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Biomedical subjects

S P Benjamin

Publications and source records attributed to S P Benjamin.

18 recordsLinked to original sources
PubMed1979

Expression of monocytic--histiocytic cytochemical markers in epithelial neoplasia.

The diagnosis of malignant histiocytosis is usually based upon typical light microscopic features of the neoplasm. Supplementary cytochemical and immunologic features have been suggested as typical of malignant histiocytosis. The present study was prompted by an unusual erythropagocytic hepatocellular carcinoma having immunologic and cytochemical markers suggesting mononuclear phagocytic origin. Twenty-four neoplasms of unquestionable epithelial origin were prospectively evaluated for activity of alpha-naphthyl acetate esterase, a cytochemical marker useful in distinguishing between the non-Hodgkin's lymphomas and malignant histiocytosis. The epithelial tumors represented a broad spectrum of tissue origins and consistently demonstrated alpha-naphthyl acetate esterase activity. Thus, erythrophagocytosis and alpha-naphthyl acetate esterase positivity may be misleading in the unusual instance in which the histopathologic differential diagnosis includes malignant histiocytosis and epithelial neoplasia. Ultrastructural assessment is useful in the exclusion of poorly differentiated carcinoma.

Carboxylic Ester Hydrolases↗
PubMed1979

Recurrent subarachnoid hemorrhage associated with aminocaproic acid therapy and acute renal artery thrombosis. Case report.

Epsilon aminocaproic acid (EACA) has been used to prevent rebleeding in patients with subarachnoid hemorrhage (SAH). Although this agent does decrease the frequency of rebleeding, several reports have described thrombotic complications of EACA therapy. These complications have included clinical deterioration and intracranial vascular thrombosis in patients with SAH, arteriolar and capillary fibrin thrombi in patients with fibrinolytic syndromes treated with EACA, or other thromboembolic phenomena. Since intravascular fibrin thrombi are often observed in patients with fibrinolytic disorders, EACA should not be implicated in the pathogenesis of fibrin thrombi in patients with disseminated intravascular coagulation or other "consumption coagulopathies." This report describes subtotal infarction of the kidney due to thrombosis of a normal renal artery. This occlusion occurred after EACA therapy in a patient with SAH and histopathological documentation of recurrent SAH. The corresponding clinical event was characterized by marked hypertension and abrupt neurological deterioration.

Acute Disease↗
PubMed1979

Immunocytochemical identification of human chorionic gonadotropin. Comparative study of diaminobenzidine and 3-amino, 9-ethylcarbazole, a nonhazardous chromogen.

An immunomicroscopic study evaluated 55 fixed, paraffin-embedded tissues from surgical and necropsy-accessioned material reflecting a variety of physiologic and pathologic disorders. The sensitive unlabeled (peroxidase-antiperoxidase) immunoperoxidase technique was used. Cytoplasmic human chorionic gonadotropin (CHCG) was readily identified in syncytial trophoblastic cells. The only tissue sections that did not demonstrate CHCG activity were primary and secondary testicular teratocarcinomas without choriocarcinoma components. When the technique was reevaluated for the non-hazardous chromogen 3-amino, 9-ethylcarbazole, excellent results were achieved with equivalent staining distribution and intensity. The unlabeled immunoperoxidase method for the identification of CHCG is a sensitive, reliable, confirmatory immunohistochemical stain. A relatively safe chromogen can be substituted for the benzidine derivatives in the procedure with equivalent results.

3,3'-Diaminobenzidine↗
PubMed1979

Pseudomembranous enterocolitis in adults.

Twenty-one patients with pseudomembranous enterocolitis were seen over a 17 year period. Major inciting factors appeared to be an antecedent operation or a serious medical illness. The most common symptoms were fever, diarrhea and abdominal pain. The most commonly involved organ was the colon. The diagnosis was missed in the majority of patients. Neither conservative treatment or surgical treatment were successful. Awareness of the disease and its course will lead to earlier diagnosis and hopefully to a higher cure rate.

Adult↗
PubMed1979

Recurrent stenosis after carotid endarterectomy.

Thirteen of 1,250 patients required a second operation for recurrent stenosis following carotid endarterectomy performed at the Cleveland Clinic between 1958 and 1978. Two other patients underwent reoperation because of recurrent stenosis following primary operations at other institutions. Thirteen of the 15 patients experienced neurologic symptoms caused by recurent stenosis, while two patients remained asymptomatic. Atherosclerosis was responsible for recurrent stenosis in 12 patients and appeared to be related to hypercholesterolemia. Three of the patients had myointimal fibroplasia. Eleven of the 16 reoperations for recurrent stenosis of the carotid artery consisted of carotid endarterectomy with vein patch angioplasty. Three patients had carotid endarterectomy with closure of the primary arteriotomy. One patient with occlusion of the internal carotid artery underwent endarterectomy of the external carotid artery because of amaurosis fugax, and a saphenous vein interposition graft was used to replace a previous Dacron graft in one patient with anastomotic stenosis. One patient had a stroke during reoperation manifest as multiple retinal emboli. Fourteen patients have remained asymptomatic from one to 70 months following reoperation. One patient with occlusion of the contralateral internal carotid artery has experienced persistent vertebrobasilar symptoms.

Age Factors↗
PubMed1978

Surface and transmission ultrastructural characteristics of desquamative interstitial pneumonitis.

A prospective study of eight patients with desquamative interstitial pneumonitis was performed, correlating surface ultrastructure as elucidated by scanning electron microscopy, transmission electron microscopy, viral cultures of fresh sterile lung tissue obtained at thoracotomy, and immunomicroscopy. The hypothesis that environmental pollutants may act as sensitizing agents to induce macrophage migration was pursued using high resolution elemental analysis to obtain a profile of the inorganic content of phagolysosomes in the free alveolar cell population. Four surface ultrastructural changes were observed: mild alveolar septal thickening, an apparent decrease in the number of pores of Kohn, alteration of the predominant alveolar lining population from membranous to granular pneumonocytes, and prominent intra-alveolar collections of cells with broad based ruffled projections and pseudopodia representing a macrophage population. Transmission electron microscopy corroborated these observations. Individual pneumonocyte degeneration manifested as cytoplasmic dissolution, mitochondrial swelling, chromatin disruption, and loss of lamellar bodies and endoplasmic reticulum was identified; occasionally degenerating granular pneumonocytes were displaced into the alveolar space by a supraseptal bulla containing fibrin and extracellular fluid. Viruses were not identified by ultrastructural or tissue culture techniques. High resolution elemental analysis of individual phagolysosome contents failed to reveal the presence of heavy metals or other inorganic compounds. Immune complexes were not identified by immunofluorescence microscopy. However, alveolar transeptal macrophage migration was observed by transmission electron microscopy. These observations suggest that desquamative interstitial pneumonitis represents a disease in which cellular, rather than humoral, immune processes predominate. Other nonspecific cellular immune responses under the influence of various lymphokines may be responsible for the observed morphologic alterations.

Collagen↗
PubMed1978

Colonoscopy and the management of polyps containing invasive carcinoma.

Experiences with 565 colonoscopic polypectomies and 91 colonic and rectal resections containing infiltrating carcinoma in polyps are reviewed. A plan of management based on pathologic study of resected polyps is formulated to avoid further unnecessary surgery. It was concluded that: (1) Tubular adenomas containing invasive carcinomas have a low incidence of metastatic node involvement. This incidence is related to the depth of carcinomatous involvement. Resection of these polyps with a margin free of carcinoma constitutes definitive and adequate treatment and that (2) Villous adenomas containing invasive carcinoma have a high incidence of metastatic nodal involvement, and operative resection of the involved area of the colon is recommended, and that (3) Pedunculated tubulovillous adenomas containing invasive carcinoma behave like tubular adenomas, and the recommendations for further surgery in the patient with tubular adenomas with carcinoma apply equally well for these lesions. Sessile tubulovillous polyps tend to behave like villous adenomas, and if invasive carcinoma is demonstrated, further operation is recommended.

Adenoma↗
PubMed1977

Ultramicroscopic ulcerations and thrombi of the carotid bifurcation.

It is widely accepted that transient cerebral ischemia and permanent stroke frequently are caused by platelet and thrombotic cerebral emboli that originate from lesions at the carotid bifurcation. Microembolization from ulcerated atheroma during carotid dissection also offers a logical explanation for the incidence of intraoperative neurologic deficits during carotid endarterectomy. The risk of intraoperative embolization is obvious when ulcers are macroscopic; but focal cerebral ischemia associated with atheroma that appear smooth and nonulcerated usually has been attributed to decreased regional cerebral blood flow. Several endarterectomy specimens were submitted for scanning electron microscopic evaluation using X20 through X4,000 malignification. Results indicate that carotid atheroma may contain superficial ulcerations and thrombi that are not appreciated by direct inspection or conventional microscopic techniques. Electron microscopic ulcerations and intraluminal thrombi may be responsible for embolic transient ischemic attacks, spontaneous strokes, and intraoperative neurologic deficits in patients in whom gross ulcerations are absent.

Carotid Arteries↗
PubMed1977

Fibrous inflammatory polyps of the ileum and cecum: review of five cases with emphasis on differentiation from mesenchymal neoplasm.

Five case histories of patients with fibrous inflammatory polyps of the ileocecum are reported. Clinical impression in all five cases was that these tumefactions represented gastrointestinal malignancies. Gross pathologic examination revealed polypoid intramural growths ranging from 2.5 to 7.0 cm in greatest dimension. Transmural desmoplasia through the bowel wall into subserosal fat was initially thought to be indicative of neoplastic invasion. Microscopic evaluation revealed a fibroblastic and vascular proliferative process. Pseudosarcomatous changes were identified in cellular fibroblastic areas with plemorphism and mitotic activity. The manner of dissection among bundles of muscularis mucosae and muscularis propria suggests an inflammatory process as opposed to the pushing aside of whole large muscle bundles as seen in mesenchymal neoplasms arising in bowel wall. All five patients experienced survival of 6 to 17 years following surgery. These lesions are thought by us to represent localized exuberant polypoid granulation tissue proliferations which simulate mesenchymal neoplasm.

Cecum↗
PubMed1977

Myofibroblastic contraction in spontaneous regression of multiple congenital mesenchymal hamartomas.

Subcutaneous nodules from a newborn boy with "multiple fibromatosis" involving the head, neck, trunk, and all four extremities were studied by light microscopy, transmission electron microscopy, and immunofluorescent techniques. Light microscopy suggested a hamartomatous process with fibroblastic adipose, vasoformative and apparent smooth muscle components. The principal cell population combined ultrastructural characteristics of both fibroblasts and smooth muscle cells. Immunofluorescent studies revealed binding of human anti-smooth muscle antibody to the cytoplasm of the spindle cell population of the subdermal nodules but not to fibroblasts of the overlying un-involved skin. The ultrastructural and immunofluorescent studies revealed the previously underscribed fact that fibrous hamartoma of infancy is principally a proliferation of myofibroblasts. At age 8 months, there was complete spontaneous regression of all subcutaneous nodules not previously altered by excisional biopsy. The authors conclude that myofibroblasts are fibrocontractile cells, which play a role in shrinkage and eventual disappearance of these subdermal hamartomas.

Hamartoma↗
PubMed1977

Structural abnormalities in COPD.

Emphysema is classified by macroscopic examination of inflated lung sections as proximal acinar, panacinar, distal acinar, and/or paracicatricial. Alveolar fenestrations, the earliest morphologic expression of alveolar wall damage, may be defined with the aid of a dissecting or scanning electron microscope. In bronchial obstructive disease, lesions of both the large and small airways contribute to respiratory impairment. The structural changes of chronic bronchitis are, for practical purposes, always associated with severe emphysematous disease. Thus, it is mandatory for the morphologist who evaluates lung specimens for COPD to pay detailed attention to the acinar pattern of destruction of inflated emphysematous lungs as well as to the gross and microscopic pathology of large and small airways. These structural changes should then be correlated with clinical parameters relative to age, sex, air pollutants, cigarette smoking allergy, and hereditary deficiencies of antiproteolytic enzymes.

Asthma↗
PubMed1977

Desquamative interstitial pneumonitis. Cellular phase of fibrosing alveolitis.

Since the original description of desquamative interstitial pneumonitis in 1967, several investigators have questioned the specificity of the disease. The concept of desquamative interstitial pneumonitis and usual fibrosing interstitial pneumonitis as two manifestations of a nonspecific disease spectrum has been proposed. Twenty-six patients with desquamative interstitial pneumonitis were evaluated with respect to clinicopathologic correlates. Biopsies were reviewed without knowledge of the patients' clinical course. The absolute histopathologic criteria for the diagnosis were (1) intra-alveolar accumulations of free alveolar cells with PAS-positive diastaseresistant cytoplasmic granules; (2) mononuclear cell interstitial inflammation; and (3) absence of necrosis, hyaline membranes, intra-alveolar fibrosis, asbestos bodies, and birefringent crystalline dust material. Transmission electron microscopic studies revealed the dominant alveolar lining cell to be the granular pneumocyte, with a prominent population of free alveolar macrophages. Patients were segregated into group 1 (cellular phase) and 2 (cicatrized phase). Although favorable short-term responses to corticosteroid therapy were observed in both groups, long-term responses were variable. Apparent complete remissions were noted in both groups.

Adult↗
PubMedDate not supplied

Pigmented lesion of the middle ear: report of a case.

Melanotic lesions of the mucosal membranes of the head and neck have been reported infrequently. Malignant melanomas are reported with much more frequency than benign nevi in this region. The first reported case of a nevus of the middle ear mucosa is presented. The distinctions between this lesion, nevus of Ota, meningioma, Schwannoma, and hematoma are discussed. The malignant potential for this lesion is not known, but it appears low enough to obviate interval tympanotomy.

Adult↗