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R R Turner

Publications and source records attributed to R R Turner.

At least 73 records · Page 4Linked to original sources
PubMed1987

Progressive histopathologic abnormalities in the persistent generalized lymphadenopathy syndrome.

Using a quantitative classification, we evaluated serial lymph node biopsies in 20 homosexual men with Persistent Generalized Lymphadenopathy (PGL), and correlated the results with peripheral blood lymphocyte counts and clinical findings. In a median follow-up interval of 19 months, ten patients (50%) had progression from one histologic subtype of this disorder to another. Lymph nodes from the other 10 patients also demonstrated decreased numbers of organized follicles in the most recent specimens, in addition to progressive abnormalities of other histologic parameters and peripheral blood T4 counts. This suggests that these patients do not have stable disease. However, in a median follow-up interval of 19 months, only one (5%) of the patients had developed AIDS. We conclude that progressive lymph node histopathologic subtypes do not correlate well with decreased T4 lymphocyte counts or clinical course over a short time interval.

AIDS-Related Complex↗
PubMed1987

Bacterial communities in acidic and circumneutral streams.

The relationship between pH and the abundance and activity of bacteria in streams was examined as part of a study of the effect of acidification on stream communities. Of the bacterial communities examined, the epilithic community appeared to be the most significantly affected by acidification. Microbial biomass, as quantified by measuring the ATP level, on rock surfaces was significantly correlated with pH. Also, bacterial production by the epilithic bacteria, indicated by incorporation of tritiated thymidine into DNA, was always higher at high-pH sites than at low-pH sites of the same stream order and elevation. Bacterioplankton concentrations varied between 0.53 x 10 and 9.42 x 10 cells . ml in the first- to fourth-order streams examined. The bacterioplankton concentration in one sample from a spring was 0.17 x 10 cells . ml. Bacterioplankton concentrations were not correlated with pH but were significantly correlated with seston concentrations. The correlation with seston is a result of increases in particle-associated bacteria at high seston concentrations. The proportion of bacterioplankton attached to particles varied from 0 to 70%. Bacterial numbers and production in the sediments were significantly correlated with the organic content of the sediment rather than with the pH of the overlying water. Thus, reduced abundance and activity of bacteria as a result of acidification could be detected only for the relatively active community on rock surfaces; this community was exposed to the low pH because of the unbuffered nature of its environment.

Journal Article↗
PubMed1987

Flow cytometric lymphocyte immunophenotyping in homosexual men with the persistent generalized lymphadenopathy syndrome: a longitudinal study of lymph nodes and blood.

We have performed lymphocyte phenotypic analysis on serial lymph node biopsies and peripheral blood samples from 11 patients with the persistent generalized lymphadenopathy (PGL) syndrome and correlated the findings with histologic and clinical findings (median follow-up 18 months) in a search for factors that may predict evolution to acquired immunodeficiency syndrome (AIDS). Follow-up lymph node biopsies showed higher percentages of T-cells, both OKT4+ and OKT8+ phenotypes, and lower percentages of Slg+ B-cells and OKla+ cells. The lymph node changes were relatively minor in degree compared to the progressive peripheral blood OKT4+ lymphocytopenia observed over a similar time interval. The one patient who developed a malignant lymphoma had a high percentage of nodal T-cells and low peripheral blood T-cell counts. We conclude that serial lymph node studies contribute to an understanding of the natural history of PGL, but that peripheral blood counts are a more sensitive indicator of immune status in individual patients.

AIDS-Related Complex↗
PubMed1986

Malignant fibrous histiocytoma tumor cells resemble fibroblasts.

The malignant fibrous histiocytomas (MFHs) are a histologically heterogeneous group of sarcomas that have been postulated to be derived from, or have the capacity to differentiate into, histiocytes. To determine whether MFH tumor cells actually express the features of histiocytes, i.e., bone marrow-derived cells of monocyte-macrophage lineage, we studied the antigenic and enzymatic phenotype of 13 MFHs in situ using frozen and plastic sections, respectively. Five pleomorphic three fibrous, two myxoid, two giant cell, and one histiocytic MFH were studied. While tumor cells in 12 of 13 cases were positive for HLA-A,B,C, tumor cells in all cases failed to express antigens present on bone marrow-derived macrophages, i.e., leukocyte common antigen (L3B12), HLA-DR, Leu-M3, and Leu-3a. Interestingly 8 of 13 cases were positive for CALLA. Although nonspecific, this may prove useful in differential diagnosis. Enzyme histochemistry demonstrated that tumor cells in 9 of 13 cases were positive for membrane 5' nucleotidase (5'N+). Four of these were also alkaline phosphatase positive (ALKP+). All cases were either negative or weakly positive for acid phosphatase (ACIDP) and alpha-naphthyl acetate esterase (ANAE). Tumor cells were unreactive for alpha-naphthyl butyrate esterase (ANBE) and adenosine triphosphatase (ATP). These findings indicate that MFH tumor cells do not express the enzymatic profile of cells of monocyte/macrophage lineage which are membrane 5'N-/ALKP- and ACIDP+/ANAE+/ANBE+/ membrane ATP+. In fact, these data suggest a similarity to fibroblasts which are membrane 5'N+, variably ALKP+, weakly ACIDP+/ANAE+, and ANBE-/membrane ATP-. Osteoclast-like giant cells present in two cases did express a histiocytic phenotype, suggesting that they are reactive elements not derived from admixed tumor cells. These results suggest that MFHs are primitive mesenchymal neoplasms, most likely sarcomas composed of poorly differentiated fibroblasts, and are unrelated to true histiocytic neoplasms.

Fibroblasts↗
PubMed1985

Development and application of the student test used in the School Health Education Evaluation.

To accurately assess the health knowledge, attitudes, and practices of students in grades four-seven, the staff of the School Health Education Evaluation (SHEE) project devoted extensive effort to identify a test appropriate for such assessment. An extensive literature review failed to produce an instrument sufficiently comprehensive or psychometrically sound that could be employed. In this paper, the philosophic orientation and the detailed processes followed in developing a noncurriculum specific, psychometrically sound evaluation instrument for use in the study is described. Included are the bases for the test framework, test objective development, test item review, the various measures constructed using the test blueprint, student performance on the test battery, the psychometric qualities of the test, and suggestions for appropriate use of the final test in other school health education settings.

Attitude to Health↗
PubMed1985

Summary of findings of the School Health Education Evaluation: health promotion effectiveness, implementation, and costs.

A summary of important findings from the School Health Education Evaluation (SHEE) are reported. This paper focuses on the four principal outcome scores of Overall Knowledge, Attitude, Practice, and Program-Specific Knowledge. The relationship of those scores to measures of program implementation and cost also is described. A consistent pattern of findings emerged across the participating health instruction programs, suggesting that health instruction was effective in meeting program objectives as taught in the study classrooms, and that school health program effectiveness was strongly related to the level of implementation. Significant increases in Overall Knowledge and Program-Specific Knowledge were found for treatment classrooms when compared with control classrooms. Smaller, yet statistically significant, increases were found for attitudes and self-reported practices. Curriculum implementation measures were related to program effectiveness. A higher level of program implementation produced greater increases in all scores, but was most strongly related to improvement in attitudes and self-reported practices. Analysis of cost data revealed wide variation across the program. Implementation costs (those associated directly with the number of classroom instruction hours) accounted for more than 90% of the total costs and were, in turn, related to program effectiveness. Analysis of effects-to-classroom hours revealed that, while relatively few hours of instruction can produce large effects for knowledge, more hours are required for the development of attitude and practice effects, and that stable effects are established for all three domains at about 40-50 classroom hours.

Attitude to Health↗
PubMed1985

School Health Education Evaluation. The impact of instructional experience and the effects of cumulative instruction.

Two substudies were conducted within the School Health Education Evaluation (SHEE) to assess implementation practices and cumulative effects. In both studies, special samples were identified that permitted independent analysis of contributing factors. For the implementation study, teachers who had taught only one year were assessed in their second year to determine what changes they made during implementation and how those changes were related to classroom performance. Teachers taught significantly fewer hours, fewer components of the curriculum, and made more changes. However, the classroom performance, compared with the first year, improved for both knowledge and attitude with a marginal trend toward improvement in self-reported practices. These results suggest that teachers became both more efficient and effective in the second iteration. The cumulative effects study tracked children through different levels of exposure to health instruction across two consecutive grade levels. Using partial classrooms as the unit of analysis, the results revealed that for knowledge, attitudes, and self-reported practices, exposure to two units of School Health Curriculum Project (SHCP) were more effective than one which was, in turn, more effective than no exposure. Analysis of self-reported smoking practices indicated cumulative program effectiveness in reducing both current smoking and future intent to smoke.

Attitude to Health↗
PubMed1985

Evolution of recurrent herpes simplex lesions. An immunohistologic study.

We performed immunoperoxidase stains on skin biopsies taken from nine patients with recurrent peripheral herpes simplex lesions at 12 h to 6 d after onset of signs of symptoms to phenotype the inflammatory infiltrate, to detect cells producing interferons alpha and gamma, and to locate herpes simplex virus antigen-containing cells. Viral glycoprotein antigen was located in the nuclei and cytoplasm of necrotic epidermal cells, often within vesicles, in biopsies taken between the first and third day. Histologically, biopsies of all stages showed intradermal focal perivascular and diffuse mononuclear inflammatory infiltrates. The cells constituting the infiltrates were predominantly T lymphocytes with lesser numbers of histiocytes; Leu 7+ (most natural killer/killer) cells and B cells were rare in the biopsy specimens. Leu 3a+ ("helper") T lymphocytes predominated in both subepidermal and perivascular regions of early lesions (12-24 h). Tissue helper/suppressor ratios ranged from 6.3 to 3.4 compared with 1.9-1.0 in blood. In later lesions (after 2 d), monocytes/macrophages were more prominent in tissue sections and the helper/suppressor ratios (2.3-2.5) more nearly approximated those of blood (1.6-2.7). The negative correlation of tissue ratios with time was significant (P less than or equal to 0.02). A large proportion of the infiltrated T lymphocytes expressed DR antigens. There was also diffuse strong DR expression on epidermal cells in five cases (all of two or more days). In six biopsies, scattered macrophages and small cells, presumably lymphocytes, demonstrated cytoplasmic or membrane staining for a substance which copurifies with interferon gamma. We identified such stained cells within vessels, suggesting that these cells circulate. Gamma interferon might have an important role within the herpetic lesions, possibly inducing macrophage activation and cytotoxic T lymphocytes and increasing DR expression on monocyte and epidermal cells.

Adult↗
PubMed1985

Frequent immunoglobulin and T-cell receptor gene rearrangements in "histiocytic" neoplasms.

The authors have analyzed the DNA of immunoglobulin and T-cell receptor genes in a series of 6 malignancies which were judged to be of histiocytic derivation on the basis of morphologic criteria. They found that 4 of these cases showed rearrangements of the beta T-cell receptor genes in spite of the lack of any specific immunohistochemical markers for B or T cells. One case showed rearrangements of both heavy and light chain immunoglobulin genes and probably represents either a sinusoidal large cell lymphoma or a B-cell lymphoma with activation of histiocytes simulating malignant histiocytosis. A single case lacked both immunoglobulin and T-cell receptor rearrangements consistent with immunologic analyses that suggested its origin from an interdigitating reticulum cell. The result of this study in conjunction with the authors' previous immunologic observations suggests that many presumed histiocytic malignancies actually represent T-cell lymphomas. Alternatively, beta T-cell receptor rearrangement may be a common feature of tumors that show monocyte/histiocytic differentiation.

Antibodies, Monoclonal↗
PubMed1985

Human dendritic cells and macrophages. In situ immunophenotypic definition of subsets that exhibit specific morphologic and microenvironmental characteristics.

Using a panel of monoclonal antibodies and antisera in situ, the authors have defined subsets of human dendritic cells and macrophages that exhibit specific morphologic and microenvironmental characteristics. All subsets contained cells that reacted with antibodies directed against HLA-A,B,C, HLA-Dr, leukocyte common, Leu-M3, and Leu-3(T4) antigens. R4/23 and anti-S100 defined three major subsets. R4/23+, S100- cells constituted the B-cell-related follicular dendritic cells, which were identified only within the germinal center/mantle microenvironment of lymphoid follicles. R4/23-, S100+ cells constituted the T-cell-related dendritic cell subset. Anti-Leu-6(T6) further subdivided this group into Leu-6(T6)- interdigitating cells within the T-cell microenvironments of lymphoid organs and Leu-6(T6)+ Langerhans cells found predominantly in epithelial microenvironments, especially the skin. R4/23-, S100- cells constituted the nondendritic tissue macrophage subset which was widely distributed, primarily outside of dendritic-cell microenvironments. These data indicate that although dendritic cells and macrophages share several common antigenic features, morphologically and microenvironmentally distinct subsets express distinct immunologic phenotypes. Such data may provide insight into the ontogeny and function of these subsets and constitute a basis for the comparison of normal dendritic cells and macrophages to various histiocytic proliferative disorders.

Animals↗
PubMed1984

Well-differentiated lymphocytic lymphoma. A study of 47 patients with primary manifestation in the lung.

Forty-seven cases of primary well-differentiated lymphocytic lymphoma (WDL) of the lung were studied. Diagnosis was based on histologic identification of a lymphangitic pattern of infiltration and monomorphous (homogenous) cytologic composition. Nineteen cases (40%) had ancillary evidence supportive of a diagnosis of lymphoma including simultaneous or subsequent involvement of other organs, monoclonal immunologic markers, or a monoclonal serum gammopathy. The prognosis for the group as a whole was excellent; follow-up (median, 4 years) was available for 33 cases. Only one patient has died of lymphoma. The authors discuss the histologic differential diagnosis of lymphocytic infiltrates in the lung, propose criteria to distinguish reactive from neoplastic lymphocytic lesions, and discuss the significance of monoclonality in the management of these patients.

Adult↗
PubMed1984

Histiocytosis X cells and Langerhans cells: enzyme histochemical and immunologic similarities.

The proliferating cell in histiocytosis X has been thought to be an abnormal Langerhans cell since the identification in 1965 of the characteristic X-bodies morphologically identical to the Birbeck granules of epidermal Langerhans cells. This conclusion is based primarily on this finding and on morphologic similarities at the light microscopic level. Enzyme histochemical data have been somewhat conflicting and have not provided strong support for this conclusion. Recently, immunohistochemical studies have shown data consistent with a Langerhans cell origin for histiocytosis X cells. This study documents the presence of nonspecific esterase, acid phosphatase, and adenosine triphosphatase in both Langerhans cells and histiocytosis X cells. Both types of cells also react with antibodies directed against widely distributed leukocyte antigens (HLA-A,B,C; Ia; L3B12); Langerhans cell/thymocyte antigen [Leu 6(T6)]; histiocyte antigen (Leu-M3); helper T-cell/histiocyte antigen [Leu-3(T4)]; and S-100 protein. These results complement earlier immunologic studies and add enzyme histochemical data that strongly support the concept of histiocytosis X as a proliferative disorder of cells of Langerhans lineage.

Adult↗
PubMed1984

Lymphocytic infiltrates of the conjunctiva and orbit: immunohistochemical staining of 16 cases.

The authors have performed frozen section immunologic stains on 16 cases of ocular lymphocytic infiltrates and correlated the results with clinical and histologic findings. Their cases included inflammatory pseudotumor (3), reactive lymphoid hyperplasia (3), atypical lymphocytic infiltrate (9), and small cleaved cell lymphoma (1). Seven of the nine cases with an atypical lymphocytic infiltrate expressed one immunoglobulin light chain, while only one of six considered reactive on histologic evaluation had immunologic results suggestive of a neoplastic B cell proliferation. The case of follicular small cleaved cell lymphoma expressed B lineage antigens but did not express immunoglobulin; this patient died of disseminated lymphoma two years after conjunctival involvement. Percentages and subset ratios of T lymphocytes were quantitated and showed similar results in reactive and neoplastic lesions. There is no apparent difference in clinical presentation or follow-up information between patients with reactive lesions and those having an atypical lymphocytic infiltrate with monotypic immunoglobulin.

Adult↗
PubMed1984

Histiocytic malignancies. Morphologic, immunologic, and enzymatic heterogeneity.

We have studied 14 hematopoietic malignancies with histologic features of histiocytic differentiation, using frozen section immunologic stains, plastic section enzyme histochemistry, and paraffin section immunocytochemistry. There was morphologic, immunologic, and enzymatic heterogeneity, including findings in seven cases that suggested differentiation toward specialized subsets of histiocytes. Four cases expressed a mature monocyte/macrophage phenotype by frozen section monoclonal antibody staining and three of these had histologic patterns diagnostic of malignant histiocytosis; two other cases had ATPase and S100 protein reactivity and morphologic features consistent with interdigitating (reticulum) cell proliferations; and one case was alkaline phosphatase positive, suggestive of differentiation toward fibroblastic reticulum cells. Four cases had histologic findings consistent with malignant histiocytosis, but weak or unreactive staining patterns and were considered poorly differentiated histiocytic or primitive hematopoietic malignancies. Three other cases, also morphologically consistent with malignant histiocytosis, were identified as probably T-cell lymphomas. The morphologic and phenotypic characteristics of non-neoplastic histiocytes and dendritic cell types and their related neoplasms are discussed. Histiocytic malignancies comprise a diverse group that can be identified and subclassified by immunologic and enzymatic techniques.

Adolescent↗
PubMed1984

The treatment of malignant histiocytosis.

Twenty-four consecutive cases of malignant histiocytosis (MH) treated at Stanford Medical Center between 1973 and 1983 have been reviewed. Most patients presented with systemic symptoms (91%) and advanced disease (stage IV, 80%). Multiple organ involvement was common. In six cases, pathologic tissue was further characterized by frozen section immune histochemistry, using a panel of monoclonal antibodies known to react with monocytes and macrophages, as well as a variety of hematopoietic cells. One case expressed a mature monocyte/macrophage phenotype; three cases were considered null cell or primitive lesions; and two cases were identified as probable T cell lymphomas. Seven patients underwent splenectomy. Two patients died prior to any treatment. Twenty-two patients were treated with CHOP (cyclophosphamide, Adriamycin, vincristine, prednisone) +/- bleomycin (B), +/- midcycle high-dose methotrexate (HD-MTX) with leucovorin rescue. Seven patients received prophylactic intrathecal MTX. Of 22 evaluable patients, there was a 68% complete response rate (CR), a 23% partial response rate (PR), and a 9% no response rate (NR). Median duration of CR was 30+ months; median duration of PR was 2.4 months. Median survival for patients attaining a CR has not been reached v 3 months for the PR and NR groups. For all 24 patients, median survival was 2 years, with a 5-year actuarial survival of 40%. Multivariate analysis revealed that a platelet count less than 150,000 (P Cox = .005) and the dose of drug delivered (P Cox = .057) were the most important prognostic factors. Prophylactic intrathecal MTX therapy and splenectomy did not influence survival. Although MH is an aggressive disease with a poor prognosis, it is potentially curable. Systematic and aggressive treatment should further improve the outcome.

Adolescent↗
PubMed1983

Clear cell sarcoma of tendons and aponeuroses: electron microscopic findings suggesting Schwann cell differentiation.

A case of clear cell sarcoma of tendons and aponeuroses arising in the elbow of a young woman is reported. Local recurrence and lymph node metastases occurred despite radiation therapy, chemotherapy, and amputation of the right arm, and the patient died of the tumor approximately ten months after the initial diagnosis. Although melanin was not observed histologically, electron microscopic studies revealed immature melanosomes. In addition, well-developed and duplicated basement membranes, and abundant intracytoplasmic microfibrils suggested melanotic Schwann cell differentiation. On sections stained immunohistochemically, S-l00 protein was present focally. The six previously reported cases of clear cell sarcoma studied electron microscopically are reviewed.

Adult↗
PubMed1983

Necrotizing lymphadenitis. A study of 30 cases.

Thirty patients with necrotizing lymph-adenitis, a disorder initially described in Japan and commonly misdiagnosed as malignant lymphoma, have been studied, in addition, stains for immunologic markers were performed. The patients included 21 United States residents and most commonly were young women with a subacute illness characterized by persistent, painless cervical adenopathy with or without fever. The excised lymph nodes were moderately enlarged and typically showed focal, well-circumscribed, paracortical, necrotizing lesions, and abundant karyorrhectic debris, scattered fibrin deposits, aggregates of large mononuclear cells, and a paucity of plasma cells and neutrophils. Immunohistochemical stains on frozen tissue sections were positive for 63D3 and Leu-2a, indicating an admixture of of histiocytes/macrophages and cytotoxic/suppressor T-lymphocytes in the necrotizing lesions. The etiology of necrotizing lymphadenitis and its distinction from other causes of reactive lymphadenitis are discussed. To our knowledge, this disorder has not previously been reported in the United States.

Adolescent↗