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S H Saul

Publications and source records attributed to S H Saul.

At least 37 records · Page 2Linked to original sources
PubMed1988

Comparison of parenteral nutrition and enteral feeding with pectin in experimental colitis in the rat.

The effect of a pectin-supplemented enteral diet on experimental colitis was compared with parenteral nutrition and with a pectin-free enteral diet. Forty-five rats had feeding catheters placed into either the stomach (IG, n = 31) or the superior vena cava (IV, n = 14) and then received acetic acid (colitis) or saline (control) enemas. After the enema, all rats received the same diet, either IG or IV, for 6 d except for 15 rats (IGP, 9 colitis and 6 controls), which had 1% pectin added to the diet. At the end of the feeding period the IGP group had significantly less colonic inflammation and/or necrosis than either IV (p less than 0.03) or IG (p less than 0.04) groups. Nitrogen balance, serum albumin, total iron-binding capacity and body weight did not differ significantly among dietary regimens. Thus, the degree of bowel injury in experimental colitis was decreased when animals were fed a pectin-supplemented enteral diet and this effect was independent of nutritional status.

Animals↗
PubMed1988

Fibrolamellar hepatocellular carcinoma: pitfalls in nonoperative diagnosis.

Results from ultrasonography, computed tomography (CT), scintigraphy, hepatic angiography, and magnetic resonance (MR) imaging were analyzed for five patients with surgically proved fibrolamellar hepatocellular carcinoma (FL-HCC)--a variant of hepatocellular carcinoma (HCC) that usually occurs in younger patients and has an improved prognosis and chance for curative resection. The radiologic findings were generally inconclusive for a differential diagnosis because the appearance of the lesions on the various imaging studies closely simulated that of either focal nodular hyperplasia, HCC, or metastases. CT and technetium-99m sulfur colloid scintigraphy were the most effective techniques for the workup of these lesions, but because they do not allow a definitive diagnosis, open biopsy is recommended for most lesions simulating focal nodular hyperplasia and HCC in younger patients. Although the current specificity of MR imaging in diagnosing liver lesions is low, further experience may permit more specific characterization of these lesions.

Adult↗
PubMed1988

Barrett's esophagus: diagnosis by double-contrast esophagography.

A blinded, retrospective study was performed to determine the role of double-contrast esophagography in diagnosing Barrett's esophagus. The study group consisted of 200 patients who had double-contrast esophagrams and endoscopy because of severe reflux symptoms. The radiographs were reviewed by two gastrointestinal radiologists who had no knowledge of the endoscopic findings. Patients were classified as being at high risk for Barrett's esophagus if the radiographs revealed a high stricture or ulcer or a reticular mucosal pattern; at moderate risk if the radiographs revealed a distal peptic stricture and/or reflux esophagitis; and at low risk if none of the aforementioned findings were present. When these radiologic criteria were used, 10 patients (5%) were thought to be at high risk, 73 (37%) at moderate risk, and 117 (58%) at low risk for Barrett's esophagus. Endoscopic correlation revealed biopsy-proved Barrett's mucosa in nine (90%) of 10 patients at high risk, in 12 (16%) of 73 at moderate risk, and in only one (1%) of 117 at low risk for Barrett's esophagus. Thus, endoscopy is clearly indicated for patients in the high-risk group. Because of the lower prevalence of Barrett's esophagus in the moderate-risk group, clinical judgment should be used in deciding when to perform endoscopy in these patients. However, most patients were in the low-risk group, and the prevalence of Barrett's esophagus was so low in this group that endoscopy does not appear to be warranted. Thus, the major value of double-contrast esophagography is its ability to separate patients into high-, moderate-, and low-risk groups for Barrett's esophagus to determine the relative need for endoscopy and biopsy.

Adenocarcinoma↗
PubMed1988

Herpes esophagitis: sensitivity of double-contrast esophagography.

During a 10-year period between 1978 and 1987, there were 25 confirmed cases of herpes esophagitis with positive esophageal brushings, biopsies, and/or cultures for the herpes simplex virus. Eighteen of those patients had double-contrast esophagrams, but two were excluded from our study because they had combined fungal and viral esophagitis. All of the remaining 16 patients were symptomatic, and 14 were immunocompromised. Herpes esophagitis was diagnosed on the original radiographic reports in nine (56%) of those 16 patients. In all nine, double-contrast radiographs revealed discrete, superficial ulcers on a relatively normal background mucosa without significant plaque formation. In the remaining seven patients, double-contrast esophagrams revealed plaquelike lesions that were indistinguishable from those of Candida esophagitis (four cases), thickened folds (two cases), and a giant esophageal ulcer (one case). During the same period, herpes esophagitis was diagnosed on seven other double-contrast esophagrams in which histologic, cytologic, and virologic studies were negative for the herpes simplex virus. However, the endoscopic findings were also suspicious for herpes esophagitis in six of those cases, suggesting that they may represent true-positive cases in which there was inadequate tissue sampling. Thus, our experience indicates that radiographic abnormalities can almost always be detected on double-contrast esophagrams in patients with herpes esophagitis, and in more than 50% of cases, a specific radiographic diagnosis can be made because of discrete ulcers without significant plaque formation.

Adult↗
PubMed1987

The fibrolamellar variant of hepatocellular carcinoma. Its association with focal nodular hyperplasia.

A case of fibrolamellar hepatocellular carcinoma (FL-HCC) associated with adjacent focal nodular hyperplasia (FNH) is described. These two regions were adjacent but distinct, both on gross and microscopic examination. Currently, it is unclear whether FL-HCC rarely arises in preexisting FNH, or whether FNH is a typical response to this vascular variant of hepatocellular carcinoma (HCC). The FNH region, which is peripheral, may be biopsied to exclude the underlying carcinoma, and thus lead to inadequate therapy. Previous reports of this association are reviewed.

Adult↗
PubMed1987

Hepatocanalicular injury associated with vitamin A derivative etretinate. An idiosyncratic hypersensitivity reaction.

A patient with pustular psoriasis developed jaundice, peripheral blood eosinophilia, and biochemical evidence of hepatocanalicular dysfunction four weeks after the initiation of etretinate therapy. A liver biopsy specimen showed bile duct damage, a periportal inflammatory infiltrate composed of neutrophils, eosinophils and lymphocytes, canalicular cholestasis, and focal hepatocyte necrosis. Clinical exclusion of other possible etiologic factors coupled with near resolution of the biochemical abnormalities within six weeks after complete discontinuation of the drug indicates that etretinate may induce an idiosyncratic hypersensitivity reaction. This is the first report to document etretinate associated bile duct injury.

Aged↗
PubMed1987

Barrett's metaplasia and adenocarcinoma of the esophagus in scleroderma.

Gastroesophageal reflux is well documented in scleroderma, but the complications of Barrett's metaplasia and adenocarcinoma are not well described. The records of 75 patients with scleroderma seen over a four-year period at the Hospital of the University of Pennsylvania were retrospectively reviewed to determine the prevalence of Barrett's metaplasia and adenocarcinoma of the esophagus and to identify clinical, manometric, laboratory, or radiographic criteria that might predict the presence of these lesions. Twenty-four of these patients underwent endoscopy. In this group, the prevalence of Barrett's metaplasia was 37 percent (nine patients) and adenocarcinoma was also present in two of these patients. The patients with and without Barrett's metaplasia were similar in age (range, 22 to 64 compared with 28 to 79, respectively), sex (six of nine compared with 12 of 15 female, respectively), frequency of esophageal motility disorders, presence of proximal skin involvement, digital ulceration, and pulmonary involvement as measured by diffusion capacity. Barrett's metaplasia was diagnosed on the basis of double-contrast esophagographic results in only one of eight patients with Barrett's metaplasia so-studied. Patients with Barrett's metaplasia tended to have longer duration of heartburn (90 +/- 40 months compared with 11 +/- 35 months) and dysphagia (39 +/- 22 months compared with 7 +/- 3 months). Patients with Barrett's metaplasia also tended to have greater impairment of lower esophageal sphincter pressure either at end-expiration (4.0 +/- 2.1 compared with 6.1 +/- 1.8 mm Hg) or mid-respiration (13.0 +/- 3.0 compared with 16.9 +/- 2.5 mm Hg). Using chi-square analysis, however, none of these differences reached statistical significance. Discrimination did occur on the basis of the presence of the CREST (calcinosis, Raynaud's phenomenon, esophageal manifestations of scleroderma, sclerodactyly, and telangiectasis) variant (55 percent compared with 7 percent, p less than 0.01), a duration of dysphagia of more than five months (p less than 0.03), and mid-respiratory lower esophageal sphincter pressure of less than 10 mm Hg (p less than 0.05). It is suggested that: Barrett's metaplasia of the esophagus occurs in one third of patients with scleroderma; clinical, manometric, laboratory, and radiographic features are poor predictors of the presence of Barrett's metaplasia; patients with CREST syndrome, prolonged dysphagia, or a very low lower esophageal sphincter pressure may have an increased risk for the development of metaplasia; patients with scleroderma and Barrett's metaplasia have an increased risk of complications such as stricture or adenocarcinoma.(ABSTRACT TRUNCATED AT 400 WORDS)

Adenocarcinoma↗
PubMed1987

Inflammatory cloacogenic polyp: relationship to solitary rectal ulcer syndrome/mucosal prolapse and other bowel disorders.

The clinicopathologic features of nine patients with inflammatory polyps of the anorectal transition zone (inflammatory cloacogenic polyp, ICP) were reviewed. All polyps were characterized histologically by crypt hyperplasia and a thickened muscularis mucosa arising beneath a surface epithelium consisting of variable proportions of squamous, columnar, and often transitional epithelium. Tubulovillous architecture was characteristic. Sialomucin predominated over sulfomucin in eight of nine cases. One polyp displayed focal dysplasia and condylomatous features, while two others had associated hemorrhoids. Three cases had been previously diagnosed as adenomas. Seven patients were women, and two were men; their median age was 54 years (range, 17 to 85). Clinical presentation was most commonly intermittent rectal bleeding, and the clinical diagnosis was anal polyp or hemorrhoids in all cases. Six patients had the solitary rectal ulcer syndrome (SRUS) and/or evidence of mucosal prolapse. Papillomavirus was demonstrated by histochemical and immunohistochemical methods in one case in which multiple foci of dysplasia were also noted. Two patients had Crohn's disease, and the remaining patient had a coexistent adenocarcinoma located several centimeters proximal to his ICP. The pathologist and clinician must be aware that although ICP is often associated with SRUS/mucosal prolapse, it may occur in other clinical settings.

Adolescent↗
PubMed1987

The immunohistochemistry of gastrointestinal stromal tumors. Evidence supporting an origin from smooth muscle.

To study the histogenesis of gastrointestinal stromal tumors, 79 cases were evaluated for desmin (DES), vimentin (VIM), and S-100 protein immunoreactivity by the avidin-biotin immunoperoxidase procedure on paraffin-embedded, Bouin's-fixed tissue sections. All tumors showed weak vimentin positivity. Trapped non-neoplastic smooth muscle and nerve twigs were often noted, particularly at the tumor periphery. Significant tumor S-100 positivity was not identified in our series. Similarly, glial fibrillary acidic protein (GFAP) immunoreactivity (performed in 11 desmin-negative tumors) was not detected within either gastrointestinal stromal tumors or enteric glial cells. Fifty-three percent (53%) of all gastrointestinal stromal tumors (GIST) displayed positive tumor cell desmin immunoreactivity. All 10 esophageal and all four colorectal tumors were diffusely desmin positive and unequivocal smooth muscle lesions. In contrast, only 17 of 37 (46%) benign and six of nine (67%) malignant gastric tumors were desmin positive. Similarly, four of 10 (40%) benign and one of nine (11%) malignant small-bowel tumors expressed desmin. Several gastric neoplasms with prominent nuclear palisading resembling schwannian Antoni A regions were nonetheless desmin positive. Epithelioid gastric tumors were more frequently desmin positive than nonepithelioid tumors; however, this positivity did not attain statistical significance. Two gastrointestinal stromal tumors that were desmin negative in paraffin-embedded material had detectable antigen in frozen sections. Gastric and small-bowel tumors measuring less than 3 cm were significantly more often desmin positive than those 3 cm or greater. We conclude that the method of fixation, tissue preparation, and immunostaining may significantly affect the expression of desmin. Although the histogenesis of gastrointestinal stromal tumors remains controversial, most of these tumors show evidence of smooth muscle differentiation.

Desmin↗
PubMed1986

Solitary rectal ulcer syndrome: a radiologic diagnosis?

The solitary rectal ulcer syndrome (SRUS) is an uncommon condition in which a solitary area of discrete ulceration is typically found on the anterior wall of the rectum. Between 1981 and 1983, we collected 8 pathologically proven cases of SRUS in which barium enema examinations had been performed (7 double-contrast, 1 single-contrast). Seven patients had rectal bleeding. On the original x-ray report, 4 cases were thought to be normal, but the pathologic tissue had been removed endoscopically in 2 of these cases prior to the radiologic study. The other 4 cases were thought to be abnormal, although the specific diagnosis of SRUS was not suggested in any case. In a blinded rereading of these 8 cases randomly interspersed with 29 other non-SRUS cases, however, the films were interpreted in light of recent radiologic experience with this condition. The same 4 cases were still thought to be normal. In the remaining 4 cases, barium enemas revealed thickened, edematous valves of Houston (3 cases) and a submucosal mass adjacent to the anal verge (1 case). The diagnosis of SRUS was suggested in all 4 cases with only 1 false-positive diagnosis due to a rectal stricture in a patient with endometriosis. Although barium enemas may be normal in patients with SRUS, the presence of thickened, edematous valves of Houston, particularly in a young patient with rectal bleeding, should suggest this condition.

Adult↗
PubMed1986

Azathioprine and hepatic venocclusive disease in renal transplant patients.

We report 3 cases of hepatic venocclusive disease occurring in renal transplant patients receiving azathioprine and combine our experience with 4 other previously reported cases. The data suggest a clinical syndrome characterized by (a) delayed clinical onset, (b) striking male predominance, (c) presentation with jaundice followed by evidence of portal hypertension, and (d) poor prognosis. One of our patients, who is still alive 40 mo after the first onset of symptoms of liver disease, showed striking clinical improvement with discontinuation of azathioprine and subsequent deterioration on reinstitution. We suggest that azathioprine may be closely linked with the development of venocclusive disease in renal transplant patients and that the frequency of this disorder may be more common than previously reported. To attempt to prevent a fatal outcome, this group of patients should be closely monitored for the earliest signs of hepatic venocclusive disease through periodic serum bilirubin and alkaline phosphatase determinations. Patients with abnormal tests should undergo liver biopsy. If hepatic venocclusive disease is found, prompt withdrawal of azathioprine is indicated.

Adult↗
PubMed1986

Enteritis cystica profunda: association with Crohn's disease.

Enteritis cystica profunda (ECP), an uncommon condition, is characterized by nonneoplastic cystic spaces within the wall of the small bowel. The cases of two patients who had ECP in association with Crohn's disease are reported, and the role of mucosal damage in the pathogenesis of ECP is discussed. Pathologists must recognize this entity and distinguish it from adenocarcinoma, which may arise with increased frequency in the small bowel in patients with Crohn's disease.

Adult↗
PubMed1986

Early esophageal cancer.

Early esophageal cancer (EEC) accounted for only seven (4.7%) of 148 cases of esophageal cancer diagnosed at the authors' hospital between 1977 and 1984. Two patients with EEC had squamous cell carcinoma and five had adenocarcinoma arising in Barrett's mucosa. All seven patients had associated clinical findings, including low-grade gastrointestinal bleeding (three cases), odynophagia (one case), and chronic reflux symptoms due to underlying reflux esophagitis and Barrett esophagus (three cases). Since Barrett esophagus is a premalignant condition, the high proportion of adenocarcinomas in this series presumably reflects the more frequent radiologic evaluation of symptomatic patients with Barrett esophagus. On esophagography, four patients had 3-4.5-cm polypoid intraluminal masses that could not be distinguished radiographically from advanced esophageal carcinoma. In the other three patients, esophagrams revealed secondary achalasia, irregular flattening of the esophageal wall, and diffuse nodularity of the mucosa. The authors conclude that "early" esophageal cancers are not necessarily small cancers, since they may undergo considerable intraluminal or intramural growth and still be classified histologically as EEC. Radiologists should be aware of these findings, since EEC has an excellent prognosis with a 5-year survival approaching 90%.

Adenocarcinoma↗
PubMed1985

Primary lymphoma of Waldeyer's ring. Clinicopathologic study of 68 cases.

The clinical and pathologic findings were studied in 68 patients with primary lymphoma of Waldeyer's ring (WR). The initial sites included: tonsil (51%; 9% bilateral), nasopharynx (35%), base of tongue (9%), and multiple areas (4%). The mean age was 58 years, with a male to female ratio of 1.1:1.0. Tonsillar and base of tongue lesions presented with sore throat and dysphagia, whereas nasopharyngeal lymphomas most commonly presented with nasal, auditory, and cranial nerve sympatomatology. A neck mass was the sole presenting symptom in 12% of patients. Work-up showed 42% Stage I, 47% Stage II, 4% Stage III, and 7% Stage IV. All were non-Hodgkin's lymphomas. Diffuse architecture predominated (71%) and 70% had a histiocytic or large cell morphology (diffuse histiocytic 51%, nodular histiocytic 19%). The National Cancer Institute (NCI) Working Formulation grades were 13% low, 81% intermediate, and 6% high. In difficult cases, detection of monoclonal immunoglobulin, absence of keratin staining, and lack of epithelial features by electron microscopy were useful adjuncts aiding in diagnosis. Following complete remission, 28 patients relapsed, 75% of these within 2 years (median, 10 months). Thirty-seven (54%) patients died with disease (median survival, 27 months). Of these, 89% had disseminated lymphoma. Local-regional disease was the direct cause of death in 13%. Recurrence or persistence of disease in WR occurred in 9% of cases, most with initial clinical evidence of soft tissue extension. Stage I patients had a significantly better median survival (67 months) than Stage II patients (20 months) (P = 0.03). Prognostically favorable histologic parameters included lower NCI Working Formulation grade and follicular architecture. Ten patients (15%) developed extranodal disease, eight involving the gastrointestinal (GI) tract, and all died within 1 year of its occurrence. The findings indicate that stage and certain histologic parameters are important prognostic factors in WR lymphoma. The study confirms the association of primary WR lymphoma with other extranodal disease, particularly involving the GI tract, and emphasizes the poor prognosis of patients in whom this occurs.

Adolescent↗
PubMed1985

Solitary rectal ulcer syndrome. Its clinical and pathological underdiagnosis.

Reports of solitary rectal ulcer syndrome (SRUS) from the United States are rare. A retrospective analysis of biopsy specimens over a period of 5 years yielded 12 patients who fulfilled the histopathologic criteria for this disorder. The clinicopathologic features of patients in this series are similar to those previously reported; the majority presented with solitary ulcerated or polypoid lesions located 4-18 cm from the anal margin. The initial clinical diagnosis was never SRUS; carcinoma and inflammatory bowel disease were considered most likely in one and three cases, respectively. Three patients had mucosal prolapse. Solitary rectal ulcer syndrome was the initial pathologic diagnosis in only four patients (33%). We conclude that SRUS is frequently underdiagnosed both clinically and pathologically in this country. The pathologist might be the first to suggest this diagnosis to the clinician by recognizing its characteristic histopathologic features.

Adult↗
PubMed1985

Identification of experimentally induced colitis by in vitro nuclear magnetic resonance.

The present study determined whether in vitro nuclear magnetic resonance could be used to assess experimentally induced colitis in rats. Acute colitis was induced in 6 Sprague-Dawley rats by acetic acid enema, while 6 control animals received saline enemas. All animals were sacrificed 24 hours post-enema, and NMR relaxation times, T1 and T2, of colonic samples were determined on a 10 MHz spin analyzer (RADX, Houston, TX). Colonic water content was determined on the same samples by desiccation. Colitis animals showed significantly higher T1 and T2 relaxation times and tissue water content than controls. T1 and T2 times correlated significantly with tissue water content. Twelve additional animals were studied histologically, six of which received acetic acid enemas and showed extensive transmural colitis. Our results suggest that in vivo proton NMR might be a useful means of non-invasively assessing the degree of colonic inflammation.

Acetates↗
PubMed1983

The black thyroid. Its relation to minocycline use in man.

We studied a patient with a grossly black thyroid gland considered to be related to minocycline therapy. Microscopically, a brown granular pigment was localized in follicular cells and colloid, which histochemically was melanin or a melaninlike substance. Ultrastructurally, the pigment is confined to lysosomes. The pigment seems to be either an oxidative degradation product of the drug itself, or the results of an as yet unknown alteration of tyrosine metabolism by the drug. Although minocycline is known to interfere with thyroid function in animals, no evidence has been presented for such an effect in humans. The occurrence of a black thyroid gland in humans seems to be virtually pathognomonic for long-term minocycline therapy.

Humans↗