophagectomy specimens after intracavitary and external-beam radiotherapy.
Pathologic findings in 21 esophagectomy specimens from patients having preoperative combined intracavitary radiotherapy (ICR) and external-beam radiotherapy (EBR) are described. Eleven patients received 1500 cGY ICR and 4000 cGy EBR (Group 1) and ten patients received 1500 cGy plus 2000 to 3000 cGy EBR (Group 2). Effectiveness of radiotherapy was expressed as the ratio between depth of radiation effect and depth of tumor invasion. Depth was expressed as one of four levels: Level I, not deeper than the muscularis mucosa; Level 2, involving but not deeper than submucosa; Level 3, involving but not deeper than muscularis propria; and Level 4, involving periesophageal soft tissue. The depth of radiation damage to tumor cells was comparable between the two groups. However, residual tumor was present in the periesophageal tissue in only one of 11 patients after high-dose EBR compared to of ten patients with lower dose EBR (P less than 0.01, chi-square test). A ratio of one between radiation effect and depth of tumor invasion was present in six patients receiving high-dose EBR and one patient receiving lower dose EBR (P less than 0.05). The authors conclude that ICR combined with EBR affords good local tumor control in the majority of patients. Higher doses of EBR give a better radiation effect in deeper layers of the esophageal wall. The ratio between depth of radiation effect and tumor invasion provides a simple and objective approach to the pathologic analysis of esophagectomy specimens.
Adenocarcinoma↗
Mediastinal lymph node necrosis: a newly recognized complication of mediastinoscopy.
Eight cases of partial mediastinal lymph node necrosis identified at thoracotomy two to 17 days after cervical mediastinoscopy are described. In 6 cases, the involved nodes were grossly abnormal at operation, requiring frozen section interpretation. In the first 2 patients, the areas of nodal infarction were misinterpreted as necrotic tumor. Permanent sections from all 8 patients showed no evidence of tumor in the infarcted nodes. Factors predisposing to nodal infarction included right-sided tumor, central tumor, and large mediastinoscopic biopsy specimens. In all instances, the infarcted nodes were subcarinal and/or main bronchial. In 2 patients, left recurrent laryngeal nerve palsy occurred after mediastinoscopy. Necrosis in distal nodal areas should be recognized as a complication of thorough mediastinoscopic sampling, presumably due to interruption of arteries supplying these nodes. Awareness of this phenomenon by surgeons and pathologists may avert falsely positive gross or microscopic diagnoses of metastatic malignancy at thoracotomy.
Humans↗
Subchronic inhalation toxicity of ethylbenzene in mice, rats, and rabbits.
Mice, rats, and rabbits (five/sex/group) were exposed by inhalation to ethylbenzene (EB) vapors for 6 hr/day, 5 days/week for 4 weeks (20 exposures). Rats and mice received 0, 99, 382, or 782 ppm EB while rabbits received 0, 382, 782, or 1610 ppm. No changes were evident in mortality patterns, clinical chemistries, urinalyses, or treatment-related gross/microscopic (including ophthalmologic) lesions. Rats exhibited sporadic lacrimation and salivation, as well as significantly increased liver weights at 382 and 782 ppm, and small increases in leukocyte counts at 782 ppm. Males at this exposure level also showed marginal elevations in platelet counts. In mice, females showed statistically increased absolute and relative liver weights at 382 and 782 ppm, while males had statistically increased relative liver-to-brain weight ratios only at 782 ppm. Female rabbits at the high exposure level of 1610 ppm gained weight more slowly than controls (not statistically significant); males showed a similar transient downward trend after 1 week, but showed no differences from controls at study's end. A no observed adverse effect level (NOAEL) of 382 ppm appears appropriate for rats and mice with a lowest observed adverse effect level (LOAEL) of 782 ppm. A NOAEL of 782 ppm and LOAEL of 1610 ppm are appropriate for rabbits.
Administration, Inhalation↗
Development of shock-induced analgesia: a search for hyperalgesia.
With the use of parameters intended to maximize the potential to observe hyperalgesia, the possibility was examined that hyperalgesia might be the immediate response to aversive stimulation, whereas analgesia is delayed (Matzel & Miller, 1987). Consistent with the later prediction, analgesia in rats, as assessed by latency to paw lick in response to thermal stimulation, increased as a function of the delay between a tailshock (Experiment 1) or footshock (Experiment 3) and the test of pain sensitivity. However, in neither case was a hyperalgesic response observed at shock offset. In Experiment 2, the strength of the analgesic response was found to increase as a direct function of both the time since the tailshock and tailshock intensity over the limited ranges examined, but no hyperalgesia was observed immediately after either low- or high-intensity shock. In Experiment 4, the opiate antagonist naloxone was found to attenuate both a weak immediate and stronger delayed analgesia, results suggesting a common underlying mechanism. This mitigates the likelihood that differential behavioral responses at short and long delays following shock were obscuring hyperalgesia at the time of shock offset or were summating with an analgesic response at the long delay to create the impression of enhanced analgesia. In total, these experiments provide evidence that opioid analgesia mediates a compensatory process that increases over time, but they provide no evidence that pain sensitivity increases above baseline levels immediately following an aversive event. These data are discussed in relation to preparatory models of endogenous analgesic functioning and the role of endogenous opioids in learning.
Animals↗
Biochemistry, cell biology, and immunology of osteoarthritis.
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Animals↗
Neuroendocrine carcinomas of the lung: clinical, radiologic, and pathologic correlation.
Neuroendocrine carcinomas of the lung are characterized by differentiation toward Kulchitsky cells and are classified as Kulchitsky-cell carcinoma (KCC) I (classic carcinoid), KCC II (atypical carcinoid), and KCC III (small-cell carcinoma). The clinical, computed tomographic (CT), and pathologic findings in 31 patients with KCC were reviewed. KCC I lesions generally occurred in younger (56 years +/- 18) nonsmoking women, were small (1.8 cm +/- 0.7 in diameter on CT scans), and were associated with lymphadenopathy in one of ten patients. KCC II tumors were found predominantly in older (66 years +/- 12) smoking men and were larger (3.9 cm +/- 1.3 in diameter, P less than .001); four of ten patients had CT evidence of lymphadenopathy. KCC III tumors occurred in older (66 years +/- 8) smoking men and were large (4.2 cm +/- 1.0); 11 of 11 patients had massive lymphadenopathy. Clinical, radiologic, or pathologic overlap was noted in three patients. Sputum cytologic and fine-needle and bronchoscopic biopsy findings were often nondiagnostic or misleading, particularly for KCC II lesions. CT of the chest provides additional discriminating information in the preoperative diagnosis of neuroendocrine lung carcinomas.
Aged↗
Hypersensitivity pneumonitis: evaluation with CT.
Thirteen chest radiographs and computed tomographic (CT) scans obtained from 11 patients with hypersensitivity pneumonitis were reviewed. The CT findings were correlated with open lung biopsy findings in seven patients. The two patients with acute hypersensitivity pneumonitis showed air-space opacification on CT scans. An open lung biopsy, done in one of these patients, demonstrated noncaseating granulomas and filling of the air spaces with macrophages. The nine patients with subacute hypersensitivity pneumonitis showed small, rounded opacities and patchy air-space opacification on CT scans. These findings reflected the histologic findings, which consisted of interstitial pneumonitis, cellular bronchiolitis, and small, noncaseating granulomas. The six patients with symptoms for 12 months or longer also showed irregular linear opacities on CT scans, corresponding to areas of fibrosis. CT scans were superior to radiographs in helping to assess the type and extent of abnormalities, and high-resolution CT scans were superior to conventional CT scans.
Adult↗
Limitations of computed tomography in the assessment of emphysema.
Thirty-eight patients undergoing lobectomy or pneumonectomy for carcinoma had preoperative computed tomography (CT) of the chest. Twenty-seven had both 1.5 mm and 10 mm collimation scans, and eleven had 10 mm collimation images only. These images were analyzed for the extent and severity of emphysema, and the analysis compared to the pathologic findings in the corresponding transverse slice of lung. The latter was graded by a modification of a panel of standards and by a grid system numerically expressing extent and severity. The grid system is theoretically superior to the panel of standards because it allows better quantitation of early emphysema and, contrary to the set of standards, is designed to analyze transverse CT images and corresponding pathologic slices. There was good correlation between the CT score and the pathologic score using the panel of standards (r = 0.81, p less than 0.001) but a lower correlation with the grid system (r = 0.70, p less than 0.001). The correlation improved slightly with 1.5 as compared to 10 mm collimation scans. Close comparison between the CT and grid scores showed that CT was sensitive in demonstrating early distal acinar and irregular emphysema. However, CT consistently underestimated the extent of centriacinar and panacinar emphysema because most lesions less than 0.5 cm in diameter were missed. We conclude that CT is insensitive in detecting the earliest lesions of emphysema.
Humans↗
Comparison of single breath carbon monoxide diffusing capacity and pressure-volume curves in detecting emphysema.
To evaluate the sensitivity of diffusing capacity (DLCO) and pressure-volume (P-V) curves in the detection of emphysema, these tests were compared with pathologic assessment of emphysema in patients undergoing lung resection for a localized tumor, and with the overall extent of emphysema as assessed by computed tomography (CT). The resected lung specimens were fixed in the inflated state and cut at 1-cm intervals in the horizontal plane. The pathologic extent of emphysema was quantitated by comparison with a standard reference panel of emphysema grading. The overall extent of emphysema on CT was assessed by a visual scoring system in a total of 55 patients, 19 undergoing lung resection and 36 not undergoing lung resection. Analysis of 37 patients by pathology scores revealed 18 with no or trivial emphysema (emphysema grades less than or equal to 5; mean grade, 2.2 +/- SD 2.6) and 19 with emphysema (grades greater than or equal to 10; mean grade, 33.2 +/- SD 24.2). Diffusing capacity, the ratio of DLCO to alveolar volume (DLCO/VA), maximal lung elastic recoil (PLmax), and lung elastic recoil at 90% of total lung capacity (PL90) were significantly different between the two groups, whereas K (the exponential constant describing the shape of the P-V curve) was not. The pathology grade of emphysema showed a significant correlation with (DLCO) (r = -0.53) and DLCO/VA (r = -0.55), which was greater than the correlation with PLmax (r = -0.42) and PL90 (r = -0.43).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
ECT for major depression in four patients infected with human immunodeficiency virus.
The authors describe four individuals infected with the human immunodeficiency virus type I (HIV) whose severe depressions were successfully treated with ECT.
Acquired Immunodeficiency Syndrome↗
Multicentricity of adenocarcinoma of the lung.
In a consecutive series of 62 lung resections for bronchogenic adenocarcinoma, 12 patients (19 percent) were found to have two or more adenocarcinomas on careful pathologic examination. These tumors all met the criteria for separate primary malignancy. In only two of the patients were the additional lesions suspected preoperatively. This incidence of multiple primary lung adenocarcinomas in apparently operable patients is several fold higher than would be anticipated from the literature. The phenomenon has important implications for preoperative radiologic evaluation, postoperative pathologic examination, assignment of TNM stage, and clinical follow-up of patients undergoing successful resection.
Adenocarcinoma↗
The CT findings of pulmonary sarcoidosis: analysis of 25 patients.
We analyzed the CT findings in 25 patients with biopsy-proved pulmonary sarcoidosis. In all 25 patients, 10-mm collimation scans were available. In 16 of the 25 patients, select 1.5-mm scans were obtained. These were retrospectively targeted by using a 20- to 25-cm field of view and a high-spatial-resolution algorithm. The CT and pathologic findings were compared in two patients in whom surgical specimens of the lung were available. CT findings included hilar and mediastinal adenopathy (n = 22), subpleural nodules (n = 19), and 1- to 10-mm-diameter nodules (n = 17) and irregular linear densities (n = 12), both mainly along the bronchovascular structures. High-resolution CT was superior to conventional CT in the assessment of subpleural nodules and irregular linear densities, but conventional CT was superior in the assessment of peribronchovascular nodules. The two gross pathologic specimens showed the sarcoid granulomas to be mostly along the lymphatics in the peribronchovascular sheath and, to a lesser extent, in subpleural and interlobar septal lymphatics. We conclude that the characteristic CT appearance of pulmonary sarcoidosis consists of small nodules and irregular linear densities along the bronchovascular bundles.
Adult↗
Prognostic significance of cystic intracranial lesions in neonates.
Thirty-five infants with cystic parenchymal lesions detected by ultrasonography during the neonatal period were evaluated via periodic neurologic and developmental assessments. Long-term neurologic status (abnormal, normal, and isolated motor deficit) was assigned at 2 years of age. Abnormal neurologic status was strongly associated with bilateral cystic lesions as well as hydrocephalus during the neonatal period. Microcephaly at 6-8 months of age also correlated with abnormal status at 2 years of age. The neurologic exam at discharge and at 6-8 months of age added further negative predictive value for the infants with isolated motor delays. A literature review was conducted to determine the incidence of motor and mental delays in a large series of infants with cystic intracranial lesions.
Brain Diseases↗
Diffuse thickening of the tracheal wall.
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Diagnosis, Differential↗