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Biomedical subjects

T M Scheinin

Publications and source records attributed to T M Scheinin.

At least 37 records · Page 2Linked to original sources

Malignant transformation in human colorectal mucosa as monitored by distribution of laminin, a basement membrane glycoprotein.

The distribution of laminin, a basement membrane glycoprotein, was studied by indirect immunofluorescence technique using rabbit anti-laminin serum in fifty-seven samples of normal, hyperplastic, adenomatous and carcinomatous colorectal tissue. As judged by the expression of laminin normal, hyperplastic and adenomatous colorectal mucosa were characterized by a continuous, linear basement membrane. A thick band-like basement membrane was seen under the surface epithelium and at the mouths of the crypts in normal and hyperplastic mucosa. The adenomatous epithelium was uniformly characterized by a thin, linear basement membrane. In contrast, marked alterations were constantly observed in colorectal carcinomas and their metastases, which showed a discontinuous, linear or patchy basement membrane. Our study suggests that the expression of laminin is related to cellular differentiation, and the thickness of the laminin-positive basement membrane parallels with the epithelial maturation of normal and hyperplastic colorectal mucosa and with the failure of the epithelial differentiation in adenomas. In colorectal carcinomas and their metastases the distribution of laminin is constantly altered and the severity of the alterations correlates with the histological grade of these tumours.

Adenocarcinoma↗

Chronic gastritis and gastric acid secretion in uraemic and renal transplant patients.

Upper gastrointestinal endoscopy with biopsies from the antrum, body and duodenum, as well as tests for acid secretion were performed on 43 uraemic patients, 17 women and 26 men, (mean age 49.7 years) and on 46 patients with well-functioning renal transplant received 10 months earlier (12 women and 34 men, mean age 40.6 years) in order to study the background of peptic lesions in uraemic patients. Eighty-nine age- and sex-matched subjects selected from a random population sample consisting of 434 persons served as a control group. All groups of renal patients were similar with respect to the prevalence and severity of antral or body chronic gastritis. Compared with control subjects their antrum had significantly less advanced chronic gastritis, which was due to the lack of atrophic changes. Furthermore, the gastric body tended to show fewer alterations than that of the controls. The acid secretion capacity in the renal patients decreased with the increasing severity of atrophic changes in the body mucosa. However, definite hypoacidity was found in some of the renal patients with normal body mucosa. Thus, a true "state of hypoacidity" seems to occur in chronic uraemia.

Adult↗

Oestrogen and progesterone receptors and disease-free interval in primary breast cancer.

Oestrogen and progesterone receptor assays were performed in 286 women with primary breast cancer, and the patient group was followed up for a minimum of 24 months. Of the 263 patients belonging to clinical stages I-III and serving as the population used for calculation of disease-free interval only 1.9% received postoperative endocrine treatment and 6.5% chemotherapy. No significant relationship between the presence or concentrations of oestrogen or progesterone receptor and the disease-free interval was observed. It is therefore possible that the positive relationship between these variables reported in some investigations reflects an influence by adjuvant endocrine measures.

Breast Neoplasms↗

Fine-needle aspiration cytology of liver allografts in the pig.

We have analyzed the inflammatory changes in pig liver allografts and autografts by fine needle aspiration biopsy (FNAB) and correlated the cytological findings with transplant histology and changes in recipient blood. In nonimmunosuppressed piglets (n = 9) the inflammatory episode of rejection occurred promptly, peaked on days 4-7, and thereafter subsided in cases in which the graft was accepted (n = 6). The early inflammatory infiltrate consisted of all major types of inflammatory leukocytes, including T lymphoblasts, B plasmablasts, and plasma cells, lymphocytes and monocytes; macrophages dominated the late inflammatory lesion of irreversible rejection. In piglets that died of rejection (n = 3), the inflammation peaked earlier and the total amount of inflammation, including the frequency of blast cells and mononuclear phagocytes, was higher. These differences were, however, statistically insignificant and not predictive for irreversible rejection. In sham-operated autograft recipients (n = 5) no inflammation was recorded in the graft. Application of cyclosporine (n = 5), significantly suppressed the total inflammation (P = 0.02 and 0.06 on days 4 and 7, respectively) and delayed the peak; in addition, both the blastogenic component (P = 0.08 on day 4) and the mononuclear phagocyte component (P = 0.03 on day 7) were clearly suppressed. These inflammatory changes, recorded by the FNAB, had a close correlation with biopsy histology. On the other hand, determinations of S-ASAT, S-ALAT, and S-AFOS was not correlated with the episodes of rejection, and no characteristic changes were seen in blood cytology during the rejection episodes either.

Animals↗

Correlation of estrogen and progesterone receptors and histological grade in human primary breast cancer.

The relationships between the presence of female sex steroid receptors and their concentrations, and the histological grade were investigated in primary breast carcinoma specimens from 151 patients. The concentrations of estrogen receptor were significantly lower in grade III tumours than in the more differentiated ones from pre- and post-menopausal patients, whereas the same was observed for progesterone receptor concentrations only between grades III and I in post-menopausal patients. Generally estrogen and progesterone receptor-positive, estrogen receptor rich tumours frequently belonged to well-differentiated tumour categories. Whereas most of the tumours belonging to grade III group were receptor-negative, approximately three fourths of receptor-negative tumours belonged to grade I and II categories. It is therefore suggested that estrogen receptor-negativity or low receptor concentrations and grade III histological appearance of breast carcinoma are independent risk indicators, and their concomitant use is recommended in designing treatment strategies for individual patients.

Breast Neoplasms↗

Multiple duodenal polyps in uraemia: a little known clinical entity.

Multiple duodenal polyps were found by endoscopy in five out of 33 patients with chronic renal failure and in one of 300 controls. In the uraemic cases the polyps were caused by circumscribed nodular hyperplasia of Brunner's glands. One of these five patients later underwent surgery for duodenal obstruction caused by the polyps; the other patients were asymptomatic. One of the controls had multiple duodenal polyps. The recorded incidence of multiple duodenal polyps was significantly higher among patients with chronic renal failure than in patients without renal disease. Patients with chronic renal failure and polyps did not differ significantly from the other renal patients in the comparison of variables such as gastric acid secretion, serum concentrations of gastrin and group I pepsinogens or mean length of dialysis treatment. The mean pH of gastric resting juice was significantly higher, however, in uraemic patients with polyps than in those without. Uraemic patients displayed a gastric acid secretion capacity within normal range, and significantly raised serum gastrin and group I pepsinogen concentrations.

Adolescent↗

Aspiration cytology of a human liver allograft.

We have analyzed one human liver transplant by frequent FNABs. We conclude that FNABs of liver transplant recipients is a safe procedure that can be performed repeatedly without danger to the graft or to the graft recipient. The inflammatory episodes of rejection may be recorded and certain changes in the transplant--in particular, cholestasis and deposits of CsA--may be demonstrated in the FNAB as well.

Adult↗

Serum vitamin B12 concentration after proximal gastric vagotomy.

The serum concentration of vitamin B12, blood hemoglobin, and gastric acid secretion capacity was studied preoperatively and 1 and 5 years after proximal gastric vagotomy (PGV) in 15 patients. There was a significant reduction in the mean concentration of vitamin B12 at 1 year, but this disappeared within 5 years after PGV. The serum concentration of vitamin B12, however, remained at all times within the health-related reference interval. The blood hemoglobin concentration was unaltered during the follow-up period. The decrease in gastric acid secretion capacity gained by PGV was permanent, and no tendency to increased acidity was observed during the 5-year period. The temporary decrease in serum concentration of vitamin B12 reflects a PGV-induced diminished production of intrinsic factor in the parietal cells. In the characterization of parietal cell function the determination of serum vitamin B12 concentration is, however, much less sensitive than gastric acid secretion tests. The observed change in vitamin B12 concentration after PGV was subclinical, self-corrected, and thus required no treatment.

Adult↗

The effect of withdrawal of beta-adrenergic blockade on intermittent claudication.

Twenty-eight patients with intermittent claudication were studied before and one month after withdrawal of treatment with beta-adrenergic blocking drugs for hypertension, coronary heart disease or both. Heart rate, blood pressure, ankle/arm systolic blood pressure ratio and ankle pulse volume recording (PVR) at rest and after treadmill exercise were recorded, as well as walking distance, time of recovery from subjective symptoms, restitution time of pressure ratio and PVR. A control group of 14 patients, whose beta-adrenergic blocking drugs were not withdrawn, was also included. The result can be summarized as showing that withdrawal of beta-blockade was not demonstrably advantageous in patients with intermittent claudication. Significant improvement was observed only during the first month of the trial, a change which was independent of withdrawal of beta-blockade. The relief of subjective symptoms after exercise occurred significantly faster after withdrawal of nonselective beta-blockade. Otherwise, there was no difference between nonselective and cardioselective beta-adrenergic blocking drugs.

Adrenergic beta-Antagonists↗

Connective tissue changes and collagen metabolism in syngeneic vena caval grafts in rats.

An attempt was made to determine if changes occurring in connective tissue and collagen metabolism of vein-to-artery grafts arose from the trauma of transplantation as such or from the higher pulsatile pressure. Segments of the supradiaphragmatic inferior vena cava were therefore transplanted to the infrarenal vena cava in syngeneic pairs of rats. The sequential changes in hydroxyproline concentration, 3H-proline incorporation and the histologic appearance of collagen, elastic fibres and fibronectin were noted. Comparisons were made with previously reported changes in syngeneic venoartery grafts in rats. The initial changes, probably resulting from the transplantation trauma, were similar in the veno-vein and veno-artery grafts. Subsequent changes, however, were less pronounced in veno-vein than in veno-artery grafts. The study thus suggests that these changes in vein-to-artery grafts are due partly to the transplantation trauma, but mainly to the increased pressure in the new environment.

Animals↗

Five-year results of proximal gastric vagotomy.

Between February 1972 and December 1976 100 proximal gastric vagotomies (PGV) were performed on duodenal ulcer patients after failure of conservative treatment. The diagnosis was verified by preoperative barium meal and endoscopy and by peroperative examination. There was no operative mortality. Mean duration of postoperative hospital stay was 9.6 days. The percentual distribution in Visick-grading at the 1-year follow-up was 90% in class I + II, and 10% in class III + IV. The corresponding figures at the 5-year follow-up were 82% and 18%. The mean postoperative basal acid output did not change from one to five years. The reduction in pentagastrin stimulated acid output was unchanged at the 1- and 5-year follow-up. Neither did the mean acid output after insulin stimulation change between one and five years postoperatively. The mean concentration of serum gastrin was raised at one year but decreased to normal at the 5-year follow-up. Ten patients (10%) had ulcer recurrence during follow-up. Seven of these were successfully treated by gastric resection and three by antacids and cimetidine.

Adult↗

The desmoid tumor. III. A biochemical and genetic analysis.

We have carefully examined four patients with desmoid tumor (DT) and their 31 relatives. In three of four cases, biopsies of the DT demonstrated low yet significant amounts of estrogen but not progesterone receptors in the tumor cytosol. In the fourth case, where the receptors were not demonstrable, the affected patient was a menopausal woman and the receptors may have been blocked by endogenous estrogen. Fourteen of their 31 relatives demonstrated multiple minor bone malformations in x-ray screening of the skeleton. The inheritance of these malformations was compatible with an autosomal dominant trait with variable penetrance. These findings are compatible with our suggestion that the basic underlying cause for DT is an inherited defect in growth regulation of the connective tissue. When a trauma is superimposed on such an individual, a DT may result. The growth of the tumor is, however, controlled primarily by sex hormones, estrogen predominance over progesterone being inducive to tumor growth.

Abnormalities, Multiple↗

Predictive value of preoperative segmental blood pressure measurements in below-knee amputations.

Segmental blood pressure criteria for below-knee amputations were assessed retrospectively. 40 patients underwent 44 below-knee amputations for advanced lower limb ischaemia. Preoperative systolic blood pressure measurements using a Doppler device as a distal sensor were performed on 31 limbs to be amputated. Healing occurred in all limbs with calf systolic pressures of 68 mmHg or more and distal thigh systolic pressures of 100 mmHg or more. With calf pressures below 35 mmHg and distal thigh pressures of 60 mmHg or less, all amputations failed. Diabetes did not affect the pressure criteria except for one obvious case with mediasclerosis. It appeared that pressure data could be used to improve the preoperative assessment of the amputation level.

Aged↗

Haematologic findings in patients with renal carcinoma.

Haemoglobin concentration and leukocyte and platelet counts were studied in 122 patients with renal carcinoma, 104 of whom subsequently underwent nephrectomy. In 61 of the operable patients the tumour was located within the renal capsule (group I) and in the other 43 it had invaded the perinephric tissues (group II). Eleven of the group II patients also had distant metastases in one or two sites. Multiple distant metastases precluded renal surgery in 18 patients (group III). Normochromic anaemia (haemoglobin less than 120 micrograms/l) was found in 17% and leukocytosis (greater than 8 x 10(9)/l) in 25% of the group I patients. The corresponding frequencies for group III were 72 and 67%. Severe anaemia was found in patients with localized tumours as well as in patients with extensive metastases. Thrombocytosis (400-800 x 10(9)/l) occurred in less than 20% of the patients in groups I and II, but in 42% in group III. Thrombocytopenia (less than 200 x 10(9)/l), on the other hand, which was present in 31% of the group I patients, was less common in those with metastasizing tumours. Haematologic anomalies in renal carcinoma suggest either bone-marrow metastases of tumour-induced mechanisms such as production of erythropoietin or thrombopoietin and phagocytic and chemotactic effects of tumour cells or auto-immune processes. When uncorrected by nephrectomy in patients without signs of metastases, such haematologic findings suggest concomitant blood disorders.

Adult↗

Severe gastrointestinal bleeding due to carcinoid tumour of the ileum.

Repeated episodes of severe intestinal bleeding in a 55-year-old male were found to originate from multiple small carcinoid tumours of the ileum. Laparatomy was performed after extensive negative endoscopic and radiological investigation of the bleeding site, and five tumours, 6 to 15 mm in diameter, were found within a 40 cm bowel segment. The most distal tumour was situated 50 cm from the ileocaecal valve. The site of bleeding was erosion of the bowel mucosa at the largest tumour. The affected bowel was excised, including its mesentery with two lymph nodes containing small islands of metastatic carcinoid tumour. Otherwise no metastases were found.

Carcinoid Tumor↗

Connective tissue changes in autogenous vein graft used as a mesocaval shunt.

Autogenous jugular vein was used as a mesocaval shunt in dogs with ligated portal vein. Nine out of fifteen animals survived the operation and could be used for further studies one month postoperatively. Immediately after the shunt procedure an increased portosystemic pressure gradient was observed. However, this returned to normal at one month after the operation. At this time the graft was patient in seven out of nine dogs. Histological studies of the graft showed a smooth neointima and an increased number of elastin fibers in the media. The collagen concentration of the vein wall was significantly reduced and the glucosaminoglycans were significantly increased. It was however, not possible to assess the relative role of the operative trauma and the new haemodynamic and anatomical environment.

Animals↗