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S Kessler

Publications and source records attributed to S Kessler.

At least 19 recordsLinked to original sources
PubMed1992

Primary small cell carcinoma of the vagina arising in a background of atypical adenosis.

BACKGROUND: Primary small cell carcinoma of the vagina is rare, with only nine cases published to date. The authors report what they believe to be the first case of primary small cell carcinoma of the vagina arising in a setting of atypical adenosis. METHODS: The tumor was studied by light and electron microscopy and immunohistochemistry. RESULTS: Intracytoplasmic electron-dense neurosecretory type granules were seen, and immunohistochemical demonstration of chromogranin A was documented. CONCLUSIONS: These features were found to be similar to small cell carcinomas arising elsewhere in the female genital tract (i.e., cervix, endometrium, ovary, and vulva).

Adult↗
PubMed1992

The fibroma-like variant of epithelioid sarcoma. A fibrohistiocytic/myoid cell lesion often confused with benign and malignant spindle cell tumors.

Five cases of a previously undescribed variant of epithelioid sarcoma are presented. This variant differs from the usual lesion in its absence of the typical necrobiotic nodular epithelioid pattern. It is instead composed of deceptively bland fibrohistiocytic and myoid cells arranged in a fibroma-like or dermatofibroma-like pattern with an affinity for osseous involvement. The clinical presentation, ultrastructural features, and presence of vimentin and low molecular weight keratin within the tumor cells justifies their designation as an epithelioid sarcoma variant.

Adolescent↗
PubMed1992

Breast cancer in patients irradiated for Hodgkin's disease: a clinical and pathologic analysis of 45 events in 37 patients.

PURPOSE: To characterize the clinical and pathologic features of patients who developed breast cancer (BC) after treatment for Hodgkin's disease (HD). Recent epidemiologic studies have shown that women who are cured of HD have an increased risk of developing BC. PATIENTS AND METHODS: The clinical data, mammograms, and pathologic specimens of 37 women who developed 45 BCs (eight bilateral events), and had a prior history of treatment for HD were analyzed. RESULTS: The median age at diagnosis of HD was 27 years (range, 11 to 60). All patients received radiotherapy (RT) to the upper part of their body, and 10 also had chemotherapy for HD. The median interval from the treatment of HD to the diagnosis of BC was 15 years (range, 8 to 34). The median age at diagnosis of BC was 43 years (range, 27 to 75), 41% of patients were 39 years old or younger. Most mammograms (81%) showed abnormal findings of mass and/or microcalcifications. Of the eight patients (22%) with bilateral tumors, four were synchronous and four were metachronous. Involvement of the medial half of the breast occurred more frequently than in patients with primary BC (39% and 21%, respectively; P < .002). But, the histologic types, grades, presence of lymphocytic reaction, and lymphatic invasion were similar to those observed in 935 primary BC patients who were previously analyzed at our center. The 6-year actuarial relapse-free survival (RFS) for node-negative BC after HD was 85%. Node-positive patients had a significantly lower RFS of 33% (P = .002). CONCLUSIONS: In comparison to patients with primary BC, patients who develop BC after HD are more likely to be younger, have bilateral disease, and have their tumors more frequently involve the medial half of the breast. Pathologic characteristics, nodal involvement, and prognosis are similar to those of primary BC. BC in women who were treated for HD is becoming an increasing problem, as more patients cured of HD reach a follow-up time of 10 to 15 years. Breast examination and mammography at an early age should be part of the follow-up program for women who are cured of HD.

Adolescent↗
PubMed1992

Female adnexal tumor of wolffian origin.

We describe a female adnexal tumor of probable wolffian origin with stage 2B disease. The presence of peritoneal implants suggests a more aggressive clinical course than is usually expected. We present the findings of light microscopic and ultrastructural evaluation as well as those of immunohistochemical and DNA ploidy analysis, which, to our knowledge, have not been previously described for this type of tumor.

Adnexal Diseases↗
PubMed1992

[The effect of various sterilization procedures on the osteoinductive properties of demineralized bone matrix].

To minimize potential infection following the transplantation of allogeneic bone, extremely rigorous selection of donors and careful processing and storage of samples are required. Other major problems related to allogeneic transplants, such as reduced osteogenic properties and immunological reactions, led to the development of demineralized bone matrix (DBM). This osteoinductive bone extract is largely free of antigens and is easy to produce. However, to eliminate the potential risk of infection, DBM should be sterilized prior to implantation. The purpose of this study was to investigate the influence of different sterilization techniques on the osteoinductive properties of DBM. A series of 76 cortical defects (drill holes) 0.6 cm in diameter in the tibiae of 11 Merino sheep were filled with DBM in addition to autogeneic and allogeneic cancellous bone. Prior to implantation DBM was sterilized by autoclaving, gamma irradiation, or application of ethylene oxide or ethyl alcohol. A further 12 drill holes were left empty as controls. The formation of new bone was examined 3 and 6 weeks postoperatively, using histological, fluorescent-optical and microradiographical techniques. The amount of newly formed bone was also quantified. Apart from autoclaved DBM all matrix grafts showed excellent new bone formation following sterilization, by far exceeding the formation with allogeneic cancellous bone.

Animals↗
PubMed1991

[Organization of a bone bank].

The transmission of infectious diseases by allografts from bone banks has led to considerable restrictions on bone transplantations. HIV and hepatitis are considered to be the most dangerous diseases transmitted in this way. To prevent the transmission of any infections, extensive precautions have to be applied when allografts are taken and during their storage. Donors have been checked for infectious diseases at the time of collection and 3 months later. In addition, the donated grafts must be cultured for aerobic and anaerobic bacteria. This elaborate series of tests can only be mastered if the bone bank is tightly organised. The number of available grafts also be increased by sterilisation and the use of demineralised bone matrix.

Acquired Immunodeficiency Syndrome↗
PubMed1991

The completeness of the afterbirth: a medical/pathological discussion.

Practical problems (with possible medicolegal implications) regarding the interpretation of the completeness of the afterbirth are discussed. The case material was obtained during surgical pathological examination and, later, at the time of autopsy of the same patient. The mother (three weeks following emergency delivery) succumbed to life-threatening complications of an epidural anesthetic accident.

Adolescent↗
PubMed1990

[Endoscopic microsurgical dissection of the esophagus: a contribution to the reduction of pulmonary complications following esophageal resection? A comparative animal experiment study].

A new endoscopic microsurgical technique for dissection of the esophagus has been developed and tried out in animals. With this technique the esophagus is dissected and removed via a cervical approach by means of a new operating endoscope. In a randomized animal study we compared endoscopic versus blunt dissection and versus abdominothoracic resection. During endoscopic dissection we saw significantly lower bleeding and no laceration of the pleural cavity or damage to the recurrent laryngeal or to the vagus nerve. Significant changes of hemodynamics or gas exchange were observed in the blunt dissection group: increase of heart frequency, decrease of arterial pressure and decrease of paO2. In contrast these parameters did not change in the endoscopic group.

Animals↗
PubMed1990

Reaming versus non-reaming in medullary nailing: interference with cortical circulation of the canine tibia.

Medullary nails have only been used with reluctance in the treatment of open fractures since reaming interferes with the cortical circulation. The technique of interlocking offers the interesting possibility of inserting a relatively stiff nail which does not necessarily require reaming. The effects of reaming prior to nail insertion upon the cortical circulation was investigated in the canine tibia. Intravital staining with procion red was used to trace areas of disturbed circulation. Nail insertion without reaming provided clear advantages for the bone's blood supply, while reaming disturbed perfusion in two-thirds of the cortical area and regionally extended through the entire thickness of the cortex. The disturbance without reaming was limited to the inner layer of the cortex and involved only one-third of the cortical cross-section.

Animals↗
PubMed1990

[Treatment of defects of the long bones using distraction osteogenesis (Ilizarov) and intramedullary nailing. Theoretic principles, animal experiments, clinical relevance].

For large shaft defects of tibia and femur, distraction-compression osteosynthesis (Ilizarov) provides an ideal autologous bone graft. Combination of this with an intramedullary interlocking nail instead of an external fixator could improve patient comfort, because transport with a small external device takes only one-third of the total fixation period. Using 21 adult female sheep we created standardized tibia shaft defects 20 mm (medium size) and 45 mm (large size) in length. The tibiae were stabilized with non-reamed intramedullary interlocking nails. Following corticotomy by chisel, segments were transported using subcutaneous traction wires with a screw as a fulcrum to maintain stationary skin exit points without soft tissue problems. The external traction devices were removed after 12 or 16 weeks. Animals were sacrificed after 12 or 24 weeks with medium-size defects, and after 16 or 32 weeks with large defects. We evaluated the results clinically, by standardized weekly X-rays and, after sacrifice, by quantitative computed tomography (QCT). No animals had to be excluded from the study. Despite primary destruction of the intramedullary circulation all distraction gaps were spanned with bone. X-Rays showed typical signs of good quality of distraction bone regeneration (narrow radiolucent zone in the middle of the regenerate, longitudinal structure), continuous calcification, and cortex formation. QCT cross sections showed completely circular bone regeneration with small and large defects. Bone regeneration was faster on the dorsal side, where more bone was formed than ventrally. Small defects can remain ventrally in the regenerate; these close secondarily.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Psychological aspects of genetic counseling: VI. A critical review of the literature dealing with education and reproduction.

The post-1979 literature dealing with the educational and reproductive outcome and process of genetic counseling is reviewed. Despite methodological difficulties, recent publications strongly suggest that genetic counseling is successful in educating counselees about diagnostic and risk information. In general, investigators suggest that there is room for improvement and the factors leading to imperfect recall of information need to be elucidated. Process studies suggest that the educational priorities of counselors and counselees may not always be consistent. The contribution of these inconsistencies to outcome measures needs further study. Also, it appears that differing counseling approaches may be equally effective in achieving educational goals. Studies on the reproductive outcome of genetic counseling show no strong impact of counseling; there appears to be a net increase of desire for more children following counseling. Precounseling reproductive intentions, rather than counseling, were found to be a major factor in determining postcounseling outcome. Process studies suggest that although many counselees say that they were influenced by genetic counseling, it is uncertain what they mean, since for many counselees, reproductive decisions seem to have been made prior to counseling.

Attitude to Health↗
PubMed1989

Endoscopic microsurgical dissection of the esophagus. Results in an animal model.

Blunt dissection of the esophagus is considered the least invasive technique in the treatment of either benign or malignant diseases of the esophagus. Its disadvantage is that it has to be carried out blindly. The results may be uncontrollable hemorrhage, unrecognized injuries to the trachea, and damage to the recurrent laryngeal nerve. In order to reduce the degree of invasiveness a new endoscopic microsurgical technique for the dissection of the esophagus has been developed and tried out in animals. This paper presents the operative technique. Our new endoscopic microsurgical technique obviates a thoracotomy, while direct endoscopic vision results in improved dissection. The magnified endoscopic view permits selective exposure of blood vessels and prevents injury to the adjacent organs.

Animals↗
PubMed1989

Social system responses to Huntington disease.

Huntington disease (HD) is an adultonset, genetic disorder with major psychosocial implications. Although many of the psychiatric symptoms of the disorder have been attributed to the HD gene, systems factors may also account for the disorder's manifestations. Three illustrative issues--patient preselection, the denial of symptom onset, and suicide induction--are discussed from the vantage point of family systems thinking. Recently developed capacity for presymptomatic testing of HD despite the current absence of treatment or cure makes it likely that family therapists increasingly will be involved in clinical work with individuals and families in which HD occurs.

Adaptation, Psychological↗
PubMed1988

Invited essay on the psychological aspects of genetic counseling. V. Preselection: a family coping strategy in Huntington disease.

Preselection refers to the "sick"-role assignment given to an asymptomatic individual in a family in which a genetic or other disorder with multiple uncertainties occurs. The selection process is made, often when the preselected person is still a child, without knowledge of who eventually will be affected. The process requires the collusion of the family members for its initiation and maintenance and serves as a major coping strategy to reduce or bind the stresses and anxieties engendered by uncertainty. Preselection is seen often in families in which Huntington disease occurs and is promoted by the delayed age of onset of the disorder and the uncertain gene status of the person at risk.

Adaptation, Psychological↗