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Biomedical subjects

W A Hawk

Publications and source records attributed to W A Hawk.

18 recordsLinked to original sources
PubMed1978

Cystosarcoma phyllodes.

Recurrence and metastases of a cystosarcoma phyllodes are poorly correlated with the histologic type and treatment used. There is some evidence, however, that the prognosis is more favorable for small tumors and minimal cellular atypism. Local excision seems to be associated with a higher incidence of recurrence of the tumor. Metastases can develop later from what appears primarily a benign, as well as a malignant, type. Mastectomy as primary treatment was not always effective in preventing the local recurrence of the tumor. If the tumor recurred after mastectomy, it gave rise to fatal metastases. The recurrence of the tumor after local excision is secondary to microscopic foci retained after enucleation. If a local excision is done, it should include a wide margin of mammary tissue around the tumor. Wide local excision, for small, slow growing and clinically benign tumors can be used as a first operation, with wider re-excision and later mastectomy if the tumor recurs. Large and rapidly growing tumors that suggest malignant disease should be treated primarily by mastectomy.

Adolescent↗
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↗
PubMed1976

Indications for surgery in Crohn's disease: analysis of 500 cases.

Data for 500 patients with Crohn's disease who underwent operations were analyzed (316 patients, 1966 to 1969; 184 patients, 1972 to 1973) by comparison of various anatomic disease locations (clinical pattern): (1) ileocolic, 225 patients; (2) small intestinal, 130 patients; (3) colonic, 127 patients; (4) anorectal, 18 patients. Indications for surgery were tabulated and compared using statistical analysis for the three large patterns. For patients with ileocolic Crohn's disease, the primary surgical indications were internal fistula and abscess, 44%, intestinal obstruction, 35%, and perianal disease, 12%. For patients with Crohn's disease of the small intestine, the primary surgical indications were intestinal obstruction, 55%, and intestinal fistula and abscess, 32%. Patients with colonic Crohn's disease had a significantly more diverse surgical indication, with poor response to medical therapy, 26%, internal fistula and abscess, 23%, toxic megacolon, 20%, and perianal disease, 19%. These values were highly statistically significant (P less than 0.0001) in all instances but one. This study demonstrates that statistically significant differences occur in the surgical indication depending on the location of Crohn's disease. Patients with ileocolic, small intestinal, and colonic involvement have striking differences in clinical course. It is concluded that Crohn's disease is not a homogeneous entity, but should be recognized as having a varying course depending on clinical pattern.

Abscess↗
PubMed1976

Gram-hegative bacillemia.

Members of the Klebsiella-Enterobacter-Serratia group now appear to be the most common cuase of gram-negative bacillemia, followed in order of frequency by E. coli, Bacteroides, polymicrobic infection, Pseudomonas aeruginosa, and miscellaneous pathogens. However, E coli continues to be the organism most frequently responsilbe for bacteremia arising from the urinary tract. Although the urinary tract remains the most common portal of entry for gram-negative bacillemia, a wide variety of extraurinary lesions have assumed increased importance in the pathogenesis of this condition. There is marked variability in the clinical course and outcome of gram-negative bacillemia. Grade of underlying disease and grade of illness cuased by infection are major determinants of fatal outcome. When the patient with gram-negative bacillemia has severe illness due to infection, prompt and decisive action is necessary to prevent death. Antimicrobiol drugs are administered on the basis of a presumptive etiologic diagnosis after appropriate smears and cultures are obtained, but before the causal organism is definitively identified or its in vitro susceptibility is determined. The presumptive etiologic diagnosis is based upon knowledge of the anatomic location of the infection, the circujstances involved in its development, and certain clinical clues. Knowledge of the antimicrobial drugs most likely to be effective against the suspected pathogen(s) will provide a rational basis for selection of antimicrobial agents until the results of definitive microbiologic studies are available. Using this approach, the mortality of gram-negative bacillemia arising from the urinary tract has been reduced markedly from the mortality reported in earlier years.

Adult↗
PubMed1975

Azaribine therapy for psoriasis. Evaluation of potential effects on the liver and other organ systems.

An open study of azaribine was carried out on 38 psoriatic patients for two years. Thirty-five patients had previously taken methotrexate. Thirty-four patients had liver biopsies performed before azaribine therapy and 14 had liver biopsies performed after azaribine therapy. Of these 14, five had grade 1 liver biopsies before and after therapy; one had grade III before and after therapy; and three had grade IV before and after therapy. Liver biopsy findings were slightly worse in two patients, and three patients showed improvement in liver biopsy findings.

Adolescent↗
PubMed1975

The structural study of the saphenous vein.

From November, 1971, to September, 1974, 1,179 patients received aortocoronary saphenous vein bypass grafts at the Cleveland Clinic Hospital. Segments of saphenous vein from each patient were sent for microscopical analysis. These vein segments were classified as normal or abnormal (phlebosclerotic). Four hundred ninety-six normal vein grafts in 295 patients were restudied and had a patency of 87.9%. One hundred forty-four abnormal vein grafts in 86 patients were restudied and showed 89.5% patency. This study suggests that histopathological identification of an abnormal (phlebosclerotic) vein segment does not constitute a determining factor as far as late patency is concerned in a vein segment that is not grossly sclerotic.

Adult↗
PubMed1975

Carcinoma of the small intestine associated with transmural ileitis (Crohn's disease).

A case of adenocarcinoma of the small bowel arising in pre-existing transmural ileitis (Crohn's disease) is reported and 28 previously reported cases are reviewed. Carcinoma associated with transmural enteritis occurs more often in the distal ileum, in younger patients, and in more males than expected from published data on carcinoma not associated with transmural enteritis. If the patient has had exclusion procedures, the carcinoma has been found to arise in the excluded bowel segment.

Adenocarcinoma↗
PubMed1975

Vesicular myocardial change: an ultrastructural study of double membrane-bound vesicles in the human heart.

Vesicular myocardial change is a specific and common finding in the diseased hearts of humans and experimental animals. The small to large vesicles are generally bound by a double membrane. They are formed within myocardial cells and then possibly extruded into the extracellular space where they disintegrate or are phagocytosed by mononuclear cells. On the basis of our studies, most vesicles appear to be of mitochonrial origin. In humans, vesicular myocardial change appears to be most extreme in primary cardiomyopathy. It may also be present, but in lesser degree, in the apparently normal hearts of human adults. Vesicular myocardial change probably represents a specific mechanism by which myocardial cells eliminate damage mitochondria or other undesirable elements that build within them as a result of disease, aging, and perhaps normal physiological activity.

Adolescent↗
PubMed1975

The role of myocardial biopsy in cardiac diagnosis.

With the advent of cardiac catheterization, cardioangiography, and selective coronary arteriography, specific types of cardiac disease can be recognized and clearly defined. This is appropriate because myocardial biopsy alone rarely plays a major role in cardiac diagnosis. Excluding Aschoff's nodules in patients with rheumatic valve disease, the light microscopic findings in patients with rheumatic heart disease, congenital heart disease, pericardial disease, hypertensive and arteriosclerotic heart disease are similar and nonspecific. In these, interstitial fibrosis and/or myocardial hypertrophy is the dominant tissue diagnosis. Occasionally a pericardial and myocardial specimen is helpful to distinguish constrictive pericarditis and restrictive cardiomyopathy. Myocardial biopsy has provided the only method for diagnosis in a small number of patients with normal hemodynamics, normal coronary arteriograms and normal ventriculograms. The patients were studied because of chest pain and/or cardiac arrhythmias. Supraventricular and/or ventricular arrhythmias were encountered. In these patients the tissue diagnosis was interstital fibrosis and/or myocardial hypertrophy. These findings are consistent with primary myocardial disease which was not recognized clinically or by angiographic studies. The procedure seems to play a major role in the diagnosis of specific types of primary myocardial disease. It is valuable in the recognition of glycogen storage disease, amyloidosis, hemochromatosis, and myocarditis. On the basis of current experience, the indications for myocardial biopsies depend on the need for a tissue diagnosis in determining the management of the patient and the availability of adequately trained personnel to perform the procedure and manage the complications.

Angiocardiography↗