Development of behavioral tolerance to morphine and methadone using the schedule-controlled behavior of the pigeon.
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Animals↗
Biomedical subjects
S A Heifetz
Publications and source records attributed to S A Heifetz.
Candida funisitis: A clinicopathologic study of 32 cases.
We report on 32 cases of Candida funisitis and describe the associated clinicopathologic features. The Candida funisitis was characterized grossly by small, circumscribed, yellow-white nodules on the umbilical cord surface and, microscopically, by subamnionic microabscesses in which fungal organisms were demonstrable. Chorioamnionitis was present in all cases. Twenty-four (75%) of the 32 infants were premature. There were 7 perinatal deaths, all in immature fetuses. Five (16%) of the 32 fetuses had congenital candidiasis. Five (16%) of the mothers had a history of intrauterine foreign body, including intrauterine contraceptive device in three and cervical cerclage in two. The diagnosis of Candida funisitis should prompt a careful examination for fetal infection, even though it is associated with congenital candidiasis in only a minority of the cases.
Adult↗
The detection of pulmonary metastases by helical CT: a clinicopathologic study in dogs.
PURPOSE: We sought to determine the accuracy of helical CT in the detection of pulmonary metastases. METHOD: Four anesthetized dogs with metastatic osteosarcoma underwent helical CT with a collimation of 5 mm, a pitch of 2, and a reconstruction interval of 5 mm. All macroscopically evident metastases were recorded at autopsy. CT images were independently reviewed by 10 radiologists and compared with pathologic results. Alternate slices in the dog with the most metastases were microscopically examined in their entirety. RESULTS: Pathologic examination of the lungs revealed 132 macroscopically evident pulmonary metastases, of which 74 (56%) were detected by at least one reader. Forty-four of the 99 (44%) metastases of < or = 5 mm in diameter were detected by at least one reader compared with 30 of 33 (91%) metastases of > 5 mm in diameter (p < 0.0001). The 10 readers reported a total of 107 false positives. Complete microscopy of alternate slices in the dog with the most metastases (n = 68) revealed an additional 38 micrometastases of < or = 3 mm in diameter. None of the 32 micrometastases of < or = 1 mm were detected by CT. CONCLUSION: Helical CT has some limitations in the detection of pulmonary metastases.
Animals↗
Hemangiomas of the umbilical cord.
Four cases of umbilical cord hemangioma are presented and analyzed with all previously reported cases. Umbilical cord hemangiomas consist of an angiomatous nodule containing and encompassed by edema and myxomatous degeneration of Wharton's jelly, often cystic. The angiomatous nodules range from 0.2 to 7 cm in largest dimension, whereas the associated edema may measure up to 15 cm. The tumors tend to occur at the placental end of the cord and presumably arise from one or more of the major umbilical vessels. The angiomatous nodules tend to be sharply demarcated from the surrounding stroma and are invariably cytologically benign. Although cord hemangiomas are strongly associated with fetal morbidity and mortality, a causal relationship has not been definitely established. There is no apparent association between cord hemangiomas and maternal age, race, or gravidity nor does one sex predominate. Unlike placental hemangiomas, cord hemangiomas are not associated with maternal hydramnios. Ultrastructural differences between umbilical cord and placental amnion explain both this differing clinical effect as well as the presence of marked edema and myxomatous degeneration of Wharton's jelly in cord tumors. Speculation concerning an underlying congenital predisposition to vascular neoplasm in these infants is presented.
Edema↗
Omphalomesenteric duct cysts of the umbilical cord.
Three cases of omphalomesenteric (OM) duct cyst within the umbilical cord are presented and analyzed together with 6 previously reported cases. The embryology of the OM duct is reviewed, emphasizing those portions of the duct that may persist beyond early fetal life. Omphalomesenteric duct cysts are located at the proximal (fetal) end of the cord and range from 0.4-6.0 cm in diameter. They appear as cystically dilated "miniature" segments of the gastrointestinal tract and are lined by columnar epithelium resembling that of the gastric, small intestinal, or colonic mucosa; islands of pancreatic tissue may be associated with the cyst lining. The cysts have peripheral angiomatoid vascularity and the surface epithelium of the cord at one site tends to be hyperplastic. These lesions occur more often in males than in females and are unrelated to prematurity or to maternal age, race, or gravidity. They only rarely cause fetal morbidity or mortality but evidence is presented to suggest that they may on occasion be associated with potentially dangerous intraabdominal anomalies of the OM duct.
Cysts↗
Intraoral plexiform (multinodular) neurilemoma.
An intraoral (buccal) mass in a 6-year-old child was found to be a benign plexiform (multinodular) neurilemoma by fine-needle aspiration (FNA) biopsy cytology and histologic examination of the excised specimen. Clinical and pathological features of these rare tumors are reviewed, and the capacity of FNA to guide surgical planning in the pediatric population is emphasized.
Biopsy, Needle↗
Myositis (fasciitis) ossificans in an infant.
Myositis (fasciitis) ossificans developed following minor trauma to the soft tissues of the posterior aspect of the right knee of a 5-month-old female infant. The clinical and pathological features of myositis ossificans are reviewed and the differential diagnosis of soft tissue ossification in early childhood is discussed.
Female↗
Pleomorphic adenoma (benign mixed tumor) of the trachea.
A 15-year-old "asthmatic" found to have a pleomorphic adenoma of the trachea was treated by staged CO2 laser excision. Primary tracheal tumors, the clinicopathologic features of mixed tumor in this rare location, and therapeutic options are briefly reviewed. Immunohistochemical stains for cytokeratin, S-100 protein, and glial fibrillary acidic protein are reliable methods of evaluating component cell types in pleomorphic adenoma, but immunohistochemical evidence has not resolved the issue of tumor histogenesis.
Adolescent↗
In situ choriocarcinoma arising in partial hydatidiform mole: implications for the risk of persistent trophoblastic disease.
The risk of persistent trophoblastic disease following partial hydatidiform mole is controversial. In spite of claims that 4 to 11% of cases require chemotherapy, there is a paucity of affected patients in the literature. A critical review of those patients suggests an alternative or unproven diagnosis in the majority. An instance of placental in situ choriocarcinoma arising in a partial mole is reported. Because in situ choriocarcinoma may represent the incipient lesion in the majority of the one-third of cases of gestational choriocarcinoma that follow a normal pregnancy, we postulate that the presence of the in situ lesion in a partial mole supports the view that the risk of persistent trophoblastic disease may be no greater after partial mole than after a normal gestation.
Adult↗
Necrotizing funisitis associated with Actinomyces meyeri infection: a case report.
Necrotizing funisitis is associated with an increased rate of stillbirth, perinatal infection, and preterm delivery. No one organism has been associated with necrotizing funisitis, although this condition has been linked with congenital syphilis in some studies. We report a case of necrotizing funisitis in a 24-year-old G2P0A2 woman who experienced preterm labor at 31 weeks of gestation. Examination of the placenta revealed severe chorioamnionitis and necrotizing funisitis; large numbers of gram-positive filamentous branching organisms could be seen on the surface of the cord and within Wharton jelly. Initial cultures of the placenta, which had not been maintained under anaerobic conditions after delivery, were negative. A fragment of the cord was then homogenized; anaerobic culture on brain-heart infusion agar yielded Actinomyces meyeri. This organism usually resides in the periodontal sulcus and has not been previously reported in the female genital tract. The mother gave a history of a dental abscess that flared up and drained with each of her three pregnancies; the pain was particularly severe during the last 2 months of this pregnancy, so she had the tooth removed after delivery. The infant was treated for prematurity and presumed sepsis and did well.
Actinomyces↗
Hepatoblastoma: the Indiana experience with preoperative chemotherapy for inoperable tumors; clinicopathological considerations.
Analysis of the prognostic importance of various clinicopathological parameters in 17 hepatoblastomas (HBs) confirmed the utility of preoperative chemotherapy to convert inoperable to resectable tumors. There was no significant survival advantage for patients who underwent initial tumor resection compared with those resected following chemotherapy, although complete resection, with or without prior chemotherapy, was critical for cure. Young age was associated with better survival but did not correlate with histologic subtype or clinical stage. A relationship between low initial alpha-fetoprotein (AFP) level and tumor resectability was noted, perhaps related to tumor size, but tumor location was of greater importance than size in determining resectability. Neither the mean proportions of fetal and embryonal epithelium, nor their mitotic activity, nor the presence of vascular invasion in the prechemotherapy biopsy specimens was predictive of outcome, but the low mitotic activity of the fetal component correlated with ultimate resectability. On the other hand, although complete resection was necessary for survival, histologic examination of postchemotherapy specimens had additional predictive value; the presence of vascular invasion, the amount of viable mesenchyme, the extent of tumor necrosis, the proportion of embryonal epithelium, and the mitotic activity of the epithelial component in postchemotherapy resection specimens were each predictive of outcome. Although the presence of osteoid was not predictive, both the proportion of HBs that contained osteoid and the extent of mature mesenchymal tissues within individual HBs were increased by chemotherapy, suggesting that maturation of previously immature clones had been induced. We conclude that although complete resectability remains the fundamental goal of therapy, evaluation of the clinicopathologic characteristics that we have found to be predictive of outcome may permit tailoring of therapeutic regimens to individual patients; those whose tumors are deemed likely to respond well may require less toxic preoperative chemotherapy, and those deemed likely to progress in spite of complete resection may be considered for more aggressive postoperative regimens.
Age Factors↗