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S Albrecht

Publications and source records attributed to S Albrecht.

At least 127 records · Page 7Linked to original sources

Managed care is in your future.

Though Texas has been slower than most other large states to move into managed care, it is gaining ground. According to the Texas Health Maintenance Organization Association, 1.2 million Texans were enrolled in HMO plans in January 1990. Three years later, 1.5 million had signed on--a 24 percent increase. State enrollment in other managed care plans, which aren't required to file reports with state regulatory agencies, was estimated to be 6.9 million (41 percent of Texans) in 1991, according to Blue Cross/Blue Shield. While these state enrollment figures are large, the most recent numbers available indicate that Texas hospitals have a long way to go. A 1991 AHA survey found that 259 Texas hospitals (47 percent of those surveyed) do not have contracts with HMOs or PPOs. With changes coming at break-neck speed, how can these hospitals position themselves to survive and prosper in the managed care world? This month, HealthTexas presents three examples of hospitals and health care systems that have successfully made the transition to managed care. Their stories illustrate three very different approaches--developing a network, direct contracting, and establishing a health plan. And, those who have led these ventures offer advice to help other hospitals make the transition a little easier.

Data Collection↗

Ubiquitin expression in inclusion body myositis. An immunohistochemical study.

Ubiquitin has been shown by immunohistochemical studies to be a component of many of the filamentous inclusion bodies that are known in neuropathology. In the current study, we examined the expression of ubiquitin in 14 cases of typical inclusion body myositis, in skeletal muscle specimens from four cases of typical amyotrophic lateral sclerosis, and in muscle specimens from three normal controls. In the cases of inclusion body myositis, rimmed vacuoles were ubiquitin immunoreactive in all cases. Intrasarcoplasmic inclusions were positive in the nine cases that had them. In four cases, there were positive intranuclear inclusions, and in seven, there was homogeneous staining of nuclei. Atrophic fibers and necrotic fibers were positive in 11 and nine cases, respectively. In the cases of amyotrophic lateral sclerosis, atrophic fibers were positive in three cases, and focal nuclear staining was seen in two. In one of the three control cases, a few atrophic fibers had faint sarcoplasmic positivity; no other staining was seen. We conclude that ubiquitin is a component of the inclusions that characterize inclusion body myositis. However, ubiquitin expression in skeletal muscle disease is not pathognomonic of inclusion body myositis.

Adult↗

Cowden syndrome and Lhermitte-Duclos disease.

BACKGROUND: Cowden syndrome (CS) is a rare but underdiagnosed autosomal dominant condition also known as "multiple hamartoma-neoplasia syndrome." Patients have multiple tricholemmomas (a type of benign skin appendage tumor) and oral papillomatosis and cutaneous keratoses. They often have goiter, gastrointestinal polyps, and hamartomatous soft tissue lesions. Breast cancer affects approximately one third of women with CS. Lhermitte-Duclos disease (LDD) is a peculiar proliferation of abnormal neuronal elements of the cerebellum that has features of a hamartoma and of a neoplasm. METHODS: The authors described two patients who have both CS and LDD. Also reviewed were 50 of approximately 62 previously described cases of LDD (identified through literature searches) in an effort to find patients with LDD who had other associated lesions. RESULTS: Only one other patient in whom both LDD and CS were recognized has been reported. In addition, a number of patients with LDD who had other neoplasms and/or thyroid lesions have been described. CONCLUSIONS: Given the rarity of these two entities, we believe that their association is not fortuitous. LDD fits into the concept of CS as a hamartoma-neoplasia syndrome. In addition, a number of patients with LDD who had other neoplasms or thyroid lesions have been reported, raising the possibility that CS and LDD are more closely linked than is generally appreciated. We suspect that there are more patients with LDD who have unrecognized CS. Patients with either of the two diseases should be examined and followed up for evidence of the other.

Adult↗

Immunohistological detection of tissue factor in normal and abnormal human mammary glands using monoclonal antibodies.

Tissue factor (TF) is the primary cell-bound initiator of the coagulation protease cascade. The cytological distribution of TF in various tissues may be described on the basis of immunohistochemistry with epitope-defined monoclonal antibodies and the extravascular distribution of TF apparently represents a haemostatic envelope ready to activate coagulation when vascular integrity is disrupted. The present study localized TF in human breast cancer tissues when compared with normal breast gland tissues and benign disorders of the mammary gland. By use of a cocktail of three epitope-defined monoclonal antibodies, TF was detected only in the myoepithelia of the resting breast gland. In proliferating disorders like fibrocystic disease or in fibroadenomas, both myoepithelia and luminal epithelia showed TF expression. Of 115 breast cancers 93 reacted with anti-TF, in an inhomogeneous manner in terms of intensity and number of positive cells. There was a tendency for more positive and intensely stained cells to be found in well-differentiated structures such as tubules. Invasive ductal carcinomas exhibiting more positive and more strongly stained cells were less commonly metastatic to lymph nodes when compared with the tumours with no detectable or very low TF immunostaining. A semi-quantitatively recorded score of TF immunostaining correlated with the procoagulatory activity measured (7 fibroadenomas and 24 carcinomas). The results of this study suggest that proliferation and differentiation of the mammary gland is associated with enhanced TF expression in the epithelia which are negative for TF staining in the resting gland. Malignant growth is characterized by randomly expressed epithelial TF, which expression is enhanced and more frequent in well-differentiated tumour cells.

Antibodies, Monoclonal↗

Constitutive tissue factor expression of human breast cancer cell line MCF-7 is modulated by growth factors.

Expression of tissue factor, the initiator of the extrinsic coagulation protease cascade, is a feature of certain malignant tumours. To study the modulation of tissue factor expression we incubated the breast cancer cell line MCF-7 with several growth factors. Epidermal growth factor (EGF), transforming growth factor alpha (TGF alpha) and interleukin-1 (IL-1) rapidly increased tissue factor expression of MCF-7 cells peaking at 6-8 h after starting point of incubation, as determined by clotting test, enzyme linked immunosorbent assay and flow cytometry. The data presented support the hypothesis that modulation of constitutive tissue factor expression in tumour cells by TGF alpha and IL-1 could also occur in vivo possibly resulting from interactions of stromal and cancer cells. The meaning for tumour biology, however, remains unclear.

Blood Coagulation Tests↗

An ELISA for tissue factor using monoclonal antibodies.

Whereas tissue factor, a high-affinity cell-surface receptor and essential cofactor for the serine protease factor VII is constitutively present in certain tissues such as epithelial tissue, brain and placenta, it is not normally expressed by cells within the vasculature. However, the stimulation of monocytes and endothelial cells by a variety of inflammatory and immunological reactions results in the induction of cell surface tissue factor (TF) expression. TF is also expressed on tumour cells, and may play a role in tumour growth and metastasis formation. To examine the role of TF in these processes we developed monoclonal antibodies to human tissue factor apoprotein. The antibodies were characterized by neutralization of the procoagulant activity and by immunoblotting. With two of these monoclonal antibodies a sandwich ELISA was developed for the rapid quantitation of TF. The sensitivity of the assay permits extensive studies involving the modulation of TF expression on small numbers of cells. The results are comparable to the functional clotting assay as evaluated with unpurified TF and with the tumour cell line MCF-7. For certain applications, monitoring of cellular TF expression by ELISA using anti-TF monoclonal antibodies is preferable because it is not influenced by other coagulation factors or by inhibitors of procoagulant activity on the cells.

Animals↗

Molecular biology in the diagnosis and prognosis of solid and lymphoid tumors.

The application of molecular biology to the study of human malignancies has led to tremendous gains in our understanding of their pathogenesis. Although their practical applications are still somewhat limited at this point, the use of molecular diagnostic tools is likely to grow at a very rapid rate as newer and more accurate prognostic markers are identified. The availability of reliable prognostic markers should allow earlier intervention in patients with aggressive disease but exhibiting only limited extent of disease at the time of initial diagnosis. Early intervention in such cases could realistically increase the probability of cure, since highly aggressive tumor cells are more likely to be eliminated by early institution of cytotoxic chemotherapy (4). The p53 tumor suppressor gene clearly represents the most promising potential prognostic marker at present, because of both the multiple phenotypic alterations caused by different p53 mutations and the high frequency of p53 mutations which have been observed in a variety of human cancers. Other prognostic markers related to oncogenes and tumor suppressor genes are almost certain to follow. Validation of new prognostic markers requires a knowledge of both histopathologic diagnostic criteria as well as the consequences for the patient of each diagnosis. There is bound to be some "shake-out" in the field of molecular diagnostics just as there was with other recently introduced techniques such as immunohistochemistry and flow cytometry which were found to provide additional useful information for some tumors and not for others. Since the clinical-pathologic studies needed for verification of putative prognostic markers require relatively long periods of follow up, progress in this area will almost certainly lag behind the ability of molecular biologists to identify new and potentially useful prognostic markers. Our collective ability to reap tangible gains in the clinical arena from our heavy investments in molecular biology and biotechnology depends to a large extent on open channels of communication between clinical and basic scientists. As our ever-increasing insights into oncogenic processes spawn new diagnostic and prognostic markers, our priorities should remain focused on those areas which are inadequately addressed by current methods, and we should avoid the technological trap of devising redundant solutions which increase the expense, but not the efficiency of patient care.

DNA, Neoplasm↗

On spinal osteochondromas.

Osteochondromas (or osteocartilaginous exostoses) make up about 30% to 40% of benign bone tumors. Most are solitary lesions but some are multiple, usually with autosomal dominant inheritance. From 1% to 4% of osteochondromas occur in the spine, where they can cause a variety of signs and symptoms, including those of spinal cord or spinal root compression. The authors present five patients with osteochondromas of the spine and review the findings together with those of over 130 cases reported since 1907. The cases were divided into: 1) spinal osteochondromas in patients with multiple osteochondromas, and 2) solitary osteochondromas occurring in the spine. The age (mean +/- standard error of the mean) of patients in the first group was 21.6 +/- 1.8 years compared to 30.0 +/- 2.1 years for those in the second group (p less than 0.02). There was a significant male predominance overall (M:F = 2.5:1; p less than 0.0005). In both groups, one-half of the lesions involved the cervical spine. Symptoms are caused by pressure on adjacent structures. Spinal cord compression was reported more than twice as frequently in the multiple osteochondroma group as in the single osteochondroma group (77% vs 33%; p less than 0.0005). Computerized tomography (CT) is the imaging procedure of choice. In both groups, the majority of surgically treated patients (90% and 88%, respectively) improve, with about three-quarters of the improved patients having no residual disease or only minor deficits.

Adolescent↗

Palsy of the deep peroneal nerve after proximal tibial osteotomy. An anatomical study.

Iatrogenic, isolated weakness or paralysis of the extensor hallucis longus muscle is a common complication in patients who have had a proximal tibial and fibular osteotomy. To investigate why this complication occurs, we dissected the deep peroneal nerve and neighboring structures, such as the tibia and fibula and the muscles of the leg, in twenty-nine specimens from cadavera, paying special attention to the motor branches supplying the extensor hallucis longus. Of forty-six motor nerves that were identified, eight entered the muscle from the lateral side in an area seventy to 150 millimeters distal to the fibular head; all of them ran close to the fibular periosteum. We suggest that, in some patients, the nerve supply to the extensor hallucis longus is at high risk for injury during a tibial osteotomy because of the proximity of the bone to the motor branches.

Fibula↗

Respiratory epithelial cyst ventral to the brain stem. Report of a case and review of the literature.

We present the case of a 30-year-old woman who suddenly developed intense occipital headaches. Computed tomography and magnetic resonance imaging demonstrated a cyst located ventrally to the brain stem at the pontomedullary junction. The lesion was resected. Histologically, it was lined by a pseudostratified, ciliated, columnar epithelium indistinguishable from respiratory epithelium. Immunohistochemistry and electron microscopy confirmed the epithelial differentiation of the lining. This case is briefly compared with the few other brain-stem cysts presented in the literature and the concept of their "origin" is discussed.

Adult↗

Hallucinogenic and neuroleptic drug interactions with potential neurotransmitter receptors in parasitic nematodes.

Receptors potentially involved in neurotransmitting have been characterised in the muscle tissue and in whole worms of the nematodes Ascaris suum and Onchocerca volvulus, respectively. Binding studies revealed a high affinity for LSD with apparent KD values of 94 nM for A. suum and 120 nM for O. volvulus, whereas those of the neuroleptics haloperidol, spiperone and mianserin were found to be in the micromolar range. A variety of neurotransmitter antagonists, known to bind with high affinities either to mammalian D1/2 or to 5-HT1/2 receptors, were tested for their ability to bind to the nematode receptor. Results from these displacement experiments using tritiated LSD, mianserin, spiperone and haloperidol show distinct specificities of the nematode receptors compared to known receptor classes of mammals. With respect to this novel specificity, the nematode receptors seem to be unique and clearly distinct from those of the hosts.

Animals↗

Lymphadenosis benigna cutis resulting from Borrelia infection (Borrelia lymphocytoma).

Swelling and erythema of the right pinna developed in a 7-year-old girl. Six months later a biopsy specimen showed a dense, diffuse lymphoplasmacytic infiltrate involving most of the dermis except for a thin Grenz zone. The appearance was consistent with lymphocytoma cutis. She had been bitten by a tick on the right ear in Switzerland 6 weeks before the onset of the lesion. Serologic tests by enzyme-linked immunosorbent assay for Borrelia burgdorferi, done 6 and 11 months after the bite, yielded optical density readings of 1.04 and 0.65, respectively; indirect immunofluorescence yielded titers of 1:256 and 1:128. A Borrelia-like organism was identified by a modified Steiner stain; immunohistochemistry was noncontributory. The spirochetal origin of lymphadenosis benigna cutis is briefly reviewed.

Antibodies, Bacterial↗

Lysozyme in abnormal dermal elastic fibers of cutaneous aging, solar elastosis and pseudoxanthoma elasticum.

Staining of elastic fibres with antilysozyme antibodies has been noted previously. In this study, we examined the staining pattern of dermal elastic fibres in aging, solar elastosis, and lesional skin of pseudoxanthoma elasticum (PXE) using an antibody to lysozyme and the indirect-peroxidase technique. To assess the effects of aging, sun-protected skin (buttock) from a younger and an older group of patients was used. Sun damage was studied in skin specimens from varying sun-exposed body regions (trunk; head and neck). No staining was seen in sun-protected skin from younger individuals, whereas sun-protected skin from older persons had scattered positive fibres. Solar elastotic material was intensely positive and the number of positive fibres appeared to correlate with the amount of sun damage. Abnormal elastic fibres in PXE also stained positively, but less intensely, than fibres in solar elastosis. This study shows that changes in the elastic fibres due to degenerative processes or genetic factors results in altered antigenic expression of the fibres. This may be an epiphenomenon secondary to changes in proteoglycans, which are known to occur with solar elastosis and PXE, or may represent an adaptive phenomenon to maintain the elastic properties of the altered fibres or to decrease their antigenicity.

Adolescent↗

Transthyretin immunoreactivity in choroid plexus neoplasms and brain metastases.

Although choroid plexus papillomas (CPP) and primary choroid plexus carcinomas (CPC) are rare neoplasms of the central nervous system, they have been the subject of a number of immunohistochemical studies. To date, no unique or specific marker for these neoplasms has been found, however. Normal choroid plexus is a major site of transthyretin (TTR) synthesis, and recently this protein has been proposed as a possible specific marker of choroid plexus differentiation in tumors. In this study, we performed immunohistochemistry for TTR on 13 choroid plexus tumors (six CPP and seven CPC) and on 23 carcinomas metastatic to the brain, four of which had a papillary architecture. We also included four ovarian teratomas that contained choroid plexus elements. Two of the CPP had diffuse staining for TTR, while the four others stained only focally. Five of the CPC stained only focally and less intensely than the control, while one case was negative. Only one CPC stained as strongly and diffusely as normal choroid plexus. Two of the papillary and six of the nonpapillary metastases had focal staining similar to that seen in the five focally positive CPC. The choroid plexus elements of the ovarian teratomas stained as strongly as the positive control. These findings indicate that TTR immunoreactivity is not restricted to primary choroid plexus tumors. Furthermore, most choroid plexus carcinomas stain only weakly or not at all. This limits the usefulness of TTR immunohistochemistry in the diagnosis of primary choroid plexus neoplasms and in the distinction of CPC from metastatic carcinoma.

Adenocarcinoma↗

Incidental glomus coccygeum. When a normal structure looks like a tumor.

The glomus coccygeum is located at the tip of the coccyx; it measures several millimeters in diameter. We describe two glomera coccygea incidentally discovered in pilonidal sinus excision specimens. Review of several reports of coccygeal glomus tumors indicates that most of them probably represent normal glomera coccygea misdiagnosed as tumors. Pathologists should be aware of this normal structure.

Adult↗

Immunohistochemistry of intravascular papillary endothelial hyperplasia.

Intravascular papillary endothelial hyperplasia is an interesting endothelial proliferation, the nature of which has aroused some controversy. Five cases were studied by light microscopy and by immunohistochemistry using antibodies to Factor VIII-related antigen (FVIII-rAg), ferritin, alpha 1-antitrypsin, alpha 1-antichymotrypsin and vimentin and were compared with conventional intravascular organizing thrombi. The results show a similar progression of the immunophenotype of the endothelial cells in both entities: they are initially positive for ferritin, then acquire vimentin positivity and only display FVIII-rAg positivity in advanced ("mature") lesions. This suggests that intravascular endothelial hyperplasia is closely related to organizing thrombi and is probably a peculiar form thereof.

Adult↗

Palisaded encapsulated neuroma: an immunohistochemical study.

Ten palisaded neuromas of the skin were studied immunohistochemically for the presence of S-100 protein, epithelial membrane antigen, neurofilaments, glial fibrillary acidic protein, and positivity with the Leu-7 monoclonal antibody. In all cases, the fascicles of tumor cells were positive for S-100 protein and negative for epithelial membrane antigen; the tumor capsules were negative for the former in all cases but positive for the latter in seven of ten cases. In three lesions, epithelial membrane antigen-positive cells formed sheaths around fascicles of tumor cells. Axons were demonstrated by anti-neurofilament antibody in seven lesions. None of the lesions stained for glial fibrillary acidic protein. All of them showed positivity with the Leu-7 antibody, which stained both tumor spindle cells as well as membranous profiles consistent with myelin sheaths. These results indicate that the tumor is composed of cells of schwannian differentiation whereas the capsule and sheaths surrounding intratumoral fascicles are of perineurial origin. They also indicate the presence of axons, some of which are myelinated. Our findings support the concept of a close relationship between palisaded and traumatic neuroma.

Adult↗

Duodenal somatostatinoma with psammoma bodies.

A duodenal somatostatinoma was found incidentally in a 60-year-old woman undergoing cholecystectomy. Microscopically, the tumor had a glandular architecture with abundant psammoma bodies. Electron microscopy revealed tumor cells resembling D-cells of the pancreatic islets. Immunohistochemically, there was staining for neuron-specific enolase, chromogranin, and diffuse cytoplasmic positivity for somatostatin only. By immunoelectron microscopy, somatostatin was identified predominantly in lucent membrane-bound secretory granules. X-ray-dispersive microanalysis showed the psammoma bodies contained calcium apatite crystals. This case is compared with other reported cases with a description of cellular localization of somatostatin and development of psammomatous calcification.

Adenoma, Islet Cell↗